Exploring Wellness Interventions in Progressive Multiple Sclerosis: an Evidence-Based Review

Abstract

We conducted a literature search on the efficacy of wellness-based interventions in patients with progressive MS published between 1985 and July 2017. The level of evidence for each trial was evaluated using the American Academy of Neurology criteria. Overall, 21 articles reporting on 16 wellness-based interventions were identified: ten trials involved exercise training, three involved emotional wellness therapies, two involved dietary modification, and one was a combined wellness intervention. There is level C evidence (possibly effective; one class II study) for the efficacy of aerobic exercise training on cardiorespiratory fitness in patients with progressive MS. There is level B evidence (probably effective; one class I study) for the efficacy of mindfulness training on psychological distress, depression, anxiety, pain, and quality of life in patients with progressive MS. There is inadequate evidence (level U) for efficacy of dietary modification (one class III study and one class IV study) and combined wellness interventions involving exercise training, meditation, and dietary modification (one class IV study). High-quality research is needed to provide evidence-based recommendations for wellness behaviors and lifestyle change in patients with progressive MS.

Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic

“…Examples include the low saturated fat Swank [19,20,21,22,23,24,25,26], plant-based low-fat McDougall [27], Mediterranean [11,28], ketogenic [29], energy restriction/fasting [30,31,32] and modified Paleolithic (Paleo) Wahls™ [33,34,35,36,37] diets. However, clear evidence to support the benefit of any specific dietary regimen is lacking and well-designed, randomized controlled trials are needed [38,39]. Because there is not currently enough evidence to recommend a specific diet for MS, the National MS Society (NMSS) [40,41] recommends pwMS follow healthy eating guidelines for the general population such as the U.S. Dietary Guidelines for Americans (DGA) [42] and those for cancer and heart disease prevention [43,44].…”

Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern

“…PwMS are eager to know what diet(s) will help their disease [28,29] but there is insufficient evidence to support the use of the WahlsElim or any other diet for the treatment of MS including Swank [30], McDougall [31], Mediterranean [32,33], ketogenic [34] or energy restricted/fasting [35,36,37]. Well-designed, randomized controlled trials are needed [38,39] to identify diets that improve disease outcomes. Since studies are not available that provide clear evidence that pwMS have different nutritional needs than the healthy population, the National MS Society (NMSS) [40,41] recommends pwMS follow dietary guidance consistent with the Dietary Guidelines for Americans (DGA) [42] and cancer and heart disease prevention [43,44].…”

Nutrient Composition Comparison between the Low Saturated Fat Swank Diet for Multiple Sclerosis and Healthy U.S.-Style Eating Pattern

“…In the 70 years since Swank developed his diet, various other dietary regimens have been proposed to treat MS including the plant-based low-fat McDougall [42], Mediterranean [43,44], ketogenic [45], energy restricted/fasting [46,47,48] and modified Paleolithic (Paleo) Wahls™ [49,50,51,52,53]. However, more research and better designed studies are needed to determine the benefits and risks of the Swank or any other diet for pwMS [54,55]. To help address this research gap, dietary intervention studies are underway that investigate intermittent fasting (NCT03539094), dietary salt and immune function (NCT02282878), ketogenic (NCT03718247) and low fat (<20% energy) diets (NCT03322982), ketogenic versus intermittent fasting versus vegetarian diets (NCT03508414), activity and balanced eating (NCT03808545), a low glycemic load diet administered via internet coaching (NCT03372187) and the effect of a gluten-free diet on blood brain barrier permeability (NCT03451955).…”