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

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.”


  1. Shara Sand says:

    According to this limited report, there is no accounting for variables other than diet, such as exercise and neuromuscular stimulation. The lack of a control group and accounting for other experimental variables is problematic. I’d like to see to full study to determine if it is diet or exercise stimulation, etc. otherwise what I see is a poorly designed study with multiple variables unaccounted for

  2. FB says:

    Good points Sara – and the study only had 38 people in it. There are increasing numbers of these dietary/lifestyle studies being published which are not as above board as they appear. What do I see in the Clinical Trials listing on the link above but the name of Terry Wahls. This sort of thing happens with other “trials” – there was one not that long ago which came up with improvements in fatigue etc if people followed a strict vegan diet. Looked behind the click-bait headlines and I found that it was funded and run by the McDougall vegan mob – now that’s more than a little bit of vested interest there (the participants attended a free full-on live in workshop on McDougall’s diet). And the HOLISM study which is ongoing was started by George Jelinek and is constantly publishing papers which support the OMS diet developed by Jelinek. The HOLISM papers are oh so carefully done to meet statistical analysis criteria but if you fill out one of their surveys you can see the bias in the surveys’ diet questions, even though they try to “compensate” for this by using recognised QoL forms etc. And HOLISM is now gaining some vicarious credibility by sitting within the “Neuroepidemiology Unit” (set up by Jelinek in 2015) at Melbourne University in Australia, and there is no disclosure as to where its funding is coming from (and several of the staff are followers of the OMS approach to MS – which does’t exactly give me confidence in their objectivity). It’s a pretty good bet that it’s funded by the OMS organisation who have now moved their management to the UK and set up as a registered charity and are constantly fundraising “to promote the OMS approach”. They had an income in 2017 of close to a million pounds, and it’s rising as they move to get a foothold in the lucrative USA “health and wellness” market.

    I have no doubt at all that a healthy diet and lifestyle is positive for MS, but it is also positive for anyone one without any health problems. I suspect that many people experience improvements because their diets before they adopt X, Y, or Z approach are pretty poor. Part of the issue I see is that many of these “MS Diets” have opposing principles (eat meat/don’t eat meat, sat fat paranoia vs sat fat is not the devil incarnate, and so on), but the one thing they all have in common is about eating lots of fresh unprocessed vegies and fruit, and that’s going to benefit anyone, MS or no MS. So until there start to be some truly objective studies about diet and MS, I will remain sceptical about studies like the one above, and many of its cousins.

  3. Elaine says:

    Whether a person has MS or not, a vegetable rich diet produces less fatigue as it does not require as much energy from the metabolic system to digest.
    Exercise can create extreme fatigue unless done under the right circumstances, cool environment, paced exertion, and use of water to promote internal cooling (check Mg. and K+ blood levels to see if normal – low levels of those elements can produce pain, dehydration, etc. that will include a negative experience in the equation that is meant to be positive!) I find swimming to be the best at toning muscle and losing weight the best and I like to garden which requires a certain amount of physical energy. The walking often produces pain which is a negative so I do not do so much. Housekeeping is exercise so when confined due to heat crank up the A/C and go to it – with pacing and safely, i.e. use a manual wheelchair to vacuum if you need it… Most of all do not be hard on yourself for not being able to do what you did yesterday. The nature of MS changes so perhaps a good day will be coming soon and the thought of it can help you today.

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