A big part of my excitement at the ECTRIMS meeting is seeing so many researchers from around the world working hard to find the best solutions for people affected by MS. I found this to be especially true in the growing area of lifestyle and wellness research -exploring diet, exercise, physical activity and other approaches - all of which people can manage themselves to improve how they feel and possibly how their MS evolves.
The idea of intermittent fasting as a way to fight inflammation is being explored by MS researchers. But anyone who’s tried it knows how challenging it can be to stick with this kind of diet. That’s why I was intrigued by a small trial involving 48 people with relapsing-remitting MS done by Dr. Markus Bock and colleagues (Universitätsmedizin Berlin). The investigators studied various diets that may affect “ketone bodies” – these are molecules in the liver that may protect the brain and spinal cord. Compared to participants who just followed their “regular” diets, participants who followed either a “ketogenic diet” (a high-fat, adequate-protein, low-carbohydrate diet) or a prolonged-fasting diet (an initial 7-day fast followed by a Mediterranean diet) reported improved quality of life. They also found that cholesterol levels improved. These results are encouraging; hopefully we will see results in larger numbers of participants in the future. (Abstract P1509)
Another interesting study reported by Dr. Aiden Haghikia (Ruhr-University Bochum, Germany) and colleagues, had previously found in mice that gut bacteria giving off short-chain (verses medium or long-chain) fatty acids could protect against the development of MS-like attacks. To begin to translate these results to human beings, the team administered daily capsules of “proprionate,” which contains short-chain fatty acids, to 18 healthy volunteers. They found no side effects, but more importantly, cells that activate immune attacks in MS were suppressed, while other cells, call Tregs, that turn off attacks, increased by 25-30%. This early report shows the potential of a nutritional supplement that could be tested for its benefits in people with MS. (Abstract 230)
Exercise and Innovative Technology
We are seeing more studies on the benefits of exercise and physical activity in people with MS. The question becomes what type of exercise or activity helps particular individuals with MS. As research advances, a personalized approach or prescription will hopefully result so that people with MS can pick what’s right for them.
Researchers are looking at how exercise may lead to changes in brain function. Dr. Francesca Tona (Sapienza University, Rome) and colleagues looked first at whether 26 people with MS with balance problems would benefit from home-based training using videogames and the Wii balance board. They used the board and games five times a week for 30-minute sessions over 12 weeks. Many experienced improvements in their balance after the program. Next, the researchers explored how “functional connectivity” – the connections between different areas of the brain measured using neuroimaging – changed after the 12 weeks, compared to connectivity before engaging in the program. They found increased connectivity in several areas of the brain including the cerebellum which controls bodily movement. This was especially strong in people who had benefited most from the program.
This is particularly exciting because participants didn’t have to go to a gym or health care facility; they could access the technology and complete the sessions at home. This study was also exciting because it provided evidence for “neuroplasticity,” the idea that the brain is capable of changing in ways that may improve people’s day-to-day function. (Abstract 183)
Meanwhile, a team from Denmark and Belgium led by Dr. Ulrik Halgas (Aarhus University) noted that people with MS tend to lose muscle mass and that they have fewer “myogenic stem cells” – cells in the body that help rebuild muscle. The team reported that after a 12-week, high-intensity training program (involving exercise machines for strengthening upper and lower body muscles), myogenic stem cells increased by 165% in people with MS. This kind of exercise program may not be for everyone affected by MS, but it’s encouraging to know that such regrowth is possible. (Abstract P813)
Finally, I am encouraged to see more studies that are showing how cognitive rehabilitation can improve learning and memory in people with MS. After all, cognition is an important part of what makes us feel well. A team from Italy and the United Kingdom, led by Dr. Micaela Mitolo, tested an intensive program designed to target multiple areas of the brain and thus multiple cognitive problems. Among the 15 people who underwent 1-hour rehab sessions for 5 days a week for 4 weeks, cognitive function improved, even in areas not specifically involved in the training. Brain imaging also showed that compared to the participants who did not undergo the program, those who did experienced increased functional connectivity. (Abstract 180)
It’s clear that researchers worldwide are uncovering more solutions that can improve wellness and lifestyle in people with MS, all of which are key parts of comprehensively managing life with MS.