In MS, diet low in wheat may ease inflammation, improve life quality

A diet low in wheat was linked to reductions in circulating inflammatory immune cells and improvements in pain-related life quality among a small group of people with relapsing-remitting multiple sclerosis (RRMS), according to findings from a pilot clinical trial conducted in Germany.

The trial’s findings build upon another recent study from the team, where it was identified that non-gluten proteins naturally found in wheat, called amylase trypsin inhibitors (ATI), exacerbated disease severity in a mouse model of multiple sclerosis (MS). These wheat proteins also increased populations of  inflammatory immune cells in the central nervous system, comprised of the brain and spinal cord.

“Until now, … there was no clear evidence that a wheat-containing diet can also influence inflammatory diseases of the central nervous system,” Detlef Schuppan, MD, PhD, a professor at Harvard Medical School, in the U.S., and the University of Mainz Medical Center, in Germany, said in a university press release.

“We have now been able to show, both in an animal model and in a clinical pilot study, that the ATI proteins in wheat can enhance the severity of MS,” Schuppan said.

Results from the trial were detailed in a study titled “Attenuation of immune activation in patients with multiple sclerosis on a wheat-reduced diet: a pilot crossover trial,” which was published in the journal Therapeutic Advances in Neurological Disorders.

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Gluten not the only wheat protein at issue in inflammation

It has become increasingly recognized that dietary components may influence MS risk, severity, and progression by altering the gut microbiome — the collection of microbes living in the gastrointestinal tract — and promoting the movement of inflammatory immune cells into the brain.

Wheat, though the most widely consumed food staple globally, is difficult to digest and known to cause inflammatory intestinal reactions. This largely has been attributed to gluten, the most abundant protein in wheat. About 1% of people worldwide have celiac disease, a condition in which reactions to gluten proteins cause intestinal inflammation.

These results show gluten is not the only problem, according to researchers.

“What is new is that other wheat proteins can generally contribute to inflammation,” Schuppan said.

Emerging evidence indicates that ATIs, proteins present in wheat products in much smaller amounts than gluten, might also play a role in inflammatory diseases. These proteins can stimulate immune reactions in the gut, causing the release of inflammatory molecules that then move through the bloodstream to boost existing inflammatory processes — particularly the activation of immune T-cells — in other organs.

In a study published last year, the researchers explored the possible effects of ATI on inflammation in a mouse model of MS. The results showed that an ATI-containing diet exacerbated disease severity in the mice. Meanwhile, gluten itself did not appear to influence disease severity relative to a control diet without these proteins.

Dietary ATI also was found to promote the infiltration of pro-inflammatory immune cells into the central nervous system. When cells taken from MS patients were incubated with ATI in the lab, the release of inflammatory molecules was promoted.

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Larger studies need on impact of wheat-reduced diet in MS

The team then launched a clinical pilot study (German Clinical Trial Register: DRKS00027967) to evaluate the effects of an ATI-reduced diet in RRMS patients.

The small study enrolled 16 RRMS patients, ages 18-60. All had stable disease without relapses in the prior three months, and were on a disease-modifying therapy. The participants continued on their standard wheat/ATI-containing diet for three months, then were asked to switch to a largely wheat-free diet — reduced by at least 90% — for another three months, or vice versa.

Consumption of wheat and other gluten-containing products was used as a proxy indicator of ATI consumption. Intake was monitored using patient-reported food questionnaires. Based on these, wheat consumption was reportedly decreased overall by about 88% from the standard diet period to the wheat-reduced period, which was supported by a reduction in levels of gluten peptides in the urine.

The trial’s main goal was to evaluate the effects of the wheat-reduced diet on inflammatory immune T-cells circulating in the bloodstream.

A wheat-free diet can reduce the severity of MS and other inflammatory diseases. Further studies combining a wheat-free diet with other drug therapies, among other things, are planned.

Overall levels of these cells were not significantly altered, however, certain T-cell subsets were decreased. Moreover, other types of immune cells, including populations of monocytes and innate lymphoid cells, showed changes under the wheat-reduced diet.

On the wheat-reduced diet, which was well tolerated, patients also experienced significant improvements in pain-related quality of life. Other life quality categories and overall disability did not significantly change.

“Our studies show how important diet, its interactions with the gut microbiome and the gut immune system are for health,” Schuppan said.

“A wheat-free diet can reduce the severity of MS and other inflammatory diseases. Further studies combining a wheat-free diet with other drug therapies, among other things, are planned,” he added.

The scientists emphasized the necessity of “a larger-scale clinical trial,” which should include patients with more severe disease and have a longer follow-up time.