A healthy diet becomes a post-diagnosis priority in MS, study finds

People diagnosed with multiple sclerosis (MS) tend to eat healthier diets and take more vitamin supplements than those without the chronic autoimmune disease, according to a new study in Egypt.

“MS patients showed a different dietary pattern characterised by higher micronutrient and supplement intake, most likely reflecting post-diagnosis behavioural change rather than a pre-existing dietary difference,” the researchers wrote.

Among MS patients, none of the dietary components were independently associated with disability or progressive disease. Still, the scientists noted that, because the study had a cross-sectional design — meaning it only looked at people at one point in time — and the groups were not perfectly matched, it is unclear whether these dietary changes may ease symptoms or prevent them from progressing.

Therefore, the findings do not allow conclusions about cause-and-effect associations and “should not inform dietary prescriptions without prospective confirmatory evidence,” the researchers wrote. Prospective studies follow participants over time.

Nonetheless, the study found that “overall dietary composition differed significantly between MS patients and controls in [several] analyses, including after adjustment for age and sex.” The team  noted that people with MS had “higher intake of vitamin D, … fruits, and vegetables, and lower intake of bread, pasta, rice, total fat, saturated fat, cholesterol and sodium compared with controls.”

The MS patients also had lower body mass index (BMI), a proxy measure for body fat, than did those without the condition, the researchers noted.

The study, “Dietary intake and nutritional status in multiple sclerosis and associations with disease phenotype and management: A case-control study,” was published in the Journal of Clinical Neuroscience.

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What exactly causes MS, a progressive neurological disease, remains unclear, but studies suggest it develops from both genetic and environmental factors, such as diet.

Further, the researchers noted that “nutritional and metabolic influences are gaining increased recognition as … potential modulators of immune dysregulation and progression of MS.”

Despite studies, evidence on diet and MS risk is ‘inconsistent

Vitamin D deficiency is one of the most studied environmental risk factors for MS. Other micronutrients, such as vitamins A, E, and C, may also help keep the immune system in check or preserve the health of nerve fibers that are progressively damaged in MS.

Still, “evidence that links diet to MS risk or progression remains inconsistent,” the researchers wrote. “Studies in this area either focus only on single nutrients, lack matched control groups, or fail to adjust for [potential influencing] factors, such as sex, body mass index, or medication use, which are highly relevant in MS populations.”

Now, a team led by researchers from Al-Azhar University in Cairo sought to learn more about the effects of diet in adults with MS. To that end, the researchers looked at the eating habits of 270 people, ages 18 to 60, diagnosed at a single MS clinic. The team compared their diet with that of 255 people without MS or related diseases, who served as a control group.

The MS patients had been living with the disease for a median of nine years, and most (90%) had relapsing-remitting MS. In that MS type, periods of worsening or new symptoms, called relapses, are followed by periods of recovery. However, the majority (86%) had been free of relapses in the previous year.

The MS group had a significantly greater proportion of women relative to the control group (67% vs. 39%) and a significantly higher mean BMI (24.75 vs. 26.34 kg/square meter). The use of medications was also significantly more common in people with MS.

Both groups completed a questionnaire designed to estimate how often people eat different foods.

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MS patients more likely to take vitamin D supplements

The results showed that people with MS reported eating significantly more fruits, vegetables, and other foods rich in beta-carotene — a plant pigment the body can convert into vitamin A —  than those in the control group. The MS group also had higher intake of vitamins A, C, and E, and its members were significantly more likely to take vitamin D supplements.

This group’s members also reported consuming significantly less bread, pasta, and rice than those in the control group. Individuals with MS also had lower total fat, saturated fat, cholesterol (a fatty molecule), and salt intake than those without the condition.

When the researchers looked at overall eating patterns, they found that the diets of people with MS were significantly different from those of the controls. This difference remained even after taking age and sex into account. However, when other factors were considered, only supplementation with vitamin D remained linked to an MS diagnosis.

In addition, among MS patients, there was no significant difference in dietary patterns between MS types or treated and nontreated patients. The researchers also found no significant association between individual dietary components and MS severity, as assessed with the validated Expanded Disability Status Scale.

The researchers concluded that people with MS tended to follow healthier diets and use more supplements than people without MS. These differences were most likely the result of changes people made after being diagnosed rather than dietary habits that existed before the disease developed, the team noted.

“Our data are consistent with an interplay between diet and MS management but do not establish causality [cause-and-effect links] or justify specific therapeutic diets, underscoring the need for prospective and interventional studies,” the researchers concluded.