Does your doctor still tell you that what you eat does not influence your multiple sclerosis (MS) disease course? Well, they are wrong! I have been fighting that battle for over a decade. I conduct clinical research testing the effects of diet in people with MS. Our studies have included the modified Paleolithic diet, ketogenic diet, and the low saturated fat diet.^1-7 We have consistently observed that following the modified Paleolithic diet leads to reductions in fatigue,^1,2,6-8 anxiety⁴, depression,⁴ and improved quality of life.^1,2,4,6,7

We are currently inviting people with relapsing-remitting MS to be in our study entitled “Efficacy of Diet on Quality of Life in Multiple Sclerosis.” I will have more details about how to sign up for this study later in this article.

I first began doing research into diet and MS in 2010, have conducted 7 clinical trials, and have published over 40 papers in peer-reviewed scientific journals. There have now been 12 randomized, controlled, dietary intervention studies in people with MS. My MS diet studies have been cited by other researchers hundreds of times. Most recently I saw an editorial in Neurology, the highest impact journal that publishes MS research, stating there is now evidence that diet can reduce fatigue and improve quality of life for people with MS.

The strongest evidence that an intervention is helpful (or harmful) is when multiple studies are combined and analyzed together. This type of analysis is called a meta-analysis. A network meta-analysis combines all known studies and compares them to identify which treatments are the most effective. There have been enough studies that examined the role of diet on fatigue and quality of life to conduct these important meta-analyses.

Our most recent paper, Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis: A Systemic Review and Network Meta-analysis of Randomized Trials, was published in Neurology, the most widely read journal by practicing neurologists, in January 2023. Dr. Linda Snetselaar conducted a network meta-analysis of randomized dietary intervention studies in MS that lasted at least 12 weeks and had either fatigue or quality of life as an outcome. The study team found published papers of 12 dietary intervention studies and 8 dietary interventions. Dr. Snetselaar used the study team’s classification for the dietary intervention when assigning studies to the 8 different dietary interventions. The dietary interventions included Mediterranean, Paleolithic, ketogenic, anti-inflammatory, low-fat, fasting, calorie restriction, and control diet (the participant’s usual diet). A total of 608 participants were enrolled in the 12 studies. When comparing each dietary intervention to control diet, three diets that were associated with significant reduction in fatigue were compared to control diets. The other five dietary patterns had smaller effect sizes that were not significantly better than the control diets. The magnitude of change for reducing fatigue severity in descending order, was Paleolithic (SMD: -1.27; 95% CI: -1.81, -0.74), low fat diet (SMD: -0.90; 95% CI: -1.39, -0.42), and Mediterranean, (SMD: -0.89; 95% CI: -1.15, -0.64). When comparing each diet to usual diet for improving quality of life, there were two diets that were associated with significant improvement in quality of life. In descending order, those two diets were the Paleolithic (SMD: 1.01; 95% CI 0.40, 1.63) and Mediterranean (SMD: 0.47; 95% CI 0.08, 0.86) diets.

I am not surprised that the largest effect size was with the Paleolithic diet since the Paleolithic diet removes the three most common food antigens (gluten, casein, and egg albumin) that cause excessive activation of the immune system. The Paleolithic diets were the modified Paleolithic diet that we have investigated in multiple studies. The effect size was the largest for the Paleolithic diet. The Paleolithic diet and Mediterranean diets have many common features, including less added sugar, less ultra-processed foods, and more non-starchy vegetables.

The Neurology editorial noted above, The Role of Diet in Multiple Sclerosis: Food for Thought, appeared in the same issue as Dr. Snetselaar’s meta-analysis. The authors of the editorial recommend that neurologists talk to their MS patients about the importance of a healthy diet and that the patient should choose the most appealing diet based on their individual tastes, culture, and background. Neurologists could send their MS patients to registered dietitians for guidance and support for helping patients improve their diet, which would likely be covered by many health insurance plans. The editorial authors also called more research that includes MRI findings and would follow people for two years.

I agree that larger, longer studies are needed. We are currently conducting our eighth clinical trial, a two-year study comparing modified Paleolithic elimination diet and time restricted ketogenic diet to usual diet control (NCT05007483). We are looking for people with relapsing-remitting MS between ages 18 and 70 who are willing to be randomized to one of three diets: the modified Paleolithic, also known as Wahls™ diet, the time-restricted olive oil ketogenic diet, or usual diet. People will come to Iowa at month 0, month 3, and month 24. We will assess mood, quality of life, and walking, hand, thinking, and vision functions at each visit. We will also obtain a research MRI (without contrast) at month 0 and month 24 so that we can assess the rate of brain volume change. People with MS have, on average, a rate of brain volume loss that is 3 times as fast as occurs with healthy aging. We are testing if adopting a healthy diet can get people to healthy rates of brain volume loss. That is important because rapid brain volume loss leads to more problems with thinking, memory, and more difficulty walking.

If you have relapsing-remitting MS, are between ages 18 and 70, are willing to come to Iowa for three visits over two years, please consider being part the study. Complete the screening tool here to see if you are eligible to part of our study, Efficacy of Diet on Quality of Life in Multiple Sclerosis. Even if you do not qualify for this study, we encourage you become part of our patient registry.  If you have optic neuritis, radiologically isolated syndrome, clinically isolated syndrome or multiple sclerosis, I encourage to complete this short survey and become part of our patient registry.

Changing the standard of care so that everyone who has MS is told that diet matters and is encouraged to improve their diet to protect their brains will take more published, peer-reviewed scientific studies. I am doing that research. I need people like you to come to Iowa and be part of our clinical trials! Let’s change the world together.

Citations

1. Bisht B, Darling WG, Grossmann RE, et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. May 2014;20(5):347-55. doi:10.1089/acm.2013.0188
2. Bisht B, Darling WG, Shivapour ET, et al. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2015;5:19-35. doi:10.2147/DNND.S76523
3. Bisht B, Darling WG, White EC, et al. Effects of a multimodal intervention on gait and balance of subjects with progressive multiple sclerosis: a prospective longitudinal pilot study. Degener Neurol Neuromuscul Dis. 2017;7:79-93. doi:10.2147/DNND.S128872
4. Lee JE, Bisht B, Hall MJ, et al. A multimodal, nonpharmacologic intervention improves mood and cognitive function in people with multiple sclerosis. J Am Coll Nutr. Mar-Apr 2017;36(3):150-168. doi:10.1080/07315724.2016.1255160
5. Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A modified MCT-based ketogenic diet increases plasma beta-hydroxybutyrate but has less effect on fatigue and quality of life in people with multiple sclerosis compared to a modified Paleolithic diet: a waitlist-controlled, randomized pilot study. J Am Coll Nutr. Jan 2021;40(1):13-25. doi:10.1080/07315724.2020.1734988
6. Wahls TL, Titcomb TJ, Bisht B, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: the WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. Jul-Sep 2021;7(3):20552173211035399. doi:10.1177/20552173211035399
7. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18. doi:10.2147/DNND.S116949
8. Reese D, Shivapour ET, Wahls TL, Dudley-Javoroski SD, Shields R. Neuromuscular electrical stimulation and dietary interventions to reduce oxidative stress in a secondary progressive multiple sclerosis patient leads to marked gains in function: a case report. Cases J. Aug 10 2009;2:7601. doi:10.4076/1757-1626-2-7601