“I saw a patient of mine with primary progressive MS last week who has had made a remarkable improvement. I hadn’t seen him for over a year due to my sabbatical. A year ago he was EDSS 6.5, i.e. needing bilateral support to walk. Last Tuesday his EDSS was 5.5; in the last year he had managed to ditch the walking stick(s). How? Diet and exercise. A year ago he weighed 107 kg with a BMI (body mass index) of 37. A year later he weighs 69kg and now has a BMI of 24. Being obese had made walking difficult so he went onto a low calorie high-fibre diet, reduced his red meat and processed carbohydrate intake and joined a gym, and gradually over 12 months has transformed himself. He now does an aerobic exercise class 6x a week and swims 3-4x a week. He said to me that he has never felt better; in fact mentally he feels more alert and less fatigued than he did before he was diagnosed with MS. His mood is better, he is sleeping well and he has been able to reduce his dose of baclofen. He has noticed fewer leg spasms at night. He has also noticed an improvement in his constipation; he now describes his bowel function as being normal. Unfortunately, his urinary symptoms have remained unchanged. The aches and pains he used to get in his feet and ankles have disappeared. I assume these were arthritic and related to his obesity and not his MS.”
“There is a science base now emerging to support the positive effects of both diet and exercise on the outcome of inflammatory disorders. You may want to read the open-access article below that reviews some of this evidence.”
“This case study simply illustrates how important an holistic approach to the management of MS is and shows that physical/dietary interventions can make a massive difference to someone with MS.”
“To put this in context. We have just finished an audit on diet in a small sample of our patients attending the MS clinic at the Royal London Hospital. In short the average MSer diet is very poor, both at a macro and micronutrient level. This is why we are going to be taking action to improve our dietary education and to try and nudge people to take make diet (and exercise) an integral part of the management of their MS. Any comments on this topic are very welcome?”
EDSS 5.5 = Disability severe enough to preclude full daily activities. Able to walk without aid or rest for 100m
EDSS 6.0 = Requires a walking aid – cane, crutch, etc – to walk about 100m with or without resting
EDSS 6.5 = Requires two walking aids – pair of canes, crutches, etc – to walk about 20m without resting
Riccio & Rossano. Nutrition facts in multiple sclerosis. ASN Neuro. 2015 Feb 18;7(1). pii: 1759091414568185.
The question whether dietary habits and lifestyle have influence on the course of multiple sclerosis (MS) is still a matter of debate, and at present, MS therapy is not associated with any information on diet and lifestyle. Here we show that dietary factors and lifestyle may exacerbate or ameliorate MS symptoms by modulating the inflammatory status of the disease both in relapsing-remitting MS and in primary-progressive MS. This is achieved by controlling both the metabolic and inflammatory pathways in the human cell and the composition of commensal gut microbiota. What increases inflammation are hypercaloric Western-style diets, characterized by high salt, animal fat, red meat, sugar-sweetened drinks, fried food, low fiber, and lack of physical exercise. The persistence of this type of diet upregulates the metabolism of human cells toward biosynthetic pathways including those of proinflammatory molecules and also leads to a dysbiotic gut microbiota, alteration of intestinal immunity, and low-grade systemic inflammation. Conversely, exercise and low-calorie diets based on the assumption of vegetables, fruit, legumes, fish, prebiotics, and probiotics act on nuclear receptors and enzymes that upregulate oxidative metabolism, downregulate the synthesis of proinflammatory molecules, and restore or maintain a healthy symbiotic gut microbiota. Now that we know the molecular mechanisms by which dietary factors and exercise affect the inflammatory status in MS, we can expect that a nutritional intervention with anti-inflammatory food and dietary supplements can alleviate possible side effects of immune-modulatory drugs and the symptoms of chronic fatigue syndrome and thus favor patient wellness.