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

[neurox]

Impossible to Digest Burger

You make a great point, Rox. A calorie is not a calorie. And all vegetarian food is not healthy. Case in point: while the new Impossible Burger is extremely meat-like, it's likely as bad for you as the real thing, and far more processed. A straight-up veggie burger without the processing is far healthier. The Washington Post just ran a story on it yesterday in fact. -D

https://www.washingtonpost.com/lifes...3c0_story.html

It’s great to see that being published, thank you and amen about highly processed vegetarian foods. They may a way for big corps to continue profiting from junky ultra delicious food in broccoli’s clothing. Who could go to Burger King for a “plant based” whopper and not get fries? But just maybe, a few moderately paced processed veggie burgers are “less bad” than a few big macs, in the long run, as long as we keep perspective on all the trappings we’re rationalizing with them.

[ActiveMSers]

You make a great point, Rox. A calorie is not a calorie. And all vegetarian food is not healthy. Case in point: while the new Impossible Burger is extremely meat-like, it's likely as bad for you as the real thing, and far more processed. A straight-up veggie burger without the processing is far healthier. The Washington Post just ran a story on it yesterday in fact. -D

But the industry has taken liberties with the definition of “plant-based.” Rather than focusing on whole foods such as vegetables, fruits, legumes and nuts, which is what health professionals mean when they recommend “plant-based eating,” food manufacturers are developing *ultra-processed burgers out of pea or soy protein, methylcellulose and maltodextrin, and liquid “eggs” out of mung bean protein isolate and gellan gum. Then they crown this ultra-processed food with an undeserved health halo.

https://www.washingtonpost.com/lifes...3c0_story.html

[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

[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]

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]

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.

[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

[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]

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

[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]

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.

[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

[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!!

[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

[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.