Could Fasting Improve Multiple Sclerosis Symptoms?

Although dietary interventions have been thought to ease the symptoms of multiple sclerosis (MS) for some individuals, the evidence has been primarily anecdotal with little research on how diet changes affect the disease.

Now, researchers from Washington University School of Medicine in St. Louis have launched a human trial to evaluate whether fasting twice a week can improve MS-related symptoms, according to a press release.

Laura Piccio, MD, an associate professor of neurology, and her colleagues are recruiting patients with relapsing-remitting MS for a 12-week study. For the trial, half of the patients will remain on their usual Western-style diet for 7 days per week, whereas the other half will maintain a similar diet 5 days per week but limit themselves to 500 calories of vegetables for the remaining 2 days.

Based on findings from a previous mouse study, the researchers believe that intermittent fasting may change the gut microbiome and affect inflammation and immune response, potentially changing the course of the disease.

Researchers conducted a pilot study with 16 individuals limiting their calorie intake every other day for 2 weeks. The results demonstrated immune and microbiome changes that reflected the ones seen in mice.

The mouse trial, led by Dr Piccio, demonstrated that intermittent fasting reduced MS-like symptoms in mice. In the study, mice were either allowed to eat freely or fed every other day for 4 weeks before receiving an immunization to trigger MS-like symptoms. Both groups of mice continued on their same diets for another 7 weeks.

According to the findings, the mice that ate every other day had fewer pro-inflammatory immune cells and more of a type of immune cell that keeps the immune response in check, compared with the mice that took daily meals.

“There are several possible ways fasting can affect inflammation and the immune response,” Dr Piccio said in the press release. “One is by changing hormone levels. We found that levels of the anti-inflammatory hormone corticosterone were nearly twice as high in the fasting mice. But it also could act through the gut microbiome.”

After 4 weeks, the mice that fasted had more of the soothing probiotic bacteria Lactobacillus in their guts, which other studies in mice have linked to milder MS-like symptoms. Additionally, transferring gut bacteria from fasting mice to non-fasting mice made the recipients less susceptible to developing MS-like symptoms, the researchers noted.

The human trial will include 40 to 60 individuals. Each participant will undergo a neurological assessment and provide blood and stool samples at the start, midpoint, and end of the study. Patients already taking injectable medications for MS will continue their prescribed regimens and those who relapse during the study will receive appropriate treatment.

The current study will more closely analyze the shifts in immune and microbiome changes that occur with partial fasting. The researchers hope the trial will lead to further research on the effects of dietary interventions in alleviating MS symptoms.

“I don’t think any physician working with this disease thinks you can cure MS with diet alone,” Dr Piccio said in the press release. “But we may be able to use it as an add-on to current treatment to help people feel better.”

Specialty Pharmacy Times' new sister site, NeurologyLive, offers even more resources for pharmacists working with multiple sclerosis.

Reference

Can fasting improve MS symptoms? [news release]. Washington University School of Medicine in St. Louis’ website. https://medicine.wustl.edu/news/can-fasting-improve-ms-symptoms/. Accessed July 9, 2018.