What we eat can make a huge difference in how we feel; what we don’t eat can also have an impact. Although there is no one multiple sclerosis (MS) diet, there are several different approaches to eating that might make a difference with the disease.
Researching how diet affects health is not an easy task and often starts with studies involving animals. Researchers will often use a mouse model of MS called experimental autoimmune encephalomyelitis (EAE) to test how different interventions affect the immune system or disease symptoms. In the MS community, we often joke that it is the mice that get all the cures. Translating their cures into human treatments has been a huge challenge.
Researchers at the University of Southern California investigating the role of diet interventions in MS found that a fasting-mimicking diet (FMD) promotes neuro-regeneration, reduces autoimmunity, and reduces symptoms in a mouse model of MS. They found that the FMD reduced the severity of clinical symptoms in all study mice and completely reversed symptoms in 20 percent of the animals. The improvements seen with FMD were associated with reduced levels of pro-inflammatory cytokines, increased corticosterone levels, and increased production of oligodendrocyte cells that encouraged remyelination (Choi et al, 2016).
In June 2016 another team of researchers in Germany reported preliminary data from a small pilot study in patients with relapsing-remitting MS who were randomly assigned to one of three study groups. Eighteen patients were placed on a fasting-mimicking diet for a 7-day cycle and then placed on a Mediterranean diet for six months. Also for six months, 18 participants were on a ketogenic high-fat diet (KD) and 12 participants consumed a control diet. Participants in both the FMD and KD groups reported improvements in quality of life and improvements in health, including physical and mental health.
What is a fasting-mimicking diet?
The FMD diet “mimics” fasting because not all food is cut out, but rather caloric intake is significantly reduced for a specified period of time. For the mouse study, mice in the FMD group were fed a very low-calorie, low-protein diet for three days out of every seven for a month. On day 1, they consumed about 50 percent of their normal caloric intake and on days 2-3, only 10 percent.
For the human trial, the modified FMD involved one day of pre-fasting followed by seven days of a very low calorie diet. On day 1, participants consumed 800 kcal of their choice of fruit, rice, or potatoes, followed by an oral laxative on day 2. On days 2-8, the modified FMD consisted of 200-350 kcal of 100 ml vegetable broth or juice with 1 tablespoon of linseed oil three times daily, plus additional calorie-free liquids. Participants were told to drink 2-3 liters of unsweetened fluids each day (water, and herbal teas) and to use an enema if tolerated. After the 7-day fasting period solid foods were stepwise reintroduced for three days, starting with a steamed apple at day 8. After the fasting and re-feeding period, a normal-calorie plant-based Mediterranean diet was maintained for six months.
Should I fast to improve MS symptoms?
Anybody who wishes to dramatically change their diet or way of eating should definitely consult with a doctor first. As mentioned above, many of these types of studies are conducted in mice and those that involve humans are small. Although these study results show that the FMD and KD interventions were safe, well tolerated, and resulted in high compliance rates, researchers point out that the study is limited because it did not test whether the Mediterranean diet alone would cause improvements, nor did it involve a functional MRI or immune function analysis. Larger clinical trials are warranted to determine whether a fasting-mimicking diet could help patients with MS or other autoimmune diseases.
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MS Diet and Nutritional Approaches to Treatment
Choi IY, Piccio L, et al. A Diet Mimicking Fasting Promotes Regeneration and Reduces Autoimmunity and Multiple Sclerosis Symptoms. Cell Rep. 2016 Jun 7;15(10):2136-46. doi: 10.1016/j.celrep.2016.05.009. Epub 2016 May 26.
Lisa Emrich is a patient advocate, accomplished speaker, author of the award-winning blog Brass and Ivory: Life with MS and RA, and founder of the Carnival of MS Bloggers. Lisa uses her experience to educate patients, raise disease awareness, encourage self-advocacy, and support patient-centered research. Lisa frequently works with non-profit organizations and has brought the patient voice to health care conferences and meetings worldwide. Follow Lisa on Facebook, Twitter, and Pinterest.