Multiple Sclerosis and Diet Therapy

Lauren Bachand

Multiple Sclerosis Primary-progressive (PPMS) Relapsing-remitting (RRMS) Secondary-progressive (SPMS) Progressive- relapsing (PRMS) Presence of lesions in both the grey and white

matter of the brain and along the spinal cord. characterized by

“acute episodes of one or more of these symptoms [blurred or double vision, slurred speech, weakness in limbs, sensory deficits, and paresthesias] followed by subsequent recovery” (p.692).

Demyelization Oliogodendrocytes

glial cells in the brain that are responsible for myelin production

Brady and Siegel(2012) state that the cause for these biochemical changes are most likely due to the “breakdown and gradual loss of myelin and its replacement by extracellular fluid, astrocytes and inflammatory cells” (p.695). The water content and decreased presence of myelin

supporting protein and lipids lead to biological changes decrease of myelin basic protein (MBP) and proteolipid

protein (PLP)

Demyelization Glial Fibrillary Acidic Proteins (GFAPs) in white

matter (cholesterol esters) cholesterol is not properly broken down and

metabolized, as a result it is esterified by phagocytes (Brady & Siegel, 2012).

Astrogliosis an increase of astrocytes in brain tissue due to the

destruction or inflammation of nearby neurons

In areas that show astrogliosis, there is an absence of myelin proteins and an increase of GFAPs which results in poor conduction between axons.

Free RadicalsWhen lesions occur, the microenvironment of the lesion can be just as harmful to the surrounding cells as the lesion itself. Free radicals and cytokines can cause direct injury to cells and “induce signal transduction events that ultimately result in injury or affect the migration of cells involved in damage repair”(Brady & Siegel, 2012, p.694).

Diet Therapy Three dietary supplements that have been the main focus of diet and multiple sclerosis research:

•Vitamin D

•Polyunsaturated fatty acids

•Antioxidants

•Gluten Free Diets

Vitamin D fat-soluble compound that is

synthesized in the kidneys derived from a form of cholesterol

Macrophanges, dendritic cells, monocytes, and active T cells all contain vitamin D receptors part of the body’s immune system.

high levels of vitamin D “reduce immunoglobulin synthesis” (a

type of immune response to foreign objects, or in the case of MS an autoimmune response to the body’s own proteins)

suppress axonal death Von Geldern and Mowry (2012)

vitamin D is thought to have an anti-inflammatory effect on T cells and may suppress the abnormal T cell responses to myelin basic protein (p.680).

Polyunsaturated Fatty Acids (PUFAs) Polyunsaturated fatty acids

(PUFAs) are long-chained fatty acids that contain more than one double carbon bond. omega-3 and omega-6 fatty acids

Biochemically the benefits of implementing a primarily omega-3 enriched diet, along with PUFA supplements include anti-inflammatory effects

relationship to reducing leukocyte migration an immune response that results in

inflammation in the brain. omega-3

key contributor to promoting myelin protein expression (von Geldern & Mowry, 2012).

Cholesterol In 2011 research was done on the relationship of cholesterol levels and

multiple sclerosis. The study found

strong association between increased levels of LDL and total level of cholesterol with higher ranked scores on the Expanded Disability Status Scale (EDSS) and severity scores for MS patients (Weinstock-Guttman, 2011).

The same study also noted that there was a decrease in the volume of MRI lesions in patients who had high levels of HDL cholesterol.

In the book Grain Brain, Perlmutter (2013) identifies the major roles that cholesterol plays in the neurochemistry of the brain Creates the membrane around the cell and maintains permeability

(Perlmutter, 2013). “the ability to grow new synapses in the brain depends on the availability of

cholesterol, which latches cell membranes together so that signals can easily jump across the synapse”

A “key component in the myelin coating around the neuron, allowing quick transmission of information” (p.91).

LDL plays a major role in this process by transporting cholesterol to the neurons.

Antioxidants and Gluten• ability to interfere with free-radicals

•since uric acid scouts out peroxynitrite, which is toxic to neurons, axons and glial cells in the brain, implementing uric acid supplements into a patient’s diet may slow down the progression of demyelination and axonal damage (Touil & Deloire-Grassin, 2001).

•Gluten: researched to see if it causes inflammation in the brainGluten

Research on effectiveness Vitamin D

“low levels of vitamin D were associated with increased relapse rate and disability in MS patients in the 2 years preceding enrolment” (Von Geldern and Mowry, 2012, p.680).

vitamin D supplements may have a positive effect on MS. 49 patients examined for one year Half of the patients were given an increased dose of vitamin D

supplements, while the other half was used as a control. The results showed that of those patients who had received the

additional vitamin D supplements, “significantly fewer had an increase in EDSS score at the end of the trial” and that there was a trend “towards a lower annual relapse rate and a higher proportion of relapse-free patients in the treatment group than in the control group” (von Geldern & Mowry, 2012, p.680).

Research on effectiveness PUFAs

One study completed by Jelinek and colleagues found that patients who were taking omega-3 supplements and implemented more fish into their diet self-reported a better quality of life and lowered sense of disability (Jelinek& Hadgkiss, 2013).

There were “trends towards lower relapse rates and reduced disease activity” although they requested that further research was needed to conclude the effectiveness of omega-3 supplements (Jelinek& Hadgkiss, 2013).

Another study examined the effects omega-3 fatty acids had on the disability progression, fatigue or quality-of-life scores verses those in a placebo group. Randomized 92 participants with RRMS examined the patients at six months and 24 months The study found no significant difference after six months in the number of lesions

on gadolinium-enhanced MRI nor did they find a significant difference in relapse rates. The results also did not show an association between the supplements and disability progression, fatigue or quality-of-life scores.

However, von Geldern and Mowry(2012) argue that “no dietary restrictions or recommendations were given to participants, which might have attenuated any benefit of the fatty acid supplementation” (p.682).

Conclusion More research is needed to determine the effectiveness of diet

intervention on Multiple Sclerosis symptoms Evidence to suggest that the implication of diet therapies

specifically polyunsaturated fatty acids and vitamin D may help with the occurrence of relapsing episodes overall quality of life on MS patients

Most studies were based upon subjective testing and questionnaires, and sample sizes were small- it is

difficult to determine the validity and reliability of diet therapies as an effective form of treatment for MS patients.

No evidence to support the harm of implementing supplements such as vitamin D and omega-3 in one’s diet

Diet therapy may be beneficial from a psychological stand-point. There is no current cure for MS, most patients prefer to try diet

therapy it provides a sense of control over the disease.