Photo credit: Sara Dubler, Unsplash
A review of the available evidence for specific diets in multiple sclerosis (MS) has been unable to recommend the routine use of any particular diet.
However it was not all bad news with the review acknowledging there was a growing body of literature suggesting diet was important in the development of MS, its clinical course, symptomology and associated health-related quality of life (HRQOL).
The review said the main proposed mechanisms by which dietary change could help people with MS (pwMS) were in reducing inflammation and promoting neuroprotection.
And a number of trials were ongoing.
However the evidence to date on specific dietary manipulations including caloric restriction/intermittent fasting, ketogenic, gluten free, low carbohydrate, high fat and low sodium diets was modest and most came with potential safety concerns.
Many studies were limited by a lack of blinding, confounders such as obesity, gender, smoking, comorbidities and exercise habits, small numbers or short duration.
“In our opinion, a balanced diet appears to be optimal for general health. However, there is currently insufficient evidence to recommend any specific diet for widespread use by pwMS,” the review said.
“The collective data suggest that certain dietary modifications, such as decreased consumption of animal products, saturated fats, salt, and processed foods coupled with a preference for consumption of whole grains, and increased consumption of legumes, vegetables, and fruit may promote general health and lead to patient-perceived, often clinically meaningful, improvement of symptoms like fatigue and HRQOL.”
The review said patients adhering to restrictive diets such as a ketogenic, Swank, McDougall or Paleo/Wahl’s diet were potentially at risk of vitamin deficiencies.
“For patients considering significant dietary manipulations or restrictive diets, we recommend consultation with a dietician to take into account individual medical comorbidities and avert nutritional deficiencies.”
Only the Mediterranean diet had no identified safety concerns.
Associate Professor Ingrid van der Mei, an epidemiologist at the University of Tasmania’s Menzies Institute for Medical Research, told the limbic that high quality dietary research in MS hasn’t yet been done.
“… and as a result we can’t actually say that these diets actually work. If you really want to recommend somebody adhere to a strict diet, then you’d want to know that it is actually valuable.”
Associate Professor van der Mie, who leads the Australian MS Longitudinal Study, said most people with MS do make an effort to eat healthily.
“We asked that question and I think it was 92% said yes to that.”
She said some people were following a specific diet – many quite loosely – while other people were making up their own diets with restrictions they felt were better for them such as gluten free.
“A lot of people do these diets because they hear anecdotally that it might work. It probably gives them some positive effects – a sense of control, it’s probably good for their overall health anyway and so they might feel a bit better and as a result do a bit more physical activity… but if you really want to say it’s based on the evidence, we can’t say that.”