Effects of a Ketogenic Diet on Acute Stroke

The Effect of a Ketogenic Diet on Blood Glucose, Function and Disease Progress in Acute Stroke Patients

The purpose of this controlled, randomized intervention is to investigate whether a fat-based (ketogenic) diet given for a week has a positive effect on blood sugar, mortality and function in patients hospitalized with acute stroke compared to the effect of a usual diet. The study hypothesis is that a ketogenic diet and reduced availability of glucose to the brain cells will reduce the volume of neuronal damage in the brain and improve function. The intervention will take place at the neurological units of Glostrup and Bispebjerg Hospital in Denmark.

A ketogenic diet can induce ketosis after a period of 2-3 days and offer the brain an alternative energy substrate to glucose in the form of ketone bodies. Feeding the brain ketone bodies can potentially benefit a stroke patient's brain in several ways: Stroke is characterized by impaired blood and oxygen supply to brain cells. This can cause glucose to convert to lactate which is toxic for the brain. Decreasing glucose availability to brain cells may thus potentially decrease the area of damage in the ischemic penumbra (perifephery of the stroke). Compared with sugar, burning ketone bodies requires less oxygen to produce the same amount of energy, suggesting that brain cells could have a potential greater chance of surviving during circumstances of reduced oxygen supply. By decreasing mitochondria activity, ROS synthesis is also decreased, which can help decrease the necrotic area around the ischemic penumbra. Furthermore, the ketogenic diet does not induce an increase in blood sugar which could be an advantage since many stroke patients are admitted with hyperglycemia associated with a worse outcome.

Acute stroke patients will receive a ketogenic diet (Ketocal 4:1 and ketogenic meals) for the first week after inclusion

Acute stroke patients will receive a control diet (the regular diet, enteral or oral, offered at the hospitals) for the first week after inclusion.

Gastrointestinal complications monitored daily are: Nausea, Vomiting, Constipation, Diarrhea, Abdominal pain

Inclusion Criteria: Patients with ischemic or hemorrhagic stroke. NIHSS score of at least 5. Both primary and recurrent cases. Inclusion as early as possible, but no later than 72 hours from symptom onset. Patients with expected hospitalization for a minimum of seven days. Adult patients with cognitive ability to give informed consent. Patients with writing and orally accepted participation. Exclusion Criteria: Patients with SAH and traumatic hematoma. Patients with pancreatic insufficiency (steatorrhea). Patients unable to give informed consent.