This study was the third in a series of studies that tested Dr Terry Wahl’s modified paleo diet on a group with Multiple Sclerosis.
The previous two studies, where 22 patients in total participated over 12 months, were multi-modal and tested the modified paleo diet along with exercise, meditation, and neuromuscular-electrical stimulation. The studies showed a reduction in perceived fatigue, improved gait, improved mood and cognitive function.
You can find these studies here:
- A Multimodal Intervention for Patients with Secondary Progressive Multiple Sclerosis: Feasibility and Effect on Fatigue (May 2014)
- Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study (Feb 2015)
- A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis (April 2017)
Dr Terry Wahls delivers a video abstract of the study:
What about diet alone as a treatment for MS?
A more recent study published in July 2017 looked at the effect of the diet alone on relapsing-remitting multiple sclerosis (RRMS).
Here is an overview of this study.
RRMS affects approximately 85% of MS sufferers.
Studies have shown there is an increased prevalence of celiac disease and gluten sensitivity in persons with MS, and that following a gluten free diet gives improvement in neurological symptoms. There is long standing evidence that cows milk consumption has a role in the development of MS.
This study set out to test whether diet alone is effective in reducing fatigue and improving qualtiy of life (QOL) as a treatment for MS.
- 34 in total, 17 to each group, baseline demographics and disease were similar in each group. All had neurologist verified relapsing remitting multiple sclerosis (RRMS), mean age 36.3, recruited from Iowa.
- Age 18 – 45 years, stable with no medication changes in the last 3 months.
- Were able to walk 25 feet
- On no other diets recommended to treat MS
- Participants were willing to be randomised to usual care – no diet change or the modified paleo diet.
- People in the study needed to be prepared to spend an extra $30.00 per week for food if randomised to the paleo diet.
How was the study done?
The length of Study was 3.5 months in total. A two week run-in and then 3 months intervention.
Prior to starting the study (2 week run-in) a 24 hour food recall was done online, as well as a 2 week food diary.
Measurements were taken at baseline and 3 months after the diet protocol started.
People were randomly assigned to either their usual care or the modified paleo diet. The first 5 people in each group were assigned by coin toss, then the rest assigned to groups so that both had a similar distribution of Fatigue Severity Scores (FSS)
The modified paleo diet protocol used in the study:
A standard paleo diet is as follows:
- Cereal grains, e.g. wheat, rye, barley, corn, oats, etc
- Grain like seeds, e.g. buckwheat, quinoa etc
- Legumes and lentils, including soy and peanuts
- Dairy products, e.g. milk, cheese, yoghurt
- Processed foods, primarily because of additives like emulsifiers, fillers, colours, preservatives and flavours
- Refined seed oils
The modified version is one that Dr Terry Wahls designed specifically to improve mitochondrial function in MS. It is similar to the auto-immune paleo diet (AIP)
The modified paleo diet (MPDI) further removes potato and eggs, and participants are asked to follow this diet that specifically included the addition of 9 cups of vegetables and fruit (source):
Subjects kept daily food logs on computer, specifically designed so that food amounts in each category above can be recorded. The control group also kept a food diary.
Both groups continued their medications.
Both the control group and diet group had a training session before starting – to teach the diet (MPDI group) or to instruct on staying on current diet with no change (control group).
Each person received a phone call weekly for the first 3 weeks, then every two weeks after that. Further support was available if requested.
The primary measure was perceived fatigue:
- Perceived fatigue using the Fatigue Severity Scores (FFS).
The secondary outcome measures were for physical and cognitive function:
- Multiple sclerosis quality of life (MSQOL)-54
- Veteran’s Specific Activity Questionnaire (a strong predictor of actual and predicted exercise capacity)
- MS functional composite to evaluate motor function (gait – 25 foot walk)
- Hand function (9 hole peg test)
- Cognitive function (paced audio serial addition test)
- Timed 6 minute walk to measure gait speed and endurance.
A trained research assistant administered the tests.
Other tests – Blood serum:
- High sensitivity C reactive protein (hs-CRP)
- Homocysteine (HCY)
- Vitamins B1 (thiamine), B9 (folate), B12 (cobalamin) vitamin K (all these play important roles in oxidative metabolism inflammation and immune function).
Adherence to the diet was assessed with the ASA-24, a free web based food recall tool. These were completed within 3 days of baseline visit and at end of month 1 and 3. Adherence to MPDI is that gluten and dairy were completely removed according to ASA-24
Subjects were removed from the study if not compliant
All but 2 in the MPDI group were compliant
Participant numbers that completed the study
8 completed MPDI and 9 in the control group
Below are the results with graphs showing the differences between the groups and between individuals. The modified paleo diet shows clear improvements in most participants compared to no diet change.
Perceived fatigue FSS decreased in MPDI but not controls
Quality of life (QOL) improved in MPDI compared to control – top graph -mental, bottom graph – physical.
Top graph – Hand function – 9 hole peg test (9-HPT ) – both dominant and non-dominant hand, MPDI completed test faster
Bottom Graph – 25 foot walk – increased gait speed, i.e. it took less time to complete. Timed 6 min walk -increased distance walked.
Vitamin K increased significantly in the MPDI group, likely a result of the vegetable component. The authors state “This may also indicate a reduction in oxidative cell and mitochondrial damage along with reduced inflammation, perhaps contributing to improved cognitive and motor function, fatigue, and QOL.”
Hs-CRP decreased in the MPDI from baseline and increased in the control, this is a measure of systemic inflammation.
HCY and B Vitamins – no change in either group. However it is pertinent to note that a criticism of paleo diets is that people will consume inadequate B vitamins when they cut out grains and fortified cereals. This study shows there is no reduction in B vitamins with a paleo diet.
This was a small study with a fairly large dropout rate. It was unblinded. Further larger studies need to be done, with blinding of research personnel. However it does show there was a positive effect of eating a paleo diet for people with multiple sclerosis.