Tuesday, 12 December 2017

Can you eat your way to happiness?

What is happiness? Once you defined it can you eat your way to the holy grail? 

Fitzgerald KC, Tyry T, Salter A, Cofield SS, Cutter G, Fox R, Marrie RA.

Diet quality is associated with disability and symptom severity in multiple sclerosis. 

Neurology. 2017 Dec 6. pii: 10.1212/WNL.0000000000004768.

OBJECTIVE:To assess the association between diet quality and intake of specific foods with disability and symptom severity in people with multiple sclerosis (MS).

METHODS:In 2015, participants in the North American Research Committee on MS (NARCOMS) Registry completed a dietary screener questionnaire that estimates intake of fruits, vegetables and legumes, whole grains, added sugars, and red/processed meats. We constructed an overall diet quality score for each individual based on these food groups; higher scores denoted a healthier diet. We assessed the association between diet quality and disability status as measured using Patient-Determined Disease Steps (PDDS) and symptom severity using proportional odds models, adjusting for age, sex, income, body mass index, smoking status, and disease duration. We assessed whether a composite healthy lifestyle measure, a healthier diet, healthy weight (body mass index <25), routine physical activity, and abstinence from smoking was associated with symptom severity.

RESULTS:Of the 7,639 (68%) responders, 6,989 reported physician-diagnosed MS and provided dietary information. Participants with diet quality scores in the highest quintile had lower levels of disability (PDDS; proportional odds ratio [OR] for Q5 vs Q1 0.80; 95% confidence interval [CI] 0.69-0.93) and lower depression scores (proportional OR for Q5 vs Q1 0.82; 95% CI 0.70-0.97). Individuals reporting a composite healthy lifestyle had lower odds of reporting severe fatigue (0.69; 95% CI 0.59-0.81), depression (0.53; 95% CI 0.43-0.66), pain (0.56; 95% CI 0.48-0.67), or cognitive impairment (0.67; 95% CI 0.55-0.79).

CONCLUSIONS:Our large cross-sectional survey suggests a healthy diet and a composite healthy lifestyle are associated with lesser disability and symptom burden in MS.

"Very little is needed to make a happy life; 
It is all within yourself, in your way of thinking"
-Marcus Aurelius, Roman Emperor

A sobering thought indeed. A chorus of cherubs play accompaniment and pantomime their way across the screen as I write this. Although, enlightening I don't think Marcus Aurelius' philosophy is entirely true.

Let me explain.

We spend most of our lives hanging on for dear life to ideologies and lifestyles, so to speak, to decamp the emotional and physical baggage of a lifetime. The next fad, the next diet; all of which require sustained commitment on our part, but none of which bring us any true level of happiness in the long run...It has taken me a while to realise that durable happiness is an assimilation of the collective camaradrie of those around you. People (plural) need other people (singular/plural) - you matter very much to your partner and your loved ones; the rest as they say is window dressing.

In this article, Fitzgerald et al. tell us that diet quality impacts on disability in MS. They have even gone as far as to define what they think is a composite of a healthy lifestyle: healthy weight (BMI <25), routinely engages in physical activity, abstains from smoking, and consumes a better than average diet (>median diet quality score). Latter was quantified in quintiles as consumption of a) more fruits, vegetables, legumes (fifth quintile=most), b) more whole grains (fifth quintile=most), c) less sugar from desserts and beverages (fifth quintile=least), and d) less red and processed meats (fifth quintile=least).
They have surveyed 11,100 active PwMS in the NARCOMS registry - that is 69% of the registry (responders and nonresponders had similar disability at enrollment). Those with better diet quality scores tended to be less overweight, more likely to partake in physical activity, follow a special diet for MS and less likely to be smokers. They also tended to have lower odds of severe depressive symptoms after adjusting for disability level.

PwMS in the highest quintile vs lowest quintile of diet quality score were at 20% lower risk for severe vs mild self-reported disability (OR 0.77; 95% CI 0.61-0.98), after controlling for age, disease-duration, BMI, income, smoking. Exposure to a weight loss plan diet was associated with lower disability (OR 0.88;m 95% CI 0.79-0.99), however the Wahls diet (adding more leafy green vegetables to your diet) and a gluten free diet was associated with greater disability (Wahls OR 1.51, 95% CI 1.25-1.78 and gluten free OR 1.31, 95% CI 1.13-1.52); although those on the Wahls diet were 50% more likely to have progressive MS and therefore this finding maybe more reflective of this. A greater intake of whole grains and diary, however, were most favourable in the individual food group analyses to have lower odds of severe disability.

Of course, none of this is a causal association for disability in MS, in a nutshell the survey is simply a snapshot of dietary habits of the healthy and not so healthy. Also, surveys as a rule attract a certain demographic and in this case, were more likely to be Caucasian, married and of a higher income.

As a vegetarian, I count myself lucky. I seem to meet the requirements of these surveys even without lifting a finger!


  1. If you don't even lift a finger, how do you eat?

  2. So I need to be a non-drinking, non-smoking, vegetarian who engages in moderate exercise? hmmm, bring on the christmas nut-roast...

  3. I am hesitant myself about these dietary cure mania, but there is emerging research going on about this issue and they have some arguments (this research above is not one of them :)).
    Prof. Mackey, who was granted last year for the development of a safer new treatment for SLE that preserves B cell immunity states:

    "Concurrently, we also investigate the effects of dietary changes on the development and treatment of autoimmune conditions like SLE as we have recently found that a high fibre diet has the potential to reverse disease and reduce pre-established auto-antibodies. Using various approaches we investigate how changes in metabolites and gut microbiota lead to the re-programming of immune responses in the SLE model."

    There are many researches linking the lack of variety in beneficial bacteria of the modern living (not only through food intake) to the increase of autoimmunity. There are also new researches on the link of gut to the brain in other neurological fields.

    The EBV theory needs a complementary reason to explain the constant increase in autoimmunity. But a lettuce on its own will not cure MS or any other autoimmune.

    1. Sorry, until someone publishes a paper showing there has never been a case of a vegan/clean eater/healthy eater etc with MS, I remain thoroughly sceptical that there is anything in these fad diets.

    2. I think you totally misread the comment. It was not about "healthy diets", but to point the theories that link the lack of variety in beneficial bacteria/microbes of the modern living (not only through food intake) to the increase of autoimmunity. These reserches are not only about food intake (I will try to post some). And it is known that gut plays a major role in the immune system.
      Also, Prof. Mackey has a theory on B cells and how to restore their tolerance, she is just using diet as a complementary means. She can be wrong of course. http://biomedicalsciences.unimelb.edu.au/sbs-research-groups/microbiology-and-immunology-research/b-lymphocytes,-baff-and-autoimmunity/developing-new-therapies-for-systemic-lupus-erythematosus

    3. Sorry, I didn't make it clear in my comment - I was responding only to Anon 7:50:00's et al's comments about fad diets - that I'm very sceptical about the benefits of fad diets - and the significance placed on them by the research alluded to in the original post.

      I don't include genuine research into the rise of incidence of autoimmune diseases and the role of the gut as fad diets. Quite the opposite.

    4. The role of diet in any disorder is difficult to quantify in studies such as these, as there is more than one factor involved. The editorial to this research refers to randomized controlled trials in this area; I'm not sure this is the answer either. How many of us have fallen off the diet band wagon through our lifetime, for the controlled effect of diet to become apparent in the body's physiology may take several years and that's not feasible in real life terms. Only this Friday, I was on top of a mountain munching my way through protein supplements in order to stave off the impending hypothermia, whilst dreaming of a piece of cake and a glass of wine (order not relevant!) when I made it down...


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