Time to Start a New Diet?
It’s that time of year when there’s much talk and publicity about diet. Modifying – i.e., improving — one’s diet – ranks high on new year’s strategies. The popular Mediterranean diet, the closest to an anti-inflammatory diet, may receive the most attention. For those dealing with Multiple Sclerosis (MS), recent scientific evidence suggests that there’s good reason to consider a diet that promotes eating anti-inflammatory foods.
However, there have been no formal, scientifically-based recommendations on the role of diet in managing MS to date. That’s largely because there have not been enough controlled studies looking into the relationship of nutrition and MS. Without quantitative data, physicians currently encourage their MS patients to maintain the same healthy diet recommended for the general population. That is: lean proteins, whole grains, and plenty of fruit and vegetables. (Source). Nonetheless, there are many reasons that suggest that dietary changes might improve the lives and possibly reduce disability progression for MS patients.
MS and Autoimmune Diseases
To start with, let’s review the disease itself. Multiple Sclerosis is an autoimmune disease, or a disease of the immune system. Autoimmune diseases such as MS, Type I Diabetes, Grave’s disease, and Celiac disease result when the immune system effectively malfunctions and can no longer tell the difference between healthy cells and invading microorganisms. As a result, the immune system targets the body’s own healthy tissues by mistake, signaling the body to attack them. (Source).
In the case of MS, the central nervous system is the erroneous target. Specifically, MS is an inflammatory, demyelinating, and neurodegenerative disease of the central nervous system. There are several hypotheses correlating inflammation and neurodegeneration in MS. Differences in inflammation and neurodegeneration in each patient could explain the different disease courses – and extent of disability. (Source.) Hence, controlling inflammation may be critical to the disease’s progression.
Nutrition and Autoimmune Diseases and MS
Nutrition is a possible factor in influencing the inflammatory cascade evident in patients with autoimmune diseases. Many inflammatory conditions, such as rheumatoid arthritis, have been managed in part by lifestyle and dietary changes. The Mediterranean diet and DASH diet, both popular dietary plans that promote eating anti-inflammatory foods, are frequently considered.
MS patients and their clinicians similarly have been looking for dietary changes that might improve their lives. As mentioned above, inflammatory, and likely, secondary neurodegenerative processes affect the progression of MS disability.
Randomized-controlled trials on the role of diet and MS
A research group in Spain recently set out to address the question of diet’s effect on MS patients. The researchers studied how dietary changes might improve the lives of MS patients. Their approach combined results from multiple randomized-controlled trials (RCTs). RCTs are studies where participants are randomly assigned to multiple groups. In this analysis, scientists pooled data from multiple studies and analyzed it — which provides greater statistically significant information to detect meaningful effects. However, it should be noted that the trial design was suboptimal with a low number of participants. The results of the combined studies therefore require interpretation and merit further research to provide definitive conclusions.
Published in October 2022, the RCTs’ analysis revealed some interesting findings about the effect of diet for the studied MS patients. A total of 515 patients across eight randomized-controlled trials were included in the meta-analysis. Various diets were investigated including a Mediterranean diet and a very low-fat vegetable diet.
The Results: Effect on fatigue, quality of life, and disability
Across the eight RCTs, the effect of dietary intervention on three different manifestations of MS patients’ experience with their disease was evaluated:
- Fatigue.
- Physical and mental quality of life; and
- Disability progression.
Fatigue is the most common symptom of MS. According to the Cleveland Clinic, overwhelming fatigue is described by 75% to 90% of MS patients. As many as 40% of patients describe fatigue as their most disabling symptom. MS patients’ chronic fatigue is difficult to deal with therapeutically and greatly impacts health-related quality of life. (Read more in our blog “Sleep and MS: The Importance of Managing Your Sleep”).
Fatigue is measured by the Modified Fatigue Impact Scale (MFIS) – generally performed during an MS patient’s visit to a neurologist. The analysis from three trials of 308 patients revealed significant improvement in the MFIS score after diet intervention.
Physical and mental quality of life is measured by the Multiple Sclerosis Quality of Life (MSQoL) scale. Across two trials including 77 patients, the MSQoL score showed significant improvements after dietary intervention.
MS’s associated disability is measured by expanded disability status scale (EDSS), considered the gold standard to describe disease progression in MS patients. (EDSS is based on a neurologic examination by a clinician; the BeCare MS Link app asp incorporates artificial intelligence (AI) to calculate our EDSS score). The analysis showed no significant effect of dietary intervention on EDSS, suggesting that diet has no impact on disease progression. (Source.)
See below for a summary of the results.
| What Studied/Effect of Dietary Intervention | RCTs (#) | Participants (#) | Result |
| Fatigue (MFIS) | 3 | 308 | Significant reduction in fatigue |
| Physical and mental quality of life (MSQOL) | 3 | 77 | Significant improvement in QOL |
| Disability (EDSS) | 6 | 337 | No significant effect on EDSS |
The study’s abstract also noted that there were no severe diet-related adverse effects evident in the trials. (Possible adverse effects include diarrhea, abdomen pain, constipation, appetite changes, and none of these effects were observed in the series of trials).
The Study’s Conclusions
The study concludes that it is still difficult to reach a “high level of evidence in dietary studies.” More research is needed on this topic with large clinical trials to shed further light on the role of diet on MS. However, given the low risk and possible benefits of dietary intervention the authors conclude:
Taking into account the potential of dietary interventions and the benefit/risk ratio in their favor, neurologists must be aware of the great importance of making interventions on diet in MS if necessary. There are dietary interventions with some evidence of benefit for patients with MS, which could be chosen based on adherence, patient preferences, and individual outcomes. (Source.)
Unfortunately, there still are no precise concrete recommendations of a specific dietary plan for MS patients.
Our Conclusion
The design of the combined studies cited above are not empirically perfect and merit further research. However, we learned that diet intervention may improve MS patients’ quality of life and levels of fatigue. As depression and fatigue greatly impact the Physical and Mental Quality of Life scales, even if the ultimate trajectory of disability is not changed, a better quality of life every day is a very important goal.
While additional studies are needed to explore the role of diet in MS patients’ lives, we recommend that you talk to your physician about your diet. In our next blog, we will go into more depth about anti-inflammatory diets.