New York researchers are doing a pilot study of whether a Mediterranean diet can reduce multiple sclerosis symptoms and improve patients’ quality of life.
Dr. Ilana B. Katz Sand, an assistant professor of neurology at the Icahn School of Medicine at Mount Sinai, is leading the research. She is also the associate medical director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis.
Recent studies have suggested that certain types of gut bacteria contribute to the worsening of MS.
Sand participated in one suggesting that people with MS have higher levels of gut bacteria that trigger inflammatory responses and fewer anti-inflammatory bacteria.
The balance between bacterial species in our gut may influence the immune system in surrounding tissue. It may also produce molecules that travel to more distant parts of the body and participate in what may look like gut-unrelated events.
Understandably, diet can change the composition of gut bacteria.
Some people with MS try to eat well to maintain their health. A poor diet can interfere with energy levels, bladder and bowel health, and possibly shift the immune system to a more or less inflammatory state.
Different nutritionists promote different diets as the best for MS, even though there is no evidence to support one over another.
Designing trials to test diets is a challenge. Some researchers are only now starting to explore in a comprehensive way how dietary changes can benefit MS patients.
Sand’s team is seeking to understand the role that diet and gut bacteria play in the inflammation and nerve cell degeneration seen in autoimmune disorders like MS.
Their pilot trial (NCT02986893) is assessing whether a Mediterranean diet can improve MS patients’ quality of life. The National Multiple Sclerosis Society is funding the work, which began in January and is expected to be completed in April.
“We want to better understand the inflammatory process, the neurodegenerative process, and the effect that diet has on MS symptoms,” Sand said in a Mount Sinai news release. “Our findings could be very important in understanding the onset of MS and how to treat it.”
A Mediterranean diet includes fish, fruit, vegetables, nuts, whole grains, and avocados. It eliminates meat, dairy products, and processed foods.
The team enrolled 36 MS patients in the study. They randomly assigned 18 to a Mediterranean diet for six months, while the others stayed with their usual diet.
Following a restricted diet can be difficult. To keep those on the diet motivated enough to stick with it, Sand, a nutritionist, and a research coordinator meet with the group monthly. They provide the patients with menu suggestions, recipes, and tips. And the patients discuss their experiences with the diet. The two sides also keep in touch by email.
The control group that has not changed their diet attend occasional study sessions and seminars on topics related to wellness in MS. At the end of the pilot study, if they want to try the diet, the nutritionist is ready to consult with them.
The diet is expected to generate changes in patients’ biological parameters, such as levels of lipids and carotenoids in blood, and salt in urine. Researchers are measuring these markers during the study.
To assess the diet’s effect on overall health, researchers are also looking for changes in body mass index, blood pressure, and cholesterol and glucose levels.
To help answer the question of whether the diet improves patients’ wellbeing, the team is using quality-of-life questionnaires and neuropsychological tests to assess wellness, fatigue, depression, and cognition.
Researchers are also analyzing bacteria in fecal specimens and doing immunological profiling with blood samples. This could help them learn more about the mechanisms involved in dietary effects.
In the future, the team plans to increase the number of study participants. They said they believe it may be possible some day to offer MS patients a gut bacteria-based therapy.