Nutrition and MS: What’s the deal with wheat?

The topic of nutrition is a perennial issue in Multiple Sclerosis. Of course, we all have to eat – and the idea that the things we consume on a daily basis have an impact on our health is absolutely plausible. Moreover, there is now sufficient evidence that the so-called “western diet” is a risk factor for autoimmune diseases. A diet rich in carbohydrates and fats also leads to obesity, which not only poses a risk for cardiovascular diseases. It can also promote the development of autoimmune diseases. Therefore, it is understandable that people affected by MS are concerned about their diet. And it is to be welcomed when serious scientists tackle these issues and investigate and publish the effects of certain dietary components on the immune system.

There is no MS diet

But the truth is that while there is a lot of interesting research data and thus an important increase in knowledge has been generated, there is still no plausible “MS diet” that can reliably modulate human MS disease. The general and sensible dietary recommendations that would be recommended to every person regardless of specific diseases remain:

• A balanced diet with sufficient fluid intake,
• Reduction of animal fats in favor of plant fats and oils,
• Reduction of meat meals,
• Use of whole grain products,
• Vegetable and fruit-rich meals –
• and above all not to consume more calories than one burns to prevent obesity.

All of this is also gladly summarized under the keyword “Mediterranean diet” and this is still the current standard of dietary recommendation in MS. This is not changed by the recently published work by Engel et al. (Ther Adv Neurol Disord 2023, Vol. 16: 1–12).

In this collaborative project of the Mainz and Münster working groups, it was examined how a wheat-reduced diet affects certain parameters of cellular immunity in MS patients. The research groups were previously able to show that the protein Amylase-Trypsin-Inhibitor (ATI), which is contained in higher concentrations in wheat than in other cereals, shows pro-inflammatory effects in the animal model of MS. The primary endpoint of the study was not a clinical endpoint, but a laboratory parameter: The number of so-called pro-inflammatory T cells. However, clinical parameters such as relapse rate and EDSS progression as well as quality of life (measured with the SF-36 questionnaire) were also examined as secondary study endpoints.

Pilot study on wheat-reduced diet

In total, 16 MS patients between the ages of 18 and 60 who were stable on an immunomodulatory therapy were examined over 6 months in an open cross-over study. Cross-over design means that in the first 3 months one half of the study group received the wheat/ATI-reduced diet and the other half ate normally – after 3 months they switched. The assignment to the study groups was random (randomized), but the study participants knew which diet they were on (open design).

The primary study endpoint was not achieved. The wheat-/ATI-reduced diet showed no effect on the composition of the T-cell pool, no reduction of pro-inflammatory T-cells could be shown. There were also no differences in the clinical parameters, although the duration of the study was set too short for this. In the “pain” subscale of the quality of life questionnaire, an advantage for the wheat-/ATI-reduced diet could be demonstrated. However, in an open study, one must be very careful with the assessment of subjective outcome parameters, as the positive expectation can have a large effect. Finally, a study of 16 patients who were also treated differently immunomodulatory, has at most a pilot character – this is how the authors themselves describe their study.

Study results have no impact on dietary recommendations for MS patients

A pilot study is an exploratory preliminary investigation that should contribute to the development of theories and hypotheses. Based on the results, it can then be decided whether the pilot study confirms the assumption (in this case: wheat-poor diet reduces inflammatory cells) and thus justifies that a larger study (the actual project) should be tackled. This was not the case here, and therefore I would also doubt whether it is really worth investing more energy in the investigation of the effects of a wheat-poor diet. And this would also answer whether the study results will have any impact on the dietary recommendations for MS patients: The answer is “no” – it is certainly still no problem to consume products based on wheat flour.