Published research illustrating the impact of diet found in Jan 2024 in a project with student G H Alzanbaqi and Dr Jonathan White.

Oily fish and omega-3 consumption and multiple sclerosis

Paper: Association Between Improved Serum Fatty Acid Profiles and Cognitive Function During a Dietary Intervention Trial in Relapsing-Remitting Multiple Sclerosis.

Journal: International Journal of MS Care. 2023

Key findings: During the 24-week period, the Omega-3 (EPA + DHA) Index in individuals on the Wahls diet showed a significant increase of approximately 50.85% from baseline. This suggests a substantial improvement in the levels of these essential fatty acids,

Consequently, participants following the Wahls diet experienced a notable improvement in SDMT-O scores. The percentage change indicates approximately a 5.47% increase from baseline, suggesting an enhancement in cognitive processing speed and attention

Description: In a randomized parallel-arm trial involving participants with relapsing-remitting multiple sclerosis (MS), the impact of modified paleolithic (Wahls) and low saturated fat (Swank) diets on cognitive function and serum fatty acid profiles was investigated. The study, comprising 77 participants, included assessments at four timepoints: run-in, baseline, 12 weeks, and 24 weeks. Both diet groups showed significant improvements in serum fatty acids (except arachidonic acid) and cognitive function (Symbol Digit Modalities Test-Oral and Perceived Deficits Questionnaire) at 24 weeks compared to baseline. Changes in omega-3 (EPA + DHA) index and EPA serum fatty acids at 12 weeks were associated with cognitive function improvements. However, the changes in fatty acid levels did not mediate the diets' effects on cognitive function. In conclusion, both the modified paleolithic and low saturated fat diets led to positive changes in serum fatty acid profiles and cognitive function in individuals with relapsing-remitting MS.

Paper: Higher dietary quality is prospectively associated with lower MRI FLAIR lesion volume, but not with hazard of relapse, change in disability or black hole volume in people with Multiple Sclerosis

Journal: Multiple Sclerosis and Related Disorders, 78, 104925. 2023


Key findings: The study found that higher diet quality*, was associated with lower fluid-attenuated inversion recovery (FLAIR) lesion volume in the periventricular region of the brain. However, there was no significant association observed between diet quality and other measures such as black hole lesion volume, hazard of relapse, and annualised disability progression.

*A high diet quality refers to a diet that is generally low in saturated fat and processed meats, and high in vegetables, fruit, nuts, and fish.

Description: In a 10-year study involving 223 participants with multiple sclerosis (MS) from the AusLong cohort, researchers investigated the impact of diet quality on MS progression and inflammatory activity. Dietary quality was assessed using the Australian Recommended Food Score (ARFS) and Diet Quality Tracker (DQT) based on self-reported dietary intake data. The study found that higher diet quality, particularly measured by ARFS, was associated with lower fluid-attenuated inversion recovery (FLAIR) lesion volume in the periventricular region of the brain. However, there was no significant association observed between diet quality and other measures such as black hole lesion volume, hazard of relapse, and annualised disability progression. The findings suggest a potential role for diet quality in modulating a specific aspect of MS inflammatory activity, but not in all clinical and MRI outcome measures.

Paper: Association of Polyunsaturated Fatty Acid Intake on Inflammatory Gene Expression and Multiple Sclerosis: A Systematic Review and Meta-Analysis.

Journal: Nutrients, 14(21), 4627. 2022

Key findings: The results of the study suggest positive associations between omega-3 fatty acid intake and MS management. Higher intake of docosahexaenoic acid (DHA) was linked to lower Expanded Disability Status Scale (EDSS) scores, and omega-3 fatty acids were found to influence gene expression in a way that may benefit individuals with MS. This could be considered good news, as it suggests a potential positive impact of omega-3 fatty acids on MS. However, it's important to note that further clinical trials are needed to confirm these potential effects. The improvement of cognitive function may be influenced by the anti-inflammatory properties of omega-3 PUFAs.

Description: This meta-analysis aimed to assess the impact of omega-3 fatty acid (FA) intake on multiple sclerosis (MS) and inflammatory gene expression (IGE), utilizing data from randomized controlled trials. Thirteen cohort studies involving 1353 participants were included, covering periods of 3 to 144 weeks. The highest vs. lowest comparison revealed a significant inverse relationship between docosahexaenoic acid (DHA) and Expanded Disability Status Scale (EDSS) scores. Omega-3 FAs were found to significantly upregulate peroxisome proliferator-activated receptor gamma (PPAR-γ) gene expression and downregulate tumor necrosis factor-alpha (TNF-α) and interleukin-1 (IL-1) expression. No significant associations were observed between omega-3 polyunsaturated fatty acids (n-3 PUFAs) and eicosapentaenoic acid (EPA) with EDSS scores. The results suggest that blood omega-3 FA concentrations may serve as potential markers for diagnosing, prognosing, and managing MS. However, further clinical trials are needed to confirm the potential effects of omega-3 FAs on MS disease management.

Paper: Low fish consumption is associated with a small increased risk of MS

Journal: Neurology - Neuroimmunology Neuroinflammation, 7(3), e717. 2020

Key findings: In this study, individuals with low fish consumption had a 20% higher risk of developing multiple sclerosis compared to those with high fish consumption

Description: This study aimed to investigate the impact of lean and fatty fish consumption on multiple sclerosis (MS) risk and whether any potential effect is mediated by vitamin D. The research, involving two population-based case-control studies with a total of 6,914 cases and 6,590 controls, compared individuals with different fish consumption habits. Results indicated that low fish consumption, including both lean and fatty fish, was associated with an increased MS risk, irrespective of sun exposure habits. This association was particularly pronounced in individuals carrying the DRB1*15:01 allele, suggesting an interaction. However, the analysis did not support vitamin D as a mediator of the relationship between fish consumption and MS risk. Additionally, there was no interaction between fish consumption and sun exposure habits in relation to MS risk. The study suggests that low fish consumption and low sun exposure are independent risk factors for MS, and fish consumption may influence MS risk through mechanisms other than its impact on vitamin D status, especially for those genetically susceptible to MS.

Paper: Dietary fish intake and the risk of multiple sclerosis: a systematic review and meta-analysis of observational studies.

Journal: Nutritional Neuroscience, 25(4), 681–689. 2020

Key findings: The consumption of fish is associated with a 23% lower risk of developing MS compared to controls.

Description: The study aimed to systematically review the association between dietary fish intake and the risk of multiple sclerosis (MS). A search of relevant databases identified six articles meeting inclusion criteria for systematic review and meta-analysis. The findings suggest that consuming fish is associated with a decreased risk of MS (odds ratio: 0.77 with a 95% confidence interval of 0.64 to 0.92, p-value = 0.004, I2 = 54.7%) compared to controls. The discussion suggests that a dietary intake of at least 0.5 servings of fish per week during adolescence and beyond may reduce the risk of MS, but additional studies are needed to further validate this potential preventive effect.

Paper: Higher fish consumption and lower risk of central nervous system demyelination

Journal: European Journal of Clinical Nutrition, 74(5), 818–824. 2019

Key findings: Higher total fish consumption (per 30 g/day, equivalent to two serves/week) was associated with an 18% reduced risk of first clinical diagnosis of central nervous system demyelination, a common precursor to MS.

Description: In this study, the relationship between fish consumption and the risk of a first clinical diagnosis of central nervous system demyelination (FCD), a common precursor to multiple sclerosis (MS), was investigated. The 2003–2006 Ausimmune Study, a case-control study conducted in Australia, involved participants matched for age, sex, and study region. Dietary data, obtained through a food frequency questionnaire, were analyzed using conditional logistic regression models. The results indicated that higher total fish consumption (equivalent to two serves per week) was associated with an 18% reduced risk of FCD. While no significant associations were found for grilled and fried fish, increased tinned fish consumption was linked to a 41% reduced risk of FCD. The study suggests that the beneficial effects may be attributed to the vitamin D and omega-3 fatty acids present in oily fish, particularly in tinned fish.

Paper: Effect of omega-3 Fatty Acids and Fish Oil Supplementation on Multiple sclerosis: a Systematic Review.

Journal: Nutritional Neuroscience, 24(7), 1–11. 2019

Key findings: The studies recommend a daily omega-3 supplementation of 4 gm for multiple sclerosis, but its effectiveness varies based on factors such as disease progression and status. Further research is needed to determine the overall impact of omega-3 fatty acids on MS health.

Description: This study systematically reviewed literature on the impact of omega-3 fatty acids (EPA, DPA, and DHA), particularly from fish oils, on the progression of multiple sclerosis (MS) in adults. The main analysed studies in this review (n = 7) included a total of 240,914 subjects from both genders. These studies, conducted on male and female participants aged 18 years or older diagnosed with MS according to McDonald 2010 criteria, consistently demonstrated the positive effects of fish oil supplementation and omega-3 fatty acids. The observed benefits included improvements in the quality of life for MS patients, attributed to their positive influence on inflammatory markers, glutathione reductase, reduction in relapse rates, and achieving balanced omega-6 to omega-3 ratios. In conclusion, the evidence suggests that omega-3 and fish oil supplementation can be beneficial in reducing relapse rates, inflammatory markers, and enhancing the overall quality of life for individuals with MS.

Paper: Seafood, fatty acid biosynthesis genes, and multiple sclerosis susceptibility.

Journal: Multiple Sclerosis Journal, 26(12), 1476–1485. 2019

Key findings: Consuming fish or seafood at least once a week or once a month, combined with regular fish oil use, is linked to a 44% lower likelihood of multiple sclerosis (MS) or clinically isolated syndrome (CIS).

Description: In a study involving 1153 individuals from the MS Sunshine Study, researchers aimed to clarify the relationship between omega-3 fatty acids and multiple sclerosis (MS) susceptibility. They investigated the impact of fish and seafood intake, as well as specific genetic factors related to omega-3 fatty acid levels, on the risk of MS. The results indicated that regular consumption of fish or seafood, particularly with fish oil supplementation, was associated with a 44% reduction in the odds of developing MS or clinically isolated syndrome (CIS). Additionally, two specific genetic variants (rs174611 and rs174618) in the FADS2 gene were independently linked to a lower risk of MS. These findings suggest that omega-3 fatty acid intake, both through diet and genetic factors, may play a crucial role in modifying the risk of MS, aligning with existing knowledge about the health benefits of consuming fish.

Paper: Estimating the Marginal Causal Effect of Fish Consumption during Adolescence on Multiple Sclerosis: A Population-Based Incident Case-Control Study.

Journal: Neuroepidemiology, 50(3-4), 111–118. 2018

Key findings: Results indicate that consuming fresh fish during adolescence is associated with a 28% lower risk of multiple sclerosis (MS), and consuming canned fish is associated with a 27% lower risk, according to the study's adjusted odds ratios, with both fresh and canned fish showing consistent risk reduction in the model-based standardised analysis; however, given the limitations of case-control studies, these associations should be interpreted cautiously.

Description: This study investigated the association between fresh and canned fish consumption during adolescence and the risk of multiple sclerosis (MS). Conducted in Tehran, the study included a total of 1,604 participants, the population-based incident case-control study included 547 cases identified from the Iranian Multiple Sclerosis Society and 1,057 population-based controls. The results, utilising inverse-probability-of-treatment weighing (IPTW) and model-based standardization, showed that both fresh and canned fish consumption during adolescence were associated with a decreased risk of MS. The marginal odds ratios were 0.72 (95% CI 0.58–0.90; p = 0.005) for fresh fish and 0.75 (95% CI 0.60–0.95; p = 0.014) for canned fish. Model-based standardized odds ratios were 0.72 (95% CI 0.58–0.91; p = 0.008) for fresh fish and 0.73 (95% CI 0.59–0.94; p = 0.006) for canned fish consumption during adolescence. Despite limitations inherent in case-control studies, the findings suggest that both types of fish consumption during adolescence may reduce the risk of MS.

Paper: Effect of fish and olive oil on mitochondrial ATPase activity and membrane fluidity in patients with relapsing-remitting multiple sclerosis treated with interferon beta 1-b.

Journal: Nutrición Hospitalaria. 2018

Key findings: At three months of the diet supplemented with fish or olive oil*, no significant difference was observed in contrast to that observed at baseline. However, after 6 months of treatment (fish or olive oil, respectively), membrane fluidity in mitochondrial membrane of platelets from patients with RR-MS reached values similar to those of control individuals and remained so until the end of the study.

*fish oil (4 g/day: 0.8 g EPA and 1.6 g DHA) or olive oil (1 g oleic acid)

Description: In a clinical trial involving 47 patients with relapsing-remitting multiple sclerosis (RR-MS), the study aimed to assess the impact of fish oil and olive oil supplementation on mitochondrial function. The results indicated that both oils normalised the fluidity of mitochondrial membranes and reduced the catabolic activity of ATP synthase in platelets, suggesting potential neuroprotective effects in RR-MS patients

There are also many references in the main book by Professor George Jelinek. The Diet section is covered on pages 71-147 of the book and includes a total of 150 scientific evidence-based research articles.