Low-Fat Diet Intervention Demonstrates Significant Impact on Multiple Sclerosis Fatigue

Vijayshree Yadav, MD, MCR, FANA, FAAN

Findings from a randomized, controlled study of individuals with relapsing multiple sclerosis (MS) showed significant effects on fatigue while on a low-fat diet over a 12-week period. These data, presented at the 2023 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 31 to June 3, in Colorado, further confirm the impact dieting has on this patient population.

Senior investigator Vijayshree Yadav, MD, MCR, FANA, FAAN, neurologist, Oregon Health State University, and colleagues included 39 individuals who were randomly assigned to either low-fat diet (n = 20) or wait-list diet (n = 19), or control, for 14 weeks. The diet group received 1 to 2 weeks of nutrition counseling followed by a strict adherence to a low-fat diet for 12 weeks, with diet adherence measured by a monthly food frequency questionnaire and 24-hour food recall. The study used change in Modified Fatigue Impact Scale (MFIS) as the primary end point, with several other secondary and clinical outcomes.

Between the 2 groups, the diet group had a higher mean age (52 [±10] years vs 47 [±13]) and a higher mean Expanded Disability Status Scale (EDSS) score (4.2 [±1.3] vs 3.4 [±1.4]). At the end of the randomized, 14-week period, findings showed a mean decrease in MFIS of 4.00 (95% CI, –12.04 to 4.04) in comparison with controls. Fatigue Severity Scale (FSS), another major outcome, was decreased by 0.41 (95% CI, –1.18 to 0.36) in those on the low-fat diet in relation to controls.

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After excluding 5 specific outliers, sensitivity analyses further strengthened the magnitude of association with a mean MFIS decrease of 13.93 (95% CI, –20.65 to –7.20) and mean FSS decrease of 1.22 (95% CI, –1.94 to –0.50) in comparison with controls. Patients on the low-fat diet also saw additional benefits, with a decrease of 10.56% (95% CI, –18.50% to –2.97%) in calories from fat compared with controls.

This was not the first instance where dieting has shown benefits on MS fatigue. A 2023 meta-analysis of randomized trials revealed several interventions may reduce MS-related fatigue and improve physical and mental quality of life. In the analysis, comprised of 12 trials comparing 8 dietary interventions, paleolithic (standardized mean difference [SMD], –1.27; 95% CI, –1.81 to –0.74), low-fat (SMD, –0.90; 95% CI, –1.39 to –0.42), and Mediterranean (SMD, –0.89; 95% CI, –1.15 to –0.64) showed the greatest reductions in fatigue compared with control.

Similar to research by Yadav et al, investigators concluded that findings of these approaches need to be confirmed in high-quality, randomized, controlled trials that include large amounts of patients. The meta-analysis, led by Tyler Titcomb, PhD, RDN, IMFCP, the Paleolithic (SMD, 1.01; 95% CI, 0.40-1.63) and Mediterranean (SMD, 0.47; 95% CI, 0.08-0.86) diets showed greater improvements in physical QoL than those on control diet. Physical QoL was also greatly improved with Paleolithic diets compared with anti-inflammatory (SMD, 1.00; 95% CI, 0.20-1.79), fasting (SMD, 0.80; 95% CI, 0.03-1.58), and low-fat (SMD, 0.60; 95% CI, 0.10-1.10) diets.

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REFERENCES
1. Chase E, Lane MA, Srikanth P, et al. Randomized, controlled trial of low-fat diet for fatigue in multiple sclerosis. Presented at: 2023 CMSC Annual Meeting; held May 31-June 3; Aurora, CO. Abstract DMX02
2. Snetselaar L, Cheek JJ, Fox SS, et al. Efficacy of diet on fatigue and quality of life in multiple sclerosis: a systematic review and network meta-analysis of randomized trials. Neurology. Published online October 18, 2022. doi:10.1212/WNL.00000000000201371