Is fasting beneficial for MS?
Several studies are currently investigating whether periodic fasting can reduce inflammation and delay disability in people with multiple sclerosis.
‘Fasting’ can be defined in various ways. Periodic fasting is when a person takes in little or no food for 1-2 days of the week and eats normally for the rest of the week; a variation of this is the ‘fasting-mimicking diet’ where a person severely restricts their calorie intake for one week every month. Alternate-day fasting is an on/off schedule of eating little or no food every other day. There is also time-restricting fasting, where the person does not eat for 6-12 hours a day. An example of this is fasting during the month of Ramadan, which requires abstinence from all food and drink between sunrise and sunset but permits eating earlier and later in the day.
Much of the enthusiasm for fasting as a treatment for MS stems from animal studies. Calorie-restricted diets and intermittent fasting have been shown to reduce inflammation in the brain and spinal cord and boost the brain’s repair mechanisms in animal models of MS (Esquifino and colleagues. J Neuroinflammation 2007;4:6. Kafami and colleagues. Avicenna J Med Biotechnol. 2010;2:47-52). Fasting may reduce the inflammatory response through changes to the micro-organisms in the gut (collectively called the microbiome) – either by inducing these organisms to produce less inflammatory products or by promoting the growth of more beneficial bugs.
These are the potential benefits in theory. But gathering evidence to support the theories is challenging. Perhaps the greatest problem is convincing people to stick with the regimen. A study at Johns Hopkins in Baltimore enrolled 90 people in a series of studies looking at calorie-restricted diets and fasting for up to 48 weeks (Roman and colleagues. Mult Scler Relat Disord 2020;42:102149). About one-quarter dropped out despite weekly reminders and the best efforts of nurses. So no benefits were seen with the diets.
A smaller study involving 36 people reported that restricting calories significantly improved people’s sense of well-being and reduced feelings of depression (Fitzgerald and colleagues. Mult Scler Relat Disord 2018;23:33-39). The improved mood may have been due in part to weight loss; people lost an average of about 3 kg (about 7 pounds) during the 8-week study. Dieting every day (22% reduction in calories) was slightly better than intermittent fasting (75% reduction in calories for two days per week) for weight loss.
Finally, a pilot study that included a fasting-mimicking diet followed by a Mediterranean diet for six months found improvements in physical and mental quality of life in 60 people with MS (Choi and colleagues. Cell Rep 2016;15:2136-2146). However, this special diet did not appear to reduce the risk of relapses compared to regular food consumption.
Several studies have looked at whether fasting during Ramadan has an impact on MS, but these have largely focussed on whether fasting is safe. For example, a study in Iran compared 40 people who fasted and 40 people who did not fast during Ramadan (Saadatnia and colleagues. Eur Neurol 2009;61:230-232). Only people with little to no disability were enrolled. Over the longer term, the one-month fast did not appear to have any adverse effects. However, fasting did not appear to have a beneficial effect on the frequency of relapses or disability worsening. A separate study found that people with long-standing MS or higher levels of disability were at risk of having a relapse during Ramadan (Hassan and colleagues. Nutr Neurosci 2021;Nov 28:1-10). But in this scenario, the risk of worsening MS appeared to be due to the disease process itself rather than to dietary changes.
These findings were anticipated by a symposium on Ramadan fasting and MS that was held almost a decade ago (Jahromi and colleagues. BMC Neurol 2014;14:56). The group found that fasting appeared to be safe for most people with MS. However, some people may experience a temporary worsening of symptoms, especially if fasting occurs during the summer months. The group cautioned that fasting is not safe for people with MS who require a wheelchair and those taking certain medications.
In this regard, fasting can affect how the body processes medications, so it is best to consult a doctor, MS nurse or dietitian before embarking on a fasting regimen – especially if you have other medical conditions such as diabetes.
Thus far, there is no strong evidence to show that fasting will improve MS symptoms or severity, although it may improve symptoms of depression and overall quality of life. And it is not clear if fasting is better than taking selected items off the menu, such as milk or carbohydrates. We will look at this issue in an upcoming issue of MSology.
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