HOLISM Study

This large international study commenced in 2011 and involved recruitment of an international sample of people with multiple sclerosis to contribute detailed health and outcome data every 2.5 years.

Professor George Jelinek is the Founder of the Neuroepidemiology Unit (NEU) within the Melbourne School of Population and Global Health at The University of Melbourne. Headed by Dr Sandra Neate, the NEU’s charter is to investigate the modifiable lifestyle risk factors that predict the progression of MS with a view to refining a preventive medicine approach to management of the disease.

Health Outcomes and Lifestyle In a Sample of people with Multiple sclerosis (HOLISM) is a large observational study that commenced in 2011. An international sample of people with MS were recruited online to contribute self-reported lifestyle, medication and MS disease outcome data.

The primary aim of HOLISM is to determine the association between lifestyle factors and MS disease outcomes as the epidemiological (population-based) foundation of a secondary and tertiary preventive strategy for managing MS, that is preventing MS progression once diagnosed.

The HOLISM study is one of the largest lifestyle databases in the world, with 2,500 participants at baseline, and comprising a comprehensive suite of modifiable lifestyle risk factors and health outcomes. The detailed methodology of HOLISM at baseline and follow-up have been published.

To date, the NEU has published in major medical journals 34 peer-reviewed papers from analysis of data from HOLISM, and further analyses are ongoing. Some of NEU’s key findings are listed below.

The study has ethics approval from The University of Melbourne, Melbourne, Australia. HOLISM is independently funded through charitable trusts and philanthropic donations.

Key research findings

Lifestyle

Diet and omega 3 supplementation

  • Meat and dairy consumption was associated with lower quality of life and higher relapse rate. Compared to HOLISM participants who did not eat meat, those who did had 17% lower physical quality of life scores and 23% higher 12 month relapse rate. Compared to HOLISM participants who did not consume dairy, whose who did had 16% lower physical quality of life scores and a 21% higher 12 month relapse rate.
  • Omega 3 intake and fish consumption was strongly associated with MS disease activity, relapse rate, disability and quality of life. Consuming omega 3 in the form of flaxseed oil supplements was associated with over 60% reduced relapse rate. Consuming fish 3 or more times a week was associated with a 12 percent increase in health related quality of life scores.
  • Smoking had significant negative associations with MS disability and quality of life. Compared to HOLISM participants who never smoked, current and ex-smokers were 30% more likely to have moderate disability than low disability.  Compared to non-smoking participants, those who smoked 1-15 cigarettes/day had 14% lower overall quality of life scores, and those who smoke 16 or more cigarettes/day have 20% lower scores.
  • Moderate alcohol intake was associated with better quality of life. Compared to HOLISM participants who consumed low or no alcohol, in moderate alcohol consumers,  physical and mental quality of life was 14% and 11% better respectively.

Exercise

  • Exercise was associated with less disability. HOLISM participants who exercised at least 30 minutes/day have 65% lower odds of moderate disability, and 93% lower odds of severe disability, than those who exercised less than 30 minutes/day.
  • Exercise was associated with better quality of life. Compared to minimally active HOLISM participants, those who were highly active had 27% better physical quality of life, as well as 39% better reported energy levels and 14% better mental quality of life.
  • Exercise was also also associated with lower risk of depression. 28% of HOLISM participants with low activity level had depression, compared to 15% in those who were moderately active, and 11% who were highly active.

Meditation

  • Frequent meditation had benefits to depression risk and quality of life. Compared to HOLISM participants who never meditated, those who meditated at least once a week had half the odds of screening positive for depression, and had 7% higher overall quality of life scores.
  • Latitude, sunlight, and vitamin D were associated with disability and quality of life. For every 10 degrees further from the equator HOLISM participants lived, they were 20% more likely to have moderate disability and 30% more likely to have major disability than little disability. In the same study, we reported higher intake of vitamin D supplementation was associated with incrementally better quality of life.

Engagement with OMS resources

  • HOLISM participants who engaged with the OMS Program by attending a retreat, reading the OMS book, and visiting the OMS website had 33% and 23% better physical and mental quality of life, one third the risk of fatigue, and one-tenth the risk of depression.
  • HOLISM participants who were more engaged with OMS information were more likely to adopt healthy lifestyle behaviours, such as physical activity, omega-3 supplementation and dairy non-consumption.

Other important findings

  • OMS Recovery Program lifestyle modifications are associated with the lowest risk of depression  and lowest risk of fatigue.
  • Smoking and obesity were associated with greater odds of substantial pain, while exercise and healthy diet were associated with lower odds of substantial pain.
  • Healthy lifestyles predicted having fewer illnesses. The more illnesses a person with MS has, the worse their quality of life, disability and likelihood of relapses.

Summary of findings

The findings of the HOLISM study, as outlined above, strongly support the pillars of the OMS Recovery Program. Given the lack of evidence for any other MS treatment programs that come close to achieving these outcomes, we have demonstrated that there is great benefit to Quality of Life and health outcomes to following the OMS lifestyle guidelines, and in particular with engaging with the OMS recovery program. Be well!

Future research directions

Ongoing research includes longitudinal analyses of data from baseline, 2.5, 5, and 7.5-year follow-up, to assess long-term effects and causal relationships of lifestyle on health outcomes including fatigue, depression, and quality of life.

Note: To remain completely unbiased and independent, OMS is an independent website that receives no funding from the pharmaceutical industry, device manufacturers, or other companies, and is not affiliated with any third party groups or organisations.


References

1. Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira N, Marck CH, van der Meer DM. Methodology of an international study of people with multiple sclerosis recruited through web 2.0 platforms: demographics, lifestyle and disease characteristics. Neurol Res Int 2013; Article ID 580596, 12 pages, doi:10.1155/2013/580596 PDF

2.Weiland TJ, De Livera AM, Brown CR, Jelinek GA, Aitken Z, Simpson Jr SL, Neate SL, Taylor KL, O'Kearney E, Bevens W, Marck CH. Health outcomes and lifestyle in a sample of people with multiple sclerosis (HOLISM): longitudinal and validation cohorts. Frontiers in Neurology. 2018 Dec 12;9:1074.

3. Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutritional neuroscience. 2015 Apr 1;18(3):125-36. PDF

 4. Jelinek GA, Hadgkiss EJ, Weiland TJ, Pereira N, Marck CH, van der Meer DM. Association of fish consumption and omega 3 supplementation with quality of life, disability and disease activity in an international cohort of people with multiple sclerosis. Int J Neurosci 2013; in press; DOI: 10.3109/00207454.2013.803104 PDF

5. George A. Jelinek, Alysha M. De Livera, Claudia H. Marck,Chelsea R. Brown,Sandra L. Neate,Keryn L. Taylor, Tracey J. Weiland Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study PDF

6. Weiland TJ, Hadgkiss EJ, Jelinek GA, Pereira NG, Marck CH, van der Meer DM. The association of alcohol consumption and smoking with quality of life, disability and disease activity in an international sample of people with multiple sclerosis. Journal of the Neurological Sciences. 2014 Jan 15;336(1-2):211-9. PDF      

 7. Jelinek GA, De Livera AM, Marck CH, Brown CR, Neate SL, Taylor KL, Weiland TJ. Associations of lifestyle, medication, and socio-demographic factors with disability in people with multiple sclerosis: an international cross-sectional study. PloS one. 2016 Aug 25;11(8):e0161701. PDF

8. Marck CH, Hadgkiss EJ, Weiland TJ, van der Meer DM, Pereira NG, Jelinek GA. Physical activity and associated levels of disability and quality of life in people with multiple sclerosis: a large international survey. BMC Neurol 2014 Jul 12;14:143 PDF

9. Taylor KL, Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis. BMC psychiatry. 2014 Dec 1;14(1):327. PDF

10. Levin AB, Hadgkiss EJ, Weiland TJ, Marck CH, van der Meer DM, Pereira NG, Jelinek GA. Can meditation influence quality of life, depression, and disease outcome in multiple sclerosis? Findings from a large international web-based study. Behavioural Neurology. 2014 Oct;2014. PDF

11. Jelinek GA, Marck CH, Weiland TJ, Pereira N, van der Meer DM, Hadgkiss EJ. Latitude, sun exposure and vitamin D supplementation: associations with quality of life and disease outcomes in a large international cohort of people with multiple sclerosis. BMC neurology. 2015 Dec;15(1):1-6. PDF

12. Hadgkiss EJ, Jelinek GA, Taylor KL, Marck CH, van der Meer DM, Pereira NG, Weiland TJ. Engagement in a program promoting lifestyle modification is associated with better patient-reported outcomes for people with MS. Neurol Sci 2015; in press PDF

13. Lin X, Yu M, Jelinek GA, Simpson-Yap S, Neate S, Nag N. Greater engagement with health information is associated with adoption and maintenance of healthy lifestyle behaviours in people with MS. International Journal of Environmental Research and Public Health. 2020 Jan;17(16):5935. PDF

14. Hadgkiss EJ, Jelinek GA, Taylor KL, Marck CH, van der Meer DM, Pereira NG, Weiland TJ. Engagement in a program promoting lifestyle modification is associated with better patient-reported outcomes for people with MS. Neurological Sciences. 2015 Jun 1;36(6):845-52. PDF

15. Weiland TJ, Hadgkiss EJ, Pereira N, Marck CH, van der Meer DM, Taylor KL, Jelinek GA. Clinically significant fatigue: Prevalence and associated factors in an international sample of adults with multiple sclerosis. PLOS ONE 2015 Feb 18;10(2):e0115541. doi: 10.1371/journal.pone.0115541 PDF

16. Marck CH, De Livera AM, Weiland TJ, Jelinek PL, Neate SL, Brown CR, Taylor KL, Khan F, Jelinek GA. Pain in people with multiple sclerosis: Associations with modifiable lifestyle factors, fatigue, depression, anxiety, and mental health quality of life. Frontiers in neurology. 2017 Sep 5;8:461.

17. Prevalence of Comorbidities, Overweight and Obesity in an International Sample of People with Multiple Sclerosis and Associations with Modifiable Lifestyle Factors PDF