Acute Effects of Medium Chain Triglyceride (MCT) Nutritional Ketosis on Parkinson's Disease (PD) Symptoms and Biomarkers (MCT-PD)

Study First Received, October 10,2020
Lead Sponsor: National Institute of Neurological Disorders and Stroke (NINDS) (Funder Type: NIH)
Conditions
Parkinson's Disease
Interventions
Dietary Supplement: Liquigen MCT oil
Study Type
Interventional
Phase
Phase 1
Status
ongoing, recruiting (32 patients)
Study Duration
2020-11-30 to 2024-06-30
Overview Outcomes Eligibility Locations Investigators No Results
Overview
Official Title
Acute Effects of Medium Chain Triglyceride (MCT) Nutritional Ketosis on Parkinson's Disease (PD) Symptoms and Biomarkers (MCT-PD)

Summary
Background: The ketogenic diet uses fats as a person's major energy source rather than carbohydrates. There is increasing interest in using this diet to treat neurodegenerative disorders like PD. Researchers want to learn more before recommending this diet in clinical practice. Objective: To study the effects of a ketogenic diet for someone with PD. Eligibility: People over age 50 with mild to moderate PD. Design: Participants will be screened with surveys and a 10-foot walking test. They will have a medical history, physical exam, and blood test. Participants will be contacted twice in a 1-week period to discuss what they ate over the last 24 hours. They will log data about their daily exercise and activities using an online fitness tracking app. Participants will stay at NIH Clinical Center for 1 week. They will be put into 1 of 2 groups. One group will follow a ketogenic diet and take MCT oil. The other group will follow a low-fat diet. Their body measurements will be taken. They will meet with a physical therapist and nutritionist. Participants will have daily respiratory and glucose monitoring. They will have cognitive tests and complete surveys. They will have walking, motor function, and reaction time/finger tapping tests. They will have heart and nerve function tests. They will have electrocardiograms and electroencephalograms. Blood will be taken twice daily. Participants will follow the ketogenic diet at home for 2 weeks. They will log their activities using the fitness tracking app. Then they will have a follow-up visit at NIH. Participation will last for 4 weeks.

Detailed Description
While three pilot studies of ketogenic diet (KD) in PD have shown either reduction in motor scores (UPDRS) or improved memory/fluency cognitive testing, there are gaps in knowledge of the time course and mechanisms of reported outcomes. Furthermore, only a standard ketogenic diet was studied while there are variations such as MCT oil supplementation shown to increase keto-induction, and other adaptations may improve tolerability and micronutrient content. It is the goal of this proposed inpatient metabolic study to address the initial question of effect size and time course of ketosis. If suggestive of benefit in PD, this pilot study may lead to a subsequent larger study of long-term feasibility and effects on disease biomarkers and disease progression, which might also compare alternate diets of interest in PD such as Mediterranean diet. Thus, a pilot feasibility study is proposed, targeting retention rate >80% and adherence in the outpatient setting. Recruitment of 32 participants is based upon power analysis of secondary outcome, testing the Timed Up & Go mobility test that has reported validity in fall prediction, additionally plotting continuous and serially repeated direct/indirect ketosis measurements and motor as well as non-motor symptoms / exploratory disease biomarkers. It is hypothesized that, compared to a non-ketogenic healthy diet (low-fat diet), ketogenic diet supplemented by MCT oil (MCT-KD) will improve mobility tested by Timed Up & Go (TUG), as well as akinesia, tremor, and memory/executive function tasks, and will reduce motor and nonmotor fluctuations within the acute period of keto-induction and early ketogenic timepoints due to improved mitochondrial function and neurotransmitter synthesis. The primary objective is to test the hypothesis that nutritional ketosis (NK) supplemented by MCT oil in a PD cohort (MCT-KD) is feasible for a duration of three weeks. The secondary objective is to show that NK improves PD symptomatology in cognition (improved attention, recall, and executive function), mobility (TUG), and motor function (bradykinesia, akinesia and tremor) to a greater extent than a standard, low fat diet (LFD) within three weeks.

Arms
Arm A Experimental Ketogenic Diet
Arm B Active Comparator Standard American Diet and Ketogenic Diet

Funder Type
NIH

Lead Sponsor
National Institute of Neurological Disorders and Stroke (NINDS)

First Received
2020-10-10

Last Updated
2020-11-24

Start Date
2020-11-30

Primary Completion
2024-06-30

Completion Date
2024-06-30

NCT Identifie
NCT04584346

Identifiers
20-N-0153 NCT04584346

Contact Information
Alexander H Choi, M.D., (301) 402-7969, alexander.choi@nih.gov

Outcomes
Eligibility
Locations
Investigators
No Results