Can fasting help with multiple sclerosis?

Nutritionist Jenna Cox gives us the low-down on this increasingly popular form of food restriction

In recent years, there’s been growing interest in the potential benefits of fasting for managing various health conditions, including multiple sclerosis (MS). But what exactly does the research say about fasting and its impact on MS symptoms?

What is fasting?

Intermittent fasting (IF) and time-restricted eating (TRE) are both dietary approaches that involve alternating periods of eating and fasting, but they differ in their specific protocols. IF typically involves cycling between eating and fasting periods throughout the day or week, with popular methods like the 16/8 protocol (fast for 16 hours and eat in an eight-hour window) or the 5:2 approach (caloric restriction on two days of the week). On the other hand, TRE focuses on compressing the eating window into a specific timeframe each day, typically lasting six to eight hours, followed by a fasting period of 16-18 hours. Unlike IF, TRE doesn’t necessarily involve calorie restriction during the eating window. In essence, IF encompasses various fasting regimens, while TRE specifically emphasises limiting the daily eating window without strict calorie restriction.

The effects on MS

Several studies have investigated this topic, shedding light on the potential therapeutic effects of fasting in MS management.

Metabolic shifts and gut health

A preliminary trial examined the effects of IF on people with MS experiencing a relapse. They found that IF may lead to significant reductions in leptin levels (a hormone which helps regulate appetite, metabolism, and fat storage), and alterations in the gut microbiome composition. These changes could potentially have therapeutic implications for people with MS, suggesting IF could play a role in modulating physiological responses during relapses.

Safety and feasibility

One study has explored the safety and feasibility of IF in people with MS. The results showed that IF could be a safe and viable approach to weight loss in MS patients, with potential additional benefits for emotional health. Furthermore, intermittent calorie restriction was found to influence T-cell populations, suggesting a role in regulating immune responses, a crucial aspect of MS management. Another study investigated the feasibility of a TRE protocol among people with MS. They found qualitative improvements in various aspects like sleep and fatigue. TRE also showed potential benefits in managing MS symptoms, particularly cognitive functions and motor skills.

Quality of life

An analysis of three pilot studies focusing on calorie restriction or intermittent fasting in MS patients showed that while sustained dietary adherence was challenging, there were trends suggesting potential benefits, particularly in improving aspects of quality of life.

Mechanisms

The mechanisms through which IF impacts MS require further exploration. Potential pathways include regulation of blood glucose levels, suppression of inflammatory responses, activation of autophagy (the body’s way of cleaning out damaged cells and regenerating newer, healthier ones), and reduction of oxidative stress. Studies have demonstrated that calorie restriction significantly increases survival rates and delays disease onset in mice models, accompanied by reductions in demyelination and inflammation. IF has also shown beneficial effects in mouse models, including reduced disease severity, decreased immune cell infiltration, and promotion of oligodendrocyte regeneration (cells in the central nervous system responsible for producing myelin).

Limitations

While these studies paint an optimistic picture of IF as a potential dietary intervention for MS, it’s important to acknowledge the limitations. The research on IF for MS is still in its early stages and the current research hasn’t followed people long enough to see how IF might affect the condition in the long run.

Studies so far have been small, making it difficult to know for sure how beneficial IF can be and for whom. Small sample sizes and limited research in this area call for further large-scale, randomised controlled trials to validate these findings. Additionally, strict calorie restriction can be tough to maintain in the long term. The studies reviewed suggest that TRE, where you limit your eating window each day, might be a more sustainable option for people with MS.

Additional benefits

Research suggests that TRE offers a range of benefits. By adhering to a consistent eating pattern within a restricted timeframe you can lower inflammation, improve gut microbiome diversity, boost energy levels, and even elevate mood. Additionally, TRE has been linked to better glycaemic control and insulin sensitivity, making it particularly beneficial for individuals with conditions like type 2 diabetes.

Optimising your eating window

While TRE offers promising advantages, it’s important to establish an optimal eating window that aligns with your body’s natural rhythms. Ideally, aim for an eating window of eight to 12 hours, starting your first meal a couple of hours after waking up. This allows melatonin levels to drop, enhancing insulin sensitivity and promoting better blood sugar regulation. It’s recommended to finish your last meal three hours before bedtime to support digestion and allow for essential repair processes during sleep.

Practical tips

Adhering to a fasting regimen can be challenging, especially initially. To improve compliance, consider shifting your eating window earlier in the day, prioritising consistency over strict adherence to specific timings. Additionally, ensure that your fasting period includes deep sleep, allowing for autophagy, the process of cell repair and regeneration, to occur optimally.

What breaks a fast?

It’s helpful to understand what breaks a fast to maximise the benefits of fasting. Beverages like black coffee or tea are generally considered acceptable during fasting periods. While medications should be taken as prescribed, be mindful of adding sugar or milk to your drinks, as this can disrupt the fasting state.

To fast or not to fast

In conclusion, while fasting shows promise as a beneficial dietary strategy for MS, more research is needed to fully understand its impact and mechanisms. The findings suggest that fasting may exert benefits in MS mice models through multiple mechanisms, including modulation of immune function, reduction of inflammation, and promotion of neuroprotection. Further research is needed to fully understand their effects and mechanisms in people with MS. Limiting the eating window to 10-12 hours has shown positive outcomes in a range of metabolic processes suggesting that this could be beneficial and an achievable goal for the majority of people. Stay tuned as researchers continue to investigate the potential benefits of fasting in the management of MS.

Jenna Cox is a registered nutritional therapist, supporting people with MS to navigate their journey to optimal health. Jenna has a personal understanding of the challenges MS can bring having been diagnosed with relapsing remitting MS in 2016. Download her free eBook ’10 dairy-free swaps for all of your favourite foods’ from www.jennacox.co.uk, and follow her on instagram @jennacoxnutrition