Acute Stroke
Conditions
Keywords
stroke, ketogenic diet, ketosis, ischemia, brain, ketones, hyperglycemia, neuroprotection
Brief summary
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.
Detailed description
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.
Interventions
DIETARY_SUPPLEMENTKetocal 4:1 (Nutricia)
DIETARY_SUPPLEMENTControl diet: Regular diet offered at the hospitals
DIETARY_SUPPLEMENTKetogenic meals
Sponsors
Glostrup University Hospital, Copenhagen
Bispebjerg Hospital
University of Copenhagen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline NIHSS (national institute of health stroke scale) at 90 days | Baseline and 90 days | NIHSS is a common stroke scale used to objectively quantify the impairment caused by a stroke |
| Change from baseline fasting blood sugar at 7 days | Baseline and 7 days | — |
| Change from baseline p-C-peptide at 7 days | Baseline and 7 days | — |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline p-LDL at 7 days | Baseline and 7 days | — |
| Change from baseline p-CRP at 7 days | Baseline and 7 days | — |
| Change from baseline p-beta-hydroxy butyrate at 7 days | Baseline and 7 days | — |
| Change from baseline p-phosphate at 7 days | Baseline and 7 days | — |
| Change from baseline p-potassium at 7 days | Baseline and 7 days | — |
| Number of patients who died (mortality) | up to 3 months | — |
| Change from baseline p-alkaline phosphatase at 7 days | baseline and 7 days | — |
| Change from baseline p-bilirubine at 7 days | baseline and 7 days | — |
| Change from baseline INR at 7 days | baseline and 7 days | — |
| Number of patients with gastrointestinal complications | Up to one week | Gastrointestinal complications monitored daily are: Nausea, Vomiting, Constipation, Diarrhea, Abdominal pain |
| Change from baseline urine-ketones at 7 days | Baseline and 7 days | — |
| Change from baseline p-ALAT at 7 days | Baseline and 7 days | — |
| Number of patients with pneunomia | Up to one week | — |
| Change from baseline p-triglyceride (fasting) at 7 days | Baseline and 7 days | — |
Countries
Denmark
Outcome results
None listed