- •Fasting-mimicking diets are safe among people with multiple sclerosis.
- •Adherence to calorie restriction diets is poor despite clinical support.
- •Poor dietary adherence is a challenge and remains a barrier to research outcomes.
- •Strict adherence to time-restricted feeding may be more feasible than calorie restriction.
Fasting-mimicking diets have shown promise in experimental autoimmune encephalitis and are currently being investigated among people with multiple sclerosis (MS). Ensuring adherence to diet changes is critical to determining the efficacy of such interventions.
Our primary aim was to evaluate the safety and feasibility of several fasting-mimicking diets and investigate whether various levels of clinical support improve diet adherence among people with MS. Secondarily, this study evaluated the impact of fasting-mimicking diets on weight and patient-reported outcomes (PROs).
We conducted three pilot studies (two randomized controlled for 6 months; one randomized with transition to single arm) restricting either the amount or timing of calorie intake over 24 or 48 weeks. Interventions included calorie restriction (daily or intermittently) or time-restricted feeding. Adherence measures varied across studies but were collected at study visits along with weight and PRO data.
A total of 90 participants enrolled; 70 completed the studies, with no serious adverse events reported. Overall adherence to the calorie restriction diets was poor. When participants were tasked with maintaining a diet in a pragmatic setting, neither previously completed intense clinical support and education, nor weekly electronic communication throughout the diet period appeared to improve diet adherence. Participants who were able to adhere to a calorie restriction diet predictably lost weight. In contrast to calorie restriction, adherence to a time-restricted feeding (TRF) diet was relatively good. No statistically significant changes in PROs were observed in an intention-to-treat analysis.
The role diet may play in clinical outcomes in MS remains unknown, as class I evidence is lacking. Diet adherence remains a primary barrier to the feasible conduct of large, randomized controlled diet trials. Strict adherence to a TRF dietary change may be more feasible than calorie restriction and should be considered in future fasting-mimicking diet trials. ClinicalTrials.gov Registry:A Pilot Study of Intermittent Calorie Restriction in Multiple Sclerosis – NCT02647502. A Pragmatic Trial of Dietary Programs in People with Multiple Sclerosis (MS) – NCT02846558
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- The effect of short message system (SMS) reminder on adherence to a healthy diet, medication, and cessation of smoking among adult patients with cardiovascular diseases.Int. J. Med. Inf. 2017; 98: 65-75
- Environmental risk factors for multiple sclerosis. Part II: noninfectious factors: environmental Risk Factors for MS.Ann. Neurol. 2007; 61: 504-513
- Environmental risk factors for multiple sclerosis. Part I: the role of infection.Ann. Neurol. 2007; 61: 288-299
- Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses.Lancet Neurol. 2015; 14: 263-273
- Pilot study of a ketogenic diet in relapsing-remitting MS.Neurol. - Neuroimmunol. Neuroinflammation. 2019; 6: e565
- A diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms.Cell Rep. 2016; 15: 2136-2146
- Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial.JAMA. 2015; 314: 1255
- Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol: Figure 1.BMJ Open. 2012; 2e000606
- Intermittent fasting confers protection in CNS autoimmunity by altering the gut microbiota.Cell Metab. 2018; 27: 1222-1235
- A PROMIS fatigue short form for use by individuals who have multiple sclerosis.Qual. Life Res. 2012; 21: 1021-1030
- Dietary modulation of intestinal microbiota: future opportunities in experimental autoimmune encephalomyelitis and multiple sclerosis.Front. Microbiol. 2019; 10 (Epub ahead of print 16 April)https://doi.org/10.3389/fmicb.2019.00740
- Dietary interventions for multiple sclerosis.Cochrane Database Syst. Rev. 2012; (Epub ahead of print 12 December)https://doi.org/10.1002/14651858.CD004192.pub3
- Prevalence and user characteristics of specific diets in people with multiple sclerosis.Mult. Scler. J. 2017; 23: 2-90
- Diet quality is associated with disability and symptom severity in multiple sclerosis.Neurology. 2018; 90: e1-e11
- Effect of intermittent vs. daily calorie restriction on changes in weight and patient-reported outcomes in people with multiple sclerosis.Mult. Scler. Relat. Disord. 2018; 23: 33-39
- A biometric study of human basal metabolism.Proc. Natl. Acad. Sci. 1918; 4: 370-373
- The effects of intermittent or continuous energy restriction on weight loss and metabolic disease risk markers: a randomized trial in young overweight women.Int. J. Obes. 2011; 35: 714
- Dietary and lifestyle factors in multiple sclerosis progression: results from a 5-year longitudinal MRI study.J. Neurol. 2019; 266: 866-875
- Alternate day calorie restriction improves clinical findings and reduces markers of oxidative stress and inflammation in overweight adults with moderate asthma.Free Radic. Biol. Med. 2007; 42: 665-674
- Use of mobile phone text message reminders in health care services: a narrative literature review.J. Med. Internet Res. 2014; 16: e222
- Randomized-controlled trial of a modified Mediterranean dietary program for multiple sclerosis: a pilot study.Mult. Scler. Relat. Disord. 2019; 36101403
- The changing demographic pattern of multiple sclerosis epidemiology.Lancet Neurol. 2010; 9: 520-532
- Childhood obesity and risk of pediatric multiple sclerosis and clinically isolated syndrome.Neurology. 2013; 80: 548-552
- Tailored, interactive text messages for enhancing weight loss among African American adults: the TRIMM randomized controlled trial.Am. J. Med. 2015; 128: 896-904
- Mobile phone intervention and weight loss among overweight and obese adults: a meta-analysis of randomized controlled trials.Am. J. Epidemiol. 2015; 181: 337-348
- Wellness and multiple sclerosis: the National MS Society establishes a Wellness Research Working Group and research priorities.Mult. Scler. J. 2017; (1352458516687404)
- Body mass index, but not vitamin D status, is associated with brain volume change in MS.Neurology. 2018; 91: e2256-e2264
- Childhood body mass index and multiple sclerosis risk: a long-term cohort study.Mult. Scler. J. 2013; 19: 1323-1329
- Body size and risk of MS in two cohorts of US women.Neurology. 2009; 73: 1543-1550
- Dietary interventions in multiple sclerosis: development and pilot-testing of an evidence based patient education program.PLOS ONE. 2016; 11e0165246
- The effects of a lifestyle-focused text-messaging intervention on adherence to dietary guideline recommendations in patients with coronary heart disease: an analysis of the TEXT ME study.Int. J. Behav. Nutr. Phys. Act. 2018; 15 (Epub ahead of print December)https://doi.org/10.1186/s12966-018-0677-1
- The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions.Arch. Int. Med. 2006; 166: 332-337
- An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event.J. Neurol. Neurosurg. Psychiatry. 2017; 88: 395-401
- Diet, Metabolites, and “Western-Lifestyle” Inflammatory Diseases.Immunity. 2014; 40: 833-842
- The NLRP3 inflammasome instigates obesity-induced inflammation and insulin resistance.Nat. Med. 2011; 17: 179-188
- Low-fat, plant-based diet in multiple sclerosis: a randomized controlled trial.Mult. Scler. Relat. Disord. 2016; 9: 80-90
Published online: May 05, 2020
Accepted: April 22, 2020
Received in revised form: April 14, 2020
Received: February 6, 2020
© 2020 Elsevier B.V. All rights reserved.