Wednesday, 16 September 2015

ClinicSpeak: treating primary progressive MS holistically

Diet and exercise in the management of MS. #ClinicSpeak #MSBlog #MSResearch

"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.

13 comments:

  1. It's the lifestyle that everyone should have, with or without MS. What with Jamie Oliver and the rest breathing down our necks about what makes a good diet, MSers need to be like everybody else and ditch the rubbish.

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  2. My development was in the same direction as I changed diet, did some more exercise. I lost 30 pounds and am now able to walk as far as I want. My fatigue blow away.

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  3. I have made a comment before on this blog about how the insinuation that there is an inevitable outcome in terms of disability with MS is neither helpful nor correct, so I do not like 'Slide 1'.

    I am a perfect weight for my height and enjoy a healthy diet and as much excercise as I can manage. No one needed to tell me to do this - it's common sense. If I hadn't done this all along, I would be in a wheelchair now - no question.

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  4. Thank you for posting this Prof G. Such posts give hope and serve as inspiration.
    How old is this patient and how long has he had MS?

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  5. I see obese people who have mobility problems, in this case wasn't the additional EDSS point due to obesity rather than MS? Should he not have been 5.5 initially because some of his disability was caused by another condition? It confuses me this.

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  6. Interesting: "Noteworthy, in the presence of aspirin, EPA and DHA form new anti-inflammatory bioactive molecules called resolvins, protectins, and maresins, which are able to reduce cellular inflammation and inflammatory pain (Xu et al., 2010; Hong and Lu, 2013; Serhan and Chiang, 2013).This may be a relevant aspect related to the nutritional intervention in MS" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342365/

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  7. Does anyone remember ARMS Action for Research into Multiple Sclerosis? They published a free booklet called Why a diet rich in essential fatty acid? It includes an explanation, diet and a few recipes for self help in MS health. I've followed it since the '80s not strictly, but the basics are all there. A Neurologist told me to swim three times a week and I did other exercise. This is nothing new, it's just been put on the back burner or dismissed. I certainly didn't become secondary progressive for nearly 30 years and only after serious illness, not MS. I still have the booklet it's a bit tatty, but it's still relevant.

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  8. I too am following the evidence based OMS programme and like many many others have seen significant improvements. Encouraging to see several neurologists & other MS specialists also embracing this empowering approach that gives real hope. Many thanks

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  9. The fact that an obese person with MS felt better after they lost weight is nothing to write home about and does not tell anyone anything at all.

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  10. There are thousands of us around the world who are reclaiming our lives by looking elsewhere for answers. It surprises me when few neurologists talk about diet and exercise. Diet and exercise are key components of healing MS.

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  11. Dear Kemel please read blog conduct to not end up in spam

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  12. Go patient X! One of the links between poor diet and ill health is poverty. I can eat well on a limited budget but I would struggle to manage on UK benefits to eat the same diet I follow now due to the amount of veg and fruit.

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    Replies
    1. In London we have a large migrant population and with it comes diverse shops. The fresh fruit and veg available in those shops are at a fraction of the price in supermarkets. I assume other parts of the country have similar access to healthy food. In Tesco this morning the woman in the queue behind me, had a trolly full of crisps, sweets, processed foods and sugary drinks for her family. I was shopping for knickers. We wonder why everyone is becoming diabetic.

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