Improved fatty acid profiles tied to cognitive gains with two MS diets

The Swank and Wahls diets, which are used by people with multiple sclerosis (MS), were associated with improvements in cognition and fatty acid blood profiles in relapsing-remitting MS (RRMS) patients, according to new analyses from the WAVES trial.

Changes in omega-3 fatty acids after about three months correlated with cognitive processing speed improvements among participants.

“The results from this secondary analysis suggest that diet and supplement interventions that enrich [blood omega-3] fatty acid profiles may also improve cognitive function among individuals with RRMS,” the researchers wrote in “Association Between Improved Serum Fatty Acid Profiles and Cognitive Function During a Dietary Intervention Trial in Relapsing-Remitting Multiple Sclerosis,” which was published in the International Journal of MS Care.

When the body breaks down fats, fatty acids are produced and absorbed into the bloodstream where they play important roles. Their ability to modulate immune cell activity has raised the possibility that they could help ease inflammation in people with chronic inflammatory or autoimmune conditions like MS.

Evidence suggests certain fatty acids might reduce the risk of MS or ease its severity, and they may also be associated with less cognitive dysfunction, a common and debilitating MS symptom that’s not always well controlled by therapies.

Omega-3 and omega-6 polyunsaturated fats (PUFAs) are thought to be of particular benefit. These so-called “good fats” are essential for human health, but the body can’t make them on its own and they have to be obtained from a person’s diet. Foods rich in PUFAs include olive oil, some nuts and seeds, and oily fish.

The Swank and Wahls diets are popular diets in the MS community. The Swank diet limits fat intake and supports the consumption of fruits, vegetables, nonfat dairy, lean meat, and whole grains. A modified version of the Paleo diet, the Wahls diet promotes consuming meat, fish, and plant-based foods, while avoiding highly processed foods, grains, dairy, soy, eggs, and nightshade vegetables. The WAVES trial (NCT02914964), launched in 2016, is comparing the effects of both diets among adults with RRMS. It’s being run by Terry Wahls, MD, the developer of the Wahls diet.

After a three month run-in period where all consumed their usual diet, participants were randomly assigned to follow the Wahls or Swank diet for about six months along with taking supplements of cod liver oil, which is a rich source of omega-3 fatty acids.

Both diets reduced fatigue, boosted life quality, and eased functional disability among participants, results showed.

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Comparing diets’ effect on cognitive function

Here, the researchers performed a secondary analysis to evaluate the diets’ effects on cognitive function and the association with blood levels of essential PUFAs. Cognitive function was evaluated with the Symbol Digit Modalities Test-Oral (SDMT-O), a clinical test of cognitive processing speed, and the Perceived Deficits Questionnaire (PDQ), a patient-reported indicator of perceived cognitive dysfunction.

Patients in both groups saw significant increases in nearly all the evaluated fatty acids after three and six months compared with the run-in.

Also, significant improvements in PDQ scores were observed in both groups after three and six months compared with pre-trial values, along with improvements in SDMT-O performance after six months, with generally no differences between the two diets. Gains were also seen across PDQ subscales, including those related to attention, memory, and planning.

Changes in combined omega-3 levels and eicosapentaenoic acid (EPA), a specific type of omega-3, after three months correlated with improvements in SDMT-O performance across both diet groups. No fatty acids were deemed to be mediators of, or directly responsible for, the observed relationship between diet and cognitive improvements, however.

“Interventions that enrich serum [omega-3] fatty acid profiles may also improve cognitive function among individuals with RRMS,” the researchers wrote, noting that changes in fatty acid profiles can’t necessarily be attributed to the diets alone, as all patients also received cod liver oil.

The relationship between omega-3 PUFAs and cognitive function in MS could be related to several factors, including the proposed neuroprotective, anti-inflammatory, and anti-oxidant activities of these molecules, said the researchers, who noted the study offers evidence for future research to  “assess the intersection between diet (including supplements), serum [omega-3] fatty acids, and cognitive function in MS.”