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At 3 months of follow-up, 147 participants in the diet group were compared to 147 age-matched and sex-matched participants who had received medical management. Eighteen patients completed the 6-month study and two patients stopped the diet prematurely (10% attrition). Twenty adolescent or adult patients with relapsing-remitting multiple sclerosis at the University of Virginia, 95% of whom were overweight or obese, were enrolled in a 6-month single-arm study of the MAD (20 g carbs/day) . Diet adherence was measured using patient self-reported continued diet use and diet-intake via food records. The most common reported adverse effects in the diet group were gastrointestinal symptoms that included nausea/vomiting, reflux, constipation, and diarrhea. Of the 13 patients in the MAD arm who withdrew, nine never started the diet and four were lost to follow-up because of intolerance or an increase in seizures. 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