The Impact On Brain Volume And Biomarkers In The Setting Of MS Using Intermittent Fasting

Do you fast intermittently, reducing your caloric intake a couple of days a week so you’re just a bit hungry? This may be a power strategy that more of us will be using in the future as part of our wellness plans.  

This study  (PMID 37005885) investigated how intermittent calorie restriction in the setting of multiple sclerosis (MS) impacted brain volume and biomarkers over a 12-week period. It was a very small pilot study, with 5 people in the intervention group and 5 in the control group. Participants needed to have relapsing-remitting MS based on the 2017 McDonald’s criteria. Participants also needed to be on a stable, disease-modifying treatment (DMT) for 3 months or not be treated with any DMTs for 6 months. Other requirements included no special diet, an expanded disability status score of 6 or less (be able to walk independently without needing a cane), and no medical comorbid problems that would make participating in the study difficult (e.g. diabetes or active eating disorders). 

The intervention was to reduce calories to about 25% of usual intake (< 500 calories) on two non-consecutive days each week and to not compensate for the reduced intake on the other days. On the reduced calorie days, participants were to eat salads with steamed vegetables and a light dressing. A study dietitian contacted participants weekly to check on dietary intake and provide motivational support.  

Participants underwent brain imaging using a 3T MRI. The intermittent calorie restriction group had statistically improved brain volume in several regions (parietal, orbital, temporal, and frontal) compared  to the control group, which did not have improved brain volume in these regions. Blood flow as measured by changes in the restrictions in the water fraction was improved in the intermittent calorie restriction group as compared to the control group. 

In animal models of dementia, intermittent calorie restriction has been very helpful for improving blood flow and cognition and reducing oxidative stress and inflammation. This is the first study to demonstrate improved brain volume and blood flow in humans with RRMS following an intermittent calorie restriction diet. 

I find this to be very exciting. Brain volume changes in just 12 weeks is very fast. Prior studies have required a two year window to measure changes in volume over time. This is the first time I have seen a study look at a 12 week window. This may be helped by the fact that MRI scanners and software to analyze brain volume changes have grown more powerful. 

The benefit of intermittent calorie restriction is that no other special restrictions exist other than reducing calories significantly two days per week. This makes the intervention easier for many people to adopt and sustain. If you follow me on Instagram, you see that I often eat every other day and have only I can my PC smoothie on the days I do calorie restriction. The smoothie, which includes phosphatidylcholine, olive oil, and a blend of essential fatty acids (alpha linolenic and linoleic acid)  and bone broth powder, and aronia berries, contains 300 to 400 calories. Thus my eating pattern is similar to what was studied.   

We are studying diet and brain volume changes over a two year period in a study called Dietary Efficacy on Quality of Life in Multiple Sclerosis. The diets we are investigating are ketogenic, modified Paleolithic, and usual diet. Participants must have relapsing remitting MS, be age 18-70, be willing to be randomized, and able to come to Iowa at month 0, 3, and 24. Learn more about the study here.  

So far, we have enrolled 81 people in our clinical trial and are over halfway to our goal of enrolling 156.  If you’d like to participate, please complete the survey here, which collects basic demographic information and allows us to confirm the diagnosis of MS. Even if you are not eligible for this study, join our patient registry so we can tell you about future studies for which you may be eligible. I have a big hairy audacious goal of changing the standard of care so that all patients who are diagnosed with MS

are told that food matters a great deal, a healthy diet can improve outcomes, and are referred to a nutrition professional to support diet improvement. To achieve this goal, more research is needed.  If you want to help me achieve this goal and make life better for those with chronic illness, sign up for our patient registry so you can be a part of our groundbreaking research.  That way you will be alerted when we are starting a new study.