AAN 2019: The latest on diets and MS
Much has been written about the pros and cons of various diets for MS, but the benefits have always been difficult to establish. In part this is because food is only one factor affecting a person’s complex biology so it’s hard to show that a dietary change is the cause of an improvement; benefits are often subjective (“I feel better being gluten-free”) and not easily measurable; and a framework for linking food effects with physiological effects has been lacking. As a result, there is little proof that diets do anything, so doctors are hard-pressed to recommend specific dietary changes.
That situation is beginning to change, in large part to the rapidly expanding research into the gut microbiome – the complex ecology of the gastrointestinal system (the stomach and intestines) that comprises trillions of micro-organisms that is continually interacting with a person’s body. Foods affect the number and type of organisms in the gut. These organisms in turn have differing effects on the gut, the immune system (most immune tissue is found in the gut) and nerve function. This is an area of research that is especially important to multiple sclerosis: foods influence whether the microbiome promotes or dampens inflammation. This inflammation can translate to inflammation throughout the body, including the brain and spinal cord, and can potentially worsen or improve MS.
Here is a sampling of new dietary research presented at the American Academy of Neurology (AAN), held in Philadelphia in May.
Diet and lifestyle: A study at the University of Buffalo, New York, looked at lifestyle factors and their impact on MRI lesions over a 5-year period (Hagemeier and colleagues. AAN 2019; abstract P5.2.002). People with MS were asked to complete a Healthy Heart Score (available free at https://healthyheartscore.sph.harvard.edu/), which looks at diet, body weight, exercise and other lifestyle factors. People with MS with a less healthy diet had significantly more inflammatory lesions in their brains compared to those making healthier food choices. The amount of brain tissue damage (which is associated with increased risks of physical and mental disabilities) was also higher among those with a less healthy lifestyle overall. These findings suggest that diet and exercise help to reduce the damaging inflammation seen in MS and/or allow the body to better heal the damage.
Ketogenic diet: The high-fat, low-carbohydrate ketogenic diet has been used successfully to treat people with epilepsy, which stimulated interest in the diet for a wide range of neurological conditions, including MS. One study found that a ketogenic diet had beneficial effects on the gut microbiome in people with MS – although these changes meant sticking with the diet for at least 6 months (Swidsinski and colleagues. Front Microbiol 2017;8:1141). A study in an animal model of MS found that a ketogenic diet reduced inflammation in the brain (Kim and colleagues. PLoS One 2012;7:e35476). More recently, a group of researchers in Philadelphia found that people with MS on a ketogenic diet reported feeling less fatigue and depression (Brenton and colleagues. ECTRIMS 2018; abstract P958). A follow-up study of 20 people with MS has now reported that 83% of people on a modified ketogenic diet experienced weight loss, 72% said they felt less MS fatigue, 50% had better stamina and 45% said they had fewer MS symptoms (Brenton and colleagues. AAN 2019; abstract P3.2.044). Side effects included constipation, diarrhea and menstrual irregularities.
Mediterranean diet: A new pilot study is looking at the possible benefits of the Mediterranean diet in people with MS (Katz Sand and colleagues. AAN 2019; abstract P4.2.066). Thus far, about 90% have been able to keep to the diet for 6 months. People on the diet reported that they felt less fatigue and MS symptoms had less impact on their daily lives.
Dine and DASH: The DASH diet (Dietary Approaches to Stop Hypertension) was developed to lower blood pressure but has become one recipe for healthy eating. The regimen emphasizes fruits and vegetables, whole grains and low-fat dairy products; and limits meat consumption, sugar and sugary drinks, and sodium. (See the guide provided by St. Michael’s Hospital, Toronto: www.stmichaelshospital.com/pdf/programs/diabetes/dash-diet.pdf). A study of people with MS found that a person’s DASH score was not directly related to the level of disability (Meier-Gerdingh and colleagues. AAN 2019; abstract P4.2.063). People who consumed more sweetened beverages were more likely to have severe disability, but it’s unclear if sugar intake is related to disability, or whether people with disability happen to consume more sweetened drinks.
Food allergies: A Harvard study has found that people with MS who have food allergies are more likely to have relapses and inflammatory flare-ups in the brain compared to those without food allergies (Fakih and colleagues. AAN 2019; abstract P4.2.068). The study asked over one thousand people with MS if they had allergies to foods, drugs or environmental factors (such as pet dander). It’s important to note that a food allergy means having an immune reaction to specific foods, such as peanuts or wheat. This does not include sensitivity or intolerance to certain foods, which can cause unpleasant symptoms but which doesn’t involve an immune response. Overall, the group with food allergies had about 30% more MS relapses, and were twice as likely to have an inflammatory lesion in the brain. Food allergies originate in antibody responses in the gut, and these antibodies (produced by a type of immune cell) may contribute to inflammation in the brain. In contrast, allergies to drugs or environmental factors (which don’t originate in the gut) didn’t appear to have an effect on MS.
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