Vegetable-rich Diet, Other Interventions, May Help Lower Fatigue in Progressive MS, Pilot Study Finds

One year of a vegetable-rich diet — combined with exercise, neuromuscular stimulation, and stress reduction techniques — is effective in easing fatigue in people with progressive multiple sclerosis (MS). Researchers say the results may be linked to changes in blood fat levels, in particular cholesterol.

This integrative intervention led to a rise in high-density lipoproteins (HDLs), or “good” cholesterol — and a drop in triglycerides and low-density lipoproteins (LDLs), known as “bad” cholesterol.

If confirmed in larger studies, screening for these fat (lipid) biomarkers may prove useful for guiding treatment decisions targeting fatigue in people with MS, a study shows.

The study, “Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study,” was published in the journal PLOS ONE.

Previous studies have suggested that high blood lipid content can have a negative impact on the outcomes of people with MS, contributing to increased inflammation and disability.

Cholesterol is essential for the proper working of cells, and for making important hormones and vitamins, as well as bile acids needed in digestion. It can be produced by the liver or obtained in foods, such as meat and dairy products. In the body, cholesterol is distributed through several components, namely LDL, HDL, and VLDL (very low-density lipoprotein).

LDL is often called “bad” cholesterol because it can build up on artery walls, increasing the risk of heart disease. Conversely, HDL is known as the “good” cholesterol because it carries lipoproteins from other parts of the body back to the liver to be removed. This keeps the cholesterol from building up in the arteries.

Now, a team from the University of Iowa conducted a pilot trial (NCT01381354) to explore whether one year of a diet-based lifestyle intervention could significantly ease fatigue and improve walking, balance, and quality of life in people with primary or secondary progressive MS.

The study applied a multimodal intervention centered on a diet rich in vegetables, which included animal and plant protein. It excluded foods with the greatest risk of allergy, such as gluten-containing grains, dairy, and eggs. Participants also were asked to perform stress-reduction techniques, including meditation and self-massage, along with stretching and strengthening workouts, and neuromuscular electrical stimulation.

Researchers measured body mass index (BMI, an indicator of body fat) and checked blood lipid levels — including total cholesterol, HDL, LDL and triglycerides — in 18 participants with primary or secondary progressive MS. Fatigue was measured using the Fatigue Severity Scale (FSS).

After completing one year of the diet-based program, fatigue scores had significantly decreased among participants, from an intial mean score of 5.51, to 2.48 at 12 months, which is in line with previous studies’ data. Importantly, fatigue reductions were accompanied by significant increases in HDL cholesterol, along with a reduction in LDLs, triglycerides, and BMI.

In addition, changes in total cholesterol — which comprises HDL, LDL and VLDL — and in HDL alone, were associated with a reduction in fatigue over those 12 months.

“Diet modulates lipid profile, which in turn influences the MS disease process and muscle function resulting in benefits on MS fatigue,” the researchers said.

The study’s results “are consistent with the possibility that lipid profile biomarkers, particularly total cholesterol and HDL cholesterol, may contribute to improvement in MS fatigue,” they said.

The researchers noted that pharmacological options for treating MS-associated fatigue are limited.  While people with MS are often prescribed modafinil or amantadine, anti-fatigue drugs have stimulant activity and are often associated with side effects.

“Our results require confirmation given the limitations of the current pilot study design, which include the small sample size, lack of control group and randomization,” the investigators said. “However, if confirmed in larger studies, lipid monitoring may become useful for guiding fatigue treatment decisions.”