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Wednesday, December 25, 2019

Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study

Introduction

Fatigue is defined as “a subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual or desired activities” []. Fatigue is a frequent and debilitating multiple sclerosis (MS) symptom []. Estimates of its prevalence range from 52% to 93% []. Fatigue affects MS patients’ quality of life independently of disability [] and adversely affects their ability to work full-time.
The etiology of MS fatigue is considered multifactorial []. Fatigue can result from MS pathobiological processes, which cause blood-brain barrier breakdown, central nervous system inflammation, demyelination, lesion formation and neurodegeneration []. Fatigue can also include contributions from co-morbidities such as depression, physical and emotional stress and external factors, e.g., poor diet and lack of sleep []. However, MS fatigue appears to be a distinct clinical entity that differs from other causes of fatigue such as disability and depression [].
Pharmacological options for treating MS-associated fatigue are limited. Patients are commonly prescribed modafinil or amantadine; fluoxetine is sometimes prescribed off-label. Anti-fatigue drugs have stimulant activity and are often associated with side effects. There is support for non-pharmacological options such as exercise, physical therapy with vestibular rehabilitation and cognitive behavioral therapy [].
Some dietary interventions have shown promise for treating MS fatigue []. Yadav et al. showed that fatigue outcome measures were improved in relapsing-remitting MS patients on a very-low-fat, plant-based diet []. We previously reported that diet-based multimodal intervention supplemented with exercise, neuromuscular electrical stimulation (NMES) and stress reduction techniques was effective at reducing fatigue in progressive MS patients []. The study diet recommended high intake of vegetables and fruits, encouraged consumption of animal and plant protein and excluded foods with gluten-containing grains, dairy and eggs. However, the physiological mechanisms underlying the effectiveness of this multimodal intervention on fatigue are not known.
The associations between diet and lipid parameters have become delineated in recent meta-analyses conducted in the context of cardiovascular disease []. The replacement of saturated fat by polyunsaturated and monounsaturated fats decreases TC, LDL-C and TG, whereas replacement of saturated fats by carbohydrates decreases TC and LDL-C, but increases TG. Saturated fat decreases and polyunsaturated fat increases the anti-inflammatory activity of HDL-C []. Replacing saturated fat with polyunsaturated or monounsaturated fat lowers HDL-C slightly. However, replacement with carbohydrates lowers HDL-C to a greater extent [].
Our working hypothesis that lipid and cholesterol pathways could be potential mediators of the effects of the study diet on fatigue was motivated by two factors. First, the study diet alters food macronutrient composition, which could affect metabolism, causing changes in lipid and cholesterol profiles. Second, an emerging body of evidence has demonstrated that metabolic changes [] underlie the immune and neurodegenerative pathophysiological processes of MS and that cholesterol biomarkers are associated with brain injury and disease progression in MS []. However, the roles, if any, of lipid and cholesterol pathways in MS fatigue have not been investigated.
The aims of this study were to characterize the changes in lipid and cholesterol biomarkers during the diet-based multimodal intervention and to investigate whether these biomarkers were associated with fatigue outcomes. We analyzed data obtained from a Phase 1 pilot trial of an integrative diet-based multimodal intervention (study diet, exercise, NMES, stress reduction) on fatigue in progressive MS patients. The aims of the trial were to assess the safety, patient adherence to the diet and other components of the study, effects and nutritional adequacy of the study diet for MS fatigue.



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How to Stay Connected When MS Has You Feeling Isolated

Meeting others with MS can make a big difference in how you feel, whether it’s in person, online, or on the phone. ~~~~~~ By Becky Upham

Caroline Craven and Michael Wentink share tips on staying socially engaged when living with MS.Photos Courtesy of Contributors

For many people who live with multiple sclerosis (MS), dealing with the physical symptoms of the disease is just one part of the struggle. Feeling lonely and isolated is another.

It can seem like the world is divided by an invisible line: on one side, “healthy” people, and on the other, people with MS, and sometimes the gap feels too wide to cross.

People with MS can experience isolation in a number of different ways, says Meghan L. Beier, PhD, a rehabilitation psychologist and assistant professor of physical medicine and rehabilitation at the Johns Hopkins University School of Medicine in Baltimore.

“This can be true even if an individual has a very supportive family or a good social support network,” says Dr. Beier. It can be common to feel as though others don’t really understand you, your disease, or how it impacts you, and that can feel very lonely, she says.

The feeling of not being understood by others can contribute to a sense of vulnerability as you try to manage concerns both immediate and distant related to MS, such as your energy level, your disease progression, and the judgments of others.

And that sense of vulnerability, in turn, can make isolating yourself seem like a safer option, even though it’s really not, says Caroline Craven, a writer and marketing consultant in her early fifties who lives outside of Pasadena, California. Craven was diagnosed with MS in 2001.

“Even though fatigue and pain can make it hard, we need to get out there and be with other people,” says Craven.

MS: Unless You Have It, You Don’t Really Understand

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