There are many possible explanations for fatigue in MS.
For example, exhaustion can result from the pathobiological processes associated with this condition, such as inflammation of the nervous system or demyelination.
Alternatively, it could be due to the poor diet and insufficient sleep that people with MS often report.
Regardless of its precise causes, treatment options for fatigue in MS are scarce, and anti-fatigue drugs such as modafinil and amantadine often have side effects.
Some research has suggested that making dietary changes could improve fatigue in MS. For instance, a previous study has shown that a very low fat, plant based diet can improve exhaustion in people with relapsing remitting MS.
New research aimed to investigate whether such positive effects were down to a change in lipid profile and cholesterol.
Murali Ramanathan, Ph.D. — a professor in the University of Buffalo School of Pharmacy and Pharmaceutical Sciences in New York — is the lead author of the new research, the results of which now appear in the journal PLOS One.
Studying the effect of the Wahls diet
Prof. Ramanathan and colleagues clinically followed 18 people with progressive MS over the course of 12 months.
During this time, the participants followed a strict Wahls diet — that is, a “Paleo” diet that Dr. Terry Wahls developed in 2008.
The Wahls diet excludes grains, dairy, eggs, and legumes and encourages the consumption of fruits, vegetables, meat, and fish.
In addition to making dietary changes, the participants enrolled in an exercise program that included stretches, strength training exercises, and neuromuscular electrical stimulation, as well as meditation and stress reducing self-massages.
During the follow-up period, the researchers tracked changes in the participants’ body mass index (BMI), calorie intake, overall cholesterol levels, triglycerides, high density lipoprotein (HDL) cholesterol levels, and low density lipoprotein (LDL) cholesterol levels.
The participants also reported their fatigue levels using the Fatigue Severity Scale.
Paleo diet improves cholesterol and fatigue
The study found that higher levels of HDL, or “good” cholesterol, correlated with improvements in fatigue. Reductions in total cholesterol also correlated with a reduction in exhaustion.
“Higher levels of HDL had the greatest impact on fatigue,” Prof. Ramanathan reports.
He speculates on the potential mechanism behind the findings, saying that the positive role of good cholesterol may be “because [it] plays a critical role in muscle, stimulating glucose uptake and increasing respiration in cells to improve physical performance and muscle strength.”
The researchers acknowledge, however, that their study is only a pilot one, and that more research is necessary.
“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,” they write.
“However, if confirmed in larger studies, lipid monitoring may become useful for guiding fatigue treatment decisions,” explain Prof. Ramanathan and colleagues.
“Fatigue in people with [MS] has been viewed as a complex and difficult clinical problem with contributions from disability, depression, and inflammation. Our study implicates lipids and fat metabolism in fatigue.”
Prof. Murali Ramanathan
“This is a novel finding that may open doors to new approaches for treating fatigue.”