The link between fats (lipids) and MS has been known for many years.
Prof. Roy Swank first suggested the connection in 1950 and published his ground-breaking 34-year study on the subject in the very well-respected journal “the Lancet” in 1990, showing a very significant long-term benefit to the disease course by following a low-saturated fat diet. Unfortunately, this hugely important piece of work was largely ignored by doctors.
Lipids are a source of stored energy and are a component of cell membranes. This type of lipid is a triglyceride, meaning it has 3 fatty acid tails.
How many of us have been told by their Neurologist or MS Nurse that “there’s no link between diet and MS” or, as I heard from one fellow OMSer “MS is bad enough without denying yourself meat and cheese”?!
But thanks to Prof. Swank’s initial work and more recently by many others, including Prof. Jelinek’s team at the NEU, we OMSers know differently, and slowly but surely, the medical community is falling in behind us as the evidence base continues to grow.
Lipids relating to levels of disability and inflamation
In an article published in November 2018 in the peer-reviewed journal “Scientific Reports”, a research team based at Imperial College London investigated the association between high levels of certain lipids in the blood and disability scores and levels of inflammation in relapsing remitting MS (RRMS).
The researchers analysed blood samples from 27 people with RRMS and 31 control subjects (who do not have MS).
The MS group ranged in age between 18 and 65, with an average disability score (EDSS) of 1.5, ranging from 1 (no significant disability) to 7 (largely restricted to a wheelchair), so reflecting a typical RRMS population. They had not received steroids or any disease modifying drugs for at least 3 months and were relapse free for at least 1 month prior to enrolling in the study.
Before explaining their results, I’m afraid there needs to be a bit of biochemistry!
Lipids and lipoproteins
Lipids (or fats as they are often known) are carried in the bloodstream by complex little packages, called lipoproteins, made up of a variety of different types of lipids (including triglycerides, cholesterol, phospholipids) and proteins.
The more lipid molecules within a lipoprotein, the lower its density.
This image shows a lipoprotein, and the letters inside are lipid molecules. C symbolises cholesterol and T a triglyceride.
“Good” and “bad” cholesterol
They are divided into four main groups of lipid:
This is why LDL is commonly called “bad cholesterol” and HDL is known as “good cholesterol”, but in fact it’s related to lipoproteins and where the cholesterol is being delivered.
The chylomicrons and VLDL also work to deliver triglycerides (a different type of lipid to cholesterol) to cells so can also be considered “bad” for the sake of this discussion.
So what did the researchers find?
- In the MS group, the lipid levels in VLDL (bad) and HDL (good) were higher than the control group.
- Concentrations of 23 different lipids were greater in those with RRMS, and levels of cholesterol in a subtype of VLDL (VLDL-2) directly correlated to disability scores, so the higher the level, the more disabled the person tended to be.
Cholesterol levels and inflammation
Another interesting result was to do with cholesterol levels and inflammation.
The immune system relies on chemical signals to turn on or turn off inflammation, mobilising white blood cells from their bases in the lymph nodes and into the bloodstream to attack. In MS we know there is a pre-disposition towards too much inflammation and inappropriate attack against our own myelin (fatty coating on some nerve cells).
- One group of these immune signals are called cytokines, and the researchers found that the higher the cholesterol in the VLDL-2, the higher the levels of 2 pro-inflammatory cytokines in the bloodstream.
So the investigators demonstrated a link between certain blood lipid levels and increased levels of both disability and inflammation in people with RRMS.
The authors concluded that “we have provided evidence that specific lipid concentrations with VLDL sub-fractions are correlated both with disability in RRMS patients and with pro-inflammatory plasma cytokine levels”.
These results are very interesting:
From a pharmaceutical perspective it adds to the case for the use of the cholesterol lowering statin drugs being used in MS, currently the subject of a randomised control trial looking at rates of disability progression and brain shrinkage in secondary progressive MS. As the authors of this paper note “these findings “suggest that clinical benefits of lipid lowering drugs with inflammatory diseases may be realised by decreasing plasma lipid concentrations”.
If we come at it from a slightly different angle, assuming lower levels of “bad cholesterol” are associated with less disability, is there another way that we could achieve this, without medication?
I think you may be able to guess the answer – the plant-based, wholefood diet has been extensively studied and repeatedly shown to be extremely effective the management of many Western diseases, including coronary heart disease, type 2 diabetes and hypercholesterolaemia (high cholesterol).
So yet again here is another new piece of evidence showing that the OMS lifestyle is a powerful ally in the fight against MS.
Dr Jonathan White MBChB MRCOG
3) Gardner CD, Coulston A, Chatterjee L, Rigby A, Spiller G, Farquhar JW. The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults: A Randomized Trial. Ann Intern Med. ;142:725–733