A Focus On: The Role of Diet in Multiple Sclerosis



For those living with multiple sclerosis (MS), wellness is paramount to increasing quality of life (QOL), and in order to feel their best, patients often query if lifestyle interventions can impact the course of the disease. The National MS Society indicates that patient interest is consistently high regarding the link between diet and wellness, specifically if a particular diet can alter the course of MS or have a positive effect on symptoms like fatigue. The internet abounds with information on ‘MS diets’, with almost half a million search results via a Google search, although to date, there is no specific diet that has been established as a disease-modifying intervention.  However, recent research findings suggest several dietary factors as potential risk factors for the development of MS.


It has long been observed that the greater the distance from the equator, the higher the risk of developing MS. Because distance from the equator reduces sun exposure and natural Vitamin D, the possible association of low Vitamin D levels with MS risk is a focus of intense study. A large study of military personnel showed that among Caucasians, risk of MS decreased with higher levels of Vitamin D.


Other diet-related risk factors include obesity–particularly in childhood–and high-sodium intake.  A large study of insurance plan members found that female childhood and adolescent obesity was associated with a higher risk of developing MS. Additionally, high sodium increases Th-17 cells–pro inflammatory cells–known to be elevated in MS. Mice fed a high salt diet developed a more severe form of EAE–an animal model of MS–and these mice had elevations of Th-17 cells.  Relatedly, a recently published study found increased clinical activity and MRI lesions in patients with multiple sclerosis who had a high sodium intake.


A number of studies are underway to look at the role of diet and dietary factors in established MS. The Vitamin D to Ameliorate Multiple Sclerosis (VIDAMS) is a trial of two different doses of Vitamin D as an add-on treatment to glatiramer acetate, an immunomodulator drug. Another study aims to investigate the effect of the Wahls modified Paleo diet on fatigue and quality of life in progressive MS. A further study is underway to investigate the effect of sodium intake on immune function.  In addition, there are a number of theories being tested regarding gut microbiota and its potential impact in MS.


In summary, there will continue to be an increase in studies on diet to assess changes in fatigue severity (a primary outcome measure) and quality of life, motor, cognitive and emotional functions (secondary measures) for those with MS. Currently, the efficacy and safety of dietary regimens for MS is still under investigation. Clinical trials will continue to investigate whether changes in dietary habits can be an effective intervention for MS patients. While no specific diet has been established as helpful–or harmful–in MS, a healthy diet is good for everyone, and MS patients may find it a positive way to manage their health.


Kathy Costello is an Associate Vice-President of Clinical Care at the National MS Society and a nurse practitioner at The Johns Hopkins Multiple Sclerosis Center. Rosalind Kalb is a Vice President of Clinical Care at the National MS Society 



Further reading:


1. Bhargava P, Cassard S, Steele SU, et al. The vitamin D to ameliorate multiple sclerosis (VIDAMS) trial: study design for a multicenter, randomized, double-blind controlled trial of vitamin D in multiple sclerosis. Contemp Clin Trials. 2014 Nov;39(2):288-93.

2. Gianfrancesco MA, Acuna B, Shen L, et al. Obesity during childhood and adolescence increases susceptibility to multiple sclerosis after accounting for established genetic and environmental risk factors. Obes Res Clin Pract. 2014 Sep-Oct;8(5):e435-47.

3. Kleinewietfeld M, Manzel A, Titze J, et. Al. Sodium chloride drives autoimmune disease by the induction of pathogenic TH17 cells. Nature. 2013 Apr 25;496(7446):518-22.

4. Farez MF, Fiol MP, Gaitán MI, Quintana FJ, Correale J. Sodium intake is associated with increased disease activity in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2015 Jan;86(1):26-31.

5. Joscelyn J, Kasper LH. Digesting the emerging role for the gut microbiome in central nervous system demyelination. Mult Scler. 2014 Oct;20(12):1553-9.

6. Bhargava P, Mowry EM. Gut microbiome and multiple sclerosis. Curr Neurol Neurosci Rep. 2014 Oct;14(10):492. 

7. Costello K, Thrower BW, and Giesser BS. Navigating Life with Multiple Sclerosis. New York: Oxford University Press; 2015


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