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Pdf 404.14 K Mehrabani et al. Int J Nutr Sci 2019;4(1):14-22 International Journal of Nutrition Sciences Journal Home Page: ijns.sums.ac.ir Review Article Dietetic Plans within the Multiple Sclerosis Community: A Review Golnoush Mehrabani1, Saeedeh Aminian2, Golshid Mehrabani3, Mina Rabiee4* 1. Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada 2. Centre for Physical Activity and Nutrition, Centre for Child Health Research, Auckland University of Technology, New Zealand 3. School of Dental Medicine, Boston University Henry M. Goldman, Boston, MA, USA 4. Department of Molecular Biology, ShahreKord Branch, Islamic Azad University, ShahreKord, Iran ARTICLE INFO ABSTRACT Keywords: Multiple sclerosis (MS) is an immune-mediated, neurodegenerative Multiple sclerosis diseasecaused by a complex interactionbetween lifetime environmental Diet Protein exposures and genes. Dieteic interventions environmental may affect Vitamin the disease activity. These modifications may happen in intake of fats, Mineral proteins, calories, vitamins, minerals, fibers, and intake of several other nutrients which have a key role in neural health. This review was *Corresponding author: undertakento investigatethe role of nutritional modifications in patients Mina Rabiee, with MS. Department of Molecular Biology, ShahreKord Branch, Islamic Azad University, ShahreKord, Iran Tel: +98-71-32341025 Email: [email protected] Received: December 6, 2017 Revised: November 9, 2018 Accepted: November 20, 2018 Please cite this article as: Mehrabani G, Aminian S, Mehrabani G, Rabiee M. Dietetic Plans within the Multiple Sclerosis Community: A Review. Int J Nutr Sci 2019;4(1):14-22. doi: 10.30476/IJNS.2019.81531.1007. Introduction vitamin D level, etc. where shown to affect MS Multiple Sclerosis (MS) is a chronic, inflammatory, development (6, 7). and immune-mediated diseaseresults in The disease is typically presented with motor neurodegenerative processes in the nervous impairment, visual disturbances, or sensory system, and is characterized by inflammation and problems, pain, fatigue and cognitive impairment myelin loss leading to a significant disability and (8). MS has two main types and usually develops unemployment because of the disease progression in young adults and usually women are more (1). The pathogenesis is complex and multifactorial likely to be influenced. The first type is the (2) that is believed to be due to complex interaction relapsing-remitting MS (85%) with inflammation between genetic and environmental exposures, and demyelination as the primary pathology and such asnutritionthat can damage thenerve fibers and the second type is primary progressive MS (15%) the myelin sheath of the nervous system (3, 4) and with neurodegeneration–axonal degeneration as the alterations in gut microbiome composition to down primary pathology (9). The prevalence of disease is regulate the inflammatory process (5). Various higher in developed countries (10); with the highest environmental factors such as viral infection, brain prevalence in Scotland, Norway, Hungary, Slovenia, injury, physical inactivity, obesity, smoking, low Germany, USA, Canada, and Czech Republic (11), 14 Int J Nutr Sci March 2019;4(1) Dietetic plan in multiple sclerosis but is extremely rare in Japan and is almost unknown inhibited the production of IL-1, IL-2, and TNF in the Indian subcontinent (12, 13). Treatment affecting the progression of the disease (31, 32). measures includechanges in lifestyle factors such Therefore, Roy Swank developed a low-saturated as diet quality,disease-modifying,physical and fat diet pattern and exhibited that increased occupational therapies and management of the consumption of fat especially from meat and dairy symptom and relapses (14-17). sources would be associated with a higher incidence Dietary intervention is a simple and relatively of MS (33). He suggested consumption of 20-30 g low risk method to potentially promote and improve of fat per day that was later revised to ≤20 g of clinical status, well-being and life expectancy of saturated fat (33) and again to ≤15 g would not lead MS patients (4). A variety of specific diets including to adverse events (34). Swank also reported that 5 plant-based low-fat McDougall (18), low saturated g of cod liver oil, 10-15 g vegetable or fish oil, with fat Swank (19), Mediterranean (17), ketogenic one egg, multivitamins, whole wheat bread and (9), energy restriction/fasting (20) andmodified fish ≥3 times per week would have neuroprotective Paleolithic (Paleo) Wahls™ (21, 22) diets were tried effects and inhibit the progression of MS disease for treatment of MS disease, however, supportive (35). Later, he increased oil consumption to 40- evidences for the benefit of any specific dietary 50 g per day in a diet consisted of an additional regimen are absent and well-designed, randomized 10 g of fat from other sources such as bread with controlled trials seem necessary (23). As currently, beneficial outcomes for patients with MS disease no spportive evidences are available to suggest (35). His findings were later presented in a book a specific diet for MS.The National MS Society entitled “Multiple Sclerosis Diet” (36). He also (NMSS) (24) recommended MS patients to follow found that in patients who were diagnosed with healthy eating guidelines for the general population relapsing remitting MS and were treated with a such as the US Dietary Guidelines for Americans low saturated fat diet, exacerbations would be less (DGA) (25) and those for cancer and heart disease frequent and less severe (37). prevention (26). Base on Dietary Guidelines for Americans, monounsaturated and polyunsaturated fat in Nutrition and MS amounts within an individual’s energy needs were Dietary habits were reported as a possible recommended for patients with MS disease (24) environmental factor influencing the risk and as they are good sources of essential fatty acids, progression of MS. There are not enough evidences energy and vitamin E for weight maintenance to recommend a specific diet for MS patients and the (24). Institute of Medicine reported a dietary National MS Society (NMSS) (25) just recommended reference intake as an Acceptable Macronutrient MS patients to follow healthy eating guidelines Distribution Range (AMDR) for the total fat intake for the general population such as the US Dietary that should cover 20-35% of the energy (38). Later, Guidelines for Americans (DGA) (24) and those for the European Society for Parenteral and Enteral cancer and heart disease prevention (26, 27). Nutrition (ESPEN) guideline for clinical nutrition in neurology suggested foods to be lower in saturated Fat intake and MS and higher in polyunsaturated fat for prevention of First studies on the effect of dietary fat on MS MS disease. In this guideline, omega-3 supplements risk dates back to 1950 in Norway (28). It was shown were not suggested for patients with MS to reduce that during progression of neuroinflammatory and the disease relapse (39). It was shown that saturated neurodegenerative diseases such as MS, the myelin fats can increase the translocation of endotoxins into around the axons with lipid composition is influenced, the blood stream and activate the innate immune so the intake of fatty acids was suggested as a factor system and inflammatory cytokines that can affect that can affect the progression of the disease. It seems MS related symptoms (40). that a correlation between the increase in circulating It was demonstrated that adequate amounts of total cholesterol levels, LDL-cholesterol, oxidized polyunsaturated fatty acids incorporated into the LDL and apolipoprotein B with adverse outcomes of neuronal cell membranes can protect neurons from the disease may exist (29) that were documented by the cytotoxic action of TNF via enhancement of consumption of saturated fatty acids, mainly from the number of insulin receptors, because insulin animal fat products regarding the mortality of MS secretion can silence the neurotoxic signal of TNF disease (30). (41). So a high intake of omega-3 polyunsaturated In this relation, the neuroprotective effect of fatty acid, particularly from fish sources was polyunsaturated fatty acids was demonstrated shown to significantly decrease the risk of CNS and was shown that polyunsaturated fatty acids demyelination (42, 43). Lipoic acid as a nutritional Int J Nutr Sci March 2019;4(1) 15 Mehrabani et al. supplement can play an important role in normal High Fiber Diets and MS mitochondrial function and stabilizing the integrity The health benefits of high fiber diets in reduction of the blood-brain barrier (BBB) in animal model of the risk of obesity, type 2 diabetes, colon of experimental autoimmune encephalomyelitis cancer, stroke, and cardiovascular diseases have (EAE) due to its antioxidant, anti-inflammatory led to the widely recommendation of high fiber diets. It and immunomodulatory properties (44, 45). In was shown that high fiber diets can increase the blood mild inactive MS patients, a significant decrease in levels of circulating butyrate as a multi-functional eicosapentaenoic acid (EPA), and a rise in dihomo- molecule affecting directly on the CNS function. gammalinolenic and stearidonic acids in red blood Butyrate was demonstrated to have significant cells were noted without any detectable EPA in pharmacological and dietary potential as a therapeutic adipose tissue and docosahexaenoic acid (DHA) in for the brain (59).There are no specific fruits
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