Safety and Tolerability of the Ketogenic Diet in Amyotrophic Lateral Sclerosis (ALS)

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Johns Hopkins University

Status and phase

Phase 3


Amyotrophic Lateral Sclerosis


Dietary Supplement: KetoCal

Study type


Funder types




Details and patient eligibility


This research is being done to see if the ketogenic diet (which is high in fat and low in carbohydrates) is safe and tolerable in amyotrophic lateral sclerosis (ALS) patients who are fed through a gastrostomy tube. This is not a study to see if ketogenic diets are effective in the treatment of ALS.


1 patient




18+ years old


No Healthy Volunteers

Inclusion criteria

  • Familial or sporadic ALS diagnosed as probable, laboratory-supported probable or definite according to the World Federation of Neurology El Escorial criteria
  • Age 18 or older
  • Capable of providing informed consent and complying with trial procedures
  • Gastrostomy tube in place for the prior month
  • Appel ALS score less than 100
  • Able to stand on a scale with assistance

For patients with Appel ALS scores greater than 80, availability of caregiver who is willing and able to:

  • Prepare, administer and log tube feeds
  • Check and log gastric residuals
  • Assist with weighing subject at home if necessary
  • Willing to chart food intake during the six-month study
  • Patients either not taking Riluzole (Rilutek) or Minocycline or on a stable dose of these for 30 days
  • Not taking Coenzyme Q10 or on a stable dose and brand for 30 days
  • Absence of exclusion criteria

Exclusion criteria

  • Forced vital capacity <50% of predicted
  • Dependence on mechanical ventilation for more than 12 hours per day
  • Exposure to any experimental agent within 30 days of onset of this protocol
  • Women who are pregnant or planning to become pregnant
  • Women of childbearing potential not practicing contraception
  • Enrollment in another research study within 30 days of or during this trial
  • Mini-Mental State Exam (MMSE) score <20
  • Patients with symptomatic cardiac disease or hypercholesterolemia
  • Patients with myocardial infarction within 6 months of this trial
  • Renal dysfunction defined as BUN and creatinine >2XULN
  • Known mitochondrial disease
  • BMI<18.5
  • Prior use of a 4:1 ketogenic diet or Atkins diet within 1 month of this trial
  • Impaired liver function, defined as AST or ALT of 3 X ULN
  • Patients who have a pacemaker or other internal electronic medical device

Trial design

1 participants in 1 patient group

Experimental group
KetoCal tube feeding formula
Dietary Supplement: KetoCal

Trial contacts and locations



Data sourced from

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