Study Recommends Some Supplementation But Generally Approves

IOWA CITY, IA—With judicious use of the type of supplements found at the pharmacy, a restrictive diet is showing promise for improving some symptoms of multiple sclerosis.

Based on preliminary studies suggesting that a modified Paleolithic diet might benefit symptoms of fatigue in progressive multiple sclerosis, the eating regimen has been adopted by many patients.

That has raised concerns among clinicians, however. The diet restricts the consumption of eggs, dairy and gluten-containing grains, which may increase the risk of micronutrient deficiencies.

That’s why researchers from the Universities of Iowa and Nebraska and the Iowa City, IA, VA Health Care System sought to evaluate the nutritional safety of this diet among patients with progressive MS. Results of the study were published in the journal Nutrients.1

For the study, the team collected three nonconsecutive 24-hour dietary recalls from 19 progressive MS participants in the final months of a diet intervention study and analyzed them using Nutrition Data System for Research (NDSR) software.

Researchers calculated food group intake and intake of micronutrients, comparing them with individual recommendations using Nutrient Adequacy Ratios (NARs). In addition, patients’ blood was drawn at baseline and the end of the study to evaluate biomarker changes.

Energy and macronutrient intake from food and supplements determined from three 24-h dietary recalls obtained from individuals with progressive multiple sclerosis (MS) (N = 19) following the modified Paleolithic diet.

Nutrient Intake (Mean ± SD) % Kilocalories
Energy (kilocalories/day) 1820 ± 506 100.0
Available carbohydrate (g/day) 1 167 ± 62.4 38.2 ± 12.1
Added sugar (g/day) 19.9 ± 19.8 5.1 ± 6.2
Fiber (g/day) 37.7 ± 15.7 NA
Protein (g/day) 79.7 ± 36.4 17.9 ± 7.3
Total fat (g/day) 91.7 ± 41.2 43.9 ± 13.2
Saturated fat (g/day) 20.5 ± 14.1 9.8 ± 5.5
Monounsaturated fat (g/day) 34.5 ± 18.9 16.7 ± 7.7
Polyunsaturated fat (g/day) 29.2 ± 16.7 13.8 ± 6.1

1 Fiber subtracted from total carbohydrate. Note: NA indicates not assumed to majorly contribute to energy.

Results indicated that mean intake of fruits and vegetables exceeded nine servings/day, and most participants excluded food groups. Researchers reported that intake of all micronutrients from food were above 100% NAR except for vitamin D (29.6 ± 34.6%), choline (73.2 ± 27.2%) and calcium (60.3 ± 22.8%). An issue was that one participant (1/19) exceeded the Tolerable Upper Limit (UL) for zinc, one (1/19) for vitamin A, and 37% (7/19) exceeded the chronic disease risk reduction (CDRR) for sodium.

“When intake from supplements was included in the analysis, several individuals exceeded ULs for magnesium (5/19), zinc (2/19), sodium (7/19), and vitamins A (2/19), D (9/19), C (1/19), B6 (3/19), and niacin (10/19),” according to the authors. “Serum values of vitamins D, B12, K1, K2, and folate significantly increased compared to respective baseline values, while homocysteine and magnesium values were significantly lower at 12 months. Calcium and vitamin A serum levels did not change.

The study team cautioned that the modified paleolithic diet “is associated with minimal nutritional risks. However, excessive intake from supplements may be of concern.”

The authors pointed out that many MS patients seek alternative therapies, including specialized diets and supplements to manage their disease, explaining, “One such specialized diet being investigated for MS is a modified Paleolithic diet based on Wahls Paleo diet principles, which recommends a dietary pattern that includes a daily intake of three one-cup servings each of leafy green vegetables, sulfur containing vegetables and intensely colored fruits and vegetables. In addition, six to 12 ounces of meat and fish are recommended daily, as well as 16 ounces of fatty fish and 12 ounces of organ meat weekly.”

Continue Reading this Article: Exclusions Raise Concerns