Changes in Lipid Profile Affect Fatigue in Persistent Multiple Sclerosis

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The aim of this pilot study was to assess the association between lipid profiles and fatigue in patients with progressive multiple sclerosis.

For patients with progressive multiple sclerosis, a diet-induced lipid profile change improved fatigue, according to a study published in PLoS One.

The aim of this pilot study was to examine lipid and cholesterol biomarker profile changes after a diet-based multimodal intervention was implemented, to assess the association between lipid profiles and fatigue in patients with progressive multiple sclerosis. Analysis of safety, adherence, and nutritional adequacy was also completed. Data from a phase 1 pilot trial of an integrative 12-month diet-based multimodal intervention was obtained via subanalysis. The diet was a modified Paleolithic diet with recommended foods that included leafy green vegetables and deeply colored fruits and vegetables.

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Foods excluded from diets were grains containing gluten, dairy, and eggs; foods that were encouraged included animal and plant proteins, omega-3 oils, nutritional yeast, kelp, blue-green algae, and nondairy milk. A home-based exercise plan, neuromuscular electrical stimulation, meditation, and self-massage were included as components of this study. Clinical and laboratory assessments included the Fatigue Severity Scale (FSS), the Kurtzke Expanded Disability Status Scale, body mass index (BMI) values, and lipid profiles comprising high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, total cholesterol, and triglycerides.

Of the 18 individuals included in the study, 72.2% were women, 94.4% were white, mean age was 51.8 years old, mean baseline BMI was 24.5 kg/m2, mean baseline FSS score was 5.5, and mean Expanded Disability Status Scale score was 6.2. There was a significant difference in dietary intakes from baseline to 12 months in total kilocalories (P =.004), grams of added sugars (P =.004), grams of saturated fat (P =.003), grams of dietary fiber (P =.009), and grams of total omega-3 fatty acids (P =.0002).

At 12 months, the mean FSS score was decreased by 2.48 (P <.001), and analysis indicated this change was associated with an increase in recommended food consumption (β=-0.28; 95% CI, -0.35 to -0.20; P <.001) and a decrease in excluded food consumption (β=0.31; 95% CI, 0.21-0.42; P <.001). At 12 months, there was a significant improvement in BMI (P <.001), triglyceride levels (P =.001), total cholesterol to high-density lipoprotein cholesterol ratios (P =.003) and triglycerides to high-density lipoprotein cholesterol ratios (P =.002). The decrease in the mean FSS score was associated with the increase in high-density lipoprotein cholesterol (β=-0.05; 95% CI, -0.1 to -0.0004; P =.048) and changes in total cholesterol (P =.005).

Limitations of this study include a diet-based multimodal intervention, the potential bias using the Food Frequency Questionnaire to assess nutrient intake, and the lack of a control group.

The researchers concluded that “the diet-based multimodal intervention are consistent with the possibility that lipid profile biomarkers, particularly [total cholesterol] and [high-density lipoprotein cholesterol], may contribute to improvement in [multiple sclerosis] fatigue.”

This study received in-kind support from DJO Inc., Pinnaclife Inc., and TZ Press LLC, and several authors report associations with pharmaceutical companies and copyrights to published books. Please see the original reference for a full list of authors’ disclosures.


Fellows Maxwell K, Wahls T, Browne RW, et al. Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: results from a pilot study [published online June 18, 2019]. PLoS One. doi: 10.1371/journal.pone.0218075