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Obesity a factor in auto- immune diseases(11/11/14)

Autoimmune diseases like Crohn’s Disease and multiple sclerosis, in which the immune system attacks its own body rather than predatory invaders, affect 5-20% of the global community. A study published recently in Autoimmunity Reviews by Prof. Yehuda Shoenfeld, the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases at Tel Aviv University’s Sackler Faculty of Medicine and Head of Zabludowicz Center for Autoimmune Diseases at Chaim Sheba Medical Center, Tel Hashomer, points to the major role obesity plays in triggering and prolonging these autoimmune diseases.

According to the research, obesity leads to a breakdown of the body’s protective self-tolerance, creating the optimal environment for autoimmune diseases, and generates a pro-inflammatory environment likely to worsen the disease’s progression and hinder its treatment.

“We’ve been aware of a long list of causes of autoimmune disorders — infections, smoking, pesticides, lack of vitamins, and so forth. But in last five years, a new factor has emerged that cannot be ignored: obesity,” said Prof. Shoenfeld. “According to the World Health Organization, approximately 35% of the global community is overweight or obese, and more than ten autoimmune diseases are known to be associated with increased weight. So it’s critical to investigate obesity’s involvement in the pathology of such diseases.”

In addition to their own research, Prof. Shoenfeld and his team from Tel Hashomer hospital conducted a systematic review of 329 studies from around the world on the relationship between obesity, adipokines (compounds secreted by fat tissue and involved in numerous physiological functions, including the immune response), and immune-related conditions like rheumatoid arthritis, multiple sclerosis, type-1 diabetes, psoriasis, inflammatory bowel disease, psoriatic arthritis, and Hashimoto thyroiditis.

“According to our study and the clinical and experimental data reviewed, the involvement of adipokines in the pathogenesis of these autoimmune diseases is clear,” said Prof. Shoenfeld. “We were able to detail the metabolic and immunological activities of the main adipokines featured in the development and prognosis of several immune-related conditions.”

Prof. Shoenfeld conducted a study on mouse populations with multiple sclerosis given a Mediterranean diet rich in unsaturated fats. He found that Vitamin D deficiency was also a result of obesity and, once corrected, alleviated paralysis and kidney deterioration associated with the disorder. It also improved the prognosis and survival of the mice.

“Modern life makes us all prone to Vitamin D deficiency,” said Prof. Shoenfeld. “We live in labs, offices, and cars. When Vitamin D is secreted in fat tissue, it is not released into the body, which needs Vitamin D to function properly. Since Vitamin D supplements are very cheap and have no side effects, they are an ideal compound that should be prescribed to anyone at risk of a compromised immune system.”

Prof. Shoenfeld welcomes the general trend toward personalized medicine, and believes his research can be a basis for specific therapies to treat autoimmune syndrome. “If a patient is at risk, he or she should be told to do everything in his or her power to maintain a healthy weight,” he said.

Source: San Diego Jewish World © 2014 San Diego Jewish World (11/11/14)

Can Multiple Sclerosis be affected by diet?(25/09/14)

The first prospective population-based study of dietary patterns and risk for multiple sclerosis (MS) has found no relationship between eating a high-quality, healthy diet and a reduced risk of developing MS.

One caveat was that the study focused on current diets in adults only, and it is possible that diet in adolescence may be more important regarding risk for MS, it was noted.

"We did not find any evidence that overall dietary quality is associated with the risks of multiple sclerosis," Dalia Rotstein, MD, from Brigham and Women's Hospital, Boston, Massachusetts, concluded. "However further research is required to determine the possible role of dietary quality in the early years and in individual dietary elements."

She presented the research at MS Boston 2014, the 2014 Joint Americas and European Committees for Treatment and Research in Multiple Sclerosis (ACTRIMS/ECTRIMS) meeting.

However, other studies presented at the same session of the conference showed that patients with MS and other comorbidities have more MS disability. With this in mind, Dr Rotstein told Medscape Medical News, "We do know that healthy diet can help people in general and reduce other comorbidities, especially cardiovascular disease, so this will help MS in the long run."

Another study presented at the meeting showed no effect of a plant-based diet very low in saturated fat on MS endpoints, although numbers were small.

However, it was linked to a significant reduction in fatigue, which was correlated with improvements in body mass index and total cholesterol. This caused the researchers, led by Vijayshree Yadav, MD, Oregon Health & Science University, Portland, to conclude that "a diet very low in saturated fats may yield longer-term quality-of-life benefits and vascular health benefits in MS subjects."

"As other studies presented here have shown patients with comorbidities have worse MS outcomes, the changes we have seen in this small study are likely to translate into better MS outcomes in the long term," Dr. Yadav told Medscape Medical News.

Dr. Rotstein and colleagues evaluated the diets from 185,000 women participating in the Nurses' Health Study (NHS) 1 and 2 who were prospectively followed (from 1984 in NHS 1 and from 1991 in NHS 2) and filled in dietary pattern questionnaires every 4 years. Records also showed 480 validated incident cases of MS in the 2 NHSs.

From the dietary information, the researchers calculated scores on various different indices of healthy eating: the alternative healthy eating index, the alternative Mediterranean diet score, and the DASH diet (Dietary Approaches to Stop Hypertension). They also used the information on the principal components of the diet to designate 2 separate diets: the Western diet (high in red meat, sugar, and refined grains) vs the Prudent diet (high in vegetables, fruit, legumes, fish, poultry, and whole grains).

They calculated baseline and mean cumulative scores for each of the above diets and investigated whether there was any relationship between these scores and the risk for MS. They used a Cox proportional hazard analysis with adjustment for known factors affecting MS risk, including age, latitude of residence at age 15, body mass index at age 18, total energy intake, and supplemental vitamin D intake.

Results found no evidence for an inverse relationship between a high-quality diet and the risk of developing MS on any of the dietary scores.

Dr. Rotstein noted that the study had many strengths, with a prospective design, participants well characterised with extensive data collection and known confounders of MS risk, and dietary scores collected at multiple different time points. But she added that dietary scores are inherently subjective.

Adolescence: A Critical Window?

On this point, she noted that obesity in adolescence has shown a strong link to an increased risk of developing MS. But studies in adults have been more mixed, and obesity in adults has not been definitely linked with an increased risk for MS.

"Our study was conducted purely in adults, with a youngest age of 25," she noted. "All we can say from our results is that there does not appear to be a direct relationship between diet quality and risk of developing MS as an adult. We cannot say anything about eating habits in adolescence and risk of MS from these data. It is possible that the adolescent years are a critical window, but our study doesn't answer that question."

She also noted that the "high-quality" diets evaluated in this study were all aimed at preventing cardiovascular disease. "It is possible that different patterns would be better for preventing immunological diseases, but we don't know that."

She added: "I have many MS patients who believe that diet may have affected them developing the disease and they feel guilty that they cannot or did not comply with a healthy diet, so these results can provide some reassurance in that regard."

Dr. Rotstein said that although a specific MS diet has not yet been found, there was a great deal of support for vitamin D. "The one nutritional factor that has been shown time and time again to be linked to MS is vitamin D deficiency. I tell all my patients to take vitamin D supplements, but other than that I think it is an open question as to whether other dietary factors affect the disease. So far there is nothing definitive to show that."

Low-Saturated-Fat Diet

The other study presented here by Dr. Yadav and colleagues, looking at a low-saturated-fat diet in MS, was inspired by the work of Dr. Roy Swank in the 1950s. Dr. Swank suggested that individuals who consumed high amounts of saturated fat were at higher risk for MS.

The study evaluated a plant-based diet very low in saturated fat known as the McDougall diet. The composition of the diet is estimated at 10% fat, 14% protein, and 76% carbohydrate, with a focus on starches such as potatoes, corn, rice, beans, oats, fruits, and vegetables. Meat, fish, and dairy are not recommended.

For the study, 61 participants were randomly assigned to this diet or to a control group. The diet group underwent dietary training in a 10-day residential program and then completed monthly food-frequency questionnaires for 1 year.

Results showed no discernible effect on the MS disease process, with no significant changes in the number of active lesions, relapse rate, or Extended Disability Status Scale scores. But the researchers say the study was probably too small and had too short a follow-up to detect such changes.

They did find, however, significant improvement in fatigue measured by an almost 50% reduction in the Modified Fatigue Impact Scale score in the diet group.

Patients in the diet group also lost an average of 20 pounds in weight and had improved cholesterol and mental health scores.

Dr. Rotstein and Dr. Yadav have disclosed no relevant financial relationships.

MS Boston 2014: The 2014 Joint Americas and European Committees for Treatment and Research in Multiple Sclerosis (ACTRIMS/ECTRIMS) meeting. Abstracts PS5.1, PS5.3, and P055. Presented September 11, 2014.

Source: Medscape Multispeciality © 1994-2014 by WebMD LLC (25/09/14)

Could high dietary salt levels worsen multiple sclerosis symptoms?(29/08/14)

High dietary salt intake may worsen multiple sclerosis symptoms and boost the risk of further neurological deterioration, indicates a small observational study published online in the Journal of Neurology, Neurosurgery & Psychiatry.

Previous research has indicated that salt may alter the autoimmune response, which is implicated in the development of multiple sclerosis (MS), but it is not clear if it has any direct effect on the course of the disease itself.

The researchers assessed the blood and urine samples of 70 people with the relapsing-remitting form of MS to check for levels of salt; a marker of inflammatory activity called creatinine; and vitamin D, low levels of which have been linked to the disease.

This group were asked to provide urine samples on three separate occasions over a period of nine months to monitor changes in dietary salt intake, and their neurological health was then tracked for two years, between 2010 and 2012.

By way of comparison, urinary salt levels were measured in a second group of 52 people with the same type of MS between June and July 2013.

Salt intake averaged just over 4 g per day in both groups, but ranged from under 2 g (low) to 2-4.8 g (moderate) to 4.8 g or more a day (high), with men tending to have a higher daily intake than women.

After taking account of influential factors, such as smoking, age, gender, length of time after diagnosis, weight, treatment and circulating vitamin D, the analysis indicated a link between levels of dietary salt and worsening symptoms.

Compared with those consuming the least salt every day, those on moderate to high intake in the first group had around three more episodes of worsening symptoms, and were almost four times as likely to have these episodes.

The researchers then looked at x-rays and scans to find out if the disease had progressed further, and once again found a link between dietary salt intake and radiological evidence of further deterioration.

Those whose dietary salt intake was high were almost 3.5 times as likely to have radiological signs of further progression.

Similar results were obtained for the comparison group.

This is an observational study, so no definitive conclusions about cause and effect can be drawn. And higher levels of salt in the urine may reflect greater disease activity rather than the other way round, the authors point out.

But high salt intake is implicated in various aspects of poor health, they say. And their findings suggest further research into whether dietary salt reduction could ease MS symptoms or slow the progression of the disease might now be warranted, they add.

Source: MedicalXpress © Medical Xpress 2011-2014 (29/08/14)

Low-fat diet helps fatigue in people with MS(02/05/14)

People with multiple sclerosis who for one year followed a plant-based diet very low in saturated fat had much less MS-related fatigue at the end of that year — and significantly less fatigue than a control group of people with MS who didn't follow the diet, according to an Oregon Health & Science University study being presented today at the American Academy of Neurology's annual meeting in Philadelphia, Pa.

The study was the first randomised-controlled trial to examine the potential benefits of the low fat diet on the management of MS. The study found no significant differences between the two groups in brain lesions detected on MRI brain scans or on other measures of MS. But while the number of trial participants was relatively small, study leaders believe the significantly improved fatigue symptoms merited further and larger studies of the diet.

"Fatigue can be a debilitating problem for many people living with relapsing-remitting MS," said Vijayshree Yadav, M.D., an associate professor of neurology in the OHSU School of Medicine and clinical medical director of the OHSU Multiple Sclerosis Center. "So this study's results — showing some notable improvement in fatigue for people who follow this diet — are a hopeful hint of something that could help many people with MS."

The study investigated the effects of following a diet called the McDougall Diet, devised by John McDougall, M.D. The diet is partly based on an MS-fighting diet developed in the 1940s and 1950s by the late Roy Swank, M.D., a former head of the division of neurology at OHSU. The McDougall diet, very low in saturated fat, focuses on eating starches, fruits and vegetables and does not include meat, fish or dairy products.

The study, which began in 2008, looked at the diet's effect on the most common form of MS, called relapsing-remitting MS. About 85 percent of people with MS have relapsing-remitting MS, characterized by clearly defined attacks of worsening neurological function followed by recovery periods when symptoms improve partially or completely.

The study measured indicators of MS among a group of people who followed the McDougall Diet for 12 months and a control group that did not. The study measured a range of MS indicators and symptoms, including brain lesions on MRI brain scans of study participants, relapse rate, disabilities caused by the disease, body weight and cholesterol levels.

It found no difference between the diet group and the control group in the number of MS-caused brain lesions detected on the MRI scans. It also found no difference between the two groups in relapse rate or level of disability caused by the disease. People who followed the diet did lose significantly more weight than the control group and had significantly lower cholesterol levels. People who followed the diet also had higher scores on a questionnaire that measured their quality of life and overall mood.

The study's sample size was relatively small. Fifty-three people completed the study, with 27 in the control group and 22 people in the diet group who complied with the diet's restrictions.

"This study showed the low-fat diet might offer some promising help with the fatigue that often comes with MS," said Dennis Bourdette, M.D., F.A.A.N., chair of OHSU's Department of Neurology, director of OHSU's MS Center and a study co-author. "But further study is needed, hopefully with a larger trial where we can more closely look at how the diet might help fatigue and possibly affect other symptoms of MS."

Source: Science Codex (02/05/14)