Multiple Sclerosis Centers of Excellence
Dietary Changes for People with Multiple Sclerosis
Gregory F. Wu, MD, PhD
People with chronic diseases, such as MS, often seek complementary therapies for their disease to help in ways that are otherwise not addressed by conventional treatment modalities. Diet can make people with MS feel that they can take charge of their disease. But how diet can impact MS is not yet clear. Emerging data suggests that diet may impact disability and symptoms such as fatigue in MS and may influence immune system function. Poor diet - defined as not adhering to US Department of Agriculture nutritional guidelines - is linked with increased risk of developing MS.
Strong data also suggests an adverse relationship between obesity and MS, with obesity increasing the risk of neurologic disability in MS. Therefore, dietary change as a way to improve MS is an attractive notion. While a logical next question about which type of diet could be helpful in MS is even more intriguing, convincing data clearly supporting any specific diet are currently lacking. Numerous diets have received public attention as benefitting people with MS and I discuss some of these below.
Swank MS Diet
One of the pioneers in understanding how diet affects MS was Roy L. Swank, MD, PhD. Very early on, Dr. Swank made observations about dietary differences in people with MS around the world. This led him to wonder if the foods that people with MS eat influence their MS symptoms or disease progression. This interest led to him developing a research study following a group of people with MS for a number of decades. As a new idea for the time, dietary changes for MS offered promise that different foods could favorably impact disability. Based on his studies, Dr. Swank promoted a low-fat diet, specifically with very low amounts of saturated fats (e.g., butter, cheese, red meat) and polyunsaturated oils (plant-based). Information on the Swank diet is available through the Swank MS Foundation.
Dr. Terry Wahls, a physician who has MS, devised a diet that was initially based on the idea that specific foods are better at providing key nutrients that maintain neurologic function. This idea has evolved into specific recommendations based on limiting certain dietary components such as lectins (a specific kind of naturally occurring protein found in most plants) that are thought to promote intestinal permeability and nervous system inflammation. In addition, Dr. Wahls has developed a form of therapy to accompany the diet that includes electrical stimulation of muscles. Despite gaining plenty of attention, clinical trials to evaluate the impact of the Wahls Protocol are still being completed.
Many cultures and religions practice fasting, sometimes in part for health benefits. Modern medical studies suggest intermittent fasting may favorably impact various health conditions, including cancer, heart disease, and autoimmunity. Intermittent fasting can take many different forms, all of which are designed to cycle between low energy consumption and non-fasting conditions.
A very interesting research study, led by Dr. Laura Piccio of Washington University in St. Louis, MO, is exploring the effects of intermittent fasting on neurologic disability in MS. Specifically, the study aims to examine how changes in the diet of people with MS may affect the type of bacteria in their intestines. This link between diet and the bacteria in the intestines, part of the so-called microbiome, is an area of intense focus. Studies in this area could eventually lead to skipping any dietary changes by instead consuming specific “helpful” bacteria as a supplement (known as a “microbiome transplant”) to improve neurologic function in people with MS.
Other diets helpful for common diseases could also have benefits for MS. One of these is the ketogenic diet. When the body relies primarily on fats rather than carbohydrates for energy, ketone bodies are produced. Ketogenic diets have been employed as one strategy to treat epilepsy for many decades. In preliminary research, people with relapsing-remitting MS showed physical and mental improvement on a ketogenic diet. Additional studies are clearly needed and have been set in motion.
How to Change Your Diet
A key ingredient in making dietary changes for health purposes is not only which diet to use but how to stick to it. A patient of mine, Gloria Baker has provided her view on making a change in her diet in the article “The Mountain”. Changes in diet are truly a lifestyle modification and require a strong commitment. Many approaches to assist with diet changes are being developed, including commercial applications. For example, one company combines monitoring certain physical and behavioral patterns with immediate and strict nutritional guidance to keep people on a ketogenic diet to help manage diabetes. Making a long-term, meaningful lifestyle change can certainly be very difficult. One aspect of Ms. Baker’s experience that has led me to reflect on diet in MS is the way in which several things, including her desire to take control of her health, all led to the possibility of making a positive change in her life. It is possible that in the near future using a phone or watch application could make these lifestyle changes simpler.
As hard as it is to change your diet, it is also challenging to study how dietary modifications can influence MS. For example, Dr. Piccio, who is leading the intermittent fasting clinical trial, has indicated that recruiting highly motivated people for her lengthy study is quite difficult. She also adds, “Despite the fact that many people with MS are very interested in diet and how it could affect their disease, quite often adhering to a diet implies a change in their lifestyle that can be difficult to implement even by very motivated people. One important component is also having the right support by the family members as they are also going to be involved. It is very different than just taking a pill!”
Overall, there are several important points to consider about diet and MS. First, there is probably no one best diet for all people with MS. At this time there is not enough scientific evidence to recommend a specific diet for people with MS. Second, diet alone does not appear to be a substitute for disease-modifying therapy prescribed to help reduce relapse rate and accumulation of MS disability over the course of disease. Third, diet is important to overall well-being, so consideration of dietary changes for MS need to take into account the health of each individual. Fourth, if you want to improve your health by changing your lifestyle, you should consider not only improving your diet but also adopting a healthy exercise regimen. Finally, changing your diet can be hard, but even small improvements may be helpful.
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