2 Nov 2016 | ~13:35 Engagement Time
The Effects of Diet on MS
Multiple Sclerosis is a chronic immune-mediated demyelinating disorder that affects the central nervous system (CNS). In MS, the immune system functions abnormally and targets cells and tissues within the CNS, causing inflammation and damage to myelin, nerve fibers and the cells that make myelin.
Several genetic and environmental factors that influence the risk for developing MS have now been identified, including low Vitamin D, exposure to the Epstein Barr Virus, smoking, childhood obesity, and others. (Perhaps the most significant dietary factor that has been linked with the occurrence of MS and its disease course is low vitamin D.)
There is increasing interest in the possible role of diet in autoimmunity and in the role of dietary interventions in diseases such as MS. Ongoing research is demonstrating a link between the gut microbiota (bacteria in our gut) and MS. Diet plays a significant role in shaping our gut microbiota and is also implicated in several other chronic diseases (type 2 diabetes, obesity, hypertension). Although there is a lot of ongoing research and many diets have been suggested as helpful to people with MS, there is no specific diet or dietary supplement that has been demonstrated in well-designed clinical trials to change the course of MS.
That said, what is known about diet and MS?
There are several diets that have been suggested to be useful in MS. While the research does not currently identify any single diet as helpful to the MS disease course, many people are interested in learning about them, and the research in MS that is being done to evaluate them. The Paleolithic, Wahls protocol, Mediterranean, Swank, Intermittent Fasting and Gluten free diets are reviewed below, including recent research findings in MS, and any possible nutritional deficiencies that may arise from following any of these diets.
The Wahls protocol was developed by Dr. Terry Wahls following her own diagnosis of MS. She found, through her own research, which following a specific diet seemed to improve her mobility. Dr. Wahls believes that dietary support of the mitochondria – the energy producer within our cells – can be beneficial in MS.
The Wahls protocol diet is similar to the Paleo diet.
In a Paleo diet, the recommendation is to eat what would have been consumed by our ancestors – before grain farming and processed foods. The Paleo diet emphasizes the intake of game (non-domesticated) meats and plant-based foods, including fruits, roots, legumes, and nuts – but avoiding cereal grains. The Paleo diet is also high in fiber (45-100 g/day) that is derived from plant sources that are not cereal based.
The modified Paleo Diet in the Wahls protocol emphasizes specific amounts of foods such as grass fed meats, wild caught fish and plenty of vegetables, particularly dark green leafy vegetables. This diet also includes are brightly colored fruits. Foods to be avoided are processed foods, soy, dairy, eggs, and beans. More specific information about the Wahls Protocol can be found here.
Dr. Wahls has pursued clinical trials of her diet, and in 2009 she and her team published findings of a small, uncontrolled, single-arm study that looked at the effect of a multimodal intervention (including exercise, electrical stimulation of muscles, and a modified Paleo diet) on people with secondary progressive MS. This study found significant improvement in fatigue scores over a period of 12 months. In 2021 Dr. Wahls and her team published a second study that compared the Swank diet and the modified paleolithic diet in relapsing-remitting MS. Results showed that fatigue was reduced, and physical quality of life scores improved with both diets. Mental MS quality of life scores improved in the modified paleolithic group.
Dr. Wahls team recently received a $2.5 million gift from the Chapman-Shreve Foundation to compare the effects of the modified Paleolithic elimination diet, the ketogenic diet, and a control diet (a person’s usual diet), on quality of life and fatigue. The two-year Efficacy of Diet on Quality of Life in Multiple Sclerosis (EDQ-MS) study will enroll 156 people who have MS. This will be one of the largest and longest MS diet studies ever done.
The Paleo diet can result in deficiencies in folic acid, thiamine, and vitamin B6 (due to reduced intake of cereals), calcium and vitamin D (due to lack of dairy intake).
Mediterranean Diet (MD)
Gluten Free Diet (GFD)
A GFD is a diet completely devoid of wheat, barley, rye and triticales (a cross between wheat and rye). Gluten is a protein composed of gliadin and glutenin, which are found conjoined with starch in wheat, rye, and barley. It is a major component of the proteins found in wheat.
Gluten sensitivity is a feature of celiac disease and GFD is a common treatment for this disorder. Besides celiac disease, gluten sensitivity has also been noted in a condition called non-celiac gluten sensitivity (NCGS), which can also lead to gastrointestinal symptoms.
The Swank diet was described by Dr. Roy Swank and was used by him to treat patients with MS for several years. The diet is essentially a low–fat diet that focuses on reducing both saturated and unsaturated fats.
Intermittent fasting is all about when you eat, where other diets are about what you eat. Intermittent fasting can mean eating during certain hours of each day, complete fasting on scheduled days or reducing calories every day or on alternate days. In any of these regimens, most people will lose weight. But researchers are also seeing benefits in Type 2 diabetes and elevated lipids.
While many different dietary strategies are being promoted for people with MS, currently there is insufficient evidence to recommend any of these strategies as having the ability to change the natural history of MS.
Interestingly, despite the differences between these diets there are several common themes. Almost all diets advocate avoiding highly processed food, foods with high glycemic index and food that is high in saturated fat. Most diets also recommend reducing consumption of fatty red meat and increasing consumption of fruits and vegetables.
To truly know “the best diet for MS,” we will need to wait for more systematic research to be conducted and published. While we wait, your most reasonable option is to follow a diet that incorporates these common, health-promoting themes. Should you have interest in this or any other diet strategy, consider a discussion with your healthcare provider.
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