It is recommended that neurologists discuss the benefits of improving diet quality with their patients with MS.

Many people with multiple sclerosis (MS) make dietary changes as a means of self-managing the progression of their disease, as it can lead to cognitive and physical disability, according to Landon J. Crippes. However, “while preliminary evidence supports the role of dietary interventions for managing fatigue and QOL, evidence regarding the effect of dietary interventions on disability in MS remains sparse,” Crippes says.

To address this gap in knowledge, Crippes and colleagues conducted a secondary analysis of the WAVES Randomized Parallel-Arm Clinical Trial, which previously revealed that the low-saturated fat and modified Paleolithic elimination diets led to significant improvement in MS-related QOL and decreased fatigue. “During the WAVES trial, participants also completed objective assessments, including the nine-hole peg test (NHPT), timed 25-foot walk (T25FW), and oral symbol digit modalities test (SDMT-O) that can be used to calculate a validated objective disability score called the Multiple Sclerosis Functional Composite (MSFC),” he says. “In this analysis, we aimed to determine the impact of these two dietary interventions on objectively measured disability with the MSFC.”

Crippes and colleagues presented their remarks at The Consortium of Multiple Sclerosis Center (CMSC) held from May 31 to June 3, 2023, in Aurora, Colorado.

Disability in Both Dietary Intervention Groups Improved in 24 Weeks

The study team evaluated physical and cognitive function in 77 participants with relapsing-remitting MS with the T25FW, NHPT, and SDMT-O at four study visits: (1) run-in, (2) baseline, (3) 12 weeks, and (4) 24 weeks. At run-in, study participants followed their usual diet and then were randomly assigned at baseline to follow either the low-saturated fat and modified Paleolithic elimination diets and followed for 24 weeks. At baseline, the researchers calculated MSFC z-scores using values from the whole study sample.

Within the low-saturated fat group, MSFC z-scores notably increased from 0.05 ± 0.12 at baseline to 0.12 ± 0.14 at 24 weeks (P=0.002). In the modified Paleolithic elimination group, MSFC z-scores grew from 0.05 ± 0.14 at baseline to 0.25 ± 0.16 at 24 weeks (P=0.01). In each group, MSFC z-score improvements were primarily driven by significant changes in NHPT and SDMT-O z-scores. The study team observed no significant changes for T25FW z-scores.

Crippes and colleagues observed that objective disability, as assessed by the MSFC, was diminished in both dietary interventions at 24 weeks, which was driven by improvements in the NHPT and SDMT-O.

“Our findings show that both dietary interventions led to improvements in the MSFC, which indicate objective reductions of MS-related disability,” Crippes says. “Reductions in disability were primarily driven by improved working memory and manual dexterity. These results provide preliminary evidence of the impact of two different diets on MS-related disability. Therefore,  additional randomized controlled trials exploring this relationship are warranted.”

Clinicians Should Discuss Benefits of Improving Diet With Patients

Neurologists should discuss the benefits of improving diet quality with their patients with MS, Crippes notes. “While additional research is needed in this area, previous research has shown that people with MS are interested in diet as a means of improving wellness and self-managing symptoms. Therefore, it is crucial for neurologists to understand the current evidence for diets, such as the low-saturated fat and modified Paleolithic elimination diets that were analyzed in this study, to be able to effectively communicate the potential benefits of such diets as adjunct therapies.”

Crippes concludes, “Given that this was a secondary analysis, well-designed randomized controlled trials with longer study duration using these objective measures as the primary endpoint are needed for further characterization of the benefits of diet for managing MS-related symptoms and reducing disability accumulation.”

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