A Randomized Study of Low Fat Diet with Omega3 Fatty Acid Supplementation in Patients with Relapsing-Remitting Multiple Sclerosis (RRMS)    Thurs, April 18, 2002
Bianca Weinstock-Guttman, Monika Baier, Peterkin LeeKwen, Joan Feichter, Suzanne Dinehart, Jaya Venkatraman, Kulwara Meksawan, Mary Rensel, Pamela Bochiechio, Carol Brownscheidle, Frederick Munschauer, Richard Rudick Buffalo, NY; Denver, CO; Cleveland, OH

 Objective:

To determine whether a low fat diet supplemented with Omega3 long chain polyunsaturated fatty acids (PUFA) positively affects quality of life in patients with RRMS  

Background:

Dietary manipulation is beneficial in patients with cardiovascular disease, and lipid modification has recently attracted attention in autoimmune diseases. PUFA and their derivatives are considered potent modulators of the immune and inflammatory responses. The benefits of dietary intervention in MS have not been rigorously studied.  

Design/Methods:

Patients with RRMS were randomized into a 1-year single-blind controlled study comparing two dietary interventions:
Group 1 received a very low total fat diet (15% of daily calories) with supplemental w-3 PUFA (6 fish oil capsules/day).
Group 2 received the American Heart Association Step I diet (total fat<30% of daily calories) with placebo supplements (6 olive oil capsules).  

Patients were on interferon b or glatiramer acetate for at least 2 months before entering the study.  

The Physical Components Summary Scale (PCS) from the Short Form Health Survey Questionnaire (SF 36) was the primary outcome measure supplemented by the Modified Fatigue Impact Scale (MFIS) and the Mental Health Inventory (MHI).

  Physician-rated secondary outcome measures were the Kurtzke EDSS and relapse frequency. Adhesion molecules (ICAM-1, VCAM), prostaglandin PGE2 and leukotriene LTB4 plasma levels were determined using an enzyme linked immunosorbent assay (ELISA).  

Results:

This is a preliminary analysis on the first 23 patients.  

Baseline characteristics were similar in group 1 vs. group 2, except for MFIS: (gender 81.8% vs. 83.3% female; age-mean 44.8 vs. 42; disease duration-3.9 vs. 3.3; EDSS 1.95 vs. 2.09, SF-36/PCS: 44.7 vs. 40.3, MFIS 57.4 vs. 37 (p=0.02), and MHI 86.3 vs. 75).  

Mean follow-up was 8 months (range 1-12 months). Eight patients completed the 1yr study, 16 completed 6 months. Patients tolerated the diet well, but no significant difference was seen in the quality of life measures examined over time.

 However, there was a significant decrease in number of relapses in Group 1 patients compared with their relapse rate 1 yr prior to the study: -.64 (SD= 0.5) (p=0.0019). In contrast, there was no difference in Group 2 patients.

 Significantly less disease progression was seen in group 1 (p= 0.0306). When comparing the levels of immunological parameters, a significant decrease in ICAM-1 from baseline was seen in the 15% diet group (p=0.0098) as well as the 30% group (p=0.0358). PGE2 levels showed a significant decrease only in the 15% diet group (p=0.04). 

 The change in ICAM-1 levels was persistent in the 15% diet group patients that finished their one year study (p=0.04).

 Conclusions:

This preliminary analysis suggests that very low fat diet (15%) with supplemental Omega3 PUFA was very well tolerated and may have a beneficial effect on disease parameters in patients with RR-MS.

Supported By:

National Multiple Sclerosis Society and Mellen Center-Cleveland Clinic Foundation  

Dr. Bianca Weinstock-Guttman joined the BGH/Baird team in Summer 1998. She is Principal Investigator of the clinical trial, "A Randomized Study of Low Fat Diet with W-3 Fatty Acid Supplementation in Patients with Relapsing Remitting Multiple Sclerosis," funded by the National Multiple Sclerosis Society. She has also initiated a study of pulse cyclophosphamide and Avonex® in MS patients in collaboration with Dr. Weiner's group at Brigham and Women's Hospital. Dr. Guttman is a co-investigator in several ongoing MS clinical trials at the Baird and BGH and sees MS patients at both practice sites