Adherence to high-quality MS diet may help ease depression in patients

Adherence to a high-quality diet may help alleviate symptoms of depression in people with multiple sclerosis (MS), a study from Australia suggests.

The study examined several dietary regimens that have been developed to help manage MS symptoms generally by avoiding foods that might increase inflammation, a key driver of MS progression.

While ongoing adherence to diets, such as the McDougall, paleo, or Swank regimens, was linked to reduced depression, adhering to the Overcoming MS (OMS) diet was also associated with a significantly lower risk of having fatigue or severe disability.

The study, “Self-reported ongoing adherence to diet is associated with lower depression, fatigue, and disability, in people with multiple sclerosis,” was published in the journal Frontiers in Nutrition.

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People with MS advised to eat a varied and well-balanced healthy diet

For people with MS, diet can be a safe and feasible approach to manage disease symptoms and improve overall health.

Generally, it is recommended that people with MS eat a varied and well-balanced diet, in line with what is typically recommended for the general population. This includes plenty of fruits, vegetables, and whole grains, and fewer processed foods or foods containing high levels of refined sugars and fats.

While there is no one diet that is considered best for people with MS, a number of diets have been proposed for patients to ease some symptoms of the disease.

Overcoming MS (OMS) is a plant-based diet that also includes fish and seafood, but eliminates processed foods, meat, eggs, dairy, and saturated fats. It has been associated with improved quality of life and lower fatigue and depression in people with MS.

However, the positive effects of any dietary strategy might depend on long-term adherence, although evidence is limited so far. Moreover, ongoing adherence to diet might be challenging for patients due to health issues, financial conditions, and a lack of support and motivation.

In the new study, researchers in Australia assessed whether the levels of adherence to MS diets can have an impact on people with MS, particularly in terms of fatigue, disability, and depression.

The analysis included 2,466 MS patients who participated in the HOLISM observational study, which is tracking MS patients over time. Participants in this study were recruited via social media platforms between October and December 2012, at which point they completed an online survey capturing clinical and demographic factors, as well as lifestyle habits and health data.

These surveys were then repeated at 2.5-year intervals. Adherence to an MS diet was only assessed at five (2017) and 7.5 years (2019) after the initial survey. Thus, the analysis was restricted to the 671 patients who completed both surveys.

Highest adherence seen in patients on Overcoming MS diet

At the time of the last survey, participants were a mean of 53.3 years old and were living with MS for a mean of 15.5 years. They were mostly women (80.8%), and most were living in Australia or New Zealand (41.2%). The majority also had a university degree (73.2%) and were employed (54.6%).

Overall, 54% of the participants were following an MS diet at the five-year survey. Most were on the OMS diet (44%), while 7% were on the Swank diet, and 7% were adhering to other diets.

The OMS diet had the highest ongoing adherence, with 76% of patients who reported being on that diet at year five still reporting adherence at the 7.5-year assessment.

Also, 49% of patients were following a high-quality diet at the five-year survey, and 84% of them were still on the diet at the 7.5-year follow-up. Of note, adherence to a high-quality diet was defined as a score higher than the median on the diet habits questionnaire, regardless of a person’s reported MS diet.

The high adherence to dietary regimens shows that, while commitment to a diet for prolonged periods can be challenging, it is acceptable and achievable for MS patients.

“Potential benefits of diet require ongoing efforts, therefore care management should consider methods to support [people with MS] to maintain high-quality diet[s],” the team wrote.

In addition, patients who consistently followed the OMS diet had a 20% lower risk of depressive symptoms, compared with those who never reported following the diet. These patients also had a 30% lower risk of depression compared with patients who stopped following the diet.

Patients who followed a high-quality diet also had a 22% lower risk of depressive symptoms than those who never followed the diet, and a 33% lower risk compared with patients who stopped following the diet.

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Study shows diet can significantly lower fatigue and disability

The beneficial effect of both diets on depressive symptoms suggests that a “sustained diet that is high in fruits, vegetables, whole grains, and fish, and low in saturated fat, refined sugar and processed meat should be encouraged,” the researchers wrote.

However, only those who continuously followed the OMS diet, and not patients on a high-quality diet, experienced significant reductions in fatigue and MS disability. Patients on the OMS diet reported a 29% lower risk of fatigue and a 57% reduced risk of severe MS disability compared with patients who stopped following the diet.

The findings indicate there may be “important elements of the OMS diet for MS management such as low saturated fat and omega-3 supplementation,” the researchers wrote. An alternative explanation might be that patients experiencing fatigue and more severe disability may be more likely to stop restrictive MS diets.

“A robust beneficial impact of ongoing adherence with depressive symptoms may suggest that [people with MS] are more able to adhere [to] dietary modification despite those symptoms, while fatigue and disability are stronger barriers for sustained engagement,” the researchers wrote.

Of note, a couple of the researchers receive royalties from authoring or co-editing publications about the OMS diet, and have previously been financially compensated for facilitating workshops about the diet.