According to the National Multiple Sclerosis Society, around 1 million people in the United States are living with Multiple Sclerosis (MS). MS is a disease of the central nervous system that interrupts the stream of information within the brain, as well as the flow of information between the brain and body due to a breakdown of myelin. Myelin happens to be the protective layer that insulates the wire-like nerve fibers, which in effect, disrupts the signals to and from the brain.
People with MS are usually diagnosed between the ages of 20 to 50, but MS can happen at any age. Moreover, it is more frequent in women than it is in men.
A new study, which was published in Multiple Sclerosis Journal on October 13, discovered that people diagnosed with MS who follow the Mediterranean Diet, ‘were more likely to experience less disability than people who did not.’
Lead author and associate professor of neurology at the Icahn School of Medicine and a neurologist at Mount Sinai in New York City, Ilana Katz Sand, MD, explains that these findings support the collecting evidence that the diet of people with MS is incredibly important. She shared, “After rigorously controlling for demographic and health-related factors, we noted a significant association between Mediterranean diet score and objectively captured disability in people with MS.”
Assistant professor of medicine and the director of pediatric multiple sclerosis and wellness at the Mellen Center for Multiple Sclerosis of the Cleveland Clinic in OH, Mary Rensel, MD, who was not part of the research study, explained, “This study does help confirm what we’ve suspected from previous literature – that a person’s particular level of adherence to the Mediterranean diet seems to matter for outcomes of MS.”
There Has Not Been a Single Diet to Improve MS
According to Dr. Rensel, researchers have been studying MS and diet for decades, but what they’ve observed is that there hasn’t been a single study since that’s shown just one nutritional pattern that works for all people suffering from MS so far. However, there is new evidence that shows how nutritional intake and a healthy diet is important when it comes to mood disorders, physical outcomes of MS, as well as the way a person feels, or their quality of life, she explains.
Dr. Rensel adds that because of this outcome, and because people with MS are quite interested in the way diets impact their condition, this study is very important.
Notably, the Mediterranean diet uses olive oil as their primary oil, while emphasizing the consumption of vegetables, fruits, nuts and seeds, legumes, as well as moderate amounts of dairy and fish products as well. Moreover, red and processed meats and sugar should only be consumed in limited amounts.
Mediterranean Diet is Associated With Improved Overall Health in Those With and Without MS
The study team evaluated the Mediterranean diet in those with MS for a number of reasons. For one, this diet is associated with improved general health outcomes, such as the prevention of cardiometabolic conditions that are ‘already adversely linked with the course of the disease.’
In addition, the cardiometabolic health includes a number of risk factors, such as type 2 diabetes and insulin resistance, cholesterol levels, high blood pressure, cardiovascular disease, and overweight and obesity.
In some lab studies, they have found that particular key components of the Mediterranean diet, such as the omega-3 fatty acids and the other anti-oxidant containing foods, which have the possible neuroprotective benefits in MS.
In another randomized controlled pilot trial by the same team, published in the November of 2019 Multiple Sclerosis and Related Disorders, they found that ‘a modified Mediterranean diet in MS showed promise: The people who stuck to the diet reported improvements in fatigue, impact of MS symptoms on everyday life, and stabilization of disability.’
Those With MS Who Carefully Followed the Mediterranean Diet Had Less Disability
The study, which included 563 people with MS between the ages of 18 and 65, had the participants complete the Mediterranean Diet Adherence Screener (MEDAS). This scores the consumption of healthy foods like vegetables, whole grains, and olive oil, as well as the avoidance of unhealthy foods like butter and red meat.
Another tool is the MS Functional Composite (MSFC), which is used to ‘objectively measure disability in MS, including cognition, arm coordination, and walking speed alterations. Patient-reported outcomes assessed physical impairment, fatigue, walking and cognitive dysfunction, depression, and anxiety.’
The research team grouped the participants of the study according to their MEDAS scores. Those with a higher score had better adherence to the Mediterranean diet.
Moreover, the team also observed that those with higher scores were associated with better MSFC performance – meaning less disability – ‘independent of demographic factors such as age, sex, race, ethnicity, and socioeconomic status, or other health conditions. Each MEDAS point score increase was linked to a 15 percent lower risk of MSFC impairment.’
The authors shared, “MEDAS was by far the best health-related predictor of MSFC.”
In addition, following the Mediterranean diet more closely was also linked with a lower disability across all patient-reported outcomes, regardless of the demographic factors and other health issues. As for the patient-reported outcomes, they found that depression had the strongest association with MEDAS scores.
The researchers shared, “Depression was worse among patients who use butter, drink sugary beverages, and consume less fish.”
So Can Diet Truly Change the Course of MS?
Dr. Rensel says that this study has a number of strengths that work to advance the research on the impact that the diet has on MS. She explained, “They used the Mediterranean Diet Adherence Screener (MEDAS), and then looked at covariates – socioeconomic, demographic, health related, and found that yes, if people were more adherent to the Mediterranean diet, they did have less physical disability from their MS, and it did seem related to their diet rather than other factors.”
Despite all the research on MS and diet, the question still remains, “Is eating a healthy diet enough to change the outcome of your MS?” says Dr. Rensel.
What these other studies have demonstrated is that ‘a composite healthy lifestyle lessens symptoms and disability, but does diet change the disease course of MS in 5, 10, or 20 years?’
Dr. Rensel shares, “They’ve chipped away at that question with this very detailed study.”
Those With MS With Lower Income or Less Education Less Likely to Follow Mediterranean Diet
Dr. Rensel also explains that the study results also found that advocates of the diet had a relation to their socioeconomic status. Moreover, she also says that this is confirmed in other conditions as well where income, education, and where a person lives can impact a person’s ability to get health food.
She added, “There’s more to be learned about this — what types of support and resources can we offer to help everyone have access to more nutritious foods.”
They Plan to Do Bigger Studies on MS and Diet
Dr. Katz Sand also shared, “We are currently conducting longitudinal studies on this topic to help us understand the impact of diet in MS over time, one of which aims to further investigate potential mechanisms for these observed effects.” As the team moves forward, they plan to conduct even bigger interventional studies that build on their current findings.
So Should People Diagnosed With MS Eat a Mediterranean Diet?
Dr. Sand explained, “We do not currently have enough evidence to recommend one particular dietary pattern definitively over another. However, we are accumulating evidence, strengthened by this paper, that diet is important in MS.”
As for Dr. Katz Sand, she is part of the National Multiple Sclerosis Society’s Wellness Research Working Group. She encourages her patients to follow the organization’s general health-eating guidelines, explaining, “This includes things like preparing meals at home when possible, trying to incorporate vegetables and fruits, and limiting intake of ultra-processed items as much as possible. In my experience, a few small changes can go a long way in terms of how someone feels each day.”
Meanwhile at the Cleveland Clinic, Dr. Rensel says they recommend that patients with MS use the Mediterranean diet. She says, “There’s so much literature behind the benefits of the diet, including improved mortality, a reduced risk of cardiovascular diseases, neurodegenerative diseases, and some types of cancer.”
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