Ilana B. Katz Sand, MD, with Amit Blushtein, a clinical trial participant, one of 18 multiple sclerosis patients randomized to follow a special dietary plan.
Neurologists have long suspected a link between diet and symptoms of multiple sclerosis (MS), but today, Ilana B. Katz Sand, MD, Assistant Professor of Neurology at the Icahn School of Medicine at Mount Sinai, and Associate Medical Director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis, is offering fresh insights.
Dr. Katz Sand and a team from the Icahn School of Medicine are currently conducting studies aimed at understanding the role of gut bacteria in inflammation and neurodegeneration. A recent publication of which Dr. Katz Sand is a co-author suggests that gut microbial composition in individuals with MS differs from that in healthy controls. Because gut bacteria communicate heavily with the resident immune system in the gut, as well as secrete molecules that can have distant effects, Dr. Katz Sand and colleagues hypothesize that changes in gut microbiota may contribute to the development of MS and other autoimmune diseases and also may influence disease course once MS is established. If further research confirms this, investigators like Dr. Katz Sand believe it may be possible someday to offer patients microbiome-based therapy to keep the bacteria in check.
One of the biggest drivers of gut microbial composition is diet, and it is this potential mechanistic link that led Dr. Katz Sand to begin studying dietary factors in MS. She says, “We want to better understand the inflammatory process, the neurodegenerative process, and the effect that diet has on MS symptoms. Our findings could be very important in understanding the onset of MS and how to treat it.”
Until recently, developing a methodology to study the possible connection between diet and MS has proved challenging because a double-blind randomized controlled trial doesn’t lend itself to studying diet. Dr. Katz Sand, who has pursued this clinical interest since she was a fellow, designed what she believes is a scientifically sound methodology that may help lay the groundwork for future clinical trials in this area.
She has developed a study to begin evaluating the hypothesis that a modified Mediterranean diet—which includes fresh fish, fruits, vegetables, nuts, whole grains, and avocados, and eliminates meat, dairy, and processed foods—may reduce inflammation characteristic of MS, whereby immune cells attack the myelin insulation that surrounds and insulates nerve fibers, causing problems with vision, balance, muscle control, cognition, and other debilitating symptoms.
She and her team have recruited 36 participants, 18 of whom have been randomized to follow this dietary plan for six months. All participants move through the study in small groups according to their assignment. The dietary-arm participants attend monthly meetings, led by Dr. Katz Sand, a nutritionist, and a research coordinator, that include presentations about various aspects of the diet to keep them motivated—one of the challenges of the study. There, they have the opportunity to discuss their experiences with their restrictive diet and to share tips.
Additionally, they are asked to complete questionnaires at the meetings and through regular emails. Certain markers, including salt, fatty acids, and carotenoids, are tested through lab work at the beginning and end of the study, and participants also are tested for the diet’s effects on body mass index, blood pressure, cholesterol, and glucose. The research team also employs quality-of-life scales that assess fatigue and measure depression, common MS symptoms. “We’ve got a nice group dynamic going,” says Dr. Katz Sand.
The non-dietary intervention participants attend study visits occasionally and also are offered seminars on topics of interest to MS patients. At the end of their study period, if they wish to start the diet, they are offered an opportunity to meet with the study’s nutritionist. The study, funded by the National Multiple Sclerosis Society, began in January 2017, and the last group of participants will finish in April 2018. The challenge for Dr. Katz Sand and her team will be to scale the study to include more participants, which they are planning to do in the near future.