Countermeasures by nutrition? »Transparent medicine

In multiple sclerosis (MS), inflammation increasingly damages the nerve fibers of the brain and spinal cord. Does an "anti-inflammatory diet" help?

The disease Multiple sclerosis (MS) affects about 6 in 10,000 people in Europe. Inflammation of the brain and spinal cord can cause vision problems, emotional disturbances and paralysis, for example. Multiple sclerosis is the leading cause of disability among youth, aside from accidents [6],

The evolution of the disease, its speed and its impact on daily life and autonomy vary considerably from person to person. [7],

Multiple sclerosis is therefore also called "disease with a thousand faces". MS treatment is not possible yet.

Medications for MS

In multiple sclerosis, various medications are used. They are intended to prevent relapses, that is to say the acute aggravation of the disease, and to slow the progression of the disease.

The quality of this success is individually different. In addition, medications have significant side effects that can limit the quality of life. [8],

Become active

Affected individuals often seek other ways or means to even influence their illness in a favorable way. "Anti-inflammatory diets" and "antioxidant supplements" such as vitamin A are being propagated for this purpose.

Does it really help with MS? A reader asked us – and we went in search of evidence for this hypothesis.

Eat against inflammation?

"Anti-inflammatory" diets aim to make the body less proinflammatory. As a result, fewer foci of inflammation occur in the brain and spinal cord, which is typical of MS.

• Thus, the preferred consumption of unsaturated fatty acids (omega-3 fatty acids, for example) would produce fewer pro-inflammatory substances than saturated fatty acids. [2],
• "Antioxidant" substances such as vitamin A, vitamin E or plant polyphenols and carotenoids to mitigate adverse reactions of pro-inflammatory substances to reduce "oxidative stress" [2],

Theoretically possible

Theoretically, the nutrition strategies discussed could certainly help. But what about the practice? Are propagated diets useful? Do they give a significant improvement to those affected and have a positive effect on daily life? With these questions, we looked for serious inquiries.

And indeed: Different diets have been studied in studies in patients with MS.

The bad news: the absence of diet or supplementation is a striking feat, sometimes even a non-significant one.

What is the use of fish oil?

Dietary supplements containing omega-3 fatty acids are still the best studied. These came from fish oil or vegetable oil, for example linseed oil.

However, we have found no convincing evidence of the benefits of omega-3 fatty acids in MS. In most studies, the research teams found no significant difference from a dummy drug – this trend is therefore ineffective.

The studies [1,3] But they are usually very bad. Inadequate methodology therefore severely limits the security of our testimony.

Vitamin A: no declaration possible

We have found that only one study on vitamin A presented as an "antioxidant" [5]However, this did not convince us because of partially contradictory results and poor methodological quality; and we can not say if this nutritional supplement can be helpful.

Studies on poor regimes

For nutritional forms like the McDougall diet [1], a modified paleo diet [2] or a Mediterranean diet [4] we were able to identify only one exam at a time. The same goes for a diet that consumes less saturated and unsaturated fats. [1] ,

Problem with all these studies: too few participants and mediocre methodological quality. In all cases, most of the diet changes have failed.

Overall, the data are too thin to draw reliable conclusions. We can not therefore say whether the use of vitamin A or the diets mentioned is effective for positively influencing MS.

Unknown side effects

To what extent does the long-term use of certain dietary supplements or dietary modification entail risks, the studies have not been reliably collected or can not be inferred due to the period of time. Relatively short study of up to two and a half years also uncertain.

A disease, different forms

Multiple sclerosis (MS) comes in many forms: it is most often diagnosed as relapsing remitting (RRMS). The symptoms appear during a push, but then come back: complete or incomplete. Between two episodes, the state of health does not deteriorate.

Over time, an RRMS can evolve what is called Progressive Progressive MS (SPMS). Second, disability also increases independently of relapses.

Predominantly progressive MS (PPMS) has no recurrent course. Deficiency increases already since the beginning of the disease [9],

How does inflammation occur?

What exactly happens in the body in MS, according to the current state of science, is not fully understood. According to a theory of the development of the disease, your immune system may be directed against the body's own tissues.

These autoimmune processes are thought to develop the typical inflammatory centers of MS in the nerves of the spinal cord and brain. As a result, for example, muscle control problems [6],

Studies in detail For our research, we found a whole series of studies. A systematic review [1] included several randomized controlled nutritional studies on MS, i. Participants were randomly badigned to an intervention or control group. These included nine studies on dietary supplementation of omega-3 fatty acids and two on dietary recommendations that, in the broadest sense, applied the principles of an "anti-inflammatory diet". In addition, we were able to identify other randomized controlled trials: one for each "modified paleo diet". [2], to a change of regime similar to the Mediterranean diet [4], with omega-3 fatty acids [3] and for vitamin A supplementation [5], The big differences make the comparison difficult All studies included patients with MS. Most of them suffered from relapsing-remitting MS. They were moderately limited in their daily lives, for example in terms of mobility and walking ability. In all the studies, the research teams evaluated whether or how the diet or supplements worked: could the progression of the disease be inhibited? Has there been any relief from existing complaints? For the collection of treatment success, partly different instruments were used. The characteristics and treatment of the subjects also varied: for example, the duration of the illness, the severity of the deficiency or the additional drugs allowed were often different. In some studies, these points have not been given. This makes it difficult to compare the results of the studies. Trend: no benefit with omega-3 fatty acids The large differences between studies are particularly noticeable in studies that tested the benefits of omega-3 fatty acid supplements (nine studies of [1] as good as [3]). The preparations used came from different sources (fish oil or plant seed oil). The dosage was very different. The studies lasted between 12 and 30 months. Most had less than 100 participants. However, because of the relatively large number of studies, the empirical values ​​of more than 1000 participants come together. However, there is no convincing evidence of the efficacy of omega-3 fatty acids in this summary. The vast majority of studies have found no improvement in the disease compared to a dummy treatment. In many cases, surveys have serious methodological flaws. Often, the data of all participants was not badyzed. The results may be biased because those who judge the success of the treatment know what remedy the patient is taking. It is therefore difficult for us to determine whether omega-3 fatty acids are actually (k) useful in MS. Many questions about vitamin A The study on vitamin A intake is even worse. In addition, we only have one study. [5] can find. Here, the 101 participants took at random either vitamin A or a dummy drug for six months, all in addition to interferon treatment. The research team then examined the evolution of limitations such as agility and the possible presence of acute relapses. The differences between vitamin A and the simulated preparation were observed only in a few aspects examined. This could be accidental discoveries. In addition, it is not possible to know if the improvements observed were really noticeable for patients. In addition, data from all participants was not evaluated. This is a serious methodological problem. Thus, the benefit of vitamin A remains uncertain in this study. Low fat diet: no benefits noted Some studies have also examined specific diets. The systematic review [1] contains a study on the so-called McDougall diet. With this exclusively vegetable food, only a small consumption of fat is allowed. Vegetable oils are also part of the "forbidden" foods in McDougall's diet. People who followed this diet were compared to those who were still waiting for proper nutrition training. In the review [1] There is another study in which the change in diet consists of a low-fat diet supplemented with fish oil capsules. This selection of foods has been compared to the rules of the American Heart Association, which recommends a maximum of 30% of calories consumed. Both studies lasted 12 months, but did not show any benefit from the particular diet for MS-related symptoms. Stone Age: unclear effects Also another study [2]testing a "modified paleo diet" over a period of three months does not make sense. Half of the participants had to change diets to eat mainly fruits, vegetables and meat. Foods containing gluten (wheat, barley, spelled), dairy products, potatoes and legumes were "banned". The other patients maintained their usual diet. From a purely mathematical point of view, the research team was able to determine the benefit of the scheme for certain measures. However, the statistical evaluation poses some problems, so that the real effects are not clear. Mediterranean diet against multiple sclerosis? Another survey [4] examined the evolution of symptoms in patients with multiple sclerosis who had received a recommendation for a Mediterranean diet or had not received any particular dietary advice. After six months, the research team found no difference between the two groups, either in terms of functional limitations or in terms of quality of life. Conclusion on diets: unclear anti-MS effect Studies of the different regimes were all relatively small and had many methodological flaws. We can not draw any reliable conclusions. Side effects were not at all or only insufficient for all dietary supplements or diets examined.

(Author: I. Hinneburg, Criticism: J. Harlfinger, C. Christof)

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Information about scientific studies

[1] Hempel 2017
Type of study: systematic review
Studies included: on nutritional modifications 12 randomized controlled trials involving approximately 1,200 participants, including 9 involving approximately 1,000 participants on omega-3 fatty acids
goal: Does nutritional change improve the clinical picture of multiple sclerosis?
Conflicts of interest: none according to the team of the author

Hempel S. et al. A systematic review of the effects of modifiable risk factor intervention on the progression of multiple sclerosis. Multiple Sclerosis 2017; 23: 513-524 (Summary of the study)

[2] Irish 2017
Type of study: randomized controlled trial
participants: 34 patients with multiple sclerosis
goal: Does maintenance of a modified Paleo diet over a three month period improve the clinical picture of multiple sclerosis?
Conflicts of interest: none according to the team of the author

Irish AK et al. Randomized controlled trial of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017 7: 1-18 (Summary of the study) (full study)

[3] Zandi 2017
Type of study: randomized controlled trial
participants: 50 patients with multiple sclerosis
goal: Does taking fish oil in addition to fingolimod for more than one year improve the clinical picture of multiple sclerosis?
Conflicts of interest: none according to the team of the author

Zandi-Esfahan et al. Evaluation of the effect of adding fish oil to fingolimod on TNF-α, IL1β, IL6 and IFN-γ in patients with relapsing remitting multiple sclerosis: a randomized double-blind placebo controlled trial. Clin Neurol Neurosurg. 2017 163: 173-178 (Summary of the study)

[4] Riccio 2016
Type of study: randomized controlled trial
participants: 21 patients with multiple sclerosis
goal: Following a 6-month diet improves the clinical picture and quality of life of multiple sclerosis
Conflicts of interest: Two people from the editorial team are employees of a company that makes the supplements studied in the study.

Riccio P et al. Nutritional anti-inflammatory intervention in patients with progressive or primary progressive multiple sclerosis: a pilot study. Experimental Biology and Medicine 2016; 241: 620-635 (Summary of the study) (full study)

[5] Bitafaran 2015
Type of study: randomized controlled trial
participants: 101 patients with multiple sclerosis
goal: Does taking vitamin A over a period of one year improve the clinical picture of multiple sclerosis?
Conflicts of interest: none according to the team of the author

Bitafaran S et al. Impact of vitamin A supplementation on the course of disease in patients with multiple sclerosis. Arch Iran Med. 2015; 18: 435-40 (Summary of the study) (full study)

Other scientific sources

[6] UpToDate (2018) Pathogenesis and epidemiology of multiple sclerosis. (Accessed the 16.10.2018)

[7] UpToDate (2018) Treatment modifying the disease of recurrent-recurrent multiple sclerosis in adults. (Accessed on 25.10.2018)

[8] UpToDate (2018)
Treatment of progressive multiple sclerosis in adults. (Accessed the 16.10.2018)