Study Shows Association between Diet Quality and MS Disability, Symptoms

Our understanding about the connection between diet and MS is an evolving body of research. A recent study published in the journal of Neurology this month adds to our overall understanding about the association between diet and disability and symptom severity in MS. This large-scale study suggests that a healthy diet and healthy lifestyle are associated with lower levels of disability and symptom severity in MS.

Study Design Summary

The research team, led by Dr. Kathryn C. Fitzgerald of the Johns Hopkins School of Medicine, conducted a cross-sectional study of dietary screener questionnaires. The dietary questionnaires were completed in 2015 by over 7,000 participants in the North American Research Committee on MS (NARCOMS) Registry.

The surveys captured participants’ intake of fruits, vegetables and legumes, whole grains, added sugars, and red/processed meats. After applying age- and sex-adjusted scoring algorithms to the survey responses, the researchers converted the responses to estimates of their intakes of these foods and converted those estimates into a singular, comprehensive diet quality score.

In addition to reporting their dietary intake, participants were also asked to report whether they followed any of 19 specific diets since being diagnosed with MS. These diets included, but were not limited to, Swank, Wahls, Paleo, Atkins and Mediterranean diets.

The study also examined the potential association between dietary quality and a “composite healthy lifestyle,” which the researchers adapted from American Heart Association guidelines and defined as maintaining a healthy weight, routinely engaging in exercise, abstaining from smoking, and eating a better than average diet.

The researchers assessed the association between disability, using Patient-Determined Disease Steps (PDDS), symptom severity in several areas (mobility, hand function, vision, fatigue, cognition, bladder/bowel, sensory, spasticity, tremor, and pain) and diet quality, and composite healthy lifestyle.

Top-Line Study Results

A total of 6,989 of the completed diet questionnaires were ultimately analyzed for the study. The overall diet quality scores had a range of 4-20, with higher scores indicating a higher quality diet, and the average diet score was 11.9.

This large-scale study found that participants whose diets were higher overall in fruits, vegetables, legumes, and whole grains, and lower in added sugars from sweets and sugar-sweetened beverages and red meat were associated with lower disability levels. Higher intakes of whole grains and dairy products were also associated with lower disability levels. In terms of symptoms, overall diet quality also had association with less severe depression, and a composite healthy lifestyle was associated with less severe depression, pain, fatigue, cognitive impairment, and disability. These findings are consistent with other smaller-scale studies of diet in MS patients.

It is important to note that association is different from causation. The researchers acknowledge that “causal inference cannot be made because poor physical or mental health may lead to poorer diet quality or food choices.”

Researchers report that one unexpected finding was that adherence to the Wahls diet was associated with increasing disability severity. However, they point out that the diet is primarily used by people with progressive disease, which may be creating a selection bias. In addition, use of a gluten-free diet and lower intakes of dairy and calcium were also more common in people with progressive disease. Researchers emphasize that further research and longitudinal assessment of MS patients who follow these diets is needed.

“This study contributes to the ever-growing body of research regarding MS and nutrition,” says Dr. Timothy Vollmer, RMMSC Medical Director and Co-Director of RMMSC at CU, “The research findings underline the importance of an overall healthy diet and active lifestyle in living with MS and maximizing your lifelong brain health.” For more information about healthy eating and MS, please check out the following RMMSC resources:

MS and Nutrition

Holly Prehn, Registered Dietician at the UCHealth Center for Integrative Medicine, presents at RMMSC’s Spring, 2017Education Summit. Holly discusses key nutritional concepts and helpful real-life strategies for healthier eating. Video | Slides

Interview with Holly Prehn, Registered Dietician

We recently spoke with Holly Prehn, registered dietician at the Center for Integrative Medicine at University of Colorado Hospital to learn more about healthy nutrition, the role of diet in MS, and practical tips for making changes in your nutritional habits. Read the article here.

Webinar: Diet and Nutrition in MS

Lauren Ott, a Registered Dietician, takes us through some important information for those living with MS -- and everyone else as well. This interactive hour-long presentation is archived here for your convenience: Video