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Effect of low saturated fat diet in early and late cases of multiple sclerosis

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Abstract

144 multiple sclerosis patients took a low-fat diet for 34 years. For each of three categories of neurological disability (minimum, moderate, severe) patients who adhered to the prescribed diet (less than or equal to 20 g fat/day) showed significantly less deterioration and much lower death rates than did those who consumed more fat than prescribed (greater than 20 g fat/day). The greatest benefit was seen in those with minimum disability at the start of the trial; in this group, when those who died from non-MS diseases were excluded from the analysis, 95% survived and remained physically active.

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... intake of saturated animal fats were associated with higher incidence of MS [7,8]. Swank placed his patients on this diet and followed them for 50 years [9], publishing a series of reports [10][11][12][13][14][15][16][17][18][19]. His main findings were a reduction in the frequency and severity of relapses when patients consumed ≤20 g saturated fat/day [9][10][11][12][13][14]. ...
... His main findings were a reduction in the frequency and severity of relapses when patients consumed ≤20 g saturated fat/day [9][10][11][12][13][14]. These patients exhibited less disability and lower mortality [17] especially when the diet was started early in the disease course [10,11,15,17]. However, his study has been criticized for comparing good versus poor diet adherents which biases the data towards positive results, for lacking a control group, blinded assessors, brain imaging data [20,21] and standardized dietary intake assessment and for missing data that is not missing at random [22]. ...
... His main findings were a reduction in the frequency and severity of relapses when patients consumed ≤20 g saturated fat/day [9][10][11][12][13][14]. These patients exhibited less disability and lower mortality [17] especially when the diet was started early in the disease course [10,11,15,17]. However, his study has been criticized for comparing good versus poor diet adherents which biases the data towards positive results, for lacking a control group, blinded assessors, brain imaging data [20,21] and standardized dietary intake assessment and for missing data that is not missing at random [22]. ...
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Multiple sclerosis (MS) is an incurable degenerative disease that attacks the central nervous system. Roy Swank proposed a low saturated fat diet to treat MS around 1950 and showed delayed disease progression in his patients. However, there is insufficient evidence to recommend this diet for MS and default dietary recommendations are the Dietary Guidelines for Americans (DGA). This study assessed the nutritional adequacy of seven-day menus developed by Swank and their compliance with the DGA; menus were modeled for comparison with the DGA Healthy US-Style Eating Pattern (HEP) for males and females 31–50 years. Swank recommended dietary supplements corrected menu shortfalls in vitamins D, E, calcium, folate and iron but not dietary fiber, potassium and choline. Healthy Eating Index-2015 score for Swank menus (93.2/100) indicated good compliance with the DGA. Nutritional adequacy of the Swank modeled diet was similar to HEP for 17 vitamins and minerals (Mean Adequacy Ratios ≥94%) with similar shortfall nutrients except magnesium (HEP males) and dietary fiber (Swank males). Alternate Healthy Eating Index-2010 scores for Swank male (90/110) and female (88/110) model diets were similar to HEP. Swank menus have similar nutritional adequacy as HEP. Inclusion of foods high in dietary fiber, potassium and choline may be advised as well as selection of foods to reduce sodium below the Tolerable Upper Intake Level.
... PwMS frequently use [16] or express interest in using [17] a variety of special diets to try to treat their disease [18]. Examples include the low saturated fat Swank [19][20][21][22][23][24][25][26], plant-based low-fat McDougall [27], Mediterranean [11,28], ketogenic [29], energy restriction/fasting [30-32] and modified Paleolithic (Paleo) Wahls™ [33-37] diets. However, clear evidence to support the benefit of any specific dietary regimen is lacking and well-designed, randomized controlled trials are needed [38,39]. ...
... At 34 years, two more patients had been lost to follow up, leaving a cohort of 144 patients for analysis [24]. Cause of death was identified and classified as MS-related or not MS-related. ...
... There were 81 deaths and 63 living patients who came in for examination. Again those who consumed ≤20 g of fat were less likely to have died (MS-related or not MS-related) and experienced fewer and less severe exacerbations and were more likely to still be walking [24]. ...
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The precise etiology of multiple sclerosis (MS) is unknown but epidemiologic evidence suggests this immune-mediated, neurodegenerative condition is the result of a complex interaction between genes and lifetime environmental exposures. Diet choices are modifiable environmental factors that may influence MS disease activity. Two diets promoted for MS, low saturated fat Swank and modified Paleolithic Wahls Elimination (WahlsElim), are currently being investigated for their effect on MS-related fatigue and quality of life (NCT02914964). Dr. Swank theorized restriction of saturated fat would reduce vascular dysfunction in the central nervous system (CNS). Dr. Wahls initially theorized that detailed guidance to increase intake of specific foodstuffs would facilitate increased intake of nutrients key to neuronal health (Wahls™ diet). Dr. Wahls further theorized restriction of lectins would reduce intestinal permeability and CNS inflammation (WahlsElim version). The purpose of this paper is to review the published research of the low saturated fat (Swank) and the modified Paleolithic (Wahls™) diets and the rationale for the structure of the Swank diet and low lectin version of the Wahls™ diet (WahlsElim) being investigated in the clinical trial.
... This autoimmune disease has already been associated with several environmental factors, such as diet and obesity [7][8][9][10]. Obesity is a well-known risk factor for multiple conditions, including cardiovascular risk and metabolic disorders, as metabolic syndrome and insulin resistance [11], and has also been associated with a nonfavorable course of several autoimmune diseases [2]. ...
Article
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Multiple Sclerosis (MS) is an autoimmune disorder of the Central Nervous System that has been associated with several environmental factors, such as diet and obesity. The possible link between MS and obesity has become more interesting in recent years since the discovery of the remarkable properties of adipose tissue. Once MS is initiated, obesity can contribute to increased disease severity by negatively influencing disease progress and treatment response, but, also, obesity in early life is highly relevant as a susceptibility factor and causally related risk for late MS development. The aim of this review was to discuss recent evidence about the link between obesity, as a chronic inflammatory state, and the pathogenesis of MS as a chronic autoimmune and inflammatory disease. First, we describe the main cells involved in MS pathogenesis, both from neural tissue and from the immune system, and including a new participant, the adipocyte, focusing on their roles in MS. Second, we concentrate on the role of several adipokines that are able to participate in the mediation of the immune response in MS and on the possible cross talk between the latter. Finally, we explore recent therapy that involves the transplantation of adipocyte precursor cells for the treatment of MS.
... The risk factors for preventing OPCs from remyelinating the axons have not yet been fully established, presenting an opportune field for scientific investigation in MS. However, it is already apparent that insufficient myelination and the consequent increased disability is unlikely to be related to a single cause, and may rather result from a combination of various genetic and lifestyle factors that have already shown such associations (Ascherio et al. 2014;Thouvenot et al. 2014;Manouchehrinia et al. 2013;Moccia et al. 2015;Tettey et al. 2014;Nelson et al. 2014;Swank and Dugan 1990;D'hooghe et al. 2012;van Rensburg et al. 2015;Davis et al. 2014). An important risk factor for inhibition of myelin synthesis is iron deficiency, since myelin production is dependent on sufficient energy production in OPCs and mature oligodendrocytes (van Rensburg and van Toorn 2010; Bartzokis 2011;Connor and Menzies 1996;Phillips et al. 2014). ...
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Results: In patients with high disability scores the mean FA was significantly lower (0.34 ± 0.067) than in the control group (0.45 ± 0.036; p = 0.04), while patients with low disability had mean FA values (0.44 ± 0.014) similar to controls (p = 0.5). Positive associations were found between FA and the iron parameters serum iron, ferritin and percentage transferrin saturation (%Tfsat) in all the white matter tracts. For % Tfsat, the associations were highly significant in 14 tracts (p < 0.01; r-values 0.74-0.84) and p < 0.001 (r = 0.83) in the superior fronto occipital fasciculus (LH). In the whole patient group a trend was found towards an inverse association between the EDSS and the %Tfsat (r = -0.26, p = 0.05) after excluding male gender and smoking as confounders, suggesting reduced disability in the presence of higher blood iron parameters. Additionally, significant inverse associations between disease duration and haemoglobin (p = 0.04) as well as %Tfsat (p = 0.02) suggested that patients with MS may experience a decrease in blood iron concentrations over time.
... Meat was another nutrient that appeared in all four study phases. This may be consistent with findings from 1950 by Swank, who showed that a diet low in total fat (especially saturated fat of animal origin) could significantly decrease the disease activity and deterioration in individuals with relapse-remitting MS [50]. Swank's research has been criticized for the lack of control group and high drop-out rates. ...
Article
Purpose: Increasing knowledge suggests that nutrition and lifestyle factors affect multiple sclerosis. This study explores how people with multiple sclerosis experience daily multiple sclerosis disease activity and the influence of nutrition and lifestyle factors (e.g., stress, sleep, and environmental temperature). Methods: Four phases mix qualitative and quantitative elements in an exploratory study. The initial two phases consisted of an exploratory study with 14 participants followed by 15 semi-structured interviews. Results from the two first phases were substantiated in a survey completed by 425 respondents (response rate: 42.5%). Finally, findings and inconsistencies were elaborated in three focus group interviews. Results: In the initial exploratory study, several of the participants linked nutrition and lifestyle factors to disease activity. Results from the semi-structured interviews showed that particularly stress, meat, fatty foods, and processed sugar were perceived to have a negative impact on disease activity, and some participants had experienced immediate effects of these factors on their disease activity. The survey supported these findings that were further elaborated in focus groups. Conclusion: People with multiple sclerosis perceive nutrition and lifestyle to affect daily disease activity. Individuals who have experienced links between their multiple sclerosis, and nutrition and lifestyle attribute some of these changes to e.g., stress, and the consumption of sugar, meat, and fatty food. • Implications for rehabilitation • A majority of the participants in this study perceived nutrition and lifestyle factors to have an effect on their multiple sclerosis, particularly stress, meat, fatty foods, and processed sugar. • Some participants with multiple sclerosis experienced that nutrition, stress, environmental temperature, and physical activity had a direct effect on the severity of daily symptom manifestations. • Nutrition and lifestyle factors that potentially influence multiple sclerosis disease activity should be considered when organizing rehabilitation and care to better meet the needs of the individual with multiple sclerosis.
... A recent study found most people with MS did not meet nutritional guidelines for fruit, vegetables, and whole grain consumption [6]. Already in the 1950s, Swank et al. observed that people who consumed less animal fat had lower rates of MS [7]. Studies investigating an MS animal model revealed harmful as well as beneficial effects of saturated fats, depending on their aliphatic chain length [8]. ...
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Background: Multiple sclerosis (MS) is a multifactorial disease with unknown etiology. It is assumed to result from interplay between genetic and environmental factors, including nutrition. We hypothesized that there are differences in nutritional parameters between MS patients and healthy controls. Methods: We examined 63 MS patients and 83 healthy controls. Nutritional status was determined by a dietary questionnaire, blood tests, quantification of cell membrane fatty acids, and serum antioxidant capacity. Results: We found that MS patients consumed a more limited diet compared with the healthy group, indicated by a lower average of 31 nutrients and by consumption levels of zinc and thiamine below the recommended daily intake. Both consumption and measured iron values were significantly lower in MS patients, with the lowest measures in the severe MS group. Long saturated fatty acids (>C16) were significantly lower in MS patients, while palmitic and palmitoleic acids were both higher. Serum total antioxidant capacity was significantly lower in the MS group compared with healthy controls, with the lowest measures in patients with severe MS. Conclusions: This study points to a possible correlation between nutritional status and MS. Understanding the clinical meaning of these findings will potentially allow for the development of future personalized dietary interventions as part of MS treatment.
... The patients' clinical outcomes were monitored, including physical and mental performance [16][17][18][19][20][21]. The Swank study found that the number of relapses and progression of disability was associated strongly with dietary saturated fat consumption [17][18][19][20][21][22]. The 50-year follow-up is a strength of the Swank study, but the absence of a control group and lack of brain imaging are limitations. ...
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Background: Fatigue is one of the most disabling symptoms of multiple sclerosis (MS) and contributes to diminishing quality of life. Although currently available interventions have had limited success in relieving MS-related fatigue, clinically significant reductions in perceived fatigue severity have been reported in a multimodal intervention pilot study that included a Paleolithic diet in addition to stress reduction, exercise, and electrical muscle stimulation. An optimal dietary approach to reducing MS-related fatigue has not been identified. To establish the specific effects of diet on MS symptoms, this study focuses on diet only instead of the previously tested multimodal intervention by comparing the effectiveness of two dietary patterns for the treatment of MS-related fatigue. The purpose of this study is to determine the impact of a modified Paleolithic and low saturated fat diet on perceived fatigue (primary outcome), cognitive and motor symptoms, and quality of life in persons with relapsing-remitting multiple sclerosis (RRMS). Methods/design: This 36-week randomized clinical trial consists of three 12-week periods during which assessments of perceived fatigue, quality of life, motor and cognitive function, physical activity and sleep, diet quality, and social support for eating will be collected. The three 12-week periods will consist of the following: 1. Observation: Participants continue eating their usual diet. 2. Intervention: Participants will be randomized to a modified Paleolithic or low saturated fat diet for the intervention period. Participants will receive support from a registered dietitian (RD) through in-person coaching, telephone calls, and emails. 3. Follow-up: Participants will continue the study diet for an additional 12 weeks with minimal RD support to assess the ability of the participants to sustain the study diet on their own. Discussion: Because fatigue is one of the most common and disabling symptoms of MS, effective management and reduction of MS-related fatigue has the potential to increase quality of life in this population. The results of this study will add to the evidence base for providing dietary recommendations to treat MS-related fatigue and other symptoms associated with this disease. Trial registration: ClinicalTrials.gov, NCT02914964 . Registered on 24 August 2016.
... Specific dietary interventions have focused primarily on the modification of macronutrient consumption (e.g., low-fat diets) and/or dietary supplementation (e.g., fatty acids, antioxidants, and vitamins) [76•, 77, 79]. Some of the earliest evidence on diet in patients with MS comes from a 34-year, prospective trial that examined a low-saturated-fat diet (G 10-15 g/day) with polyunsaturated fatty acid (PUFA) supplementation, commonly referred to as the "Swank diet" [80]. This study reported lower rates of mortality and levels of disability among patients who were classified as "good dieters" (FAT G 20 g/day) compared to "poor dieters" (FAT 9 20 g/day) over the study period; however, there are a number of methodological limitations of this trial including the lack of a control condition and randomization. ...
Article
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Purpose of review: There has been recent interest in the role of lifestyle and wellness-based approaches in the treatment and management of multiple sclerosis (MS). These approaches may be particularly relevant for patients with progressive MS, considering limited therapeutic options currently available. The purpose of this review is to examine the role of wellness-based interventions including exercise training, emotional well-being therapies, and dietary modification in patients with progressive MS. Recent findings: We conducted a literature search on the efficacy of wellness-based interventions in patients with progressive MS published between 1985 and July 2017. The level of evidence for each trial was evaluated using the American Academy of Neurology criteria. Overall, 21 articles reporting on 16 wellness-based interventions were identified: ten trials involved exercise training, three involved emotional wellness therapies, two involved dietary modification, and one was a combined wellness intervention. There is level C evidence (possibly effective; one class II study) for the efficacy of aerobic exercise training on cardiorespiratory fitness in patients with progressive MS. There is level B evidence (probably effective; one class I study) for the efficacy of mindfulness training on psychological distress, depression, anxiety, pain, and quality of life in patients with progressive MS. There is inadequate evidence (level U) for efficacy of dietary modification (one class III study and one class IV study) and combined wellness interventions involving exercise training, meditation, and dietary modification (one class IV study). High-quality research is needed to provide evidence-based recommendations for wellness behaviors and lifestyle change in patients with progressive MS.
... In addition, various studies on independent cohorts have shown that overweight in adolescents, expressed by increased body mass index, increases the risk of MS in boys and girls [30,31]. An older study published in The Lancet demonstrated initial evidence for the positive effects of a diet with a lower proportion of saturated long-chain fatty acids (less than 20 g/day) in a smaller study group of MS patients [32]. ...
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Zusammenfassung Die Ursachenforschung auf dem Gebiet der Multiplen Sklerose (MS) hat dank neuer molekularbiologischer Techniken und großer Konsortien in den letzten Jahren vor allem hinsichtlich des genetischen Risikos immense Fortschritte erlebt. Allerdings bleibt die funktionelle Relevanz krankheitsassoziierter Risiko-Genvarianten unklar und spielt mit ca. einem Drittel des Gesamtrisikos die Genetik gegenüber den Umwelt-Risikofaktoren eher eine untergeordnete Rolle. Somit ist die weitere Identifikation und ggf. Prävention von Umwelt-Risiken aktuell im Fokus der Forschung. Hier haben sich jüngst vor allem Risikofaktoren für die MS gezeigt, die eng mit Lifestyle und Ernährung in Zusammenhang stehen, wie die sog. westliche Diät und Lebensstil, u. a. mit hohem Kochsalzkonsum und Zigarettenrauch. Darüber hinaus rückt der menschliche Darm immer weiter in den Fokus der Forschung: Mit seiner großen Oberfläche bietet der Darm immense Interaktionsmöglichkeiten zwischen den im Darm ansässigen Bakterien, der Nahrung und ihren Stoffwechselprodukten sowie dem Darm assoziierten Immunsystem. In der vorliegenden Arbeit fassen wir bisherige Erkenntnisse aus dem stetig wachsenden Forschungsgebiet zusammen, das sich mit dem Darm, der Ernährung und der MS befasst und diskutieren, wie diese Erkenntnisse, wie zuletzt für Fettsäuren von uns gezeigt, translational-therapeutisches Potenzial haben könnten.
... In addition, various studies on independent cohorts have shown that overweight in adolescents, expressed by increased body mass index, increases the risk of MS in boys and girls [30,31]. An older study published in The Lancet demonstrated initial evidence for the positive effects of a diet with a lower proportion of saturated long-chain fatty acids (less than 20 g/day) in a smaller study group of MS patients [32]. ...
Article
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During recent years, research into the causes of multiple sclerosis (MS), especially in the field of genetic risks of this disease, has made immense advances, thanks to new molecular biology techniques and large consortia. However, the functional relevance of disease-associated risk gene variants remains unclear, and representing about one-third of the overall risk compared to environmental risk factors, plays a smaller role. Thus, the further identification and, where appropriate, prevention of environmental risks is currently the focus of research. Here recently, risk factors for MS have been shown which are closely related to Western diet and lifestyle, such as high consumption of salt and cigarette smoking. In addition, the human gut continues to be the focus of research: with its large surface, the gut offers immense opportunities for interaction between intestinal bacteria, food and their metabolic products, as well as the immune system associated with the gut. In the present paper, we summarize the findings of the constantly growing research field dealing with the gut, nutrition and MS, and discuss how these findings, as shown recently for fatty acids, could have translational-therapeutic potential.
... patterns, especially the overconsumption of dietary fats and high energy dietary regimens, are more likely to be associated with the etiology of MS (Hedström et al., 2014). Nowadays, it is accepted that weight gain in MS patients may be associated with greater disability because the overweight may aggravate the MS symptoms (Swank & Dugan, 1990;Khurana et al.). ...
Article
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Intermittent fasting diet (IF) as a restrictive regimen prevents neural degeneration and stimulates overexpression of various neurotropic factors in the hippocampus of animal models. This study evaluates the potential effect of the IF in the prevention of learning and memory dysfunction and improving the alterations in the number and volume of neurons in an ethidium bromide (EB) induced mouse model of demyelination.Mice were randomly assigned into N group (Normal Diet and normal saline injection), F group (IF and normal saline injection), EBN group (Normal Diet and EB injection), EBF group (IF and EB injection). The hidden platform test was carried out based on path length, escape latency and swim speeds of mice. Stereological studies were determined by the Cavalieri and the Optical Dissector technique. Maintenance of mice on the IF results in significantly decreased the body weight and biochemical parameters, increased total number of neurons and volume of the hippocampus, and improved learning and memory parameters of adult male mice. However, IF in EBF group did not show as excellently as F group. The EBF group displayed significantly spatial memory improvement than that in EBN group. There were no statistically significant differences between EBF and EBN groups in stereological and learning parameters, though the EBF group displayed faster escape latencies, and swam faster and shorter path lengths than the EBN group in these parameters. Therefore as a conclusion, The IF fairly improved some adverse effects of EB in experimental demyelination models.
... Even though a cure to MS has yet to be developed, dietary modifications have shown promising results in delaying and easing symptoms of MS. A low fat diet has been shown to result in lower deterioration and death rates (Swank and Dugan 1990). Similarly, a low fat diet supplemented with the omega-3 fatty acids from fish oil has also been shown to decrease the severity of MS symptoms (Weinstock-Guttman et al. 2005). ...
Article
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A paradox is a seemingly absurd or impossible concept, proposition, or theory that is often difficult to understand or explain, sometimes apparently self-contradictory, and yet ultimately correct or true. How is it possible, for example, that oxygen “a toxic environmental poison” could be also indispensable for life (Beckman and Ames Physiol Rev 78(2):547–81, 1998; Stadtman and Berlett Chem Res Toxicol 10(5):485–94, 1997)?: the so-called Oxygen Paradox (Davies and Ursini 1995; Davies Biochem Soc Symp 61:1–31, 1995). How can French people apparently disregard the rule that high dietary intakes of cholesterol and saturated fats (e.g., cheese and paté) will result in an early death from cardiovascular diseases (Renaud and de Lorgeril Lancet 339(8808):1523–6, 1992; Catalgol et al. Front Pharmacol 3:141, 2012; Eisenberg et al. Nat Med 22(12):1428–1438, 2016)?: the so-called, French Paradox. Doubtless, the truth is not a duality and epistemological bias probably generates apparently self-contradictory conclusions. Perhaps nowhere in biology are there so many apparently contradictory views, and even experimental results, affecting human physiology and pathology as in the fields of free radicals and oxidative stress, antioxidants, foods and drinks, and dietary recommendations; this is particularly true when issues such as disease-susceptibility or avoidance, “healthspan,” “lifespan,” and ageing are involved. Consider, for example, the apparently paradoxical observation that treatment with low doses of a substance that is toxic at high concentrations may actually induce transient adaptations that protect against a subsequent exposure to the same (or similar) toxin. This particular paradox is now mechanistically explained as “Adaptive Homeostasis” (Davies Mol Asp Med 49:1–7, 2016; Pomatto et al. 2017a; Lomeli et al. Clin Sci (Lond) 131(21):2573–2599, 2017; Pomatto and Davies 2017); the non-damaging process by which an apparent toxicant can activate biological signal transduction pathways to increase expression of protective genes, by mechanisms that are completely different from those by which the same agent induces toxicity at high concentrations. In this review, we explore the influences and effects of paradoxes such as the Oxygen Paradox and the French Paradox on the etiology, progression, and outcomes of many of the major human age-related diseases, as well as the basic biological phenomenon of ageing itself.
... Take diet for example, which is probably one of the most studied but most controversial of risk factors for MS progression. Since the uncontrolled intervention study of Swank and Dugan over an extraordinarily long timeframe showed that "poor dieters" had much worse outcomes than those who could dramatically reduce animal fat in their diets (24), numerous epidemiological studies (25) and a few very small RCTs (26,27) have provided evidence about animal fat being a key risk in MS disease progression, along with resultant poor blood lipid profile (15,28,29) and overweight and obesity (11,30). ...
... For example, Swank and Duggan first noted that diet had a significant influence on MS in 1987. 26 Since then, the Paleolithic diet has become a popular approach for tackling weak digestion. 27 More recently developed easy-to-digest diets include the Whole 30 and GAPS [Gut and Psychology Syndrome] diets. ...
Article
The incidence of complex chronic health conditions is rising. Some of these conditions might have their roots in gut disturbances, which in Chinese Medicine would be categorized as Spleen and Stomach Qi Disharmonies. In this article, the author explores these issues from an integrative perspective and suggests areas where acupuncture techniques could be helpful. Five cases are described briefly to illustrate the use of acupuncture.
... Dr. Swank studied this approach in an open-label trial and found that subjects that followed the diet vigorously had better health 34 and 50 years later [45,46]. Adherence to the diet appeared to be associated with reduced relapse rate, reduced disability progression, and improved overall survival. ...
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Multiple Sclerosis (MS) is a chronic, disabling neurologic disease that has its onset in young adulthood. While the knowledge about underlying pathogenesis of MS has improved significantly over the last few decades, the exact cause still eludes us. Despite the availability of several United States Food and Drug Administration-approved disease-modifying therapies (DMT) for MS in the last two decades, the disease remains disabling for many. DMT use is limited by its partial effectiveness, significant side effects in many cases, and high cost that leads people with MS (PwMS) to look for alternative management options. Dietary intervention as a possible mode to help MS seems very appealing to PwMS; however, scientific data supporting this notion remains sparse. New information on the role of various non-MS health factors, especially vascular disease risk factors such as hypertension, hyperlipidemia, salt intake, and obesity, that may play a role in MS pathogenesis appears very intriguing as it may partly explain the heterogeneity seen in MS activity and disability. This review will highlight the emerging information on various dietary approaches that may affect MS and their possible underlying mechanism.
... compatible with the known epidemiology and genetics implicating little sun but a lot of meat and known involvement of the 'de novo' pathway. [347][348][349] It will have been partly iatrogenic if increasing the dose of nicotinamide with supplements also affects caloric hunger and obesity levels and other diseases where NNMT induction has been demonstrated. 350,351 Phenotypic diversity may be explained by individual variation whether genetic or from previous environmental exposure and in differential sensitivity of cell types to NAD upsets. ...
Article
Meat and vitamin B3 – nicotinamide – intake was high during hunter-gatherer times. Intake then fell and variances increased during and after the Neolithic agricultural revolution. Health, height, and IQ deteriorated. Low dietary doses are buffered by ‘welcoming’ gut symbionts and tuberculosis that can supply nicotinamide, but this co-evolved homeostatic metagenomic strategy risks dysbioses and impaired resistance to pathogens. Vitamin B3 deficiency may now be common among the poor billions on a low-meat diet. Disease transitions to non-communicable inflammatory disorders (but longer lives) may be driven by positive ‘meat transitions’. High doses of nicotinamide lead to reduced regulatory T cells and immune intolerance. Loss of no longer needed symbiotic ‘old friends’ compounds immunological over-reactivity to cause allergic and auto-immune diseases. Inhibition of nicotinamide adenine dinucleotide consumers and loss of methyl groups or production of toxins may cause cancers, metabolic toxicity, or neurodegeneration. An optimal dosage of vitamin B3 could lead to better health, but such a preventive approach needs more equitable meat distribution. Some people may require personalised doses depending on genetic make-up or, temporarily, when under stress.
... Sunlight may be implicated in the aetiology of the disease, therefore, although it is not the sole explanation as rates of the disease are relatively low in some northern areas. Some studies suggest there may be an interaction between sunlight and diet (Swank et al. 1952;Swank & Dugan 1990;Kampman et al. 2007), and this might explain the geographical variations in risk for French farmers which is not obviously related to sunlight, but may be related to the intake of oily fish as lower risk pervades in regions on the Atlantic coast (Vukusic et al. 2007). Of course, the geographical distinctiveness of MS could be influenced by both nature and nurture. ...
... The only prospective study investigated the Swank diet and showed that for poor dieters, the average worsening significantly exceeded those of the good dieters. 19 Fish consumption (associated with vitamin D and fatty acid intake) has been evaluated in three studies. Studies differed in risk factor timing and outcome measures and reported conflicting results with regard to the presence or absence of a negative association with MS progression. ...
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Background: The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors. Objective: To systematically review modifiable risk factors and exposures associated with MS progression. Methods: We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence. Results: In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = -0.22; confidence interval (CI) = -0.32, -0.12; 11 studies; I(2) = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I(2) = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures. Conclusion: MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.
... Omega-3 fatty acids may have clinical and biochemical effects in patients with MS. This supplement may Some Unique Considerations in Treatment of Multiple Sclerosis have anti-inflammatory, antithrombotic, antioxidant, immuno-modulatory functions, as well as neuroprotective effects 16,17 . Because increased oxidative damage has been associated with disease progression, a reduction of proinflammatory cytokines and oxidative stress could benefit patients. ...
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With the advent of novel vesicular drug delivery systems especially bilosomes, for large molecular weight proteins and peptides, their oral administration seems a viable approach. These nano-vesicles have shown promising results for the effective delivery of insulin and other therapeutics, perhaps due to their structural composition. The present review has elaborated the biopharmaceutical challenges for the oral delivery of therapeutic proteins and peptides as well as presented a novel approach to deliver the essential macromolecules through oral route as bilosomes. The extensive search has been presented related to the formulation, evaluation and in vivo performance of bilosomes. Some of the crucial findings related to bilosomes have corroborated them superior to other colloidal carriers. The successful drug delivery through bilosomes requires significant justifications related to their interaction with the biological membranes. The other aspects such as absolute absorption, safety and toxicity of bilosome drug delivery should also be equally considered.
... Lipid Profile Mean Changes (95% CI), mg/dl B ! Intake Mean Changes (95% CI) C # The study diet differs from the low-saturated fat Swank diet [28] and the plant-based, lowfat McDougall diet [7] in that it does not restrict consumption of animal protein, fat or saturated fat. The study diet and McDougall diet restrict dairy and eggs but the Swank diet allows <1% milk fat dairy and egg whites ad libitum and up to three whole eggs per week. ...
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Purpose To investigate associations between lipid profiles and fatigue in a cohort of progressive multiple sclerosis (MS) patients on a diet-based multimodal intervention. Methods This pilot study included 18 progressive MS patients who participated in a prospective longitudinal study of fatigue following a diet-based multimodal intervention that included exercise, neuromuscular electrical stimulation and stress reduction. The diet recommended high intake of vegetables and fruits, encouraged consumption of animal and plant protein and excluded foods with gluten-containing grains, dairy and eggs. Fatigue was measured on the Fatigue Severity Scale (FSS) at baseline and every 3 months for 12 months. A lipid profile consisting of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) was obtained on fasting blood samples at baseline and 12 months. Results FSS scores decreased from a baseline of 5.51 (95% CI: 4.86, 6.16) to a mean of 3.03 (95% CI: 2.23, 3.82) at 12 months (p < 0.001). At 12 months, increases in HDL-C (mean change: +6.0 mg/dl; 95% CI: 0.3, 12.0; p = 0.049) and decreases in BMI (mean change: -2.6 kg/m²; 95% CI: -3.6, -2.5; p < 0.001), LDL-C (mean change: -10.4 mg/dl; 95% CI:-19.7, -1.2; p = 0.029), TG (mean change: -29.2 mg/dl; 95% CI: -44.3, -14.2; p = 0.001), TG to HDL-C ratio (mean change: -0.6; 95% CI: -1.0, -0.3; p = 0.002) and TC to HDL-C ratio (mean change:-0.6; 95% CI: -1.0, -0.3; p = 0.003) were observed compared to baseline. Improvements in FSS were associated with increases in HDL-C (β = -0.05; 95% CI: -0.1, -0.0004; p = 0.048) and changes in TC (p = 0.005) from baseline to 12 months. Conclusions Lipid profile variables are associated with improvements in fatigue in progressive MS patients on a diet-based multimodal intervention.
... The incidence of MS exacerbations during the first prediet year in the study was shown to be approximately doubled when compared with the subsequent 2 years on low fat diet [9]. The same population (with very low dropout rate of only six patients) was later followed for an additional 34 years and showed that the group with the lowest consumption of dietary saturated fat (≤20 g/day) had three times lower mortality rate than those with dietary fat intake ranging between 24 and 42 g/day (31 vs 81% of deceased subjects) [10]. A smaller and shorter longitudinal study of low fat intake and supplementation with omega (ώ)-3 also demonstrated improvement in patient-reported physical and mental health [11]. ...
Article
Multiple sclerosis (MS) is a lifelong inflammatory and neurodegenerative disease influenced by multiple lifestyle-based factors. We provide a narrative review of the effects of modifiable risk factors that are identified as being associated with risk to develop MS and/or influencing the future clinical disease outcomes. The emerging data regarding the beneficial effects of diet modifications and exercise are further reviewed. In contrast, obesity and comorbid cardiovascular diseases are associated with increased MS susceptibility and worse disease progression. In addition, the potential influence of smoking, coffee and alcohol consumption on MS onset and disability development are discussed. Successful management of the modifiable risk factors may lead to better long-term outcomes and improve patients' quality of life. MS specialists should participate in educating and facilitating lifestyle-based modifications as part of their neurological consults.
... patterns, especially the overconsumption of dietary fats and high energy dietary regimens, are more likely to be associated with the etiology of MS (Hedström et al., 2014). Nowadays, it is accepted that weight gain in MS patients may be associated with greater disability because the overweight may aggravate the MS symptoms (Swank & Dugan, 1990;Khurana et al.). ...
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HASSANPOUR, A.; REZVANI, M. E.; HOSSEINI, M. S. & BASIRI, M. The effect of intermittent fasting diet on the hippocampus of adult male mouse after inducing demyelination by ethidium bromide injection. Int. J. Morphol., 37(3):805-814, 2019. SUMMARY: Intermittent fasting diet (IF) as a restrictive regimen prevents neural degeneration and stimulates overexpression of various neurotropic factors in the hippocampus of animal models. This study evaluates the potential effect of the IF in the prevention of learning and memory dysfunction and improving the alterations in the number and volume of neurons in an ethidium bromide (EB) induced mouse model of demyelination.Mice were randomly assigned into N group (Normal Diet and normal saline injection), F group (IF and normal saline injection), EBN group (Normal Diet and EB injection), EBF group (IF and EB injection). The hidden platform test was carried out based on path length, escape latency and swim speeds of mice. Stereological studies were determined by the Cavalieri and the Optical Dissector technique. Maintenance of mice on the IF results in significantly decreased the body weight and biochemical parameters, increased total number of neurons and volume of the hippocampus, and improved learning and memory parameters of adult male mice. However, IF in EBF group did not show as excellently as F group. The EBF group displayed significantly spatial memory improvement than that in EBN group. There were no statistically significant differences between EBF and EBN groups in stereological and learning parameters, though the EBF group displayed faster escape latencies, and swam faster and shorter path lengths than the EBN group in these parameters. Therefore as a conclusion, The IF fairly improved some adverse effects of EB in experimental demyelination models.
... The "Swank diet," a low saturated fat diet (not more than 10-15 g/day), has been widely used by MS patients since 1950s and shown, possibly, to modestly reduce MS disease activity and disability progression in follow-up studies. [49][50][51] Complementary and alternative medicines (CAM), usually with vitamins, minerals, and essential fatty acids, also have been taken by MS patients in conjunction with conventional treatments, but with limited research evaluating their safety and effectiveness. 52, 53 We did not observe a significant difference of dietary structure between MS and HHCs in this relatively small cohort study, but a correlation of diet and gut microbiome was detected, which will be further explored in the larger study. ...
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Background Evidence for a role of human gut microbiota in multiple sclerosis (MS) risk is mounting, yet large variability is seen across studies. This is, in part, due to the lack of standardization of study protocols, sample collection methods, and sequencing approaches. Objective This study aims to address the effect of a household experimental design, sample collection, and sequencing approaches in a gut microbiome study in MS subjects from a multi-city study population. Methods We analyzed 128 MS patient and cohabiting healthy control pairs from the International MS Microbiome Study (iMSMS). A total of 1005 snap-frozen or desiccated Q-tip stool samples were collected and evaluated using 16S and shallow whole-metagenome shotgun sequencing. Results The intra-individual variance observed by different collection strategies was dramatically lower than inter-individual variance. Shallow shotgun highly correlated with 16S sequencing. Participant house and recruitment site accounted for the two largest sources of microbial variance, while higher microbial similarity was seen in household-matched participants as hypothesized. A significant proportion of the variance in dietary intake was also dominated by geographic distance. Conclusion A household pair study largely overcomes common inherent limitations and increases statistical power in population-based microbiome studies.
... Moreover, the development of liver cancer promoted by obesity depends on the production of tumor promoting cytokines IL-6 and TNF, which can cause liver inflammation and activation of oncogenic transcription factor STAT3 [39]. The pathway k556 most correlated with Lactobacillus ruminis was reported to be implicated in multiple sclerosis [40], which is closely related to diet [41,42] and IL-6 [43,44]. On the other hand, Haemophilus parainfluenzae was negatively associated with high plantbased diet, and was linked to elevated total indoxyl sulfate (IS) levels [45]. ...
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The analysis of microbiome data has several technical challenges. In particular, count matrices contain a large proportion of zeros, some of which are biological, whereas others are technical. Furthermore, the measurements suffer from unequal sequencing depth, overdispersion, and data redundancy. These nuisance factors introduce substantial noise. We propose an accurate and robust method, mbDenoise, for denoising microbiome data. Assuming a zero-inflated probabilistic PCA (ZIPPCA) model, mbDenoise uses variational approximation to learn the latent structure and recovers the true abundance levels using the posterior, borrowing information across samples and taxa. mbDenoise outperforms state-of-the-art methods to extract the signal for downstream analyses.
... However, it is worth noting that the available evidence is not conclusive regarding the impact of dietary and/or supplemental xanthophyll consumption on various clinical and functional outcomes, especially in the MS population. Studies related to the impact of nutritional intake on MS have explored several outcomes including disease incidence (48) and mortality rates (49), functional outcomes such as ambulation (50) and cognition (51), and subjective self-report measures such as anxiety, depression (52), and fatigue (53,54). Fewer studies, however, have integrated objective biomarkers associated with disease pathophysiology and nutritional status. ...
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Background Multiple sclerosis (MS) can cause retinal thinning among persons with MS with optic neuritis (MS-ON). Macular xanthophylls are carotenoids that comprise the macular pigment, filtering blue light and countering photo-oxidation. However, macular xanthophyll status and its implications for markers of neuroaxonal degeneration have not been examined in MS. Objectives This study characterized differences in macular and serum xanthophylls, and retinal morphometry [retinal nerve fiber layer thickness at the macular (mRNFL) and optic disc (odRNFL) and total macular volume (TMV)] in individuals with MS and healthy controls (HC). Associations between macular pigment optical density (MPOD) and retinal morphometry were also examined. Methods Adults aged 45–64 y (HC, n = 42; MS, n = 40) participated in a cross-sectional study. MPOD was measured via heterochromatic flicker photometry. Retinal morphometry was measured via optical coherence tomography (OCT). Serum carotenoids were quantified using HPLC. Dietary carotenoids were collected using 7-d records. One-factor ANOVA was conducted to determine group effects on macular, serum, and dietary carotenoids. Partial correlations examined the relations between MPOD, retinal morphometry, diet, and serum carotenoids. Results Relative to HC, persons with MS-ON had lower MPOD (Cohen's d = 0.84, P = 0.014), lower odRNFL (Cohen's d = 2.16, P <0.001), lower mRNFL (Cohen's d = 0.57, P = 0.028), and lower TMV (Cohen's d = 0.95, P = 0.011). MS without ON (MS) had lower odRNFL (Cohen's d = 0.93, P = 0.001) than HC and lower serum lutein than MS-ON subjects (Cohen's d = 0.65, P = 0.014). Among MS, MPOD was positively correlated with odRNFL thickness (ρ = 0.43, P = 0.049) and TMV (ρ = 0.45, P = 0.039), whereas odRNFL was negatively correlated with serum lutein (ρ = −0.68, P = 0.016) and zeaxanthin (ρ = –0.62, P = 0.028). Conclusions Persons with MS-ON exhibited poorer xanthophyll status in the macula and serum. MPOD was associated with beneficial anatomical features in the MS group. These findings warrant confirmation with larger cohorts and prospective trials to evaluate xanthophyll effects on the anterior visual pathway in MS.
... The main aim of this paper is to report on the dietary choices and health outcomes of pwMS who volunteered because they received venous percutaneous transluminal angioplasty (PTA). Many diets have been proposed for the management of multiple sclerosis and other neurodegenerative diseases [17][18][19][20]. Australians with MS frequently adopt diets low in fat, sugar, and gluten [21]. ...
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Of the 1575 participants of the CCSVI-Tracking Survey, 475 patients recorded their quality of life and EDSS outcomes for at least 2 months. Self-reported use of complementary and conventional therapies included diet, use of drug therapy, symptoms, quality of life, and mobility. Analysis included comparing outcomes related to different diets within and between groups. Adherence to the MS diet was not associated with a greater quality of life, less disability, a lower Symptom Score, or faster walking speed compared to other diets. Alternately, the participants from the Mediterranean diet region as a whole (µ = 32.65 (SD = 11.37, SEM = 2.37, p = 0.05) had a significantly greater QoL (µ = 60, p = 0.05) and a lower MS symptom score, µ = 32.65 (11.37), p = 0.0029. A decline of symptoms was observed in all diet groups over 3 months with the most dramatic decline observed in participants from the Eastern Mediterranean diet region. The main effect for the within-subjects factor was significant, F(3, 1056) = 55.95, p < 0.001, indicating that there were significant differences between the groups.
... The link between diet and MS has not been sufficiently consigned; some studies have observed a correlation between body-mass index in adolescence and incidence of MS [88]. However, the food intake might affect the disease course, because MS patients that are on a low-fat diet have lower mortality rates compared to a patients on a diet that have high levels of animal protein and fat [89,90]. ...
Article
Persistent neuroinflammation is now recognized as a chief pathological component of practically all neurodegenerative diseases. Neuroinflammation in the central nervous system (CNS), is accompanied with immune responses of glial cells. Glial cells respond to pathological stimuli through antigen presentation, and cytokine and chemokine signaling. Therefore, limiting CNS inflammation represents prospective therapeutic approach in diseases like Alzheimer's, amyotrophic lateral sclerosis, Parkinson's, ischemia, various psychiatric disorders and Multiple sclerosis (MS). As a complex disease, MS is characterized by neuroinflamation, demyelination and sequential axonal loss. Due to unknown etiology and the heterogeneous presentation of the disease, MS is hard to treat and the search for potential therapeutics is wide and meticulous. However, finding a proper anti-neuroinflammatory drug may bring an advance in selecting noveltreatment regimens of ample of neurodegenerative diseases and neurological disorders. The present review gives the overview of the existing and potential therapies in MS, aimed to modulate neuroinflammation and ensure neuroprotection.
... prevalansının yüksek olduğu ülkelere göç eden topluluklarda yapılan epidemiyolojik çalışmalarda yaş faktörünün oldukça önemli olduğu görünmektedir. 14-15 yaşından önce göç edenlerde prevelans, göç edilen ülkeye uymakta, sonra göç edenlerde ise terk ettikleri ülkeye uyduğu görülmektedir 7 Belirlenen diyete (≤20 g yağ/gün) bağlı nörolojik yetersizlik (minimum, orta, şiddetli) üç kategorinin her biri için, belirlenenden daha fazla yağ tüketenlere (>20 g yağ/gün) göre daha az kötüye gitme ve daha düşük ölüm oranları göstermiştir 23 ...
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Amaç: Bu çalışmada Multiple Skleroz (MS) hastalığı öncesi ve MS hastalığı sonrası beslenme alışkanlıklarının karşılaştırılması, yeterli ve dengeli beslenmenin MS ataklarına olan etkisi incelenmiştir. Yöntem: Bu çalışma internet üzerinden oluşturulan veri toplama formu doğrultusunda yer gözetmeksizin ulaşılan, MS tanısı almış yaş ortalaması 34,08±7,93 yıl olan 98 hastanın katılımı ile oluşmuştur. Katılımcıların MS öncesi ve sonrası beslenme durumları, genel bilgileri, ağırlık ve boyları, eğitim düzeyleri, çalışma durumları ve fiziksel aktivite düzeyleri değerlendirilmiştir. Veriler değerlendirilirken SPSS programı kullanılmıştır. Bulgular: Sonuçlara göre atak sıklığını azaltmada probiyotik, prebiyotik, posa, B1 vitamini ve selenyum kaynağı ürünleri tüketiminin olumlu etkisi gözlenmiştir. Sadece B1 vitamini kaynaklarının atak sıklığı ile istatistiksel olarak anlamlı bir ilişkisi olduğu saptanmıştır. Omega-3 ve D vitamini takviyesi alım durumlarının atakların sıklığı ve çeşidine etkisi gözlenmemiştir. Sonuç: Bütün hastalıklarda olduğu gibi MS oluşumunda, atakların sıklığında ve çeşidinde yeterli ve dengeli beslenmenin ne kadar önemli olduğu bu çalışmada da görülmüştür. Sadece yeterli ve dengeli beslenmenin değil sağlıklı bağırsak mikrobiyota oluşumunu etkileyen probiyotik, prebiyotik ürünlerin, posanın, fonksiyonel besinlerin de antioksidan özelliklerinden dolayı mutlaka tüketilmesi gerekmektedir.
... The diet was based on an early observation in 1950 that the incidence of MS appeared to correlate with fat consumption [5]. In a follow-up, 34-year-long, non-randomized study of low-fat diets in MS patients, it was found that MS patients that consumed more fat had higher rates of disability compared to MS patients that limited their fat intake; of the patients that began the study with minimum disability, patients that limited their fat intake to below 20 g of fat per day had a lower final mean neurological grade versus patients that consumed 20 g or more of fat per day [6]. ...
Article
People with multiple sclerosis (PwMS) commonly use complementary and alternative medicines (CAM), but an understanding of their efficacy is lacking. Here, we quantitatively review the class I and class II studies of treatment efficacy for multiple sclerosis from January 2001 to January 2017, in order to assess the modern evidence for CAM use. The 38 studies included in this review are divided across five CAM types (cannabis, diet, exercise, psychological approaches and other). We found little evidence to support CAM efficacy. The studies contained little replication in intervention, primary outcomes or study design. Six of 16 CAMs included in this review were only researched in a single study. Future work in this area should build consensus around study methodologies and primary outcomes.
Article
The prevalence of autoimmune diseases (ADs) worldwide has rapidly increased over the past few decades. Thus, in addition to the classical risk factors for ADs, such as genetic polymorphisms, infections and smoking, environmental triggers have been considered. Recent sequencing-based approaches have revealed that patients with extra-intestinal ADs, such as multiple sclerosis, rheumatoid arthritis, type 1 diabetes and systemic lupus erythematosus, have distinct gut microbiota compositions compared to healthy controls. Faecal microbiota transplantation or inoculation with specific microbes in animal models of ADs support the hypothesis that alterations of gut microbiota influence autoimmune responses and disease outcome. Here, we describe the compositional and functional changes in the gut microbiota in patients with extra-intestinal AD and discuss how the gut microbiota affects immunity. Moreover, we examine how the gut microbiota might be modulated in patients with ADs as a potential preventive or therapeutic approach. Patients with autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis, type 1 diabetes and systemic lupus erythematosus, have distinct gut microbiota compositions compared to healthy controls. This Review explores how the gut microbiota influence autoimmune responses in extra-intestinal autoimmune diseases and discusses potential preventative and therapeutic strategies targeted at the microbiota–immune interface.
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Chronisch neurodegenerative und neuroinflammatorische Erkrankungen, wie beispielsweise das idiopathische Parkinson-Syndrom, die amyotrophe Lateralsklerose und die Multiple Sklerose, stellen eine therapeutische Herausforderung dar. Ihre Ursachen sind nicht gut verstanden, eine Heilung ist für keines dieser Krankheitsbilder möglich. In den zurückliegenden Jahrzehnten haben sich die Lebens- und Ernährungsgewohnheiten in den modernen Industrienationen verändert und es mehren Hinweise, dass sich auch Krankheitsprävalenzen und klinische Präsentationen verändern. Epidemiologische Untersuchungen deuten darauf hin, dass es einen Zusammenhang zwischen Nahrungsmittelbestandteilen und der Pathogenese chronisch neurologischer Erkrankungen gibt. Ein profundes Verständnis solcher Zusammenhänge könnte eine verbesserte Krankheitsprävention sowie auch Therapie ermöglichen. Im vorliegenden Weiterbildungsartikel werden daher die aktuellen Erkenntnisse zu ausgewählten Nahrungsmittelbestandteilen und ihren Effekten auf Entstehung und Verlauf chronisch neurologischer Erkrankungen dargestellt.
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Background: Multiple sclerosis (MS) is a chronic immune-mediated central nervous system disorder that affects females twice as often as males. MS patients show increased susceptibility to obesity and related cardiometabolic disorders, while diet may influence disease course. In the present randomized controlled study, we aimed to increase Mediterranean Diet (MedDiet) adherence in MS women and improve their nutritional status. Methods: Adult women with relapsing-remitting MS (n = 40) were randomly allocated to intervention (n = 20) or control group (n = 20). Individual dietary plans based on MedDiet together with nutritional consultation were provided to the intervention group. Controls received general lifestyle advice according to “National Dietary Guidelines”. Medical history, anthropometry, dietary records, and blood withdrawal were performed at baseline and at 3 months. Results: Compared to controls, the intervention group demonstrated greater MedDiet adherence (p < 0.001), which was negatively associated with cholesterol intake levels (p < 0.05). At 3 months, women following MedDiet had ameliorated body weight and body composition compared to baseline (p < 0.001). Serum 1,25(OH)2D was significantly higher in both study groups at 3 months (p < 0.001), but in the intervention group, the mean increment was twofold compared to controls (p < 0.001). Conclusion: Personalized nutritional intervention in MS patients may improve MedDiet adherence and nutritional status towards cardioprotective health outcomes.
Article
Background : Diet has been associated with the onset and progression of multiple sclerosis (MS). Multiple diets, varying in recommendations, have been proposed as beneficial to people with MS. The characteristics of those who follow specific diet-programs and the relationships of these diet-programs with diet quality is under-explored. Methods : Data from the HOLISM study were analysed. Adherence to selected MS-specific diets (Ashton Embry Best Bet, McDougall, Overcoming MS (OMS), Palaeolithic, Swank, and Wahls Elimination) were each queried on 5-point Likert scales, and moderate (≥3/5) and rigorous (≥4/5) adherence defined. Sociodemographic and clinical characteristics of adherence were evaluated by log-binomial regression. Relationships of diet-program adherence with diet quality were assessed by linear and log-binomial regression, as appropriate. Characteristics of diet quality as measured by Diet Habits Questionnaire was assessed by linear regression. Multivariable models were adjusted for age, sex, socioeconomic status (SES), education, and clinically significant fatigue. Results : Forty-nine percent of participants reported at least 12-month adherence to a diet-program for their MS. Of these, 31.3% rigorously adhered to OMS, 4.9% to Swank, 1.7% to Wahls, and <1.5% to other diet-programs. Only adherence to any diet-program, OMS, Wahls, and Swank, were quantitatively assessed. Females, and participants of lower-than-average SES and longer disease duration were less adherent to any diet-program for MS, as well as those with higher disability, more clinically significant fatigue, greater depression risk, and more comorbidities. Those with higher-than-average SES were more adherent, as were those with higher physical and mental quality of life. Similar relationships were seen for OMS diet-program adherence. Adherence to Wahls diet-program was higher among those with progressive MS types and longer disease duration. No associations were found for adherence to Swank diet-program. Overall diet quality was higher among participants following any diet-program, particularly OMS and Swank, but not Wahls. Conclusion : Greater adherence to MS specific diets was associated with higher SES, and higher quality of life. Following any diet program was associated with higher overall diet quality, with those adhering to the OMS diet having the highest diet quality. These results may inform health professionals in providing guidance to patients regarding diet in MS.
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The objective of this study was to evaluate the role of immune-inflammatory, metabolic, hormonal, and oxidative stress biomarkers in disability progression (DP) and clinical forms of multiple sclerosis (MS). The study evaluated 140 MS patients at admission (T0), and eight (T8) and 16 months (T16) later. The Expanded Disability Status Score (EDSS) and biomarkers were determined at T0, T8, and T16. A DP index (DPI) defined as an increase of ≥1 rank on the EDSS score indicated that 39.3% of the patients had significant DP. Quantification of the ordinal EDSS rank score was performed using optimal scaling methods. Categorical regression showed that the quantitative T16 EDSS score was predicted by T0 homocysteine (Hcy), T0 parathormone (PTH), T0 advanced oxidized protein products (AOPP) (all positively), low T0 vitamin D (<18.3 ng/mL) and T8 folic acid (<5 ng/mL) concentrations while higher T8 calcium concentrations (≥8.90 mg/dL) had protective effects. Linear Mixed Models showed that the change in EDSS from T0 to T16 was significantly associated with changes in IL-17 (positively) and IL-4 (inversely) independently from the significant effects of clinical MS forms, treatment modalities, smoking, age and systemic arterial hypertension. Hcy, PTH, IL-6, and IL-4 were positively associated with progressive versus relapsing-remitting MS while 25(OH)D was inversely associated. In conclusion, the ordinal EDSS scale is an adequate instrument to assess DP after category value estestimation. Aberrations in immune-inflammatory, metabolic and hormonal biomarkers are associated with DP and with the progressive form of MS.
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Multiple sclerosis (MS) is a multifactorial, inflammatory, and neurodegenerative disease of the central nervous system, where environmental factors interact with genetic susceptibility. The role of diet on MS has not been comprehensively elucidated; therefore, through an extensive search of relevant literature, this review reports the most significant evidence regarding nutrition as a possible co-factor influencing the inflammatory cascade by acting on both its molecular pathways and gut microbiota. Since nutritional status and dietary habits in MS patients have not been extensively reported, the lack of a scientific-based consensus on dietary recommendation in MS could encourage many patients to experiment alternative dietetic regimens, increasing the risk of malnutrition. This work investigates the health implications of an unbalanced diet in MS, and collects recent findings on nutrients of great interest among MS patients and physicians. The aim of this review is to elucidate the role of an accurate nutritional counseling in MS to move toward a multidisciplinary management of the disease and to encourage future studies demonstrating the role of a healthy diet on the onset and course of MS.
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Although there is no dietary pattern than has been proven to be effective for reducing the number of relapses or enhancing lesions in patients with multiple sclerosis (MS), several pilot studies have demonstrated the efficacy of dietary plans to reduce MS-related symptoms. Low saturated fat (Swank), low fat vegan (McDougall), modified Paleolithic (Wahls), gluten free, Mediterranean, intermittent fasting, calorie restriction, and intermittent calorie restriction (fasting mimicking diet) all have been associated with reduction of MS-related symptoms such as reduced fatigue, improved mood, and improved quality of life. Mediterranean diet has proven effectiveness for prevention and reduction of comorbid disease severity.
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Introduction: Nutritional intervention, such as a whole-food plant-based (WFPB) diet, is suggested to improve symptoms of autoimmune disorders. Its effects on neuromuscular junction (NMJ) diseases are less known. Case Description: A 56-year-old female with a combined myasthenia gravis and Lambert-Eaton myasthenic syndrome presented with persistent musculoskeletal weakness and pain, fatigue, and diminished concentration. Methods: A WFPB diet was implemented for 5 months in this case study. Functionality, biometrics, and quality of life were assessed at regular intervals via blood work, vital signs, and patient surveys. Results: After 10 weeks, 2 medications were de-prescribed due to improvement in blood glucose levels and blood pressure readings. Neuromuscular symptoms lessened as measured by the Myasthenia Gravis Illness Index. Weight loss of 18.7 pounds was achieved. No deterioration in physical activity was reported throughout the 5-month trial of WFPB diet. Discussion: Our results have implications that an individualized dietary strategy may be considered as one component of management of NMJ diseases. The effects of WFPB diet on NMJ diseases remain inconclusive.
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Objective The role of diet in multiple sclerosis (MS) course remains largely unknown. Children with MS have a higher relapse rate compared with MS in adults. Thus, studying the effect of diet on relapse rate in this age group is likely to provide more robust answers. Methods This is a multicentre study done at 11 paediatric MS centres in the USA. Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome (CIS) with disease onset before 18 years of age and duration of less than 4 years were included in this study. Dietary intake during the week before enrolment was assessed with the validated Block Kids Food Screener. The outcome of the study was time from enrolment to the next relapse. 219 patients with paediatric RRMS or CIS were enrolled. Each 10% increase in energy intake from fat increased the hazard of relapse by 56% (adjusted HR 1.56, 95% CI 1.05 to 2.31, p=0.027), and in particular each 10% increase in saturated fat tripled this hazard (adjusted HR: 3.37, 95% CI 1.34 to 8.43, p=0.009). In contrast, each additional one cup equivalent of vegetable decreased the hazard of relapse by 50% (adjusted HR: 0.50, 95% CI 0.27 to 0.91, p=0.024). These associations remained with mutual adjustment and persisted when adjusting for baseline 25(OH) vitamin D serum level. Other studied nutrients were not associated with relapse. Conclusions This study suggests that in children with MS, high energy intake from fat, especially saturated fat, may increase the hazard to relapse, while vegetable intake may be independently protective.
Article
Background: The role of dietary interventions in improving the symptoms of Multiple Sclerosis (MS) has always been considered, but few studies have been conducted in this area. This study aimed to investigate the effects of modified anti-inflammatory diet on fatigue, quality of life, and inflammatory markers among patients with Relapsing-Remitting Multiple Sclerosis (RRMS). Methods: This randomized clinical trial was conducted on 100 patients with RRMS. The patients were randomly divided into the diet group (anti-inflammatory diet) or the control group (healthy diet recommendations) for 12 weeks. Fatigue and quality of life were assessed by Modified Fatigue Impact Scale (MFIS) and Multiple Sclerosis Quality of Life (MSQoL-54), respectively. Anthropometric measures and inflammatory biomarkers, including Interleukin 17 (IL-17), Interleukin 4 (IL-4), and high sensitivity C-Reactive Protein (hs-CRP), were assessed at baseline and end of the study. Results: The results showed a significant improvement in MFIS as well as in physical and mental components of MSQoL-54 (p = 0.001, p = 0.015, and p = 0.003, respectively) in the diet group compared to the control group. The results also showed a significant increase in IL-4 level (p = 0.022). However, no significant changes were detected in IL-17 and hs-CRP levels (p = 0.091, 0.418, respectively). Conclusion: Modified anti-inflammatory diet could improve fatigue and quality of life and increase IL-4 level.
Article
Background: There is a high level of interest in the potential role of diet among the MS community. There is a limited level of evidence for a Mediterranean-style dietary pattern in MS; the feasibility of conducting studies using educational tools to deliver this type of intervention and study its effects is unknown. Objectives: To establish clinical trial feasibility for future studies utilizing educational delivery of a dietary intervention in MS; to explore the effects of a modified Mediterranean dietary intervention in MS. Methods: We randomly assigned women with MS to follow/not follow the prescribed modified Mediterranean dietary intervention for 6 months, delivered through educational sessions. The diet encouraged the intake of fish and other foods high in poly- and monounsaturated fats, fresh fruits, vegetables, and whole grains and eliminated meat, dairy, and most processed foods and limited salt intake to <2 g/day. Primary endpoints related to meeting target enrollment within the specified time frame, adherence, and study completion. Clinical endpoints were evaluated in an exploratory fashion. Results: We screened 128 potential participants and enrolled 36 within 9 months, surpassing target enrollment of 30 participants at a single center in 1 year. Self-reported adherence was excellent (90.3%), with an overall study completion rate of 94.4%. The intervention group exhibited a statistically significant decline in the trajectory of Neurological Fatigue Index-MS scores (p = 0.01), a trend toward reduced Multiple Sclerosis Impact Scale-29 scores that became significant after outlier removal (p = 0.12; p = 0.023), and a reduction in Expanded Disability Status Scale (p = 0.01) over time as compared to the non-intervention group. Conclusions: It is reasonable to expect a high level of interest and commitment to this type of dietary intervention study in MS, and feasible to deliver it purely through education in a clinical setting with high adherence levels despite restrictive requirements. In this pilot study, a modified Mediterranean dietary intervention reduced fatigue, impact of MS symptoms, and disability. Further work is needed.
Article
Background Dietary patterns and their association with subsequent clinical course have not been well studied in early multiple sclerosis (MS). Objectives To describe dietary patterns in people in 5 years following first clinical demyelination and assess associations with MS conversion and relapse. Methods This study included baseline food frequency questionnaire dietary intake (entry to the Ausimmune Study) and 5-year follow-up; iterated principal factor analysis was applied. MS conversion and relapse risks were assessed by Cox proportional hazards models, adjusted for age, sex, study site, education, body mass index (BMI), smoking and omega-3 supplement use. Results In cases with a first clinical diagnosis of central nervous system (CNS) demyelination, we identified three major dietary patterns, ‘Prudent’, ‘High-Vegetable’ and ‘Mixed’, explaining 43%, 37% and 24% of diet variance in dietary intake, respectively. Fruits, vegetables, fish, wholegrains and nuts loaded highly on the Prudent pattern, starchy vegetables and legumes on the High-Vegetable pattern, and meats and alcohol on the Mixed pattern. Diet factor scores were not associated with MS conversion risk. Those with baseline Prudent scores above the median had significantly lower relapse risk (adjusted hazard ratio = 0.54, 95% confidence interval (CI) 0.37, 0.81) with some evidence of a plateau effect. Conclusion Prudent diet factor score above the median was prospectively associated with lower relapse risk in the 5 years following the first clinical demyelinating event.
Article
Full-text available
Multiple sclerosis (MS) is a chronic inflammatory and demyelinating disease of the central nervous system. In addition to the genetic, epigenetic and immunological components, various other factors e.g. unhealthy dietary habits play a role in the MS pathogenesis. Dietary intervention is a highly appealing approach, as it presents a simple and relatively low risk method to potentially improve outcomes in patients with brain disorders in order to achieve remission and improvement of clinical status, well-being and life expectancy of patients with MS. The importance of saturated fat intake restriction for the clinical status improvement of MS patients was pointed for the first time in 1950s. Recently, decreased risk of first clinical diagnosis of CNS demyelination associated with higher intake of omega-3 polyunsaturated fatty acids particularly originating from fish was reported. Only few clinical trials have been performed to address the question of the role of dietary intervention, such is e.g. low saturated fat diet in MS treatment. This review summarizes current knowledge about the effect of different dietary approaches (diets low in saturated fat and dietary supplements such as fish oil, lipoic acid, omega-3 polyunsaturated fatty acids, seeds oils, high fiber diet, vitamin D, etc.) on neurological signs, patient's well-being, physical and inflammatory status. So far the results are not conclusive, therefore much more research is needed to confirm and to understand the effectiveness of these dietary interventions in the long term and well defined studies.
Article
Full-text available
Purpose of Review This review seeks to examine current research related to the role of diet in multiple sclerosis (MS). Recent Findings Recent research in preclinical models, epidemiologic studies, and limited prospectively followed cohorts provide preliminary evidence that dietary factors influence MS incidence, disease course, and symptomatology. Current evidence for the effects of fatty acids, fruits and vegetables, whole grains, dairy, and salt are reviewed. Dietary patterns including overall diet quality, caloric restriction, McDougall diet, Paleolithic diet, and Mediterranean diet are discussed. Hypotheses regarding potential mechanistic connections underlying observed effects are also presented. Summary Several individual dietary components and patterns demonstrate potential for significant impact in MS. Definitive answers regarding the ability of diet to act as a disease modifier in MS will ultimately require large-scale clinical trials. Continued prospective studies and clinical trials to further advance this line of research are warranted.
Article
Background: Multiple sclerosis (MS) is a common demyelinating disease of the central nervous system. Although the exact pathogenesis remains unknown, the leading theory is that it results from immune system dysregulation. Approved disease-modifying therapy appears to modulate the immune system to improve MS-related outcomes. There is substantial interest in the ability of dietary interventions to influence MS-related outcomes. This is an update of the Cochrane Review 'Dietary interventions for multiple sclerosis' (Farinotti 2003; Farinotti 2007; Farinotti 2012). Objectives: To assess the effects of dietary interventions (including dietary plans with recommendations for specific whole foods, macronutrients, and natural health products) compared to placebo or another intervention on health outcomes (including MS-related outcomes and serious adverse events) in people with MS. Search methods: On 30 May 2019, we searched CENTRAL, MEDLINE, Embase, and Web of Science. We also searched ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform (ICTRP), and Networked Digital Library of Theses and Dissertations (NDLTD). We checked reference lists in identified trials and requested information from trial authors to identify any additional published or unpublished data. Selection criteria: We included any randomized controlled trial (RCT) or controlled clinical trial (CCT) examining the effect of a dietary intervention versus placebo or another intervention among participants with MS on MS-related outcomes, including relapses, disability progression, and magnetic resonance imaging (MRI) measures. Data collection and analysis: We used standard methodological procedures expected by Cochrane. Planned primary outcomes were number of participants experiencing relapse and change in disability progression, according to a validated disability scale at the last reported follow-up. Secondary outcomes included MRI activity, safety, and patient-reported outcomes. We entered and analysed data in Review Manager 5. Main results: We found 41 full-text articles examining 30 trials following full-text review. Participants were adults with MS, defined by established criteria, presenting to MS clinics in Europe, North America, and the Middle East. Study design varied considerably, although all trials had at least one methodological issue leading to unknown or high risk of bias. Trials examined: supplementation to increase polyunsaturated fatty acids (PUFAs) (11 trials); a variety of antioxidant supplements (10 trials); dietary programmes (3 trials); and other dietary supplements (e.g. acetyl L-carnitine, biotin, creatine, palmitoylethanolamide, probiotic, riboflavin) (6 trials). In three trials comparing PUFAs with monounsaturated fatty acids (MUFAs), the evidence was very uncertain concerning difference in relapses (risk ratio (RR) 1.02, 95% confidence interval (CI) 0.88 to 1.20; 3 studies, 217 participants; 75% in the PUFA group versus 74% in the MUFA group; very low-certainty evidence). Among four trials comparing PUFAs with MUFAs, there may be little to no difference in global impression of deterioration (RR 0.85, 95% CI 0.71 to 1.03; 4 studies, 542 participants; 40% in the PUFA group versus 47% in the MUFA group; low-certainty evidence). In two trials comparing PUFAs with MUFAs (102 participants), there was very low-certainty evidence for change in disability progression. None of the PUFA versus MUFA trials examined MRI outcomes. In one trial comparing PUFAs with MUFAs (40 participants), there were no serious adverse events; based on low-certainty evidence. In two trials comparing different PUFAs (omega-3 versus omega-6), there may be little to no difference in relapses (RR 1.02, 95% CI 0.62 to 1.66; 2 studies, 129 participants; 30% in the omega-3 versus 29% in the omega-6 group; low-certainty evidence). Among three trials comparing omega-3 with omega-6, there may be little to no difference in change in disability progression, measured as mean change in Expanded Disability Status Scale (EDSS) (mean difference (MD) 0.00, 95% CI -0.30 to 0.30; 3 studies, 166 participants; low-certainty evidence). In one trial comparing omega-3 with omega-6, there was likely no difference in global impression of deterioration (RR 0.99, 95% CI 0.51 to 1.91; 1 study, 86 participants; 29% in omega-3 versus 29% in omega-6 group; moderate-certainty evidence). In one trial comparing omega-3 with omega-6 (86 participants), there was likely no difference in number of new T1- weighted gadolinium-enhancing lesions, based on moderate-certainty evidence. In four trials comparing omega-3 with omega-6, there may be little to no difference in serious adverse events (RR 1.12, 95% CI 0.38 to 3.31; 4 studies, 230 participants; 6% in omega-3 versus 5% in omega-6 group; low-certainty evidence). In four trials examining antioxidant supplementation with placebo, there may be little to no difference in relapses (RR 0.98, 95% CI 0.59 to 1.64; 4 studies, 345 participants; 17% in the antioxidant group versus 17% in the placebo group; low-certainty evidence). In six trials examining antioxidant supplementation with placebo, the evidence was very uncertain concerning change in disability progression, measured as mean change of EDSS (MD -0.19, 95% CI -0.49 to 0.11; 6 studies, 490 participants; very low-certainty evidence). In two trials examining antioxidant supplementation with placebo, there may be little to no difference in global impression of deterioration (RR 0.99, 95% 0.50 to 1.93; 2 studies, 190 participants; 15% in the antioxidant group versus 15% in the placebo group; low-certainty evidence). In two trials examining antioxidant supplementation with placebo, the evidence was very uncertain concerning difference in gadolinium-enhancing lesions (RR 0.67, 95% CI 0.09 to 4.88; 2 studies, 131 participants; 11% in the antioxidant group versus 16% in the placebo group; very low-certainty evidence). In three trials examining antioxidant supplementation versus placebo, there may be little to no difference in serious adverse events (RR. 0.72, 95% CI 0.17 to 3.08; 3 studies, 222 participants; 3% in the antioxidant group versus 4% in the placebo group; low-certainty evidence). Authors' conclusions: There are a variety of controlled trials addressing the effects of dietary interventions for MS with substantial variation in active treatment, comparator, and outcomes of interest. PUFA administration may not differ when compared to alternatives with regards to relapse rate, disability worsening, or overall clinical status in people with MS, but evidence is uncertain. Similarly, at present, there is insufficient evidence to determine whether supplementation with antioxidants or other dietary interventions have any impact on MS-related outcomes.
Article
Background: Evidence from observational studies increasingly highlights the association between unhealthy diet and poor health outcomes in adults with multiple sclerosis (MS), but very few intervention trials for dietary change have been completed. Improving diet quality via a low glycemic load (GL) diet has demonstrated improvements in cardiometabolic risks, cognitive risks, and psychosocial variables in diseases other than MS. The purpose of this study was to test the feasibility of delivering a low GL dietary intervention implemented via telehealth in a sample of adults with relapsing remitting MS (RRMS). The secondary purpose was to explore the potential impact of the diet on MS outcomes and cardiometabolic risks. Methods: Participants followed a low GL diet consisting of 100g of carbohydrate and GL of ≤45 points/1000 kcal daily for 12 weeks. Each participant received weekly calls from a telecoach, education and behavioral supports via weekly emails, and recorded all food intake on a mobile app. Feasibility was measured as time to recruit, retention and study completion, and intervention adherence. An a priori cut point of 80% completion was used to determine feasibility. Exploratory outcomes included the Multiple Sclerosis Functional Composite (MSFC) and patient-reported outcomes of anxiety, pain, mood, and fatigue. Cardiometabolic risks included body composition, fasting glucose, hemoglobin A1c, and blood pressure. Results: Twenty adults with RRMS (85% female, 50% African American) enrolled in the study and n=18 (90%) completed the intervention and follow-up measures. Participants completed 90% of scheduled calls and recorded at least one meal on 82% of intervention days (mean (SD) = 68 (25.5) days). Participants exceeded recommended daily GL reductions (recommended daily GL: 96.66 (12.97) points, reported follow-up daily GL: 90.32 (39.36) points). Timed 25-foot walk test and symbol digit modalities test both changed in the desired direction. Sleep, mood, anxiety, emotional health, and pain all moved in the expected directions, and anxiety (r=.24), pain (r=-.43), and emotional health (r=-.36) were moderately correlated with reductions in GL. Participants lost a mean of 2.93 (6.31, p=.003) kg, and had reductions in both fat and lean mass (fat mass: 1.94 (2.5) kg; lean mass: .72 (1.29) kg). Conclusion: A low GL dietary intervention is feasible for adults with RRMS and may lead to improvements in MS outcomes and cardiometabolic risk. Additional research is needed with more tightly controlled feeding trials and larger sample sizes to further understand the impact of this dietary pattern on RRMS.
Article
Full-text available
The dietary intake of 83 people with multiple sclerosis (MS) was assessed by the 7-day weighed intake method prior to dietary advice and at 6-monthly intervals thereafter up to 36 months. The P:S ratio of the diet increased from an initial value of 0.8 to 1.5 after 6 months and 1.34 at 36 months. Biochemical investigation of plasma essential fatty acid (EFA) status specifically linoleic, eicosapentanoic and docosahexanoic acids showed significant correlations with diet. Concurrent 6-monthly neurological and physiotherapy assessments were also carried out, the neurological results are discussed in relation to a nutrient scoring system.
Article
MULTIPLE SCLEROSIS is so often inevitably progressive, despite its tantalizing remissions, that both the profession and the public have come to consider it uniformly hopeless. In fact, if a neurologic disease seems at length to be nonprogressive, the diagnosis of multiple sclerosis is more than likely to be discarded. Yet, a wide clinical experience with this exceedingly pleomorphic disease strongly suggests that it may on occasion be a mild disorder indeed—mild in its onset, in its pattern of evolution, or in its ultimate results. It may even remain "clinically silent" for years—or forever.The uniformly evil reputation of multiple sclerosis results from two simple facts: first, it is indeed a malignant disease at one end of its spectrum of severity, and, second, physicians see a biased selection of the "bad" cases but tend to miss or lose the more benign ones. On the one hand, the onset may be
Article
One hundred and sixteen patients with acute remitting multiple sclerosis (MS) took part in a double-blind controlled trial of treatment with polyunsaturated fatty acids and were randomly allocated to one of four groups. Two groups received linoleic acid, one alone as a spread and one with gamma-linolenic acid in capsules (Naudicelle); and two control groups received oleic acid, one as a spread and one in capsules. Rates of clinical deterioration and frequencies of attacks were not significantly different between treated and control groups. Exacerbations were shorter and less severe in patients receiving a high dose of linoleic acid than in controls, but those receiving a lower dose--that is, Naudicelle--showed no such difference. Thus supplementing the diet with 20 g linoleic acid marginally affected the duration and severity of relapses of MS but had no effect on overall disability. The dose of Naudicelle used provided insufficient supplementation.
Article
We have studied the effect of a dietary supplement with linoleic acid (LA) in 76 patients with MS. We could detect no effect of this supplement on the progression of neurological findings, the relapse rate, or the severity of relapses. We were also able to show that oral supplementation with a linoleic acid preparation would raise the blood level of LA in these patients. We were unable to show that there was any reduction in the linoleic acid blood levels associated with acute relapses of MS during this study.
Article
Between 1949 and 1984, 150 multiple sclerosis patients consumed low-fat diets. Fats, oils, and protein intakes; disability; and deaths were determined. On daily fat consumption of less than 20.1 g (average 17 g), 31% died and deterioration was slight. Daily intakes of greater than 20 g (average of either 25 or 41 g) were attended by serious disability and deaths of 79% and 81%, respectively. Oil intakes bore an indirect relationship to fat consumption. Treatment early and before severe disability developed improved prognosis, and females tended to do better than males. High sensitivity to fats suggests they are involved in the genesis of multiple sclerosis.
Article
This article provides a review of Legionnaire's Disease, a bacterial pneumonia caused by Legionella species, and of Pontiac Fever, the flu-like illness caused by these microorganisms. The authors draw on their personal experience with major human outbreaks of Legionnaire's Disease and with animal models of Legionella pneumonia. Emphasis is placed on the sources in nature from which legionellosis is acquired, the means of dissemination of bacteria, the epidemiology of human infections, the pathogenetic mechanisms of disease and host defense, the clinical manifestations, and the treatment.
Article
A group of young patients having multiple sclerosis was treated with dietary supplements containing calcium, magnesium and vitamin D for a period of one to two years. The experimental design employed self-pairing: the response of each patient was compared with his/her own case history as control. The number of exacerbations observed during the program was less than one half the number expected from case histories. No side effects were apparent. The dietary regimen may offer a new means of controlling the exacerbation rate in MS, at least for younger patients. The results tend to support a theory of MS which states that calcium and magnesium are important in the development, structure and stability of myelin.
Article
Demonstration of similarities in geographic distribution of multiple sclerosis (MS) and component of diet would strengthen a consideration that diet plays a causal role in MS. Prevalence of MS in many countries was correlated with average daily per capita consumption of fats and oils, protein, and calories, including calories of animal origin. Of these dietary factors, only calories of animal origin and fats and oils correlated significantly with MS prevalence. When the latter two were combined (animal-fats), a significant correlation with MS prevalence of.70 resulted, suggesting that increased consumption of animal-fat may be associated with MS. Experimental and clinical observations relating diet to increased adhesiveness of formed blood elements, to biochemical alteration of central myelin, and to impaired delayed hypersensitivity are plausible mechanisms linking risk of MS to high animal-fat consumption.
Article
Seventy-five patients in London and Belfast with multiple sclerosis were given daily supplements of a vegetable oil mixture containing either linoleate or oleate for two years in a double-blind control trial. Relapses tended to be less frequent and were significantly less severe and of shorter duration in the linoleate-supplemented group than in those receiving the oleate mixture, but clear evidence that treatment affected the overall rate of clinical deterioration was not obtained.
Article
THIS paper assesses the author's experience in treating cases of multiple sclerosis with a low fat diet for more than 20 years. Previous reports of these studies1-5 were preliminary in intent. The present paper is intended to be final, both in treatment of the data and in conclusions.Materials and Methods Patient Material.— Evaluation and discussion of the materials and methods were presented in detail in a previous paper.4 The more pertinent points, however, will be included here. From December 1948 to April 1954, 264 patients with multiple sclerosis were examined at the Montreal Neurological Institute; 108 were seen only a few times. The remaining 156 patients maintained contact to and beyond April 1954, and no patients were added after this date. Two were rejected because of uncertain diagnosis, and eight were lost during the ensuing years. The remaining 146 patients are included in this report of
Article
Data from three double-blind trials of linoleic acid in the treatment of multiple sclerosis (MS) were reanalyzed to examine whether inconsistency in the results was due to a relationship between patient characteristics and treatment response. The combined data consisted of neurologic assessments over 2 1/2-year trials for 87 treated patients and 85 control patients. Treated patients with minimal or no disability at entry had a smaller increase in disability than did controls (p less than 0.05). In addition, treatment reduced the severity and duration of relapses at all levels of disability and duration of illness at entry to the trials.
Article
One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
Article
IN TWO previous papers the hypothesis has been developed that the geographic variations in the incidence of multiple sclerosis are influenced by the average amount of the fat consumed: A high-fat consumption is associated with a high incidence of multiple sclerosis; a low-fat consumption is associated with a low incidence of multiple sclerosis.1 Evidence has also been presented which suggests that the consumption of relatively saturated milk and animal fats is more likely to be associated with a high incidence of multiple sclerosis than is the consumption of unsaturated vegetable and fish oils. In either event fat intake seems to increase the incidence of multiple sclerosis by precipitating the disease in susceptible persons. With the information at hand it is not possible to prove that the apparent relationship of high-fat consumption to a high incidence of multiple sclerosis is not due to factors other than fat which have the
Article
This article has no abstract; the first 100 words appear below. THE investigation of the distribution of cases of multiple sclerosis in Switzerland between the years 1918 and 1922 seems to have established that the frequency of this disease can vary greatly in different geographic locations.¹ The subsequent studies by Gram² in Denmark and more recent investigations in the United States³,⁴ leave little doubt that these variations may be real and not due to technical errors in diagnosis, methods of collecting the data and so forth. In another study, Swank⁵ has suggested the possibility that these variations are related directly to the amount (and possibly the nature) of the fat consumption. . . . *Supported by a special grant from the Multiple Sclerosis Society of Canada. Source Information MONTREAL, CANADA, AND OSLO, NORWAY †From the Department of Neurology and Neurosurgery, McGill University and the Montreal Neurological Institute. ‡Research Fellow at the Institute of Hygiene, University of Oslo. §Professor of Hygiene, University of Oslo. ¶Chief, Bureau of Vital Statistics, Central Bureau, Oslo.
Forme benigne de le sclerose en plaques
  • Lehoczky
Lehoczky T, Halasy-Lehoczky M. Forme benigne de le sclerose en plaques. Presse Med 1963; 71: 2294.
Legionnaires' disease: isolation of a bacterium and demonstration of its role in our respiratory disease
  • Mcdade
  • Je
  • Shepard
  • Cc
  • Fraser
  • Dw
McDade JE, Shepard CC, Fraser DW, et al. Legionnaires' disease: isolation of a bacterium and demonstration of its role in our respiratory disease. N Engl J Med 1977; 297: 1197-203.
The multiple sclerosis diet book
  • Swank Rl
  • Dugan
  • Bb
Swank RL, Dugan BB. The multiple sclerosis diet book. Garden City, NY: Doubleday, 1987.