Evaluating the Effects of Dietary Interventions on Disease Progression and Symptoms of Adults with Multiple Sclerosis: An Umbrella Review

Abstract

Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system. The role of diet in the progression of MS and severity of symptoms remains unclear. Various systematic literature reviews (SRs) have reported the effects of single nutrients on MS progression or the role of dietary factors on specific symptoms of MS. Narrative reviews have examined the effects of various dietary patterns in MS populations. An umbrella review was undertaken to collate the findings from review articles and evaluate the strength of the scientific evidence of dietary interventions for people living with MS. Scientific databases including MEDLINE, PubMed, CINAHL, and The Cochrane Library were systematically searched up to April 2019. Review articles and meta-analyses were included if they examined the effect of any dietary intervention in adult populations with MS. Outcomes included MS progression indicated by relapses, disability, MRI activity and disease classification, and MS symptoms. Characteristics and findings from both review articles and their included primary studies were extracted and summarized. A total of 19 SRs and 43 narrative reviews were included. Vitamin D and PUFAs were the most commonly studied interventions. Across SR studies, vitamin D supplementation had no significant effect on relapses, MRI, or disability progression; however, an inverse association was found between vitamin D status and disability scores through observational studies. Effects of PUFA supplementation on major outcomes of MS progression were inconsistent across review articles. Other interventions less commonly studied included vitamin, mineral, and herbal supplementation and varying dietary patterns. Strong consistent evidence is lacking for dietary interventions in persons with MS. The body of evidence is primarily focused around the isolation of individual nutrients, many of which demonstrate no effect on major outcomes of MS progression. Stronger food-focused studies are required to strengthen the evidence.

The Role of Diet and Interventions on Multiple Sclerosis: A Review

“…However, Bagur et al reported in their systematic review that existing studies on the effect of vitamin D supplementation in MS are inconsistent with respect to EDSS, MRI lesions, overall functional status, and relapse rate [ 13 ]. It has been suggested that empirical replacement with high doses of vitamin D supplementation (at least 4000 IU/day orally) and for a prolonged period appears to be safe and is associated with low risk for adverse events, although available data are limited [ 12 , 19 , 20 , 21 ].…”

“…Conversely, one Swedish and one Australian study reported low incidence of MS in people following diets enriched in PUFAs [ 5 , 12 , 13 , 25 , 26 ]. Results from meta-analyses suggest that PUFAs may reduce the frequency of relapses, but are not effective against the progression of the disease [ 1 , 19 ]. In human studies, a low fat diet supplemented with PUFAs was associated with lower levels of disability assessed by EDSS, slight improvement in relapse rat, as well as improved quality of life [ 13 , 25 ].…”

iRhom1 rescues cognitive dysfunction in multiple sclerosis via preventing myelin injury

“…MS is a chronic inflammatory autoimmune disease of the central nervous system 25 . Learning and memory dysfunction has been shown to be a common symptom in MS patients and is associated with hippocampal neuron demyelination, but the exact mechanism remains opaque 2,13 .…”

Efficacy of diet on fatigue, quality of life and disability status in multiple sclerosis patients: rapid review and meta-analysis of randomized controlled trials

“…There is a lack of strong and consistent evidence for dietary interventions in people with MS, demonstrating any effect on key outcomes of MS progression. More robust studies focusing on foods rather than nutrients are needed to strengthen the evidence [ 67 ]. At present, it is necessary to provide objective information to the patient, taking into account the growing importance of some interest points in the origin and maintenance of the disease, such as nutrition as a possible cofactor influencing the inflammatory cascade, gastrointestinal symptoms, the state of the microbiota and intestinal barrier, allergies and individual food intolerances or obesity in MS patients.…”