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Evaluation of a ketogenic diet for improvement of neurological recovery in individuals with acute spinal cord injury: a pilot, randomized safety and feasibility trial

Spinal Cord Series and Casesvolume 4, Article number: 88 (2018) | Download Citation


Study design

Longitudinal, randomized study.


(1) Test the safety and feasibility of a ketogenic diet (KD) intervention in the acute stages of spinal cord injury (SCI), (2) assess the effects of a KD on neurological recovery, and (3) identify potential serum biomarkers associated with KD-induced changes in neurological recovery.


Acute care and rehabilitation facility.


The KD is a high-fat, low-carbohydrate diet that includes ≈70–80% total energy as fat. Seven participants with acute complete and incomplete SCI (AIS A–D) were randomly assigned to KD (n = 4) or standard diet (SD, n = 3). Neurological examinations, resting energy expenditure analysis, and collection of blood for evaluation of circulating ketone levels were performed within 72 h of injury and before discharge. Untargeted metabolomics analysis was performed on serum samples to identify potential serum biomarkers that may explain differential responses between groups.


Our pilot findings primarily demonstrated that KD is safe and feasible to be administered in acute SCI. Furthermore, upper extremity motor scores were higher (p < 0.05) in the KD vs. SD group and an anti-inflammatory lysophospholipid, lysoPC 16:0, was present at higher levels, and an inflammatory blood protein, fibrinogen, was present at lower levels in the KD serum samples vs. SD serum samples.


Taken together, these preliminary results suggest that a KD may have anti-inflammatory effects that may promote neuroprotection, resulting in improved neurological recovery in SCI. Future studies with larger sample size are warranted for demonstrating efficacy of KD for improving neurological recovery.

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The authors sincerely thank the participants and their families for their tireless dedication. We also thank Rhonda Pierce, RD, Margaret Peoples, RD, and the UAB Bionutrition Kitchen for development and delivery of KDs, as well as the UAB Department of Emergency Medicine Research Assistant Program for their assistance with study coordination and data collection.


This work was supported by KL2TR001419-01 (CY-F) and UAB Center for Clinical and Translational Science (UL1-TR-001417).

Author information


  1. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    • Ceren Yarar-Fisher
    • , Jia Li
    • , Cassandra Renfro
    •  & Hammad Aslam
  2. School of Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    • Adarsh Kulkarni
  3. Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    • Paige Farley
  4. Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    • Patrick Bosarge
  5. Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA

    • Landon Wilson
    •  & Stephen Barnes


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The authors declare that they have no conflict of interest.

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Correspondence to Ceren Yarar-Fisher.

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