How MS Patients Have Tried to Manage Their Disease
Most people dealing with multiple sclerosis take an active role in managing their disease. In fact, MS patients try a wide variety of holistic treatments to help ease some of the many symptoms and adverse effects of the disease. A 2010 survey showed that between 30% and 60% of MS patients have used complementary and alternative medicine (CAM) and supplements. A 2014 study reported that 60% of MS patients in California and Massachusetts use CAM therapies. Another study in British Columbia discovered that 67% of MS patients had tried CAM. (Source).
Available CAM therapies seems limitless. You name it: herbs, spices, nutritional supplements, reflexology, yoga, aromatherapy, acupuncture, magnetic field therapy, hyperbaric oxygen therapy, and toxin removal therapy all make the list. (For a NIH report on CAM therapies, click here.) The above-cited 2010 survey reports that the most common interventions with the greatest positive impact are dietary modifications, omega-3 fatty acid supplementation, and antioxidants.
Goals of Dietary Intervention for MS Patients
Our recent blog Diet and Multiple Sclerosis covers a preliminary randomized-trial study that suggests that dietary intervention reduces fatigue and improves an MS patient’s quality of life. In this blog, we’ll dig deeper those three most common interventions used by MS patients – diet, supplementation, and antioxidants.
Three possible goals should guide dietary intervention:
- Reducing the inflammatory state
- Protecting against neurodegeneration
- Repairing the MS lesions through a remyelination (re-covering of the nerves that have lost their covering during a MS attack)
Gut Health and MS
A discussion of diet’s effect on MS patients starts with gut health.
The connection between the gut health and MS is clear. One retrospective study showed that at the disease’s onset, MS patients were 3.7 times more likely to have inflammatory bowel disease (IBD) than the general population. Similarly, over 65% of MS patients are plagued by at least one persistent gastrointestinal symptom. That includes dysphagia (difficulty swallowing), dyspepsia (heartburn/indigestion), constipation, fecal incontinence, and IBS.
Role of Gut Microbiota
The role of gut health and MS becomes clearer when you learn about the biology of how our digestive system works.
The gut houses many microorganisms, including genes proteins, and metabolic products. This is referred to as the gut microbiota. The bi-directional communication between the gut and the brain is encapsulated in the widely accepted gut-brain axis thesis. Over the past 15 years, microbiota has become regarded by researchers as the key regulator of gut-brain function. (Source) Gut microbiota is believed to influence the interaction between the central nervous system and the intestinal functions. Moreover, the thesis suggests that gut microbiota, for some patients, shapes the disease course of MS.
As we discussed in Managing MS: Why Gut Health is so Important, changes in the gut microbiome causes disruption to the intestinal barrier, making it more permeable. As a result, some of the GI microbiome “leaks” and enters the circulation. Ultimately, the important function of the central nervous system’s microglia is altered and may contribute to cognitive deficits and the progression of neurodegenerative disorders. (Source)
Gut Microbiota and MS: What’s the Connection?
What is known is the gut actively influences the pro-inflammatory activity of intestinal T cell (T lymphocyte) activity. While specifics need to be better understood, many researchers believe that a change in the balance of inflammatory factors and intestinal microbiota plays a role in the genesis and progression of MS. Some suggest that restoring the balance in the microbial population helps decrease inflammatory events.
The bottom line is that more diverse diets promote more diverse microbiomes. Much of that microbial diversity in the gut has been lost over the last 50 years due to dietary changes.
Diet and MS: What’s the Relationship?
While there is no conclusive evidence, investigators support different theories on the best diets for MS patients. For example, we know that unhealthy diets can have a negative effect on the disease. One study concludes that the risk of developing multiple sclerosis is associated with increased dietary intake of saturated fatty acids. Dietary saturated fatty acids may be pro-inflammatory and may also adversely impact disability progression.
Similarly, a high intake of saturated fats, sugars, and animal proteins can promote proliferation of pathogenic bacteria in the intestines. Gut inflammation results and the intestinal T cell function is altered. Specifically, the dynamic balance in the intestinal barriers controlled by the intestinal microbiome of T helper-17 cells (Th17) and regulatory T cells (Tregs) is disrupted. Experimental MS models have suggested that the function of Tregs is negatively impacted by altered intestinal microbiota. Importantly, microbial metabolites can cross the blood-brain barrier and have direct impact on immune cells in the central nervous system.
Intermittent Fasting Diet
There is possibly good news about the increasingly popular intermittent fasting diet. (Some might call it a craze: a 2022 global research study reported that 75% of the respondents have tried intermittent fasting). Findings from animal studies reveal promising results of intermittent fasting’s effect on the neurobiological health in the animal subjects. The results suggest that intermittent fasting may offer protection for the central nervous system.
Another set of research focused on the role of cytokines on MS. Cytokines are small, secreted proteins released by cells that have a specific effect on the interactions and communications between cells.
A 2015 study showed that high fatigue scores in MS patients correlated with higher concentration of pro-inflammatory cytokines. Another study found that certain anti-inflammatory cytokines (such as IL-4) were higher in patients with milder disability than those with moderate and severe disability. Conversely, pro-inflammatory cytokines were higher in MS patients than the control. Thus, the association of cytokine and progression of MS has inspired new clinical trials that study exposure to gluten and the production of cytokine.
The immune response to gluten has been studied for all auto-immune diseases, particularly for Celiac disease and MS. In fact, there may be a relationship between these two diseases. The authors of a 2011 article in BMC Neurology pointed out that while there is a much higher prevalence of celiac disease among people with MS and their relatives than in the general population. Regardless, clinical trials have suggested that gluten-free diets, eliminating gluten, casein, and lecithin reduces patient-reported fatigue.
Another popular diet has been shown to improve the quality of life for MS patients: a Paleolithic diet, aka Paleo or “caveman diet.” (A Paleo diet includes meat, fish, eggs, seeds, nuts, fruits, and veggies, along with healthy fats and oils, and avoids processed foods, grains, and sugar). A 2017 randomized control trial found that modified Paleolithic intervention results in significant reduction in fatigue and improvement in the quality-of-life scores for 17 individuals with RRMS studied in the trial.
Accumulating evidence suggests that oxidative stress plays a major role in the development of MS. Let’s start with an explanation of oxidation.
Oxygen is pivotal for multicellular life. Conversely, oxygen can be a reactive and threatening agent. To guard against the possible harmful effects of oxygen, intracellular homeostasis is maintained by balancing oxidation and reduction reactions. Oxidative stress results when there is an imbalance between production and accumulation of oxygen reactive species (ROS) in cells and tissues and the biological system’s ability to detoxify these reactive products. (Source)
Oxidative stress has been linked to several neurological diseases, including MS, Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), and memory loss. Hence, our interest in antioxidant therapy. An overabundance of ROS can cause inflammation and oxidation of different parts of cells, leading to a cascade that can accelerate disease progression. (Source) Reduction of oxidative stress for MS patients may combat chronic demyelination and neurodegeneration – the #2 goal of dietary intervention.
Several antioxidants have supposedly produced beneficial effects against oxidative stress. Antioxidants such as melatonin, Vitamin D, and Omega-3 polyunsaturated fatty acids may have helped protect against the neurodegenerative element of MS, as well as the inflammatory effect of oxidative stress. (Source)
More long-term, large-scale studies are needed on dietary interventions to fully understand the effectiveness of different therapies. Improving the quality of life and levels of fatigue for MS patients is a big positive outcome. As depression and fatigue greatly impact the scores on Quality-of-Life scales, even if the ultimate trajectory of disability is not changed, a better quality of life every day is a significant goal.
Importantly, dietary changes have a favorable risk–benefit analysis. In other words, the dietary interventions that we discussed do not present potential harm and stand to help you feel better. As an MS patient, we encourage you to talk to your physician about your diet and dietary supplements.
Any questions or comment, please add them in the comment field below.