Highlights
- •Both diets had significant improvements in anxiety and depression scores.
- •Serum levels of homocysteine were reduced, and folate and vitamin B12 increased.
- •No association of depressive symptoms changes with serum homocysteine or vitamin B12.
Abstract
Background
Depression and anxiety are common psychiatric comorbidities among people with multiple
sclerosis (MS). Emerging data suggest abnormal serum homocysteine, vitamin B12, and folate levels in people with MS, which are related to a range of neurological
disorders, including mood and mental illnesses. Evidence suggests that dietary interventions
could affect mood disorders via several pathways. This study aimed to evaluate the
impact of the low-saturated fat (Swank) and modified Paleolithic elimination (Wahls)
diets, along with a supplement regimen, on mood as assessed by Hospital Anxiety and
Depression Scale (HADS), and Mental Health Inventory (MHI). The secondary objective
was to identify changes in serum levels of homocysteine, folate, and vitamin B12 and the association and mediation effects between their changes and HADS and MHI
scores and their subscales among people with relapsing-remitting MS (RRMS).
Methods
In a previously conducted randomized parallel-arm trial, participants with RRMS (n = 77) were randomly allocated to either the Swank or Wahls diets at baseline and
followed for 24 weeks. Blood was drawn at four study visits spaced 12 weeks apart:
(1) run-in, (2) baseline, (3) 12 weeks, and (4) 24 weeks. Serum vitamin B12, folate, and homocysteine were analyzed. HADS and MHI questionnaires were also completed
by participants at the four study visits to assess symptoms of depression and anxiety,
behavioral control and positive affect respectively.
Results
Significant improvement in severity of depression (HADS-D) and anxiety (HADS-A) symptoms,
MHI total, and MHI subscores were seen at 12 and 24 weeks in each diet group. Further,
a significant within-group reduction in serum homocysteine and a significant increase
in serum vitamin B12 level were observed in both groups at 12 and 24 weeks compared to corresponding baseline
values (p ≤ 0.05 for all). All participants exceeded the analytical maximum threshold for folate
of 20 nmol/L at 12 and 24 weeks. Changes in serum levels of homocysteine and vitamin
B12 were not associated with and did not mediate changes in HADS depression, anxiety,
MHI total and four subscales scores (p > 0.05).
Conclusion
Participants on both Swank and Wahls dietary interventions, including folate and vitamin
B12 supplements, showed significant improvement in mood. However, the favorable effects
of both diets on mood were not associated with or mediated by the effect of the diets
on serum levels of homocysteine, folate, and vitamin B12 (p > 0.05).
Keywords
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Article info
Publication history
Published online: May 01, 2023
Accepted:
April 30,
2023
Received in revised form:
April 16,
2023
Received:
February 2,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
