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

[ActiveMSers]

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.

[Marinadca]

I am actually very relieved to hear/read this. There are few diet plans out there for MS and they seem to be low-fat, vegetarian, gluten free, dairy free diets.

That might work for some people,but I have not wanted to give up meat, gluten, or fat from my diet. I have worried that keeping these things was harming me, and that I should give them up and follow one of the low inflammation diets. So this is rather validating for me.

[ActiveMSers]

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.

This is a stark, straightforward result. I've long said that it is smart to eat healthily, and that you'll likely feel better if you do, but not to rely on diets to "cure" your MS. Yes, technically the jury is still out on other specific diets (Wahls, gluten-free, et. al.), but folks please think twice before opting solely for a diet and foregoing disease modifying therapy until there is evidence that a certain diet influences MS progression.

My 2 cents. And I hear you, Marina.

[Marinadca]

Oh, definitely eat healthy! I don't mean I eat fried food, fast food, junk, etc. But I enjoy a steak, most nights I eat chicken or fish, and you will rip cheese and wine from my cold dead hands

[girl1dir]

My food choices didn't get me here

I don't believe my food choices can get me out of it.

I am happy to hear I can keep eating my red meat!!

[Brightangel]

Plant based diet

The important thing to note about this study is that although it is a RCT, its
major weakness is that it is a very small sample size and the effect size would need to be very large to show significance. It does not specify what type of MS the participants have according to the above abstract. Also from the abstract it is not clear about whether the participants were on DMD's and of what type

This study is based upon a diet regime that is now widely recognised for good cardio and physical health and longevity generally. There is nothing fad about it. It does not prohibit gluten.

For what one can draw from the study acknowledging its limitations. There are factors relevant for MS for instance the recent studies linking obesity to MS progression, and there was a positive effect of weight loss. There were also positive effects on important metabolic markers which are relevant to cardiovascular health, relevant if MSers are unable to exercise to maintain cardiac health. An improvement was noted in MS fatigue, a problem which bedevils many MSers.
The finding that there was no difference in
MRI may be confounded by DMD's need to see the full study report to form a view. Query whether the time frame was long enough to evidence brain changes. Diet is not steroids - a change in diet takes time to act at a cellular level.

A healthy eating lifestyle is optimum for everyone, not just people with MS

[ActiveMSers]

People with RRMS were tested in the above trial. In related diet studies, Dr. Wahls published a study a couple years ago on her diet, albeit much smaller in scale (six completed the study) and it was not randomized or controlled. The results were similar: fatigue improved.

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J Altern Complement Med. 2014 May;20(5):347-55. doi: 10.1089/acm.2013.0188. Epub 2014 Jan 29.

A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue.

Bisht B1, Darling WG, Grossmann RE, Shivapour ET, Lutgendorf SK, Snetselaar LG, Hall MJ, Zimmerman MB, Wahls TL.

Author information

Abstract

BACKGROUND:

Multiple sclerosis is an autoimmune disease influenced by environmental factors.

OBJECTIVES:

The feasibility of a multimodal intervention and its effect on perceived fatigue in patients with secondary progressive multiple sclerosis were assessed.

DESIGN/SETTING:

This was a single-arm, open-label intervention study in an outpatient setting.

INTERVENTIONS:

A multimodal intervention including a modified paleolithic diet with supplements, stretching, strengthening exercises with electrical stimulation of trunk and lower limb muscles, meditation, and massage was used.

OUTCOME MEASURES:

Adherence to each component of the intervention was calculated using daily logs. Side-effects were assessed from a monthly questionnaire and blood analyses. Fatigue was assessed using the Fatigue Severity Scale (FSS). Data were collected at baseline and months 1, 2, 3, 6, 9, and 12.

RESULTS:

Ten (10) of 13 subjects who were enrolled in a 2-week run-in phase were eligible to continue in the 12-month main study. Of those 10 subjects, 8 completed the study and 6 subjects fully adhered to the study intervention for 12 months. Over a 12-month period, average adherence to diet exceeded 90% of days, and to exercise/muscle stimulation exceeded 75% of days. Nutritional supplements intake varied among and within subjects. Group daily average duration of meditation was 13.3 minutes and of massage was 7.2 minutes. No adverse side-effects were reported. Group average FSS scores decreased from 5.7 at baseline to 3.32 (p=0.0008) at 12 months.

CONCLUSIONS:

In this small, uncontrolled pilot study, there was a significant improvement in fatigue in those who completed the study. Given the small sample size and completer rate, further evaluation of this multimodal therapy is warranted.

[Marjo54]

diet

I was diagnosed with MS over 40 years ago and I'm still active and walking. In my opinion, if I had continued to eat fatty, red meat, I would have been bed-ridden within a few years.
Diet has everything to do with having a better life with M.S.

[ActiveMSers]

Marjo, I might disagree that diet has "everything" to do with having a better life with MS, as I know a number of people who are on strict diets and are also severely disabled, but I am glad diets have worked so well for you.

This is an interesting article on whether diets matter in multiple sclerosis and the challenges of research from MS Discovery, a nonprofit group I highly respect (alas they had to recently shutter due to funding).

http://www.msdiscovery.org/news/news...iple-sclerosis

[Suebee]

Great article Dave! I hadn't seen that article and it did give me pause as I ate my cheese burger for lunch.
I note that the scope of the article didn't allow for the writer to speak of Dr Wahls's belief that two things are needed to "cure" ms - diet to repair the mitochondria AND retraining the electrical pathways that are rebuilding with diet with outside electric muscle stimulation.
Dr. Wahl's views seem rational so I felt it was worth a try, but I was unable to get any PT or Dr. to support this kind of treatment (as Dr. Wahl recommends) because I am told, this is unproven science. (My neuro had much less kind words.) However, I am still willing to give it a try - shock the living daylights out of my muscles for 6 week clinical trial if I could find one. One can get a hold of athletic muscle simulators on amazon, but not only are they very pricey, I would have no idea what I was doing anatomically, and so I figured I might cause more harm than good zapping myself. If you're reading this and thinking it is all hokem, though, I ask rhetorically why would electric muscle stimulation be beneficial for the paralyzed, stroke victims, and for elite athletes but not an MS patient who has impaired nerve conduction and therefore can't exercise fully? I once sat next to a stroke patient all hooked up to the electric stimulation device in PT and we compared physical weaknesses. Mine was the same as hers. We jokingly offered to to switch rehab treatments, I get shocked on stationary bike and she gets to walk treadmill while PT asks if she is tired yet.
Dr. Wahl's body suit for electric muscle stimulation is patented, and if available commercially I would be first in line to try it. Very similar body suits are popping up in special gyms, promising to give an athlete the edge and fully body workout in short time. Can't some entrepreneur look at the clinical data and do a clinical trial for MS patients!?! Please!

[ActiveMSers]

Here's a piece by a NY Times writer about a common-sense approach to diet. A good read about the author's take on simple rules to follow for healthy eating. - D

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Over the past few months, I’ve written a number of times on how nutrition recommendations are seldom supported by science. I’ve argued that what many people are telling you may be inaccurate. In response, many of you have asked me what nutrition recommendations should say.

http://www.nytimes.com/2015/04/21/up...line&te=1&_r=0

[ActiveMSers]

This study came up again when discussing the results from the recent Wahls study. Both this and her study found fatigue reductions in plant-based diets. There is growing science that lowering your BMI and improving cholesterol numbers could lessen fatigue.

[neurox]

BMI and MS Outcomes

From the conclusions:

The conclusion says ...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.

I think it is important to note that there ARE studies that correlate BMI with MS outcomes.

Study
http://n.neurology.org/content/91/24/e2256.long

Conclusions
Higher BMI appears to be associated with greater reductions in nGMV and nBPV, which is relevant because, in particular, nGMV loss portends greater longer-term disability. Because obesity is modifiable, further studies should explore these relationships in detail, and evaluating the effect of reducing BMI on imaging and clinical outcomes in MS may be warranted.

[ActiveMSers]

neurox, you are absolutely correct. While based on these results (and those from other studies), diet alone doesn't influence relapses, lesions or disability, diet clearly affects weight. Specifically BMI. And higher BMIs, as you posted, is associated with negative MS outcomes.

Correct me if I'm wrong, but it appears the general takeaway from MS diet studies is a) eat a healthy, balanced diet, and b) if you are overweight, make a concerted effort to lose those extra pounds. It might not matter how you lose those lbs (vegetarian, Mediterranean, Keto, gluten free, Wahls, etc.). Your MS will thank you. But if you are at a healthy weight, no "MS Diet" has been shown—in any clinical trials to date—to have any effect on disease progression.

Based on your username, it sounds like you may be a neurologist. And with an "x" it sounds even cooler, like a superhero. You just need a cape and a wicked Neuro X logo. Thoughts? On the diet part?

[neurox]

cupcakes vs cucumbers

Thank you Dave,

The name is a combo of latin for “nerves” and my real name. Trying for tragically cool but not fraudulently cool - I’m not a neurologist. Of course everyone will know my actual superpowers as soon as I use them

But if you are at a healthy weight, no "MS Diet" has been shown—in any clinical trials to date—to have any effect on disease progression.

I agree that nobody has proven, scientifically, that a diet made up of specific foods will stop MS disease progression.

You underscored my point in posting about the BMI study - that implicitly, a good diet can lead to “better” general health (measured in part by BMI) which could improve or reduce MS symptoms. I have light RRMS (20 years) but I too notice my symptoms are not as bad when I “take care of myself” through diet and exercise.

I DO look forward to the time when doctors will be more adamant with their patients about the difference between the 500 calories in a frosted cupcake vs the 500 calories in a chicken salad. Along those lines, here’s my new favorite nutrition article outlining some randomized food trials and general health.

Dave thank you for your tireless efforts in sharing ways for MSers to do our absolute best.

Processed Foods Are a Much BIgger Problem Than We Thought
In two new papers published in the BMJ, the more ultraprocessed — or industrially manufactured — foods a person ate, the more likely they were to get sick and even die. In one study, they were more likely to suffer from cardiovascular problems. The other linked an ultraprocessed diet to a higher risk of death from all causes.
https://www.vox.com/platform/amp/sci...mpression=true