Diet and MS
New Directions in MS Research: New Therapeutic Approaches
People with multiple sclerosis long have sought to improve their health and stabilize the course of their MS through diet. While the impact of specific eating plans and foods on MS itself continues to be investigated (as discussed below), clinicians emphasize the importance of following sound nutritional approaches generally to improve overall health, reduce risk for common comorbid conditions such as high blood pressure and diabetes, and to support energy levels and immune function.
Turning to studies looking at specific issues related to MS and diet, one recent analysis involving 277 people with MS found that the better you eat, the better you think – and move. In this study, the participants had an average age of 48.2 years and an average body mass index (BMI) of 28.2, which is in the overweight range. More than three-quarters were women. All participants completed the MS Performance Test (MSPT) assessment of neurologic function and a questionnaire on how often they ate 153 different food items. Investigators used the Healthy Eating Index 2010, a measure of dietary quality, to assign each participant a score from 0 (poorest quality diet) to 100 (highest quality diet). Based on those scores, researchers placed people into four quartiles, or groups, with one group composed of people with the highest quality diets, one made up of people with the worst-quality diets, and the other two groups for people with intermediate degrees of lower- or higher-quality diets. Next, the researchers drew on the MSPT results to see how performance in various aspects of neurologic function differed from group to group.83
The analysis found that people in the highest quartile of dietary quality had significantly faster cognitive processing speeds and 25-foot walking speeds than those in the lowest quartile, and marginally faster manual dexterity speeds. They also were at significantly lower risk of moderate disability. The study’s authors concluded, “High dietary quality was associated with lesser disease severity using measures of disability, mobility, and cognitive function.” They added that ongoing studies would be important to determine if high-quality diets are associated with slower rates of disease and disability progression.83
Ketogenic diets (KD), which are high-fat, low-carbohydrate eating plans, have attracted significant interest from people with MS. Proponents of these diets point to indications that this approach to food intake reduces inflammation and oxidative stress. A recent study examined the ability of people with MS to follow a ketogenic diet over time, as well as how that diet affected conditions that commonly accompany MS.84
The study involved 20 individuals with stable relapsing multiple sclerosis (RMS). A dietitian provided study participants with inperson education on how to adhere to a modified ketogenic diet, such as the Atkins diet. Daily urine testing then was employed to check levels of ketone – markers of adherence to the diet. Researchers also collected data on patient-reported fatigue and depression, while laboratory testing at the start of the study (before people began their ketogenic diets) and at six months assessed insulin resistance, liver function, electrolytes, and other markers of health. Brain magnetic resonance imaging was also performed at baseline and at six months.
None of the study participants showed clinical or imaging signs of disease worsening while on the diet. Meanwhile, improvements were seen in fatigue and depression scores (p=0.03), as were reductions in body mass index (BMI). Insulin resistance was significantly reduced at three months.
While data were still being collected when these initial results were released, the findings to date prompted researchers to conclude that for people with RMS, a ketogenic diet “appears to be safe, feasible, and welltolerated,” while offering a number of health benefits.84
Another recent study showed that high consumption of monounsaturated fatty acids (MUFAs) – which are found in olive oil, avocados, nuts, and other foods – may limit the negative impact of MS on gray matter in the brain.85
Researchers used baseline data from the NYC RESERVE cohort, an ongoing study evaluating risk factors and protective factors for disability in people who have been diagnosed with MS in the past five years. They analyzed information on 140 people with MS. Ninety of those study subjects were women. The average age of the overall group was 34.7 years, and the average time from diagnosis of MS was 2.2 years.
The investigators divided the study participants into three groups based on whether the people had reported low, medium, or high intake of fatty acids when completing a food-frequency questionnaire. The researchers then used MRI to measure participants’ cortical thickness (CT) and normalized grey matter (nGM) in the brain. Reduced cortical thickness reflects atrophy, which is a shrinking or loss of brain cells.
The study found that cortical thickness was lower among patients with low MUFA intake than in patients with medium or high intake. Results were similar for normalized grey matter. By contrast, the researchers did not find significant links between saturated or polyunsaturated FA intake and cortical thickness or amount of normalized gray matter.
The researchers concluded that their findings suggest that “MUFA intake may serve a protective role in MS patients, limiting the impact of MS-related lesions on cerebral gray matter, which may have important implications later in the disease.”85
Turning to another question regarding nutrition and multiple sclerosis, a recent study of 479 people recently diagnosed with MS found no indication that mineral intake was an important factor in their developing the condition.86 Researchers drew on more than 170,000 food-frequency questionnaires completed by participants in the Nurses’ Health Study (which ran from 1984 to 2002) and the Nurses’ Health Study II (1991 to 2007), focusing especially on the information provided by 479 participants who were diagnosed with MS during follow-up. They found no association between MS risk and the amount of potassium, magnesium, calcium, phosphorus, iron, zinc, manganese, or copper in participants’ diets.86 While negative studies such as this one do not yield guidance on whether patients should increase or decrease their intake of certain foods, they nonetheless are valuable in helping investigators set research priorities.