MSers react to research - Possible role of diet in multiple sclerosis

Here at Shift.ms, we want to ensure MSers voices are heard throughout all of our work. That is why we have updated our MS Latest page to shine the spotlight on what’s currently happening in the MS space, but through the eyes of our community. We hope you enjoy our first research reaction piece, if you would like to write one please email eleanor@shift.ms. 

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Possible role of diet in MS - by Rebecca Maguire 

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Reflections on the paper by Saul et al (2023) A pro-inflammatory diet in people with multiple sclerosis is associated with an increased rate of relapse and increased FLAIR lesion volume on MRI in early multiple sclerosis: A prospective cohort study. Multiple Sclerosis Journal, 13524585231167739.

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Should you change your diet because you have multiple sclerosis? 

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Whether or not to change one’s diet when living with MS has been the topic of debate among the MS community for quite some time. Compared to disease modifying treatments (DMTs), far less research has explored the role of diet and other lifestyle factors in the context of MS. As such, there are a lot of questions surrounding this, including whether it is worth changing one’s diet at all? 

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When I was first diagnosed with MS back in 2007, I was very keen to explore whether I may be able to make any changes to my lifestyle that could possibly help my prognosis. I remember asking my neurologist at the time if it might be worth changing my diet, and he said no - that there was no evidence for this and that all that could be done was to start on a DMT. Then, almost as an afterthought, he suggested that I might consider taking vitamin D supplements. Since then, in all my consultations over the years there has never been any mention of dietary of lifestyle changes at all. I wonder if this is a similar experience for other people with MS.

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More recently, evidence for the possible role of dietary factors in MS has been growing. For example, an interesting study published in the Multiple Sclerosis Journal this summer explored the relationship between dietary factors and certain clinical measures of MS. In a nutshell, by tracking people over a period of 10 years from their initial diagnosis, the authors found that people who had a more pro-inflammatory diet (using a measure known as the “Dietary Inflammatory Index”) had a greater risk of experiencing MS relapses, along with an increased risk of inflammatory lesions on MRI. 

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What does this mean?

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So, does this mean that a diet high in inflammatory foods is bad for MS? While this is certainly possible, unfortunately we can’t be sure of this. It is difficult to apply the same principles to the study of diet that we would typically see in the context of a clinical trial. In an ideal world, researchers would randomly assign patients to one or another dietary condition (which they would strictly adhere to) and follow them up years later. In this study, only associations between an individual’s chosen diet and MS were explored. It is possible that people who choose a healthier diet also have other characteristics, aside from diet, that decrease their likelihood of experiencing a relapse. Also, it is disappointing to note that in this study no associations were found between diet and disability progression. This means that, regardless of diet followed, participants had the same level of disability progression after 10 years.

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From my personal perspective, I still hold out hope for a possible protective role of diet in MS and I am certainly glad to see more research being directed at this issue. Looking back to my diagnosis in 2007, ignoring the advice I got from my own neurologist, I immersed myself in reading and, in doing this, came across the Swank diet which essentially advocates for the use of a diet low in saturated fats (a key class of “pro-inflammatory foods”). While, the evidence for this particular diet was also not subject to the same experimental rigour that we would see in clinical trials, my attitude was, even if a change in diet did nothing for my MS, at least it couldn’t hurt! Since then, while I can’t say I have rigidly adhered to this or any other diet, I have changed my lifestyle significantly and overall consider myself to have quite a healthy diet. 

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Unfortunately, the potential role of diet in the management of MS is not well known among general society. One of the issues that I sometimes struggle to deal with is being almost apologetic when in company as to why I can’t eat that slice of cake, chips or bit of chocolate etc. In restaurants, I am often embarrassed to ask for something without a certain ingredient or to have a dressing on the side. This is less of an issue for me now as I am open about my MS, but I can imagine that it is difficult for people who may not want to disclose their diagnosis to others.

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I think the question as to whether to make a change in diet is a very personal one for people with MS. Given that the evidence is not yet definitive, it is difficult to make a strong recommendation one way or the other but generally, it is probably worth striving to be more healthy in what you eat. In any event, I will be sticking with my quest to eat healthily (where I can), but try to get me to give up coffee – now that’s another story!

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