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How To Eat To Manage Multiple Sclerosis Symptoms, From A Leading Researcher

Author:

Terry Wahls, M.D.

March 24, 2023

Author and Professor of Medicine

By Terry Wahls, M.D.

Author and Professor of Medicine

Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and board-certified internal medicine physician. She conducts clinical trials, testing the efficacy of diet and lifestyle changes in the setting of autoimmunity.

Image by Liliya Rodnikova / Stocksy

March 24, 2023

I have been conducting clinical research testing the effects of diet on people with multiple sclerosis (MS) for many years. My research is part of a growing body of evidence showing that diet does indeed make a difference for people with MS. Here's what to know about the latest findings.

The evidence that diet eases MS symptoms

The strongest evidence that an intervention is helpful (or harmful) is when multiple studies are combined and analyzed together. This type of analysis is called a meta-analysis. A network meta-analysis combines all known studies and compares them to identify which treatments are the most effective.

In January 2023, there was an editorial in Neurology, the most widely read journal by neuroscientists and practicing neurologists, stating there is now evidence that diet can reduce fatigue and improve the quality of life for people with MS. This is huge.

In this editorial, Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis: A Systemic Review and Network Meta-analysis of Randomized Trials1, Linda Snetselaar, Ph.D., and her team at the University of Iowa conducted a network meta-analysis of randomized dietary intervention studies in MS that lasted at least 12 weeks and had either fatigue or quality of life as an outcome.

The study team found published papers of 12 dietary intervention studies and eight diets. The diets studied included Mediterranean, Paleolithic, ketogenic, anti-inflammatory, low-fat, fasting, calorie restriction, and control diet (the participant's usual diet). A total of 608 participants were enrolled in these 12 studies.

The standardized mean difference (SMD) was calculated for improvements in the measures of fatigue, mental health quality of life, and physical health quality of life for the intervention diet and the control diet.

In analyses like this, the 95% confidence interval (CI) is calculated for the intervention diet and the control diet. If the improvements and the 95% CI are entirely on the side of the intervention, then scientists can safely state the intervention is effective for reducing fatigue or improving quality of life.

When comparing each dietary intervention to control diet, three diets had confidence intervals that were entirely on the side of reducing fatigue. (The other five diets were not significantly better than the control diet.) The magnitude of change for reducing fatigue severity in descending order, was Paleolithic 2 (SMD: -1.27; 95% CI: -1.81, -0.74), low-fat diet (SMD: -0.90; 95% CI: -1.39, -0.42), and Mediterranean (SMD: -0.89; 95% CI: -1.15, -0.64).

We should not be surprised the largest effect size was with the Paleolithic diet. The three most common food antigens that cause excessive activation of the immune system (gluten, casein, and egg albumin) are removed in the modified Paleolithic diet.

So, why does diet seem to make a difference? From animal models of MS, we know that the bacteria, yeasts, and viruses that live in the microbiome influence how reactive the immune cells are in the brain and in the bloodstream. I expect the foods we eat help determine the makeup of our microbiome, which in turn influences how reactive our immune system is.

In addition, in animal models of MS, diet changes gene expression. So the foods we eat likely change our gene expression too. The more added sugars and highly processed foods we consume, the more likely we are to have a microbiome that drives up inflammation. And the more likely we are to have genes expressed that worsen inflammation.

How to eat to manage MS symptoms

Given these findings, what steps can you take to improve your energy and quality of life with MS using food? The three diets with the best data to date are the Mediterranean, modified Paleolithic, and low-saturated-fat diets. Here's a peek at each:

The Mediterranean diet is filled with nonstarchy vegetables, fish, legumes, and olive oil. It's low in added sugars, processed foods, and white breads.
The low-saturated-fat diet includes 4 servings of whole grains per day, 4 servings of vegetables per day, white fish, and white poultry. It limits saturated fat to less than 15 grams per day and reduces or eliminates added sugars, processed foods, and fast foods.
The modified Paleolithic diet recommends 6 to 9 servings of vegetables and berries per day, 6 to 12 ounces of meat/fish per day, and fermented foods. It eliminates grains, dairy, and eggs.

There are common themes with all three diets: more vegetables and fruits, more dietary fiber, less added sugar, less processed foods, and fewer white-flour-based foods and pastas.

In my practice, I recommend my patients start by adding foods before they tackle the elimination phase. I also warn them that removing sugar, processed foods, gluten-containing grains, and dairy often results in cravings, irritability, and headaches for the first week. Those symptoms diminish and are typically resolved in one to two weeks.

If you do plan to make changes to your diet, have a conversation with your medical team and talk with your family members to explore which eating style you could adopt most successfully together. Pair your healthy diet with regular physical activity that is enjoyable and a stress-reducing practice to give yourself the best chance of reducing MS disease activity.

The future of MS management research

In animal models of MS, changes in diet do make a difference. However, we do not have human trials that have gone on for long enough for us to know for certain that diet will slow or accelerate disease progression. Larger, longer studies are needed. My lab is currently inviting people with relapsing-remitting MS to be in our study titled "Efficacy of Diet on Quality of Life in Multiple Sclerosis." (If you have relapsing-remitting MS, are between ages 18 and 70, and are interested in participating in the study, complete the screening tool here.)

Based on my clinical experience with other people with MS, I expect that we will be able to get people back to healthy rates of brain volume loss when they improve their diets. This is important because rapid brain volume loss leads to more problems with thinking and memory and more difficulty walking.

The takeaway

It will take studies that last two to five years for us to know for sure that MS patients can improve their diets to protect their brains. In the meantime, disease-modifying treatments (DMTs) do a very good job of reducing the number of enhancing lesions and relapses that people with MS experience. Pairing a DMT with a healthy diet—high in vegetables, fruits, and fiber and low in sugar, refined grains, and processed foods—and good self-care practices will likely be the most effective way for stopping disease progression.