Multiple Sclerosis: Better Ways to Test Diet Changes

Will a Mediterranean-style, non-dairy, low-carb diet improve symptoms for patients with multiple sclerosis (MS)?

Helping MS patients by changing their diets is an old concept, but an MS specialist at Mt. Sinai Hospital in New York City has some new thoughts about how to prove whether that it works.

The idea is that testing “wellness” initiatives like diet changes is not the same as testing drugs.

“People are not mice. We can’t put them in a cage and feed them exactly what we want to feed,” Ilana Katz Sand, a Mt. Sinai assistant professor of neurology, told Nature.

This lack of strict control inherent in changing what people eat is a research disadvantage in comparison with more clinically accepted drug studies, which can closely monitor subjects’ consumption of exactly the same medication while the subjects don’t know what medication or a placebo they are on.

Sand plans to have 30 MS patients do their own food shopping and preparation.

Over a six-month period they will follow a modified Mediterranean diet of whole grains, fruits, vegetables, and healthy fats from foods like fish, nuts, and avocados. Their meals also will include items such as almond milk, blueberries, carrots, fish, whole grains and nuts. They’ll pass up cow’s milk, cheese, meat, crackers, refined flour, and sugar.

Adherence to the diet will be monitored by checking patients’ food questionnaires. Those results then will be verified by blood tests measuring levels of salt, fatty acids, and other nutrients.

The lack of a control group in some of the classic studies of MS and diet, which date back to the 1940s, has been a flaw that has prevented diet from being a well-accepted for treating MS, according to Sujata Gupta, the author the Nature article. In the past, control groups for dietary studies have faltered because of a high drop-out rate as they are asked to wait months or years to make dietary changes on their own, he wrote.

Sand’s approach covers a shorter research period, and attempts to discourage dropouts in the test group by providing monthly meetings on health and wellness. She has a waiting list control group that will have an incentive to stick with the study because they will be able to follow the same diet and test procedures at the end of the study.

A literature review of mainly animal studies showing a correlation between foods, supplements and dietary restrictions and positive MS results, suggested to Sand that her dietary approach was worth studying, Gupta reported. Sand’s study got underway in October.

Terry Wahls, MD, a clinical professor at the University of Iowa Carver College of Medicine in Iowa City, Iowa, is researching a comparison of her high-fat modified Paleolithic diet and a with low-fat diet designed in the 1940s. Her modified Paleolithic diet is higher in vegetables and lower in meat, Gupta explained. Wahls’ research project, however, does not have a control group. She has secondary progressive multiple sclerosis, according to her website.

The benefits of the low-fat diet Wahls is including in her study were researched for 30 years by Roy Swank, MD, at the University of Montreal in Canada. In 1949, he put a group of Norwegian MS patients on his low-fat diet and analyzed the results in 1990. The results showed that 95 percent those who consumed less than 20 grams of fat per day enjoyed normal activities for the next 30 years, Gupta wrote. A 2012 follow-up of Swank’s findings discounted them because Swank did not have a control group and lacked adequate screening criteria, Gupta added.

The full study by Gupta was published December 1 in Nature, “Changing the Recipe: Dietary changes may be able to alleviate the symptoms of multiple sclerosis, but testing the effects of diet will need a different protocol to the one used for drugs."

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