Is a Modified Paleolithic Diet Safe, Effective for MS-Associated Fatigue?

Exclusions Raise Concerns

The report raised concerns, however, because the specialized diet also excludes all dairy, gluten-containing grains, and eggs and processed foods, added sugar and trans-fat are to be avoided. It encourages fermented foods, seaweed. algae and nutritional yeast, as well as supplements including cod liver oil, methyl-folate, methyl-B12, and vitamin D3.

While a multimodal intervention in 2015 involving some of the same researchers as the current study found some improvements in fatigue and quality of life, it was unclear whether the cause was the diet or other interventions, including targeted supplementation, strengthening and stretching exercises, stress reduction techniques and neuromuscular electrical stimulation.²

A follow-up study from the University of Iowa and the Iowa City VAMC concluded, however, that “a Paleolithic diet may be useful in the treatment and management of MS, by reducing perceived fatigue, increasing mental and physical quality of life, increasing exercise capacity, and improving hand and leg function. By increasing vitamin K serum levels, the MPDI may also reduce inflammation.” Another study from the same institutions, meanwhile, determined that participants consuming the a medium chain triglyceride-based ketogenic diet achieved nutritional ketosis but said that eating plan was not associated with significant clinical improvement in this study. On the other hand, those researchers report that the modified Paleolithic diet was associated with significant clinical improvements and called for larger randomized controlled trials to determine the safety and efficacy of the modified Paleolithic and MCT-based ketogenic diets on MS. ^3,4

“This analysis of 24-h dietary recalls demonstrates that [people with MS] consuming a modified Paleolithic diet based on Wahls Paleo diet principles increased fruit and vegetable consumption to greater than nine daily servings, which confirms previous self-reported daily food log findings] and exceeds current guidelines,” authors of the current study wrote. “Study participants were more compliant with the recommendation for intensely colored fruits and vegetables than for leafy green or sulfur-rich vegetables, likely due to preference for the fruit included in this group. Furthermore, most participants were successful in eliminating gluten-containing grains, eggs and dairy from their diet, which again is in line with previous self-reported findings. Self-reported fruit and vegetable consumption and avoidance of gluten-containing grains were independently associated with reduced fatigue in this cohort.”

Researchers wrote that mean caloric intake was 1,820 ±506 kilocalories/day—about 38% from carbohydrates, 18% from protein and 44% from fat. While micronutrient intake from food surpassed individual recommendations for most vitamins and minerals, they added, “However, vitamin D, choline, and calcium all had NARs below 100%, indicating obvious nutrients of concern. Low vitamin D status is associated with increased disease activity], which makes the inadequate vitamin D intake from food observed in this study alarming.”

The authors noted, however, that the Healthy U.S.-Style Eating Pattern is also deficient in vitamin D, and vitamin D supplementation already is recommended for MS patients.

Another concern was serum calcium, but researchers state that levels remained stable throughout the study period despite calcium intake below individual requirements for 95% of the cohort. “Inadequate calcium intake may exacerbate risk of osteoporosis, especially in those who are immobile or taking drugs that inhibit calcium absorption,” they explained. “Because osteoporosis is a common comorbidity among pwMS, ensuring adequate intake of calcium may be beneficial, especially for those unable to engage in weight-bearing exercise.”

Ultimately, the authors pointed out that, while “the modified Paleolithic diet used in this study was associated with adequate intake of most micronutrients and favorable metabolite changes among people with progressive MS,” they also recommended targeted supplementation of specific micronutrients or inclusion of specific nutrient-rich foods for MS patients without over-supplementing.

1. Titcomb TJ, Bisht B, Moore DD 3rd, et al. Eating Pattern and Nutritional Risks among People with Multiple Sclerosis Following a Modified Paleolithic Diet. 2020;12(6):1844. Published 2020 Jun 20. doi:10.3390/nu12061844
2. Bisht B, Darling WG, Shivapour ET, et al. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study [published correction appears in Degener Neurol Neuromuscul Dis. 2015 Sep 10;5:91]. Degener Neurol Neuromuscul Dis. 2015;5:19-35. doi:10.2147/DNND.S76523
3. Irish A.K., Erickson C.M., Wahls T.L., Snetselaar L.G., Darling W.G. Randomized control trial evaluation of a modified paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: A pilot study.  Neurol. Neuromuscul. Dis. 2017;7:1–18. doi: 10.2147/DNND.S116949.
4. Lee J.E., Titcomb T.J., Bisht B., Rubenstein L.M., Louison R., Wahls T.L. A modified mct-based ketogenic diet increases plasma β-hydroxybutyrate but has less effect on fatigue and quality of life in people with multiple sclerosis compared to a modified paleolithic diet: A waitlist-controlled, randomized pilot study [published online ahead of print, 26 Mart 2020] Am. Coll. Nutr. 2020:1–13. doi: 10.1080/07315724.2020.1734988.