Association between improved metabolic risk factors and perceived fatigue during dietary intervention trial in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES trial

Aneli T Villa; Betty H Tu; Tyler J Titcomb; Solange M Saxby; Farnoosh Shemirani; Patrick Ten Eyck; Linda M Rubenstein; Linda G Snetselaar; Terry L Wahls

doi:10.3389/fneur.2022.1022728

Association between improved metabolic risk factors and perceived fatigue during dietary intervention trial in relapsing-remitting multiple sclerosis: A secondary analysis of the WAVES trial

Front Neurol. 2023 Jan 19:13:1022728. doi: 10.3389/fneur.2022.1022728. eCollection 2022.

Authors

Aneli T Villa¹, Betty H Tu¹, Tyler J Titcomb^{1

2}, Solange M Saxby¹, Farnoosh Shemirani¹, Patrick Ten Eyck³, Linda M Rubenstein², Linda G Snetselaar², Terry L Wahls¹

Affiliations

¹ Department of Internal Medicine, University of Iowa, Iowa City, IA, United States.
² Department of Epidemiology, University of Iowa, Iowa City, IA, United States.
³ Institute for Clinical and Translational Science, University of Iowa, Iowa City, IA, United States.

Abstract

Background: Preliminary dietary intervention trials with the low-saturated fat (Swank) and modified Paleolithic elimination (Wahls) diets have shown favorable effects on fatigue among people with multiple sclerosis (MS); however, their impact on metabolic health is unknown.

Objective: To evaluate the impact of the Swank and Wahls diets on markers of metabolic health and to determine the association and mediation effect between changes in metabolic health and perceived fatigue among people with relapsing-remitting MS (RRMS).

Methods: As part of a randomized parallel-arm trial, vital signs, blood metabolic biomarkers, and the fatigue scale for motor and cognitive functions (FSMC) were collected from participants with relapsing-remitting MS (n = 77) at four study visits spaced 12 weeks apart: (1) run-in, (2) baseline, (3) 12-weeks, and (4) 24-weeks. Participants followed their usual diet at run-in, then were randomized at baseline to either the Swank or Wahls diets and followed for 24 weeks.

Results: Both groups had significant reductions in weight, body mass index (BMI), total cholesterol, and low-density lipoprotein (LDL) at 12- and 24-weeks compared to respective baseline values (p ≤ 0.04 for all). The Swank group also had a significant reduction in high-density lipoprotein (HDL) at 12- and 24-weeks (p = 0.0001 and p = 0.02, respectively), while the Wahls group had significant reductions in diastolic blood pressure (DBP). In addition, both groups had significant reductions in FSMC total perceived fatigue and the motor and cognitive fatigue subscales at 12- and 24-weeks (p ≤ 0.01 for all); however, change in the cognitive subscale was not significant at 12-weeks in the Swank group (p = 0.06). Furthermore, the favorable effects, of both diets, on markers of metabolic health were not associated with and did not mediate the effect of the diets on perceived fatigue (p > 0.05 for all).

Conclusion: Both diets lead to significant reductions in perceived fatigue, weight, BMI, total cholesterol, and LDL, but the significant reductions in perceived fatigue were independent of changes in markers of metabolic health.

Keywords: cholesterol; fatigue; insulin; low-saturated fat diet; modified Paleolithic elimination diet; multiple sclerosis; weight.

Grants and funding

This study was supported in part by the National Multiple Sclerosis Society grant RG-1506- 04312 (TW), the Institute for Clinical and Translational Science (ICTS) at the University of Iowa, and University of Iowa institutional funds. The ICTS was supported by the National Institutes of Health Clinical and Translational Science Award program (grant UL1TR002537). TT was a research trainee of the University of Iowa Fraternal Order of Eagles Diabetes Research Center (T32DK112751-05). TT, SS, and FS were supported by the Carter Chapman Shreve Family Foundation and the Carter Chapman Shreve Fellowship Fund for diet and lifestyle research conducted by the Wahls Research team at the University of Iowa. AV and BT were supported by the University of Iowa Medical Student Research Program. In-kind support was provided by the University of Iowa College of Public Health Preventive Intervention Center.