Presents

DAILY DIGEST

REPORTING FROM ACTRIMS

Americas Committee for Treatment and Research in Multiple Sclerosis
West Palm Beach, Florida

SUNDAY, MARCH 1

Can Patients With Multiple Sclerosis Eat Their Way to Healthier Disease Course?

WEST PALM BEACH, FL — At the ACTRIMS Forum on Saturday, February 29, Ellen Mowry, MD, MCR, addressed the big elephant in the room: are there any dietary modifications that can alter the disease course in multiple sclerosis (MS)? Dr. Mowry's presentation was the final talk to wrap up the 3-day scientific program packed with cutting-edge research in MS, much of it focusing on mechanisms of secondary progressive pathology. "When I first started looking into this, there were about 13 million hits on Google for MS and diet," she said. "Each of the top three hits claimed to know exactly the right diet for people living with MS. But they were all different."

With the increased focus on the gut microbiome in many disease states, it would seem logical that diet may play a role in MS pathogenesis. Dr. Mowry, Associate Professor of Neurology at Johns Hopkins Medicine in Baltimore, MD, reviewed current data from a variety of dietary approaches studied in MS. A Mediterranean diet, while good for cardiovascular disease and metabolic syndrome, has not been shown to have an impact in MS disease course, Dr. Mowry said. Data from the Ausimmune suggested that this diet may be associated with a lower risk of developing MS, although the Nurses' Health Study contradicted these findings. The Wahl's diet, a rather extreme version of the Paleolithic diet, has many anecdotal followers but "sparse rigorous scientific evidence," Dr. Mowry said.

"There's a lot of interest in obesity and how it impacts neurodegenerative disease," Dr. Mowry said. "We know that adipose tissue itself is essentially pro-inflammatory, pushing all parts of the immune system in ways that we don't like, especially for people with MS." In addition to its underlying effects on promoting cardiovascular disease and diabetes, obesity also leads to the infiltration of lymphoid organs including the thymus and bone marrow, potentially reducing immune surveillance and promoting autoimmunity, infections, and likely cancers. Obesity appears to be longitudinally related to grey matter volume changes in MS.

What about caloric restriction approaches? In mouse models of MS, fasting-style diets have been shown to prevent or delay onset of MS, reduce disease severity, reduce levels of pro-inflammatory cytokines, and on a cellular level promote changes such as protecting oligodendrocyte precursor cells (OPCs) from apoptosis. Research at Johns Hopkins is seeking to learn if these findings translate from mice to humans. A small study, the Altering the Timing or Amount of Calories in MS (ATAC-MS), randomized people with MS to one of three groups for eight weeks: a maintenance diet with normal caloric intake, intermittent fasting with calorie restriction for five days followed by a two-day break, and a more extreme caloric restriction group. Food was delivered directly to participants through collaboration with the USDA Human Nutrition Research Center. The caloric restriction group had clinically meaningful improvements in emotional well-being, as well as changes in functionally relevant groups of metabolites such as phosphatidylcholines, plasmalogens, fatty acid metabolites, and bile acids, all of which may be potentially relevant to MS.

Dietary interventions do not exist in isolation, Dr. Mowry cautioned. "Lifestyle factors are intertwined." A new diagnosis of MS can inspire people to change their diets in an effort to modify the effects of the disease, which may influence research outcomes. Newer evidence suggests there could be a prodrome stage of MS, during which people may alter their diets in an effort to feel better, she said.

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By Katherine Wandersee, for the Consortium of Multiple Sclerosis Centers (CMSC)

 

© 2020, Consortium of Multiple Sclerosis Centers. Published by Delaware Media Group, LLC. All rights reserved. None of the contents may be reproduced in any form without prior written permission from the publisher. The opinions expressed in this publication are those of the presenters and do not necessarily reflect the opinions or recommendations of their affiliated institutions, the publisher, or Bristol-Myers Squibb.

WEST PALM BEACH, FL — At the ACTRIMS Forum on Saturday, February 29, Ellen Mowry, MD, MCR, addressed the big elephant in the room: are there any dietary modifications that can alter the disease course in multiple sclerosis (MS)? Dr. Mowry's presentation was the final talk to wrap up the 3-day scientific program packed with cutting-edge research in MS, much of it focusing on mechanisms of secondary progressive pathology. "When I first started looking into this, there were about 13 million hits on Google for MS and diet," she said. "Each of the top three hits claimed to know exactly the right diet for people living with MS. But they were all different."