Anti-inflammatory diet, synbiotics ease progressive MS symptoms

An anti-inflammatory diet combined with synbiotic supplements eased fatigue, pain, sexual dysfunction, and bladder and bowel problems in people with progressive forms of multiple sclerosis (MS) in a small clinical trial.

Synbiotics contain probiotics, healthy bacteria for the gut, and prebiotics, or plant fibers that feed probiotics and help them grow.

“Given the growing interest in dietary modifications for MS and the lack of diet-based trials specifically for progressive forms of the disease, the combination of an anti-inflammatory-antioxidant-rich diet and synbiotics holds promise as a complementary treatment,” the researchers wrote in “Anti-inflammatory-antioxidant modifications and synbiotics improved health-related conditions in patients with progressive forms of multiple sclerosis: A single-center,randomized clinical trial,” published in Complementary Therapies in Clinical Practice. 

People with progressive forms of MS, which features worsening disability even in the absence of relapses, have access to very few disease-modifying therapies. For them, complementary approaches such as exercise and dietary changes may address common, but stubborn symptoms, like fatigue, pain, bowel and bladder dysfunction, and sexual problems.

Among the key processes implicated in the neurodegeneration that marks MS are inflammation and oxidative stress, a type of cellular damage that arises when there’s an imbalance in toxic reactive oxygen species and the antioxidant molecules needed to counteract them.

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Diet’s effect on MS

Research is indicating that anti-inflammatory diets like the Mediterranean diet and higher antioxidant intake may help MS patients.

Diet can also have a significant effect on the gut microbiome — the collection of microbes living in the gut — which influences gut function along with brain and immune health. Probiotic supplements, which contain healthy bacteria thought to benefit the gut, have been found to ease certain MS symptoms.

A number of studies on diet and/or supplementation have been conducted in relapsing forms of MS. None have examined their combined effects in progressive forms of the disease, however, said the researchers, who conducted a randomized, controlled clinical trial to assess the impacts of diet among 69 people with progressive forms of MS who were seen at a clinic in Iran. Most participants (77%) were female and had secondary-progressive MS (68%).

The participants received daily synbiotic supplements with an anti-inflammatory, antioxidant rich diet or a placebo supplement with their usual diet for four months, on top of their usual MS therapies.

The synbiotics were taken every day two hours after lunch. The anti-inflammatory diet consisted of 55% carbohydrates, 15% protein, and 30% fats, most of which were sourced from olive oil, fish, and vegetables.

A trained dietitian counseled both groups and their target calorie intake was adjusted based on each person’s ideal body weight. The patients recorded a three-day dietary record each month, which was analyzed by a nutritionist to determine adherence. Fatigue, pain, sexual satisfaction, and bladder and bowel control were evaluated via patient questionnaires before the trial started and at its end.

‘Crucial to prioritize’ dietary modifications

The synbiotic supplements plus anti-inflammatory diet were associated with significant reductions in fatigue and pain intensity from the study’s start (baseline) relative to the control group. The experimental diet group also saw improved bladder control, bowel control, and sexual function from baseline, while the placebo group’s symptoms got worse in some measures.

No serious side effects were reported during follow-up and the prescribed diets were adhered to well.

“The present findings provide preliminary support for the feasibility of anti-inflammatory, antioxidant-rich diet and synbiotics supplementation in patients with progressive forms of MS,” the researchers wrote. “Given the potential effectiveness of dietary modifications in managing MS, it is crucial to prioritize this aspect for patients. The findings may not be generalizable to people with relapsing MS or healthy people, they said.

The diet plus supplement approach may ease the symptoms via a number of different mechanisms, including reduced oxidative stress, lower inflammation, increased nerve cell signaling and higher gut fiber. Further research should use biochemical and cellular analyses to understand how the diet might influence cellular function and nerve cell signaling to ease symptoms, the scientists said.