What does gut health have to do with MS? Research shows it could be significant.

Our blog archives include many articles that point to the influence of diet on our health not only today, but what that could look like in the future. And now we’re seeing more evidence that the state of our gut and its microbiome could play a big role in the prognosis of autoimmune neurological disease including multiple sclerosis (MS).

The gut microbiome refers to microbes or the bacteria, fungi, etc. that live mostly in the small and large intestines and act almost as another functioning organ. Not only is the gut microbiome critical to digestion, but we’re also learning that it affects the wellbeing of our immune health as well.
 
We know a there’s essentially a direct route between our gut and our brain – so we’d expect that the state of our microbiome could affect our neurological wellness too. 
 
Recently we read an article that explores the fascinating connection between the microbiome and MS, noting the many studies which have found patients with the disease have a gut microbiome that is very different than people who do not have the disease – but what causes this isn’t fully understood. What is known, however, is that to a large degree, we really are what we eat. And diet whether we have a known disorder or not can certainly influence how we feel and how well our immune system protects us.

Immune system modulation.
 
In a review published in Nature, scientists did find that “modulation of the microbiome could be therapeutically beneficial,” presenting evidence from trials conducted in mice and humans that these effects of the gut microbiota on the immune system are important in the development and course of MS. Additionally, they looked at strategies for manipulating the microbiome status and whether it could be used to influence disease-related immune dysfunction, such as we see with MS, and may potentially result in novel therapeutics.
 
Another study concluded that “diet is able to influence the composition of the intestinal bacterial flora and indirectly favor the development of autoimmune inflammatory diseases such as MS.” The investigators stated that while the cause of MS is not always known and depends on heterogeneous factors (both genetic and environmental) that determine the RISK of disease, our eating habits, lifestyle, and other modifiable risk factors can influence the COURSE of the condition.

How and what we eat can impact our gut health.

Extensive research suggests that certain dietary patterns may indeed have an impact on disease progression and symptom management. Our colleague and friend, Dr. Terry Wahls, who following her MS diagnosis from over 20 years ago designed and adhered to a unique protocol that includes dietary controls, recently wrote about the benefits of intermittent fasting and caloric restriction as a tool for disease management.
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In her June blog, she spotlighted the results of a small trial that used intermittent caloric restriction over a period of 12 weeks, following this physician- and dietitian-supervised regimen: The intervention was to reduce calories to about 25% of usual intake (< 500 calories) on two non-consecutive days each week and to not compensate for the reduced intake on the other days. On the reduced calorie days, participants were to eat salads with steamed vegetables and a light dressing. 
 
Exciting results emerged at the end of the study period – participants showed a marked increase in brain volume measurement as determined by MRIs, as well as improved blood flow. Dr. Wahls noted too that previous trials in animal models had shown intermittent caloric restriction to enhance blood flow and cognition, as well as reducing oxidative stress and inflammation. 
 
More research is forthcoming as the scientific community continues to pursue the potential benefits of these and similar approaches to MS as well as other immune-mediated disorders.

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So, what tangible efforts can we make that could aid in managing MS?

Our recommendation for all patients – and even if you aren’t challenged by a neuroimmune or other diagnosis – is, when possible, to choose fresh over processed foods, preferably organic and non-GMO products. There are also certain foods to avoid, such as:

Dairy
Breads (e.g., wheat, rye, white, sourdough, etc.) 
Cereals and many grains (i.e., barley, most commercial oatmeal)
Wheat or semolina pastas
Crackers, cookies (any prepared or baked goods that use flours other than rice or another acceptable gluten-free starch)
Processed foods (soups, frozen meals, etc.)
Beer (derived from problematic grains)
 
Following a healthy diet can help also help in addressing obesity, a known factor at the root of many diseases including MS. In fact, obesity in childhood has been shown to increase the risk of MS developing in young adults and later in life.
 
Depending on your particular health needs and if there are no contraindications with any medicines, there are foods to consider including as part of a healthy diet, like fermented items (i.e., kimchi), sauerkraut) and probiotics; fiber-rich foods like fresh vegetables and fruits; lean proteins; olive oil; high quality vitamin D supplements, and more.
 
Importantly, never change or add anything to your diet without consulting your physician, whether it’s a new supplement and certainly if you are interested in intermittent fasting and caloric restriction…this should only be undertaken with medical supervision.
 
Of course, while diet alone cannot replace disease-modifying or other medically prescribed treatments, it can play a positive, complementary role in managing the condition and promoting overall wellbeing. Be sure to check our blog archives for more related reading and let us know if we can help!
 
In hope and healing,
Dr. Suzanne Gazda
 
References:
 
Gazda, S. Does all disease begin in the gut
Weiss, K. Can gut health affect multiple sclerosis? Everyday Health. (2022) https://www.everydayhealth.com/multiple-sclerosis/can-gut-health-affect-multiple-sclerosis/
 
Schepici G, Silvestro S, Bramanti P, Mazzon E. The Gut Microbiota in Multiple Sclerosis: An Overview of Clinical Trials. Cell Transplant. 2019;28(12):1507-1527. doi:10.1177/0963689719873890
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923550/
 
Correale, J., Hohlfeld, R. & Baranzini, S.E. The role of the gut microbiota in multiple sclerosis. Nat Rev Neurol 18, 544–558 (2022). https://doi.org/10.1038/s41582-022-00697-8.
 
Wahls, T. The Impact On Brain Volume And Biomarkers In The Setting Of MS Using Intermittent Fasting. terrywahls.com. (2023)
https://terrywahls.com/the-impact-on-brain-volume-and-biomarkers-in-the-setting-of-ms-using-intermittent-fasting/
 
Gazda, S. Intermittent fasting and dietary restriction for MS. suzannegazdamd.com. (2021)
https://www.suzannegazdamd.com/blog---ms-in-the-news/intermittent-fasting-and-dietary-restriction-for-ms
 
Gazda, S. Childhood obesity linked to higher risk of MS. suzannegazdamd.com. (2020)
https://www.suzannegazdamd.com/blog/childhood-obesity-linked-to-higher-risk-of-ms
 
Gazda, S. Upset stomach? Your brain may be trying to tell you something. suzannegazdamd.com. (2021)
https://www.suzannegazdamd.com/blog---ms-in-the-news/upset-stomach-your-brain-may-be-trying-to-tell-you-something