Date Published: June 18, 2019
Publisher: Public Library of Science
Author(s): Kelly Fellows Maxwell, Terry Wahls, Richard W. Browne, Linda Rubenstein, Babita Bisht, Catherine A. Chenard, Linda Snetselaar, Bianca Weinstock-Guttman, Murali Ramanathan, Alessandra Solari.
To investigate associations between lipid profiles and fatigue in a cohort of progressive multiple sclerosis (MS) patients on a diet-based multimodal intervention.
This pilot study included 18 progressive MS patients who participated in a prospective longitudinal study of fatigue following a diet-based multimodal intervention that included exercise, neuromuscular electrical stimulation and stress reduction. The 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. Fatigue was measured on the Fatigue Severity Scale (FSS) at baseline and every 3 months for 12 months. A lipid profile consisting of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG) was obtained on fasting blood samples at baseline and 12 months.
FSS scores decreased from a baseline of 5.51 (95% CI: 4.86, 6.16) to a mean of 3.03 (95% CI: 2.23, 3.82) at 12 months (p < 0.001). At 12 months, increases in HDL-C (mean change: +6.0 mg/dl; 95% CI: 0.3, 12.0; p = 0.049) and decreases in BMI (mean change: -2.6 kg/m2; 95% CI: -3.6, -2.5; p < 0.001), LDL-C (mean change: -10.4 mg/dl; 95% CI:-19.7, -1.2; p = 0.029), TG (mean change: -29.2 mg/dl; 95% CI: -44.3, -14.2; p = 0.001), TG to HDL-C ratio (mean change: -0.6; 95% CI: -1.0, -0.3; p = 0.002) and TC to HDL-C ratio (mean change:-0.6; 95% CI: -1.0, -0.3; p = 0.003) were observed compared to baseline. Improvements in FSS were associated with increases in HDL-C (β = -0.05; 95% CI: -0.1, -0.0004; p = 0.048) and changes in TC (p = 0.005) from baseline to 12 months. Lipid profile variables are associated with improvements in fatigue in progressive MS patients on a diet-based multimodal intervention.
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 observed changes in nutrient intake on the study diet are consistent with changes expected from the guidelines to reduce or eliminate grains (carbohydrate) and dairy (carbohydrate and saturated fat), while encouraging large quantities of fiber-containing vegetables and fruits plus foods and supplements containing omega-3 fatty acids. The reductions in saturated fat, trans fat, added sugars, and increases in dietary fiber and omega-3 fatty acids are consistent with changes recommended in the Dietary Guidelines for Americans .
The results from this pilot study of the diet-based multimodal intervention are consistent with the possibility that lipid profile biomarkers, particularly TC and HDL-C, may contribute to improvement in MS fatigue. Our results require confirmation given the limitations of the current pilot study design, which include the small sample size, lack of control group and randomization. However, if confirmed in larger studies, lipid monitoring may become useful for guiding fatigue treatment decisions.