Author Archives: Ana Pena PhD

Missouri Trial to Examine if Fasting Alters Gut Microbiome and Immune System of RRMS Patients in Helpful Ways

A 12-week clinical study is recruiting people with relapsing-remitting multiple sclerosis (RRMS) to evaluate if intermittent fasting can improve their immune response, metabolism, and gut microbiome — the bacterial community that inhabits the gastrointestinal tract. Its findings may also hint at whether such a diet might ease MS symptoms or alter discourse course and, if used in conjunction with other treatments, boost their efficacy. Conducted by researchers at Washington University in St. Louis, Missouri, the trial is supported by their findings in an earlier mouse study.  Results showed that fasting worked to ease MS-like symptoms in a mouse model of the disease, the research team reported. Specifically, EAE mice fed every other day were less prone to symptoms that included difficulty in walking, limb weakness, and paralysis than mice allowed to eat freely.  A fasting diet also enriched bacterial diversity in the mice guts, and shifted immune cell populations there toward a lower inflammatory response. When gut bacteria were transferred from fasting mice to nonfasting mice, the later also were seen to be better protected against MS-like movement problems, supporting the influence of the gut microbiome on MS symptoms. Several diets have been proposed to help ease disease progression in MS patients, but solid scientific evidence is lacking to support any one diet over another, leaving the issue much to an individual’s choice. “The fact is that diet may indeed help with MS symptoms, but the studies haven’t been done,” Laura Piccio, MD, an associate professor of neurology at WUSTL and the study's lead author, said in a WUSTL news release written by Tamara Bhandari. Taking place at the Missouri university, the trial is expected to enroll 60 RRMS patients. Half will be randomly assigned to eat a standard Western-style diet seven days a week, and the other half to Western-style diet five days a week, with two days set aside for fasting (consuming a maximum of 500 calories each day). On fasting days, patients can only drink water or calorie-free beverages and eat fresh, steamed or roasted non-starchy vegetables All will undergo a neurological assessment, and provide blood and stool samples in the study's beginning, at mid-point or week six, and at its end (week 12). Those using MS medications will continue on their prescribed treatment regimens throughout the study. More information, including enrollment information, is available here. Piccio noted that a pilot study on diet in 16 MS patients showed that limiting calories every other day for two weeks led to immune and gut microbiome changes that resembled those observed in the mice study she helped to lead. Its researchers concluded that intermittent fasting had the potential to positively manipulate the immune response in MS patients by changing their gut microbiome. The gut microbiome plays a central role in digestion, and in producing vitamins and amino acids (the building blocks of proteins). But a growing body of evidence indicates that it also determines how our immune systems develops and matures. Indeed, an increasing number of studies link irregularities in the gut microbiome with MS. “There are several possible ways fasting can affect inflammation and the immune response,” Piccio said. “One is by changing hormone levels. We found that levels of the anti-inflammatory hormone corticosterone were nearly twice as high in the fasting mice. But it also could act through the gut microbiome.” The new trial will allow the team to analyze more deeply the effects of a fasting diet — and perhaps gather evidence for a larger study investigating if skipping meals can ease MS symptoms. Its goal is to find out "whether people on limited fasts undergo changes to their metabolism, immune response and microbiome similar to what we see in the mouse,” Piccio said. “I don’t think any physician working with this disease thinks you can cure MS with diet alone,” she added, “but we may be able to use it as an add-on to current treatments to help people feel better.”

Pilot Study Is Testing Whether Mediterranean Diet Can Help MS Patients

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.

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