Summary

This pilot study aimed to test the effect of diet in a group of people with relapsing remitting MS. 61 people took part in a year-long study; 29 continued with their usual diet while 32 followed the McDougall diet, a plant-based diet which is very low in saturated fats.

There was no difference in the number of lesions seen on MRI scans or disability between the two groups, suggesting that diet might not influence the course of MS. People who followed the diet did show improvements in measures of fatigue, lost significantly more weight than the control group and had significantly lower cholesterol levels. People who followed the diet also had higher scores on a questionnaire that measured their quality of life and overall mood.

The small numbers of people in the study and the relatively short duration of the study make it difficult to draw firm conclusions from the results. Improvements in fatigue seen in the diet group may have resulted from weight loss, a finding which has been seen in other studies.  The researchers also point out that simply participating in the diet group, with the expectation of benefits, could have contributed to lower fatigue levels.


Background

Many people are interested in the potential to manage their MS through diet. This is a controversial topic and opinions range from denying any benefit to claims that particular diets can effectively cure MS. Several dietary approaches to managing MS have been proposed, usually as a part of a wider programme of lifestyle changes, including Overcoming multiple sclerosis, the Swank diet and the Best Bet diet.

This pilot study aimed to test the McDougall diet, a very low fat vegetarian diet based on starchy vegetables, plus fresh or frozen fruits and other vegetables.

How this study was carried out

61 people with relapsing remitting MS took part in the year-long study; 29 (control group) continued with their usual American diet while 32 (diet group) followed the McDougall diet. This diet is based on starchy plant foods (beans, breads, corn, pastas, potatoes, sweet potatoes, and rice with the addition of fruits and non-starchy vegetables). Meat, fish, eggs, dairy products and vegetable oils (such as corn and olive oil) are prohibited.

At the start of the study, the diet group attended a residential diet training course.  The control group had no diet training but did attend an exercise seminar. All participants had clinic visits at the beginning of the study and then at months 1, 3, 6, 9, and 12. Most of the participants in both groups were already taking a disease modifying drug and continued with this throughout the study.

What was found

There was no difference between the two groups in the number of lesions detected on MRI scans, in relapse rate or level of disability measured by EDSS.  However, people who followed the study diet showed improvements in measures of fatigue, lost significantly more weight than the control group and had significantly lower cholesterol and fasting insulin levels. People who followed the diet also had higher scores on a questionnaire that measured their quality of life and overall mood.

What does it mean?

There was no difference in MRI or disability between the two groups, suggesting that diet might not influence the course of MS, but the small numbers of people in the study and the relatively short duration of the study make it difficult to draw firm conclusions from the results.

The improvement in fatigue levels seen in the diet group was associated with weight loss, a finding which has been reported in other studies. The researchers point out that simply participating in the diet group, with the expectation of benefits, could have contributed to this effect. This highlights one of the key problems with carrying out research into dietary modifications; that it is impossible to prevent participants from knowing which group they have been assigned to, which then introduces a potential bias in the results.

Yadav V, et al
Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial
Multiple Sclerosis and Related Disorders 2016; 9: 80-90
Abstract
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More about diet

Our diet A-Z looks at the elements of a healthy diet and summarises and reviews evidence about diet in MS .

More recently, research has suggested that low levels of vitamin D are associated with an increased risk of getting MS. In established MS, low levels of vitamin D have been associated with relapses and increased disability.  At the moment, there is limited evidence to show that taking vitamin D supplements will reduce the severity of MS.  Studies are underway to evaluate vitamin D supplementation.  Some MS neurologists recommend that people with MS and their family members take 4000-5000 IU vitamin D per day, some propose lower doses of between 800-3000 IU/day, while others advise waiting for more evidence of effectiveness from clinical trials before taking supplements.  For more information, see our vitamin D A-Z.

While research into diet and multiple sclerosis has been limited, there has been considerable research into a healthy diet for other conditions.  Following a healthy, balanced diet which is low in fat and includes plenty of fruit and vegetables is important for maintaining general health and reducing the risk of developing other conditions such as heart disease, stroke and diabetes. Your GP or MS nurse can give you advice on how to achieve and maintain a healthy weight through diet and exercise.

NHS Choices has some excellent resources on health eating.

Research by topic areas...

Causes of MS

Newland PK, Heitkemper M, Zhou Y.
The Emerging Role of the Gut Microbiome in Adult Patients With Multiple Sclerosis.
J Neurosci Nurs. 2016 Dec;48(6):358-364.
abstract

CCSVI

Fox RJ, Diaconu C, Baus L, et al.
No Association of Chronic Cerebrospinal Venous Insufficiency with Multiple Sclerosis.
Can J Neurol Sci. 2016 Jan;43(1):195-7.
abstract
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Co-existing conditions

Chung WS, Lin CL, Tsai TC, et al.
Multiple sclerosis increases the risk of venous thromboembolism: a nationwide cohort analysis.
Eur J Clin Invest. 2015 Dec;45(12):1228-33.
abstract

Diagnosis

Traboulsee A, Simon JH, Stone L, et al.
Revised Recommendations of the Consortium of MS Centers Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-Up of Multiple Sclerosis.
AJNR Am J Neuroradiol. 2016 Mar;37(3):394-401.
abstract
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Traboulsee A, Létourneau-Guillon L, Freedman MS, et al.
Canadian Expert Panel Recommendations for MRI Use in MS Diagnosis and Monitoring.
Can J Neurol Sci. 2015 May;42(3):159-67.
abstract
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Disease modifying drugs

Dörr J, Baum K.
Alemtuzumab in the treatment of multiple sclerosis: patient selection and special considerations.
Drug Des Devel Ther. 2016 Oct 18;10:3379-3386. Review.
abstract
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Zettl UK, Schreiber H, Bauer-Steinhusen U, et al.
Baseline predictors of persistence to first disease-modifying treatment in multiple sclerosis.
Acta Neurol Scand. 2016 Oct 30. [Epub ahead of print]
abstract

Risson V, Saini D, Bonzani I, et al.
Patterns of Treatment Switching in Multiple Sclerosis Therapies in US Patients Active on Social Media: Application of Social Media Content Analysis to Health Outcomes Research.
J Med Internet Res. 2016 Mar 17;18(3):e62.
abstract
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Devonshire VA, Feinstein A, Moriarty P.
Adherence to interferon β-1a therapy using an electronic self-injector in multiple sclerosis: a multicentre, single-arm, observational, phase IV study.
BMC Res Notes. 2016 Mar 8;9:148.
abstract
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N'gbo N'gbo Ikazabo R, Mostosi C, Quivron B, et al.
Immune-reconstitution Inflammatory Syndrome in Multiple Sclerosis Patients Treated With Natalizumab: A Series of 4 Cases.
Clin Ther. 2016 Mar;38(3):670-5.
abstract

Chan A, de Seze J, Comabella M.
Teriflunomide in Patients with Relapsing-Remitting Forms of Multiple Sclerosis.
CNS Drugs. 2016 Jan;30(1):41-51.
abstract

Ingwersen J, Aktas O, Hartung HP.
Advances in and Algorithms for the Treatment of Relapsing-Remitting Multiple Sclerosis.
Neurotherapeutics. 2016 Jan;13(1):47-57.
abstract

Duquette P, Giacomini PS, Bhan V, et al.
Balancing Early Aggression Against Risk of Progression in Multiple Sclerosis.
Can J Neurol Sci. 2016 Jan;43(1):33-43.
abstract
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Rommer PS, Dörner T, Freivogel K, et al.
Safety and Clinical Outcomes of Rituximab Treatment in Patients with Multiple Sclerosis and Neuromyelitis Optica: Experience from a National Online Registry (GRAID).
J Neuroimmune Pharmacol. 2016 Mar;11(1):1-8.
abstract

Drugs in development

Chataway J.
Biotin in progressive multiple sclerosis: A new lead?
Mult Scler. 2016 Nov;22(13):1640-1641. No abstract available.
abstract

Gajofatto A, Turatti M, Benedetti MD.
Primary progressive multiple sclerosis: current therapeutic strategies and future perspectives.
Expert Rev Neurother. 2016 Nov 4. [Epub ahead of print]
abstract

Shirani A, Okuda DT, Stüve O.
Therapeutic Advances and Future Prospects in Progressive Forms of Multiple Sclerosis.
Neurotherapeutics. 2016 Jan;13(1):58-69.
abstract

Epidemiology

Tao C, Simpson S Jr, van der Mei I, et al.
Higher latitude is significantly associated with an earlier age of disease onset in multiple sclerosis.
J Neurol Neurosurg Psychiatry. 2016 Nov 3. pii: jnnp-2016-314013. [Epub ahead of print]
abstract
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Dobson R, Ramagopalan S, Topping J, et al.
A Risk Score for Predicting Multiple Sclerosis.
PLoS One. 2016 Nov 1;11(11):e0164992.
abstract
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Brown JW, Chard DT.
The role of MRI in the evaluation of secondary progressive multiple sclerosis.
Expert Rev Neurother. 2016;16(2):157-71.
abstract

Warren SA, Janzen W, Warren KG, et al.
Multiple Sclerosis Mortality Rates in Canada, 1975-2009.
Can J Neurol Sci. 2016 Jan;43(1):134-41.
abstract
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Other treatments

Westerdahl E, Wittrin A, Kånåhols M, et al.
Deep breathing exercises with positive expiratory pressure in patients with multiple sclerosis - a randomized controlled trial.
Clin Respir J. 2016 Nov;10(6):698-706.
abstract
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Dressler D, Bhidayasiri R, Bohlega S, et al.
Botulinum toxin therapy for treatment of spasticity in multiple sclerosis: review and recommendations of the IAB-Interdisciplinary Working Group for Movement Disorders task force.
J Neurol. 2016 Oct 27. [Epub ahead of print]
abstract

Nazari F, Soheili M, Hosseini S, et al.
A comparison of the effects of reflexology and relaxation on pain in women with multiple sclerosis.
J Complement Integr Med. 2016 Mar;13(1):65-71.
abstract

Paediatric MS

Verhelst H, De Waele L, Deconinck N, et al.
Multiple sclerosis in Belgian children: A multicentre retrospective study.
Eur J Paediatr Neurol. 2016 Oct 25. pii: S1090-3798(16)30188-X. [Epub ahead of print]
abstract

Brenton JN, Banwell BL.
Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis.
Neurotherapeutics. 2016 Jan;13(1):84-95. Review.
abstract
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Physical activity

Plow MA, Golding M.
A Qualitative Study of Multiple Health Behaviors in Adults with Multiple Sclerosis.
Int J MS Care. 2016 Sep-Oct;18(5):248-256.
abstract
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Prognosis

Tilling K, Lawton M, Robertson N, et al.
Modelling disease progression in relapsing-remitting onset multiple sclerosis using multilevel models applied to longitudinal data from two natural history cohorts and one treated cohort.
Health Technol Assess. 2016 Oct;20(81):1-48.
abstract
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Alroughani R, Akhtar S, Ahmed S, et al.
Is Time to Reach EDSS 6.0 Faster in Patients with Late-Onset versus Young-Onset Multiple Sclerosis?
PLoS One. 2016 Nov 1;11(11):e0165846.
abstract
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Rehabilitation

Peruzzi A, Zarbo IR, Cereatti A, et al.
An innovative training program based on virtual reality and treadmill: effects on gait of persons with multiple sclerosis.
Disabil Rehabil. 2016 Nov 3:1-7. [Epub ahead of print]
abstract

Pilutti LA, Paulseth JE, Dove C, et al.
Exercise Training in Progressive Multiple Sclerosis: A Comparison of Recumbent Stepping and Body Weight-Supported Treadmill Training.
Int J MS Care. 2016 Sep-Oct;18(5):221-229.
abstract
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Salcı Y, Fil A, Armutlu K, et al.
Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study.
Disabil Rehabil. 2016 Oct 29:1-7. [Epub ahead of print]
abstract

Services

Davies F, Wood F, Brain KE, et al.
The Transition to Secondary Progressive Multiple Sclerosis: An Exploratory Qualitative Study of Health Professionals' Experiences.
Int J MS Care. 2016 Sep-Oct;18(5):257-264.
abstract
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Bray M, Wolfson C, Moore F, et al.
General Practitioner Preferences in Managing Care of Multiple Sclerosis Patients.
Can J Neurol Sci. 2016 Jan;43(1):142-8.
abstract
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Stem cells

Harris VK, Vyshkina T, Sadiq SA.
Clinical safety of intrathecal administration of mesenchymal stromal cell-derived neural progenitors in multiple sclerosis.
Cytotherapy. 2016 Dec;18(12):1476-1482.
abstract

Abi Chahine N, Wehbe T, Rashed J, et al.
Autologous Bone Marrow Derived Stem Cells for the Treatment of Multiple Sclerosis.
Int J Stem Cells. 2016 Oct 31. [Epub ahead of print]
abstract
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Kyrcz-Krzemień S, Helbig G, Torba K, et al.
Safety and efficacy of hematopoietic stem cells mobilization in patients with multiple sclerosis.
Hematology. 2016 Jan;21(1):42-5.
abstract

Symptoms and symptom management

Nociti V, Losavio FA, Gnoni V, et al.
Sleep and fatigue in multiple sclerosis: A questionnaire-based, cross-sectional, cohort study.
J Neurol Sci. 2016 Oct 27. pii: S0022-510X(16)30684-0. [Epub ahead of print]
abstract

Mauruc E, Guinet-Lacoste A, Falcou L, et al.
Nocturnal Urinary Disorders in Multiple Sclerosis: clinical and urodynamic study of 309 patients.
J Urol. 2016 Nov 2. pii: S0022-5347(16)31671-8. [Epub ahead of print]
abstract

Marck CH, Jelinek PL, Weiland TJ, et al.
Sexual function in multiple sclerosis and associations with demographic, disease and lifestyle characteristics: an international cross-sectional study.
BMC Neurol. 2016 Nov 4;16(1):210.
abstract
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Phé V, Pakzad M, Haslam C, et al.
Open label feasibility study evaluating D-mannose combined with home-based monitoring of suspected urinary tract infections in patients with multiple sclerosis.
Neurourol Urodyn. 2016 Nov 4. [Epub ahead of print]
abstract

Taylor PN, Wilkinson Hart IA, Khan MS, et al.
Correction of Footdrop Due to Multiple Sclerosis Using the STIMuSTEP Implanted Dropped Foot Stimulator.
Int J MS Care. 2016 Sep-Oct;18(5):239-247.
abstract
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Vitamin D

Muris AH, Smolders J, Rolf L, et al.
Immune regulatory effects of high dose vitamin D(3) supplementation in a randomized controlled trial in relapsing remitting multiple sclerosis patients receiving IFNβ; the SOLARIUM study.
J Neuroimmunol. 2016 Nov 15;300:47-56.
abstract