Abstract
Preliminary studies suggest that a modified Paleolithic diet may benefit symptoms of fatigue in progressive multiple sclerosis (MS). However, this diet restricts the consumption of eggs, dairy, and gluten-containing grains, which may increase the risk of micronutrient deficiencies. Therefore, we evaluated the nutritional safety of this diet among people with progressive MS. Three nonconsecutive 24-h dietary recalls were collected from (n = 19) progressive MS participants in the final months of a diet intervention study and analyzed using Nutrition Data System for Research (NDSR) software. Food group intake was calculated, and intake of micronutrients was evaluated and compared to individual recommendations using Nutrient Adequacy Ratios (NARs). Blood was drawn at baseline and the end of the study to evaluate biomarker changes. Mean intake of fruits and vegetables exceeded nine servings/day and most participants excluded food groups. The intake of all micronutrients from food were above 100% NAR except for vitamin D (29.6 ± 34.6%), choline (73.2 ± 27.2%), and calcium (60.3 ± 22.8%), and one participant (1/19) exceeded the Tolerable Upper Limit (UL) for zinc, one (1/19) for vitamin A, and 37% (7/19) exceeded the chronic disease risk reduction (CDRR) for sodium. When intake from supplements was included in the analysis, several individuals exceeded ULs for magnesium (5/19), zinc (2/19), sodium (7/19), and vitamins A (2/19), D (9/19), C (1/19), B6 (3/19), and niacin (10/19). Serum values of vitamins D, B12, K1, K2, and folate significantly increased compared to respective baseline values, while homocysteine and magnesium values were significantly lower at 12 months. Calcium and vitamin A serum levels did not change. This modified Paleolithic diet is associated with minimal nutritional risks. However, excessive intake from supplements may be of concern.
Highlights
Multiple sclerosis (MS) is a chronic immune-mediated neurodegenerative disease characterized by the demyelination of neurons due to an inflammatory response caused by migration of T lymphocytesNutrients 2020, 12, 1844; doi:10.3390/nu12061844 www.mdpi.com/journal/nutrientsNutrients 2020, 12, 1844 into the central nervous system [1]
This analysis of 24-h dietary recalls demonstrates that people with MS (pwMS) consuming a modified Paleolithic diet based on Wahls PaleoTM diet principles increased fruit and vegetable consumption to greater than nine daily servings, which confirms previous self-reported daily food log findings [13] and exceeds current guidelines [16]
Study participants were more compliant with the recommendation for intensely colored fruits and vegetables than for leafy green or sulfur-rich vegetables, likely due to preference for the fruit included in this group
Summary
Multiple sclerosis (MS) is a chronic immune-mediated neurodegenerative disease characterized by the demyelination of neurons due to an inflammatory response caused by migration of T lymphocytesNutrients 2020, 12, 1844; doi:10.3390/nu12061844 www.mdpi.com/journal/nutrientsNutrients 2020, 12, 1844 into the central nervous system [1]. Multiple sclerosis (MS) is a chronic immune-mediated neurodegenerative disease characterized by the demyelination of neurons due to an inflammatory response caused by migration of T lymphocytes. The disease affects nearly one million people in the U.S [2], and patients experience a variety of symptoms including pain, fatigue, and changes in vision, cognition, and movement [3]. Disease-modifying drugs are associated with reduced frequency of relapse and delayed disease progression [1] but are costly [5] and have adverse side effects [6,7]. Many people with MS (pwMS) seek alternative therapies, including specialized diets and supplements [8]. One such specialized diet being investigated for MS is a modified Paleolithic diet based on Wahls
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