We know that more than fifty per cent of people living with MS (pwMS) have made changes to their diet and/ or take supplements in an effort to improve their symptoms or long-term prognosis. Whether it be the Overcoming MS program, Wahls’ protocol, Coimbra protocol or Best-Bet diet, there are many to choose from, and it can be difficult to know which to follow.
At Overcoming MS we believe that our dietary recommendations are backed up by a robust scientific evidence base, however it remains a fact that no one regimen is currently considered as the “gold-standard” in the management of MS; at least not in the eyes of many healthcare professionals. This can be really confusing and off-putting for those trying to find a way forward and to access the best advice and support as early as possible. To reach our goals, we need increased evidence to prove what many OMSers know to be true, that lifestyle modification can significantly improve our symptoms and allow us to live well with MS.
Stronger evidence for Overcoming MS is regularly being shared by research teams worldwide
The HOLISM Study from the Neuroepidemiology Unit (NEU) at the University of Melbourne is one of the cornerstones of the Overcoming MS evidence base, but independent results from groups such as the Menzies Research Institute and NARCOMS Registry corroborate and expand on Prof. Jelinek and the other members of the NEU’s findings. The greater the number of scientists producing similar results, the more likely it is that neurologists and pwMS will hear the all-important message, backing the Overcoming MS approach.
The latest new evidence for the impact of diet on MS
The MS Register, based at the University of Swansea and supported by the MS Society in the U.K. is a database of over 16,000 pwMS. It collects data from clinicians and patients, enabling researchers to gain a greater understanding of various aspects of the condition. In a paper soon to be published in the journal “Nutrition Research”, researchers assessed the dietary habits of 2,410 pwMS and compared them to 24,852 healthy control subjects.
Using the EPIC Norfolk food frequency questionnaire (FFQ), participants were asked to fill in a 30-minute survey, assessing how often they consumed certain food groups, such as fruit and vegetables, meat, fish, dairy products, grains etc. ranging from ‘never or less than once a month’ to ‘6+ times a day’. They were also asked to provide information on cooking methods and any supplement use. These results generated a standardised diet quality score, and the validated statistical tools of fatigue severity score (FSS) and EQ-5D assessment were then used to ascertain fatigue levels and health-related quality of life respectively.
Results of this MS nutrition study
Their results were very interesting. The headline findings were that pwMS consumed less nutrients than the general population, had high levels of supplement use (most commonly vitamin D and omega-3) and that those participants with better diet quality had lower levels of disability. But as with most research papers, it is worth digging a little deeper.
Fatigue symptoms reduced through diet
The researchers sub-divided dietary components into two broad categories, anti-inflammatory and pro-inflammatory. Anti-inflammatory nutrients included those found in fruit and vegetables, whole grains, oily fish and the micronutrients carotene and magnesium. Pro-inflammatory nutrients were sodium (salt), sugar, red and processed meats and full-fat dairy products.
The study showed that those pwMS with higher consumption of anti-inflammatory foods had lower fatigue levels and higher quality of life scores, as well as reduced levels of anxiety and depression. Regular fish consumption specifically had a highly significant association with reduced fatigue scores on the FSS, and oily fish consumed once or more each week had significant associations with better mobility and mental health scores.
Those with lower diet quality scores and consuming more pro-inflammatory food groups were found to have lower overall quality of life scores, with red meat consumption associated with worse pain, more fatigue and higher levels of anxiety and depression. The authors concluded
“we suggest that a diet rich in anti-inflammatory promoting nutrients and food will contribute to the alleviation of fatigue and in turn improve quality of life for pwMS”.
About the study
This was a large and well-conducted study, using reliable statistical tools, whose results correlate very closely to those of Prof. Jelinek’s original work in the HOLISM Study. It provides extra reassurance for those of us following the Overcoming MS Program, or considering doing so, that the dietary choices we make can positively influence our physical and mental health.
The authors quite rightly point out the age-old issues in qualitative lifestyle research, namely that of “reverse causality”. This concept refers to the fact that results observed may in fact be the cause rather than an effect. For example, increased fatigue levels may lead to poorer diet quality rather than the other way round. This is feasible of course, as being more fatigued might make a person more likely to choose to put a ready-meal in the microwave rather than cooking something from scratch using fresh ingredients. We also know that people with deteriorating health are less likely to engage or persist with healthy lifestyle behaviours, which makes it all the more important that healthy changes are made as soon as possible. To that end, Overcoming MS would like to show you how to eat healthily when you need something quick and easy through our regular content.
It should be pointed out that Prof. Swank’s original study, as well as later work from the NEU, clearly demonstrates the benefits of diet and lifestyle changes at any stage in the course of the condition, but the sooner the better.
Whilst the basic science and results of many other studies make it likely that these results are indeed accurate, the best way to address the ever-present reverse causality issue is to perform more well-conducted, prospective trials, as we saw in the Ausimmune study.
mentioned earlier. Thankfully, the interest in the role of lifestyle in MS is rapidly gathering pace, with ever more researchers around the world now engaging in this crucial area.
But until we have the “definitive proof” that some require for the role of diet in MS, my question to you would be “why wait?!”.
The results of multiple studies have repeatedly shown that pwMS engaging in healthy lifestyle behaviours have better physical and mental health, often with significant improvements in MS symptoms and less disability progression. If the “side-effect” of lifestyle modification is added protection against many of the common conditions that cause so much ill health in our population, such as heart disease, diabetes and cancer, then I personally don’t see that there is anything to lose, and a huge amount to gain.
Takeaway message from this study:
Introduce more anti-inflammatory foods to improve fatigue and quality of life:
· Fruit and vegetables
· Whole grains
· Oily fish
· Micronutrients carotene and magnesium
Avoid pro-inflammatory foods to improve fatigue and quality of life:
· Sodium (salt)
Stay safe and take care.