Intermittent fasting and dietary restriction for MS.

Every day we see more and more evidence that what and how we eat affects not just our general health, but the health of our brains as well. For patients challenged by the effects of a neurological disorder, nutritional oversight is an especially important part of our integrative “toolkit” and one that can make a big difference in the short and long term. 

At the 2021 Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) virtual forum, new research was presented regarding dietary restriction to lessen the severity of multiple sclerosis (MS) by modulating levels of the fat hormone leptin.
 
Adipokines are cytokines secreted by the fat-storing adipose tissue; the first adipokine to be discovered was leptin.
 
The presentation “Weight, Obesity and Adipokines” detailed the study whereby participants were divided into two groups. Those in the fasting group underwent intermittent energy restriction (IER); rather than fasting every other day, they ate only a very small amount of food every other day (total 400–500 calories daily, comprised of roughly one or two salads with non-starchy vegetables and a light dressing). Participants in the control group ate a normal diet. 
 
In the fasting group, investigators saw increased levels of a type of gut bacteria with anti-inflammatory properties, called Faecalibacterium along with some evidence of increased regulatory T-cells activity. 
 
Faecalibacterium prausnitzii, is one of the most abundant and important commensal bacteria of the human gut microbiota.
 
I previously have discussed how obesity (including obesity in childhood) is one of the risk factors for MS and the disease’s progression; this is due in part to the associated higher levels of proinflammatory cytokines that drive neurodegeneration. And remember too that obesity also changes the gut microbiome in a way that further drives inflammation.
 
Intermittent fasting approach.
 
So how can we potentially change this dynamic and improve the potential for patient outcomes? First, we start with looking at and considering key dietary changes - an autoimmune, paleo, organic diet, along with dietary restriction and intermittent fasting are all ways that we can LOWER inflammation.
 
As studies in mice models have shown, intermittent fasting consistently decreases levels of pro-inflammatory immune cells (Th17 cells) in the intestine, while it increases levels of anti-inflammatory immune cells (regulatory T-cells). It is now well understood that fasting can cause the metabolism to switch from using glucose as fuel to using fatty acids and that this shift seems to trigger our stem cells to become more active and regenerative.1
 
Intermittent fasting also changes the makeup of the bacteria in the mice’s guts. Researchers presenting at the ACTRIMS forum noted that generally the mice undergoing intermittent fasting had a more diverse makeup of gut bacteria as well as higher levels of bacteria known to have anti-inflammatory effects, namely bacteria of the Lactobacillaceae, Bacteroidaceae, and Prevotellaceae families.2
 
These findings support additional research that found in calorie restriction and starvation, proinflammatory adipokines decline and anti-inflammatory adipokines increase.3 It also reflects our discussions regarding the importance of the microbiome and its role in multiple sclerosis.4 The alteration of the gut microbiota is a key factor in both the genesis of autoimmune disease and the advancement of disease, with immune cells linking the gut and the brain with constant “crosstalk.” All of this means that the blood-brain barrier (BBB) scientists once thought was impenetrable can actually be breached – but a strong microbiome can be integral to building an immune fortress for the wellbeing of our brains.
 
Fasting-mimicking protocol.
 
Researchers including Dr. Walter Longo, a renowned expert on aging, showed that periodic three-day cycles of a fasting mimicking diet (FMD) are effective in ameliorating demyelination and symptoms in a murine experimental autoimmune encephalomyelitis (EAE) model. During the fasting-mimicking diet, cortisone is produced and this action initiates the destruction of autoimmune cells. Since this study, evidence continues to emerge that illustrates that the fasting-mimicking diet, particularly its ability to cause immune cell turnover, may provide beneficial effects in the treatment of auto-immune diseases such as multiple sclerosis. In animal studies, all mice with multiple sclerosis on the fasting-mimicking diet exhibited decreased clinical symptoms, and 20 percent recovered fully. 
 
Of the 60 subjects in this study, Dr. Longo and the investigating team found that:

• A seven-day fasting mimicking cycle, followed by six months of a Mediterranean diet, led to observed improvements in quality of life, including physical and mental health.
• The fasting mimicking diet also led to an over 20 percent reduction in the total T cell count in 72 percent of the patients.
• These figures may very well account for the reported reduction of MS symptoms.

 
What is the ProLon® program?
 
The ProLon approach, which we often recommend for patients, is a 5-day, plant-based, and very low calorie meal plan developed by Dr. Longo who is the director of the Longevity Institute at the University of Southern California, Los Angeles and has extensively studied the effects of fasting on the immune system.
 
Designed to deliver 34 to 54 percent of normal caloric intake and intended to be repeated over time, the plan suggests that people with obesity or who are overweight complete one, 5-day cycle per month for three consecutive months; individuals who are at a healthy weight and who regularly exercise can complete one to two cycles per year.
 
Unlike a true fast where you abstain from eating any food for a specified period, the ProLon program calls for eating 1,090 calories on day 1 and roughly 725 calories on days 2 through 5, with a focus on low carbohydrate, high fat foods.
 
It’s important to remember that making ANY dramatic changes to your eating plan, even for just a few days, should only be done under the guidance of a healthcare provider who is familiar with your MS medications, individual symptoms and specific health issues. It’s also imperative that an expert advises you on what to eat to avoid malnutrition and how to transition toward a Mediterranean eating style or another healthy, balanced diet.
 
Learn more about the brain-boosting benefits of the Mediterranean diet and its foundation ingredient, olive oil at https://www.suzannegazdamd.com/blog/olive-oil-the-heart-of-the-mediterranean-diet-thats-good-for-your-brain-too.
 
While the intermittent fasting or fasting-mimicking diets address a particular approach to eating that may positively impact disease status, ANYONE can benefit from adopting a sound nutritional program that eliminates processed foods, excessive sugar and high sodium snacks. All of these contribute to inflammation that even in the absence of a neurological diagnosis simply make us feel terrible and can ultimately result in disease initiation. Talk to your physician or nutritional counselor about an approach that fits your health needs and see how eating well for life really can be life changing!
 
In hope and healing,
Dr. Suzanne Gazda 
 
Visit our Medical Resources section to download our comprehensive guide to “Nutritional Approaches in MS.”
 
References:
 
1 Choi, I. Y., Piccio, L., Childress, P., Bollman, B., Ghosh, A., Brandhorst, S., Suarez, J., Michalsen, A., Cross, A. H., Morgan, T. E., Wei, M., Paul, F., Bock, M., & Longo, V. D. (2016). A Diet Mimicking Fasting Promotes Regeneration and Reduces Autoimmunity and Multiple Sclerosis Symptoms. Cell reports, 15(10), 2136–2146. https://doi.org/10.1016/j.celrep.2016.05.009
 
2 Multiple Sclerosis News Today: ACTRIMS 2021
https://multiplesclerosisnewstoday.com/news-posts/2021/03/03/actrims2021-dietary-restriction-limit-severity-multiple-sclerosis/
 
3 Mancuso P. (2016). The role of adipokines in chronic inflammation. ImmunoTargets and therapy, 5, 47–56. https://doi.org/10.2147/ITT.S73223
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970637/
 
4 Gazda Integrative Neurology, Microbiome and MS
https://www.suzannegazdamd.com/scientifically-speaking1/the-importance-of-the-microbiome-in-multiple-sclerosis
 
5 USC News
https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/