1. Multiple Sclerosis and Diet Therapy
Lauren Bachand

2. Multiple Sclerosis
 Primary-progressive (PPMS)
 Relapsing-remitting (RRMS)
 Secondary-progressive (SPMS)
 Progressive- relapsing (PRMS)
 Presence of lesions in both the grey and white matter of
the brain and along the spinal cord.
 characterized by
“acute episodes of one or
more of these symptoms
[blurred or double vision,
slurred speech, weakness in
limbs, sensory deficits, and
paresthesias] followed by
subsequent recovery” (p.692).

3. Demyelization
 Oliogodendrocytes
 glial cells in the brain that are responsible for myelin
production
 Brady and Siegel(2012) state that the cause for
these biochemical changes are most likely due to the
“breakdown and gradual loss of myelin and its
replacement by extracellular fluid, astrocytes and
inflammatory cells” (p.695).
 The water content and decreased presence of myelin
supporting protein and lipids lead to biological changes
 decrease of myelin basic protein (MBP) and proteolipid
protein (PLP)

4. Demyelization
 Glial Fibrillary Acidic Proteins (GFAPs) in white
matter (cholesterol esters)
 cholesterol is not properly broken down and metabolized,
as a result it is esterified by phagocytes (Brady & Siegel,
2012).
 Astrogliosis
 an increase of astrocytes in brain tissue due to the
destruction or inflammation of nearby neurons
 In areas that show astrogliosis, there is an absence
of myelin proteins and an increase of GFAPs which
results in poor conduction between axons.

5. Free Radicals
When lesions occur, the
microenvironment of the
lesion can be just as
harmful to the
surrounding cells as the
lesion itself. Free radicals
and cytokines can cause
direct injury to cells and
“induce signal
transduction events that
ultimately result in injury
or affect the migration of
cells involved in damage
repair”(Brady & Siegel,
2012, p.694).

6. Diet Therapy
Three dietary
supplements that have
been the main focus of
diet and multiple sclerosis
research:
•Vitamin D
•Polyunsaturated fatty
acids
•Antioxidants
•Gluten Free Diets

7. Vitamin D
 fat-soluble compound that is
synthesized in the kidneys
 derived from a form of cholesterol
 Macrophanges, dendritic cells,
monocytes, and active T cells all
contain vitamin D receptors
 part of the body’s immune system.
 high levels of vitamin D
 “reduce immunoglobulin synthesis” (a
type of immune response to foreign
objects, or in the case of MS an
autoimmune response to the body’s own
proteins)
 suppress axonal death
 Von Geldern and Mowry (2012)
 vitamin D is thought to have an anti-
inflammatory effect on T cells and may
suppress the abnormal T cell responses
to myelin basic protein (p.680).

8. Polyunsaturated Fatty Acids (PUFAs)
 Polyunsaturated fatty acids
(PUFAs) are long-chained fatty
acids that contain more than one
double carbon bond.
 omega-3 and omega-6 fatty acids
 Biochemically the benefits of
implementing a primarily omega-
3 enriched diet, along with PUFA
supplements include
 anti-inflammatory effects
 relationship to reducing
leukocyte migration
 an immune response that results
in inflammation in the brain.
 omega-3
 key contributor to promoting
myelin protein expression (von
Geldern & Mowry, 2012).

9. Cholesterol
 In 2011 research was done on the relationship of cholesterol levels
and multiple sclerosis.
 The study found
 strong association between increased levels of LDL and total level of
cholesterol with higher ranked scores on the Expanded Disability Status
Scale (EDSS) and severity scores for MS patients (Weinstock-Guttman,
2011).
 The same study also noted that there was a decrease in the volume of
MRI lesions in patients who had high levels of HDL cholesterol.
 In the book Grain Brain, Perlmutter (2013) identifies the major roles
that cholesterol plays in the neurochemistry of the brain
 Creates the membrane around the cell and maintains permeability
(Perlmutter, 2013).
 “the ability to grow new synapses in the brain depends on the availability
of cholesterol, which latches cell membranes together so that signals can
easily jump across the synapse”
 A “key component in the myelin coating around the neuron, allowing quick
transmission of information” (p.91).
 LDL plays a major role in this process by transporting cholesterol to the
neurons.

10. Antioxidants and
Gluten
• ability to interfere with
free-radicals
•since uric acid scouts out
peroxynitrite, which is toxic
to neurons, axons and glial
cells in the brain,
implementing uric acid
supplements into a
patient’s diet may slow
down the progression of
demyelination and axonal
damage (Touil & Deloire-
Grassin, 2001).
•Gluten: researched to
see if it causes
inflammation in the brain
Gluten

11. Research on effectiveness
 Vitamin D
 “low levels of vitamin D were associated with increased
relapse rate and disability in MS patients in the 2 years
preceding enrolment” (Von Geldern and Mowry, 2012,
p.680).
 vitamin D supplements may have a positive effect on MS.
 49 patients
 examined for one year
 Half of the patients were given an increased dose of vitamin D
supplements, while the other half was used as a control.
 The results showed that of those patients who had received the
additional vitamin D supplements, “significantly fewer had an
increase in EDSS score at the end of the trial” and that there
was a trend “towards a lower annual relapse rate and a higher
proportion of relapse-free patients in the treatment group than in
the control group” (von Geldern & Mowry, 2012, p.680).

12. Research on effectiveness
 PUFAs
 One study completed by Jelinek and colleagues found that patients who were
taking omega-3 supplements and implemented more fish into their diet self-
reported a better quality of life and lowered sense of disability (Jelinek&
Hadgkiss, 2013).
 There were “trends towards lower relapse rates and reduced disease activity”
although they requested that further research was needed to conclude the
effectiveness of omega-3 supplements (Jelinek& Hadgkiss, 2013).
 Another study examined the effects omega-3 fatty acids had on the
disability progression, fatigue or quality-of-life scores verses those in a
placebo group.
 Randomized
 92 participants with RRMS
 examined the patients at six months and 24 months
 The study found no significant difference after six months in the number of
lesions on gadolinium-enhanced MRI nor did they find a significant difference
in relapse rates. The results also did not show an association between the
supplements and disability progression, fatigue or quality-of-life scores.
 However, von Geldern and Mowry(2012) argue that “no dietary restrictions or
recommendations were given to participants, which might have attenuated any
benefit of the fatty acid supplementation” (p.682).

13. Conclusion
 More research is needed to determine the effectiveness of diet
intervention on Multiple Sclerosis symptoms
 Evidence to suggest that the implication of diet therapies
 specifically polyunsaturated fatty acids and vitamin D
 may help with the occurrence of relapsing episodes
 overall quality of life on MS patients
 Most studies were based upon
 subjective testing and questionnaires, and sample sizes were
small- it is difficult to determine the validity and reliability of diet
therapies as an effective form of treatment for MS patients.
 No evidence to support the harm of implementing
supplements such as vitamin D and omega-3 in one’s diet
 Diet therapy may be beneficial from a psychological stand-
point.
 There is no current cure for MS, most patients prefer to try diet
therapy
 it provides a sense of control over the disease.