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14 August 2023

New HOLISM Study: A long-term high-quality diet reduces the risk of disability progression

Dr Jonathan White discusses new research from the HOLISM Study, that shows a long-term high-quality diet reduces the risk of disability progression!

It won’t come as much of a surprise to learn that we at Overcoming MS are obsessed with food! I don’t mean in the ‘stuff your face until you explode’ kind of way, but rather the knowledge that what we put in our mouths every day makes a very real difference to how we feel physically and mentally. Furthermore, we are utterly convinced that what we eat in turn plays a pivotal role in the long-term prognosis and trajectory of someone’s MS. This is reflected in published evidence going back over 60 years, with new studies continuing to be released on what seems a weekly basis, showing a very clear correlation between the quality of an individual’s diet and MS outcomes.

Sadly though, far too many people living with MS as well as healthcare providers seem unaware of this message.  We work tirelessly to change this, and I personally am very heartened by our progress, yet so much more needs to be done!

The HOLISM Study in the 'European Journal of Neurology'

Last month, our long-term partners from the Neuroepidemiology Unit at the University of Melbourne published their most recent work from the HOLISM Study in the ‘European Journal of Neurology’.  Their paper, entitled ‘Longitudinal associations between quality of diet and disability over 7.5 years in an international sample of people with multiple sclerosis’, is the culmination of a huge amount of work over many years.  To say it is important might be a slight understatement; in fact to quote Overcoming MS Program Founder, Professor George Jelinek – “this one needs to be shouted from the rooftops!”

Who took part?

602 people with MS from around the world were followed-up for 7.5 years. Rather than taking a group of people with a particular disease and looking backwards in time to find patterns and associations, the team recorded a participant’s baseline diet quality score (using the Diet Habits Questionnaire – DHQ) and then examined the relationship between their baseline diet and subsequent changes in disability progression over time. 

A longitudinal cohort study

This prospective data collection method, known as a longitudinal cohort study, represents the highest level of medical evidence short of a randomised controlled trial. We all know how hard it is to randomly allocate people to a particular diet and expect them to stick to it so that we can see what effect it has on their health. But it is precisely this sort of study that is considered vital in order to convince healthcare professionals of the value of diet in long-term MS outcomes, and the HOLISM Study is the first study in the world to do this.

The cohort was followed-up at 2.5 yearly intervals over the next 7.5 years, and their Patient-determined MS Severity Score (P-MSSS) was recorded to determine levels of disability, along with updated diet quality data.

The results

Previous studies have found that higher quality of diet was associated with lower frequencies of disability, fatigue and depression, and a lower relapse rate, with both diet and the health outcomes measured at the same time. But the real question is: does what you eat now predict your FUTURE disability? And here is the enormous headline result from this study: eating a high-quality diet now significantly reduces a person’s risk of future disability progression, and those with the highest scores for diet quality had a more than 50% reduced risk over the 7.5 years! Can you imagine the press releases if a new pharmaceutical treatment could quote those figures?!

When you look closely at the results, there were some other rather striking findings. Firstly, if someone’s diet quality decreased over the first 2.5 years from baseline, this predicted a greater risk of disability progression at 7.5 years. Examination of the sub-sections within the DHQ found that, as we have been saying for years at Overcoming MS, fat consumption had the strongest and most consistent associations with future disability, but while associations with fruit & vegetables, fibre, omega-3, and food choices subdomains were also significant, these were less consistent. These results support previous HOLISM study findings, where baseline fat, fruit & vegetable, and fibre sub-scores were strongly predictive of subsequent disability progression at 2.5 years and greater adherence to a low-fat diet was associated with better 2.5 to 7.5-year clinical progression. 

Meat and dairy findings

The findings for meat and dairy consumption and disability progression were also consistent with previous HOLISM results from baseline to 2.5 years, where their consumption was associated with worsening disability. 


I hope that this landmark piece of research will receive the attention it so richly deserves. The findings provide high quality evidence of the very real and measurable benefits of eating well when living with MS, and highlight the importance of future studies to further tweak the effect of different dietary approaches on health outcomes. This will create much-needed consensus amongst healthcare professionals, allowing them to feel confident in making lifestyle recommendations to their patients and clients, alongside the traditional pharmaceutical management of MS. When that day comes, everyone with MS wins.

Until then, keep your eyes firmly fixed on Overcoming MS, the world’s leading MS healthy lifestyle charity.


DOI: 10.1111/ene.15980