New diet resource for MS
The U.S. National MS Society has created an online resource that summarizes studies on different diets that people with MS often ask about. The website was announced at the recent Americas Committee for Treatment and Research in MS meeting (Spain and colleagues. ACTRIMS 2022;P421). The website link is provided below.
Information is provided for various diets, including the Mediterranean diet, which is high on olive oil, legumes, fruits and vegetables and low on meat; the ketogenic diet, which is low in carbohydrates; fasting diets; the paleolithic or Wahls diet, which excludes dairy, eggs and gluten; the McDougall diet, which is a low-fat vegan diet; and the Swank diet, a low-fat diet. It is unclear why certain studies were selected from the hundreds that have been published.
The website also addresses dietary questions that are often raised, such as whether to avoid dairy products, go gluten-free and avoid salt.
Many people with MS adopt some form of modified diet in the hope that eating or avoiding certain foods will provide some benefit. It would seem self-evident that foods could have an impact on the MS disease process. Unfortunately, demonstrating that a given nutrient helps or harms MS is very difficult. Studies are often poorly done, as one diet promoter, Terry Wahls, has admitted (Wahls and colleagues. Nutrients 2019;11:352).
The NMSS website does not list meta-analyses (which combine data from multiple studies), although many have looked at dietary studies. For example, a recent analysis of 41 studies found little evidence to support the use of omega-3 or antioxidant supplements to improve MS symptoms or disability (Parks and colleagues. Cochrane Database Syst Rev 2020;5(5):CD004192). Analyses have also concluded that there is also not enough evidence to show that being gluten-free will have an impact on MS (Lynge Thomsen and colleagues. Mult Scler Relat Disord 2019;27:156-163). The evidence for intermittent fasting on MS is also limited (Morales-Suarez-Varela and colleagues. Nutrients 2021;13:3179).
Still, a lack of evidence does not necessarily mean a lack of benefit. Many diets provide indirect benefits because they cause weight loss, which can improve fatigue and mobility. A problem with promoted diets is that they can be expensive, it may be time-consuming to find items, and people may have added costs because they must prepare other meals for the rest of the family. A further concern is ensuring an adequate intake of nutrients such as vitamin D, calcium, iron and potassium, which can become deficient with the paleolithic and other elimination diets (Chenard and colleagues. Nutrients 2019;11:537).
Proper nutrition – avoiding processed or fast foods, reducing salt intake, avoiding saturated fats – will likely provide as much benefit.
It is likely that better information on diet will emerge over the next few years as researchers gain a better understanding of the gut microbiome, the environment of micro-organisms that live in the digestive tract. There is some preliminary evidence that some parts of the Western diet – red meat, high salt, fried foods, low fibre, sugary drinks – can promote a more inflammatory response that may be harmful in MS (Riccio and colleagues. ASN Neuro 2015;7:1759091414568185). But until better guidance is available on what to eat/what to avoid, the most useful advice is probably to eat sensibly and in moderation.
Click the link to visit the National MS Society website: www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Diet-Nutrition/Dietary-Studies-in-MS
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