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Old 08-03-2016, 05:12 PM
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Exclamation STUDY: Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial

Finally, a randomized, serious diet study in MS! What happened when patients with multiple sclerosis ate a very low-fat, plant-based diet--no meat, fish, eggs, dairy products, or vegetable oils--for a full year? The eye-opening results are in.

This is disappointing, but not surprising. For those who follow strict diets, will you modify your diet based on these findings? - D

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Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial

Vijayshree Yadav, Department of Neurology at Oregon Health & Science University in the United States, and colleagues.

Abstract

Highlights

•MS subjects tolerated and adhered to the one-year very-low-fat, plant-based diet.
•Study duration and sample size limit MRI, relapse & disability data interpretation.
•Diet group subjects experienced improvements in the MS fatigue.
•Diet-resultant weight and lipid improvement may yield long term benefits in MS.

Background

The role that dietary interventions can play in multiple sclerosis (MS) management is of huge interest amongst patients and researchers but data evaluating this is limited. Possible effects of a very-low-fat, plant-based dietary intervention on MS related progression and disease activity as measured by brain imaging and MS related symptoms have not been evaluated in a randomized-controlled trial. Despite use of disease modifying therapies (DMT), poor quality of life (QOL) in MS patients can be a significant problem with fatigue being one of the common disabling symptoms. Effective treatment options for fatigue remain limited. Emerging evidence suggests diet and vascular risk factors including obesity and hyperlipidemia may influence MS disease progression and improve QOL.

Objectives

To evaluate adherence, safety and effects of a very-low-fat, plant-based diet (Diet) on brain MRI, clinical [MS relapses and disability, body mass index (BMI)] and metabolic (blood lipids and insulin) outcomes, QOL [Short Form-36 (SF-36)], and fatigue [Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS)], in relapsing-remitting MS (RRMS).

Methods

This was a randomized-controlled, assessor-blinded, one-year long study with 61 participants assigned to either Diet (N=32) or wait-listed (Control, N=29) group.

Results

The mean age (years) [Control−40.9±8.48; Diet−40.8±8.86] and the mean disease duration (years) [Control −5.3±3.86; Diet−5.33±3.63] were comparable between the two groups. There was a slight difference between the two study groups in the baseline mean expanded disability status scale (EDSS) score [Control−2.22±0.90; Diet−2.72±1.05]. Eight subjects withdrew (Diet, N=6; Control, N=2). Adherence to the study diet based on monthly Food Frequency Questionnaire (FFQ) was excellent with the diet group showing significant difference in the total fat caloric intake compared to the control group [total fat intake/total calories averaged ~15% (Diet) versus ~40% (Control)]. The two groups showed no differences in brain MRI outcomes, number of MS relapses or disability at 12 months. The diet group showed improvements at six months in low-density lipoprotein cholesterol (Δ=−11.99 mg/dL; p=0.031), total cholesterol (Δ=−13.18 mg/dL; p=0.027) and insulin (Δ=−2.82 mg/dL; p=0.0067), mean monthly reductions in BMI (Rate=−1.125 kg/m2 per month; p<0.001) and fatigue [FSS (Rate=−0.0639 points/month; p=0.0010); MFIS (Rate=−0.233 points/month; p=0.0011)] during the 12-month period.

Conclusions

While a very-low fat, plant-based diet was well adhered to and tolerated, it resulted in no significant improvement on brain MRI, relapse rate or disability as assessed by EDSS scores in subjects with RRMS over one year. The diet group however showed significant improvements in measures of fatigue, BMI and metabolic biomarkers. The study was powered to detect only very large effects on MRI activity so smaller but clinically meaningful effects cannot be excluded. The diet intervention resulted in a beneficial effect on the self-reported outcome of fatigue but these results should be interpreted cautiously as a wait-list control group may not completely control for a placebo effect and there was a baseline imbalance on fatigue scores between the groups. If maintained, the improved lipid profile and BMI could yield long-term vascular health benefits. Longer studies with larger sample sizes are needed to better understand the long-term health benefits of this diet.

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