Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis

Abstract

Background:Emerging evidence suggests a role for diet in multiple sclerosis (MS) care; however, due to methodological issues and heterogeneity of dietary interventions in preliminary trials, the current state of evidence does not support dietary recommendations for MS.Objective:To assess the efficacy of different dietary approaches on MS-related fatigue and quality of life (QoL) through a systematic review of the literature and network meta-analysis (NMA).Methods:Electronic database searches were performed in May 2021. Inclusion criteria were: 1) randomized trial with a dietary intervention; 2) adults with definitive MS based on McDonald criteria; 3) patient-reported outcomes for fatigue and/or QoL; and 4) minimum intervention period of 4 weeks. For each outcome, standardized mean differences (SMDs) were calculated and included in random effects NMA to determine the pooled effect of each dietary intervention relative to each of the other dietary interventions. The protocol was registered at PROSPERO (CRD42021262648).Results:Twelve trials comparing 8 dietary interventions (low-fat, Mediterranean, ketogenic, anti-inflammatory, Paleolithic, fasting, calorie restriction, and control [usual diet]), enrolling 608 participants, were included in the primary analysis. The Paleolithic (SMD: -1.27; 95% CI: -1.81, -0.74), low-fat (SMD: -0.90; 95% CI: -1.39, -0.42), and Mediterranean (SMD: -0.89; 95% CI: -1.15, -0.64) diets showed greater reductions in fatigue compared to control. The Paleolithic (SMD: 1.01; 95% CI 0.40, 1.63) and Mediterranean (SMD: 0.47; 95% CI 0.08, 0.86) diets showed greater improvements in physical QoL compared to control. For improving mental QoL, the Paleolithic (SMD: 0.81; 95% CI 0.26, 1.37) and Mediterranean (SMD: 0.36; 95% CI 0.06, 0.65) diets were more effective compared to control. However, the NutriGRADE credibility of evidence for all direct comparisons is very low due to most of the included trials having high or moderate risk of bias, small sample sizes, and the limited number of studies included in this NMA.Discussion:Several dietary interventions may reduce MS-related fatigue and improve physical and mental QoL; however, due to the limitations of this NMA, which are driven by the low quality of the included trials, these findings must be confirmed in high quality, randomized, controlled trials.

Managing the Symptoms of Multiple Sclerosis

“…Some dietary changes have been associated with improved fatigue, but most results are preliminary. 187 Improving diet, exercise, and sleep hygiene all involve lifestyle modifications, which can take years to reach a satisfying equilibrium, even under conditions of MS quiescence. Consequently, the causes of fatigue are a moving target that requires a multidisciplinary approach with physical therapists, nutritionists, sleep neurologists, psychiatrists, and other specialists.…”

“…Caffeine can improve attention and concentration in patients with MS who can ambulate without a walking aid. 187 Other non-prescription stimulants such as B-vitamins and amino acids can also be considered.…”

Self-reported ongoing adherence to diet is associated with lower depression, fatigue, and disability, in people with multiple sclerosis

“…Adherence to the low-fat, plant-based McDougall resulted in reduced body mass index (BMI) and improved fatigue in a 12-month clinical trial of 61 pwMS (13). Adherence to the Paleo diet, which limits foods that became common when farming emerged, was associated with reduced fatigue and improved QoL in a 3-month clinical trial among 17 pwMS (14,15). The Wahls diet, a modified Paleo diet to increase intake of nutrients key to neuronal health and limit lectins, has also been shown to reduce fatigue and improve QoL in a clinical trial of 77 pwMS (16).…”

“…While the MS diets adherence and high-quality diet have demonstrated potential benefits on health outcomes, robust evidence supporting long-term dietary modification is limited due to insufficient sample sizes and short durations of dietary adherence (15,27). Moreover, ongoing adherence to diet may be challenging for some due to individual barriers of health, finance, lack of support, and personal motivation (28,29).…”

A low-fat diet improves fatigue in multiple sclerosis: Results from a randomized controlled trial

“…Diets such as Paleolithic, ketogenic, Mediterranean, and intermittent fasting have been tried in MS with variable effects on fatigue. [3][4][5][6][7][8][9][10][11] Low-fat diets studied in PwMS include one popularized by Dr. Roy Swank with a saturated fat intake of less than 20 grams/day and another by Dr. John McDougall with a total fat intake of less than 10% of daily calorie intake. 10,12,13 Low-fat diets, while not as clearly defined, have been studied for weight loss and their effect on cardiovascular outcomes.…”