How changing your diet may reduce your disability
PLUS New research opportunities with the Wahls research team

Key points:

• Both the low saturated fat (Swank) and modified paleolithic (Wahls) diet led to improvements in quality of life and walking endurance.
• Both diets also led to a reduction in fatigue in people with multiple sclerosis (MS).
• Changing diet led to significantly improved hand coordination and better memory in people with MS. However, 25-foot walking function did not change.
• A web-based wellness program has demonstrated improved quality of life and reduced fatigue.
• The study is no longer recruiting people with MS but is recruiting people with fibromyalgia and people with post-acute sequela of COVID-19.
• Recruitment is still ongoing for a study comparing ketogenic and modified Paleolithic diet to usual diet for people with MS.
• Learn more about studies we are actively recruiting for and sign up to be notified about future clinical trials in the Wahls research lab. Links provided later in the article.

Can disability be reduced by changing your diet?

Do you have difficulty using your hands, walking, and/or remembering things? Those are common disabilities for those with multiple sclerosis (MS) or other neuroimmune problems. People often ask me if changing their diet could improve their function and lessen disability. Finally, I have an answer for you.

Our recent paper, Diet-induced changes in functional disability are mediated by fatigue in relapsing-remitting multiple sclerosis: a secondary analysis of the WAVES parallel-arm trial⁽¹⁾, presents our answer to that question. The WAVES trial assessed walking, hand function, and working memory at the initial visit. People then continued their usual diet and returned in 12 weeks for repeat assessments of walking and hand function, short term recall (working memory), and patient-reported outcomes (fatigue and quality of life). Then they were randomized to be trained on a low fat (Swank) diet or a modified paleolithic elimination (Wahls) diet.⁽²⁾ They returned for the same assessments 12 weeks later and again at the end of the study at 24 weeks. We found that both diets were associated with reduced fatigue and improved quality of life. The Wahls diet was better than the Swank diet for some but not all of the fatigue and quality of life assessments.⁽²⁾

In this study, we used clinical measures to assess hand function, walking function, and working memory. Hand function was assessed using the 9-hole peg board in the dominant and non-dominant hand (9HPB). The task is to remove 9 pegs, place them in a shallow bowl, then put them back into the peg board. As coordination improves, it takes less time to complete the task. Walking function is measured by how many seconds it takes to walk 25 feet (25FWT). As walking function improves, it takes less time to walk 25 feet. Memory is assessed by the symbol digit test oral (SDMT-o), which requires matching shapes to numbers using a key sheet with 10 shapes and corresponding numbers. There are 100 symbols to match with a number; as working memory improves, the number of correct responses increases.

The results of the three tests (9HPB, 25FWT, and SDMT-o) are combined into the MS Functional Composite (MSFC) score, which measures overall function or disability. This is a much more effective way to measure disability than the Expanded Disability Status Scale (EDSS). The EDDS is weighted toward walking and has little emphasis on hand function or working memory, both of which are major contributors to job loss. I consider the MSFC a superior assessment of function and a more sensitive tool for measuring change in disability.

Results

There were 44 in the Swank and 43 in the Wahls diet groups. The MSFC was calculated prior to randomization and again at both 12 and 24 weeks. The original WAVES study was focused on fatigue, quality of life, and 6-minute walk test. The study team also collected secondary outcomes, including 9HPB, 25WT, and SDMT-o. The MSFC was calculated and reported in this paper.

The Swank group did have a significant improvement in MSFC at 12 weeks (p value=0.04), in part due to the improved SDMT-o (working memory) score. The Wahls group had no significant improvement at 12 weeks but did have significant improvement at 24 weeks (p value 2< 0.002). Hand function improved significantly in both groups (p< 0.001). The SDMT-o improved for the Swank group at 12 weeks (p<0.001) and 24 weeks (p=0.009). The SDMT-o did not improve at 12 weeks for Wahls group but did at 24 weeks (p=0.02). There were no significant changes within either group for the 25FWT. Note that the authors have already reported on the results of the 6-minute walk test (6MWT), which assesses how far someone can walk in 6 minutes and is an excellent measure of endurance. Neither Wahls nor Swank had improved endurance at 12 weeks, though when comparing 24 weeks to baseline values, the Wahls group could walk much farther than at baseline (p=0.007).⁽²⁾ This suggests that it takes 24 weeks for improved endurance to show up. Walking mechanics did not improve because the time it took to walk 25 feet (the 25WT) did not change. It may be that it takes longer than 24 weeks for walking speed to improve. Perhaps that improvement might be observed in a 12- or 24-month study.

We are currently conducting the Efficacy of Diet in Quality-of-LIfe Study, which will last two years and compares a ketogenic diet and modified paleolithic diet to a usual diet arm. It will be very interesting to see if walking speed improves in this study. Read on to find out how you can participate in this study.

This is the first paper that combined hand function, walking function, and working memory to analyze the effect of diet on function. We now have very good evidence that it is possible to reduce measured disability–function of hands and working memory–by adopting the Swank or Wahls diets. This is a significant contribution to the body of research on diet and MS.

Imagine how much more progress could be made by combining diet quality improvement with a strategy to improve sleep, manage stress, and exercise muscles that have become weak. What we do for diet and self-care is vital to protecting our future function and preventing and reversing disability.

Are you working to improve your diet and self-care? Has it been hard for you to achieve your desired goals? Adopting new habits and letting go of old ones is very hard for most of us. Many of us need additional support to adopt and sustain desired changes. We can help!

Can a web-based wellness program really help people change behavior and improve quality of life?

We have another paper, Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial, that examined whether access to an online program can improve quality of life or fatigue.⁽³⁾ A commercially available online wellness course for people with an autoimmune diagnosis was used (Autoimmune Intervention Mastery Program). This program provides expanded access to learn about wellness behaviors, allowing people to complete the course through their smartphones or computers with no need to drive to appointments.

The University of Iowa Conflict of Interest in Research Committee required the study team to use a person who was blinded or masked to group assignment to ensure the study findings would not be biased. People with self-reported MS were enrolled in the study and either got immediate access to the course or waited 12 weeks to get access to the course. After the study ended, the group that got immediate access was compared to the group that had to wait 12 weeks. The immediate access group experienced reduced fatigue and improved quality of life as compared to the waitlist control group who did not have access to the course.⁽³⁾ This suggests that taking the online wellness course was helpful for reducing fatigue and improving quality of life.

Participate in a Clinical Trial – Two New Populations for a study of an Online Wellness Program

While the study of MS patients is complete, we have added two new populations to the trial (NCT05057676): Fibromyalgia and post-acute sequela of COVID 19. This study evaluates whether access to an online wellness course leads to reduced symptoms and improved quality of life in these two conditions. You must be an adult and live in North America to participate in the study.

• If you have fibromyalgia, complete this survey to see if you are eligible to participate in the study.
• If you have post-acute sequela of COVID-19, complete this survey to see if you are eligible to be in the study.

Improving Your Success: The Wahls Behavior Change™ Model

The Wahls Behavior Change™ model is a 15-step process that helps people more successfully adopt their desired habit changes.⁽⁴⁾ This process grows internal motivation and helps people more successfully meet their goals related to diet, exercise, sleep, and other habits. I use this behavior change process in my clinical trials and clinics. It’s also part of the online wellness program, Autoimmune Intervention Mastery Program.

Get Notified for New Opportunities to Be in a Wahls Research Study!

We write proposals for new trials every few months. Once they are approved by the Institutional Review Board (IRB), we email our participant registry to tell them about the new study and invite them to participate. If you are not eligible for the current study but would like to learn about our future studies, complete the survey to join our Participant Registry for Future Studies.

Participate in an MS Diet Study

If you have relapsing remitting MS and are between the ages of 18-70, live in the U.S., Canada, or Mexico, you may be eligible for our current study, Efficacy of Diet on Quality of Life in Multiple Sclerosis (NCT05007483). This study compares keto and paleolithic diets to the usual diet. Learn more about the study here. The study lasts two years. Participants must travel to Iowa City, Iowa at months 0, 3, and 24. Complete the screening survey here to see if you are eligible. Or scan the QR code to screen to see if you are eligible for the clinical trial.

Citations

1. Crippes LJ, Saxby SM, Shemirani F, Bisht B, Gill C, Rubenstein LM, et al. Diet-induced changes in functional disability are mediated by fatigue in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES randomized parallel-arm trial. Mult Scler J Exp Transl Clin. 2023;9(4):20552173231209147.

2. Wahls TL, Titcomb TJ, Bisht B, Eyck PT, Rubenstein LM, Carr LJ, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021;7(3):20552173211035399.

3. Titcomb TJ, Sherwood M, Ehlinger M, Saxby SM, Shemirani F, Eyck PT, et al. Evaluation of a web-based program for the adoption of wellness behaviors to self-manage fatigue and improve quality of life among people with multiple sclerosis: A randomized waitlist-control trial. Mult Scler Relat Disord. 2023;77:104858.

4. Elliott-Wherry AN, Lee JE, Pearlman AM, Wahls TL. The Wahls Behavior Change Model for Complex Chronic Diseases: A Clinician’s Guide. Degener Neurol Neuromuscul Dis. 2022;12:111-25.

Clinical trials for which we are actively recruiting:

Autoimmune Intervention Mastery Course Study (AIM) NCT05057676

Efficacy of Diet on Quality of Life in Multiple Sclerosis (EDQ) NCT05007483