Evaluating Dietary Interventions for the Management of Multiple Sclerosis

Multiple sclerosis (MS) is a neurodegenerative and inflammatory disease that affects about 2.5 million people worldwide. There are many medical and nutritional interventions. Some of the accepted drug approaches include an immunomodulatory agent such as Glatiramer aceate, anti-inflammatory compounds Interferon-β1a and β1b, and substances that attenuate disease progression, including natalizumab and mitoxantrone (National Multiple Sclerosis Society, 2008). More recently, short-term pilot studies with low doses of Naltrexone^®, an opiate receptor antagonist, suggest the mental quality of life may be improved among those presenting relapsing-remitting or secondary progressive MS disease (Cree et al., 2010; Sharafaddinzadeh et al., 2012). In addition, muscle pain may be reduced while lymphocyte functions may be improved following the introduction of Naltrexone^® (Gironi et al., 2008).

Understanding the numerous pathologies associated with MS, many investigators have reported on the potential applications of dietary interventions. These interventions focused on nutrients that may influence the inflammatory processes and immune system and included supplementation with omega-3 fatty acids, vitamin D, vitamin B-12, probiotics, and an array of other vitamins and selected botanicals, as well as caloric and gluten restriction (Simi et al., 2009; Riccio, 2011; Shor et al., 2009).

A summary of global epidemiological studies suggests increased prevalence among populations that consume higher levels of saturated fats and lower prevalence among other populations with an
elevated intake of polyunsaturated fatty acids (Ferinotti et al., 2009). In vitro studies with peripheral blood mononuclear cells suggest EPA and DHA may attenuate bloodbrain disruption by decreasing the activity of matrix metalloproteinase- 9 produced by T-lymphocytes and CD4+ T cells (Shinto et al., 2011). However, a recent review indicates data are insufficient on n-3 fatty acid consumption or supplementation among individuals diagnosed with MS to substantiate potential benefits. Studies that compared linoleic acid (n-6) and oleic acid (n-9) consumption suggest these fatty acids may alter the course of the disease.

The global map of MS prevalence suggests increased risk of developing it with increased distance from the equator (http://www.mult-sclerosis.org/ms_world.html) . This implies a relationship between vitamin D and MS risk. A recent summary of vitamin D status among children living at higher latitudes indicates a greater risk of deficiency and possible increased risk of developing MS in later life (Holick, 2012). However, assessment of the MS and vitamin D status relationship in the Nurses' Health Study of 1986 and 1998 indicated intake of this nutrient during adolescence was not associated with MS risk. Yet there appeared to be a risk among those consuming ≥ 400 IU/day independent of milk consumption (Munger et al., 2011). Additional assessment of known polymorphisms associated with vitamin D metabolism, including vitamin D receptor, which is diminished during the later years of life, indicated possible benefits (80% reduced risk of developing MS) only among those with the "ff" genotype and consuming 400 IU/day (Simon et al., 2010).

Several animal studies suggest caloric restriction may attenuate induced inflammatory disease and reduce conditions associated with chronic inflammation, including neurodegenerative diseases, among non-human primates and humans (Piccio et al., 2008; González et al., 2012; Ingram et al., 2007; Duan and Ross, 2010). MS, like obesity, is a complex, multifaceted inflammatory disease. Calorie restriction may be neuroprotective in some experimental models and affect several networks associated with inflammatory processes; however, adequate clinical evidence among MS patients following a calorie-restricted regimen has yet to become a standard of care.

Interestingly, there is mounting evidence that suggests those with neurological disease present antibodies to wheat and rye, which contain gluten.

There are many therapies intended to reduce the progression of MS and to restore normal functions. These strategies include innovative diagnostics and pharmacological approaches, most of which focus on inflammatory and demyelination processes. Dietary interventions, including those that impact impaired sodium and potassium functions within the disease process, while interesting, have yet to provide consistent results (Ontaneda et al., 2011).

References cited in this article are available from the authors. 

Roger Clemens, Dr.P.H.,
Contributing Editor
Chief Scientific Officer, Horn Company, La Mirada, Calif.
[email protected] 

James D. Adams Jr., Ph.D.
Associate Professor,
University of Southern California School of Pharmacy
Los Angeles, Calif. 
[email protected]