Researchers are about to start a new study to investigate if intermittent fasting can help reduce MS symptoms.
“There is good evidence that calorie restriction has a possible anti-inflammatory role,” Laura Piccio, PhD, associate professor of neurology, Washington University in St. Louis, told Healthline.
Piccio is currently recruiting patients with relapsing-remitting MS for a 12-week trial to test intermittent fasting and its role with MS-related inflammation.
“There are several possible ways fasting can affect inflammation and the immune response,” Piccio said. “One is by changing hormone levels. We found that levels of the anti-inflammatory hormone corticosterone were nearly twice as high in the fasting mice. But it also could act through the gut microbiome.”
Inflammation is a leading cause of MS exacerbations and symptom disruptions.
What do we know about intermittent fasting?
Intermittent fasting has been around since the beginning of humankind. Either because food was scarce and humans had to hunt and gather, or due to religious practices.
Until the last century, humans were much more likely to have health issues from too little food than too much food.
Now, some nutrition and wellness experts have posited that going back to a more restrictive diet could have health benefits.
The use of intermittent fasting on a high-protein/low-carbohydrate diet was made popular in 2012 in the BBC documentary, “Eat, Fast and Live Longer,” and in the Netflix documentary, “The Magic Pill.”
Other diets like the popular ketogenic or Keto diet also echo these types of diet patterns.
The growing success of intermittent fasting for wellness and weight loss has spurred an increase of fasting diets and protocols available.
There is whole-day fasting, alternative-day fasting, and time-restricted feeding. Whole-day fasting includes specific 24-hour periods where one fasts without any calories.
Alternative-day fasting includes a 24-hour fast followed by 24 hours of nonfasting. During a fasting day, a total of 500 to 600 calories can be consumed. A person may eat five days and fast two days (not in a row). This is called a 5:2 diet.
Time-restricted feeding is when a person eats only during certain number of hours during the day, such as 16 hours of fasting and 8 hours of allowable feeding time, called a 16:8 protocol.
In anecdotal stories, like those shared in “The Magic Pill,” a Netflix documentary about the global effects of diet change in humans, people talk about how some symptoms improved as they changed their diet. Patients used intermittent fasting and a reduced-carbohydrate/high-protein-and-fat diet to better control diabetes, lose weight, and control other disease symptoms.
Now Piccio and fellow researchers, intrigued with intermittent fasting, want to see what intermittent fasting can do for people living with MS.
After researching calorie restriction in mice with the MS model, a small human trial was created.
“There was a pretty clear effect on mice — enough to look at humans,” said Piccio.
There is not one reason why calorie restriction works, but a variety of reasons. “Overall, the calorie restriction reduced inflammation,” explained Piccio. “It reduced pro-inflammatory molecules while increasing anti-inflammatory molecules.”
Severe calorie restriction can also reduce body weight, but it can be hard to maintain.
But “reducing calories by 40 percent is severe,” Piccio explained, “It’s almost unfeasible in patients. So, we switched to an intermittent fasting plan, [which] makes it more feasible for patients.”
The mice research concluded that intermittent fasting created the same results as calorie restriction, so Piccio and team created a very small pilot study for humans.
MS patients taking steroids were compared to MS patients taking steroids and using intermittent fasting. The human-based results did not exactly mimic the mice study finding, but showed enough similarities to encourage the team to apply for a bigger grant from the National MS Society.
The new trial at St. Louis will enroll forty patients. The patients will randomly be given either a regular western diet or be placed on intermittent fasting. The trail will run for twelve weeks. Tests will be performed to measure inflammation in blood bio markers, brain activity, and the gut microbiota. Participants need to be able to travel to St. Louis area for this trial.
Other research on intermittent fasting
“This is another small but intriguing study which adds to the growing literature investigating the connections between the immune system, the gut, and the nervous system,” said Dr. Barbara Giesser, professor of clinical neurology at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA) and clinical director of the UCLA MS program.
There are numerous other studies under way to look at the impact a changing diet will have on MS symptoms. There is another trial, based on the same mouse study, that will also look at the results of intermittent fasting on MS.
Headed up by Dr. Ellen Mowry, associate professor of neurology at the Johns Hopkins Hospital, this trial investigates the use of technology, specifically the Lose It! App, to help patients adhere to a calorie-specific diet. The trial also looks at fatigue and quality of life due to resulting weight loss.
Participants will either be on a regular feeding program, or will participate in a 16:8 intermittent fasting protocol, fasting for 16 hours a day, feeding during the other 8 hours.
A clinical trial in Berlin is currently recruiting to research intermittent fasting, specifically the Ketogenic diet, and MS disease outcome. The control group will be given a vegetarian-focused, anti-inflammatory diet. Patients receive a ketogenic diet, which is carbohydrate-reduced with a high amount of fat. Patients fast for one week every six months. Additionally, the patients do an intermittent fasting, for at least 14 hours a day.
“While it is too early to recommend intermittent fasting as a routine part of MS management, it also underscores the importance of partnering lifestyle strategies with pharmacologic agents for the optimum management of persons with MS,” added UCLA’s Giesser.
When fasting can be unsafe for people with MS
A recent review found possible benefits from Ramadan-related fasting for people living with MS, but warns patients to be cautious. Research suggests those with active MS or history of new attack during or after Ramadan, those on antispasmodic, anticonvulsive, corticosteroid and immunosuppressive drugs, and patients with significant disabilities, abstain from Ramadan fasting, specially in hot summer months
Nick LaRocca, PhD, vice president of healthcare delivery and policy research for the National Multiple Sclerosis Society, pointed out how fasting can alter systems in the body.
“Intermittent fasting can alter the immune system,” said LaRocca. “Part of what these diets do is change the balance to a more anti-inflammatory state,” he explained.
He also added that fasting by our ancestors was very different since fasting at one time was a way of life, and today, we are surrounded by an abundance of food.
“Intermittent fasting allows microorganisms that have been tamped down by modern diet, take a more significant role in our immune system,” concludes LaRocca, “Maybe intermittent fasting is inching the biome back to an ancestral pattern, and there may be some benefit.”
Krista Cantrell-Brennan was an IT executive until her MS-related fatigue and cognition problems forced her into early retirement.
“I wasn’t interested in intermittent fasting as a weight-loss program,” Cantrell-Brennan told Healthline. “But when I saw that the NMSS was funding research about intermittent fasting, I decided it was time to try it.”
The weight loss was an added benefit. After her MS symptoms subsided, Cantrell-Brennan decided to become an intermittent fasting coach.
Brennan’s consulting services for weight loss and to alleviate MS symptoms is FastingJourney.com
For her personal use, Krista uses a 16:8 fasting program along with three-day fasts once a quarter. She creates custom protocols for her clients.
“You have to start slow,” Brown advised. “If you rush, you’re not going to like it,” she warned, “done improperly, patients will want to overeat and overconsume, undoing everything they just did.”
“Use common sense,” cautioned LaRocca, “The old saying ‘If a little is helpful than a lot is better,’” is not the case.
LaRocca recommends looking at a comprehensive approach to wellness. “Do everything you can to live your best life with regards to all aspects of life.”