Diet and Multiple Sclerosis: Scoping Review of Web-Based Recommendations.

BACKGROUND: There is currently no scientific evidence supporting the use of specific diets in the management of multiple sclerosis (MS); the strongest dietary associations are observed with vitamin D and omega-3 fatty acid supplementation. Despite this, there are many websites that provide advice or suggestions about using various dietary approaches to control symptoms or disease progression. OBJECTIVE: The objective of this study was to assess the dietary advice for the symptomatic management of MS available on the internet. METHODS: This study was a systematic review of webpages that provided dietary advice for the management of MS. Webpages were selected from an internet search conducted in November 2016 using Google, Yahoo, and Bing search engines and the search term "MS diet." The first two pages of results from each search engine were included for the initial assessment. Duplicates were removed. Data extracted from websites included specific advice relating to diet and its rationale and the citation of supporting scientific literature. Authorship and credential information were reviewed to assess webpage quality. RESULTS: We included 32 webpages in the final assessment. The webpages made a wide variety of specific recommendations regarding dietary patterns and individual foods to help manage MS. The most common dietary pattern advised on these webpages was the low-fat, high-fiber balanced diet, followed by the low-saturated fat diet, near-vegetarian Swank diet, and the Paleo diet. The main categories of individual foods or nutrients suggested for addition to the diet were: supplements (especially omega-3 and vitamin D), fruits, vegetables, and lean protein. In contrast, the most commonly recommended for removal were saturated fats, dairy, gluten-containing grains, and refined sugar. These recommendations were often accompanied by rationale relating to how the particular food or nutrient may affect the development, prevalence and symptoms of MS; however, very little of this information is supported by the current scientific evidence between diet and MS. Only 9 webpages provided full authorship including credential information. CONCLUSIONS: There is a wide variety of Web-based dietary advice, which in some cases is contradictory. In most cases, this advice is the result of peoples' individual experiences and has not been scientifically tested. How people living with MS use this information is not known. These findings highlight the important role health professionals can play in assisting people living with MS in their health information-seeking behaviors.

The Association between Seasonal Variation in Vitamin D, Postural Sway, and Falls Risk: An Observational Cohort Study.

Introduction. Low serum vitamin D levels are associated with increased postural sway. Vitamin D varies seasonally. This study investigates whether postural sway varies seasonally and is associated with serum vitamin D and falls. Methods. In a longitudinal observational study, eighty-eight independently mobile community-dwelling older adults (69.7 ± 7.6 years) were evaluated on five occasions over one year, measuring postural sway (force platform), vitamin D levels, fall incidence, and causes and adverse outcomes. Mixed-methods Poisson regression was used to determine associations between measures. Results. Postural sway did not vary over the year. Vitamin D levels varied seasonally (P < 0.001), peaking in summer. Incidence of falls (P = 0.01) and injurious falls (P = 0.02) were lower in spring, with the highest fall rate at the end of autumn. Postural sway was not related to vitamin D (P = 0.87) or fall rates, but it was associated with fall injuries (IRR 1.59 (CI 1.14 to 2.24, P = 0.007). Conclusions. Postural sway remained stable across the year while vitamin D varied seasonally. Participants with high values for postural sway demonstrated higher rates of injurious falls. This study provides important evidence for clinicians and researchers providing interventions measuring balance outcomes across seasons.

Age-related changes in physical fall risk factors: results from a 3 year follow-up of community dwelling older adults in Tasmania, Australia.

As the population ages, fall rates are expected to increase, leading to a rise in accidental injury and injury-related deaths, and placing an escalating burden on health care systems. Sixty-nine independent community-dwelling adults (60-85 years, 18 males) had their leg strength, physical activity levels and their annual fall rate assessed at two timepoints over three years, (summer 2010 and summer 2013) monitoring balance. Force platform measures of medio-lateral sway range increased significantly under conditions of eyes open (mean difference MD 2.5 cm; 95% CI 2.2 to 2.8 cm) and eyes closed (MD 3.2 cm; 95% CI 2.8 to 3.6 cm), respectively (all p < 0.001) indicating worsening static balance control. Dynamic balance showed similar changes (p < 0.036). Leg strength was not significantly different between visits (p > 0.26). Physical activity reduced significantly (MD -909 Cal/week; 95% CI -347 to -1,470 Cal/week; p = 0.002) during the course of the study. Participants maintained aerobic activities, however resistance and balance exercise levels decreased non-significantly. The likelihood of falling was higher at the end of the study compared to the first timepoint (odds ratio 1.93, 95% CI 0.94 to 3.94; p = 0.07). Results of this study indicate that despite maintenance of leg strength there was an increase in medio-lateral sway over a relatively short time frame, with higher than expected increases in fall rates.

Make vitamin D while the sun shines, take supplements when it doesn't: a longitudinal, observational study of older adults in Tasmania, Australia.

Low vitamin D status has been associated with a number of chronic conditions, particularly in older adults. The aim of this study was to identify how best to maintain optimum vitamin D status throughout the year in this high-risk population. The main objectives of the study were to assess seasonal vitamin D status; identify the main determinants of vitamin D status; determine if taking part in the study led to alterations in participant behaviour and vitamin D status. A longitudinal design across four consecutive seasons observed ninety-one 60-85 year old community-dwelling adults in Tasmania (41π S) over 13 consecutive months, with a follow-up assessment at next winter's end. Associations between solar UVB exposure, sun protection behaviours, dietary and supplemental vitamin D with serum 25(OH)D concentrations were assessed. Variation in serum 25(OH)D demonstrated an identical pattern to solar UVB, lagging 8-10 weeks. Serum 25(OH)D was positively associated with summer UVB (mean 15.9 nmol/L; 95%CI 11.8-19.9 nmol/L, p<0.001) and vitamin D supplementation (100-600 IU/day: 95%CI 10.2 nmol/L; 0.8-19.6 nmol/L; p = 0.03; 800 IU/day: 21.0 nmol/L; 95%CI 8.1-34.0 nmol/L; p = 0.001). Seasonal variation in serum 25(OH)D was greatly diminished in supplement users. The most common alteration in participant behaviour after the study was ingesting vitamin D supplements. Post-study vitamin D supplementation ℘800 IU/day was seven times more likely than during the study resulting in mean difference in serum 25(OH)D between supplement and non-supplement users of 30.1 nmol/L (95%CI 19.4-40.8 nmol/L; p<0.001). The main limitation was homogeneity of participant ethnicity. Solar exposure in summer and ingestion of vitamin D supplements in other seasons are the most effective ways of achieving and maintaining year-round vitamin D sufficiency in older adults in the Southern hemisphere. Vitamin D supplementation has greatest effect on vitamin D status if ingested during and after winter, i.e. between the autumn and spring equinoxes.

Chickpea supplementation in an Australian diet affects food choice, satiety and bowel health.

The study aimed to examine both changes in food consumption, satiation and perceived bowel health while consuming a diet rich in chickpeas, and participants, feelings about the dietary change. Forty-two participants completed an ordered crossover study, consuming their habitual diet for 4 weeks, a chickpea supplemented (average 104 g/day) diet for 12 weeks, and their habitual diet for another 4 weeks. Weighed dietary records were quantitatively analysed for changes in consumption of foods from within eight food groups. Perceived changes to bowel function and satiation were semi-quantitatively assessed using anchored visual analogue scales. Focus groups were used to qualitatively explore the acceptability of chickpea consumption and the benefits of, and barriers to, legume consumption for 15 participants. Intake of foods from all food groups was lower during the chickpea supplemented phase, particularly foods of the Cereal food group (P=0.01). Participants tended to eat more processed snack foods (high energy, low fiber) after ceasing chickpea consumption (P=0.09), a trend supported by focus group discussion. Perceived satiation increased while participants consumed chickpeas and perceived bowel function improved. Health benefits, increases in dietary variety and satiation with legume consumption were the main perceived benefits, while inconvenience and gastrointestinal upset discouraged legume consumption.

Chickpeas may influence fatty acid and fiber intake in an ad libitum diet, leading to small improvements in serum lipid profile and glycemic control.

Optimal replacement macronutrient/s for dietary saturated fat to reduce cardiovascular disease risk remains controversial. Chickpeas are rich in dietary fiber and polyunsaturated fatty acids. This exploratory study, conducted from September 2004 to May 2005, assessed the effect of incorporating chickpeas in the ad libitum diet of 45 free-living adults. Participants consumed a minimum of 728 g of canned, drained chickpeas per week (the amount in four 300-g cans) as part of their habitual diet for 12 weeks (chickpea phase), followed by 4 weeks of habitual diet without chickpeas (usual phase). In the chickpea phase, mean dietary fiber intake was 6.77 g/day more and mean polyunsaturated fatty acid consumption (as a percentage of total fat) was 2.66% more (both P<0.001), causing the polyunsaturated to saturated fatty acids ratio to change from 0.39 to 0.47 (P=0.045). Serum total cholesterol and low-density lipoprotein cholesterol were 7.7 mg/dL (0.20 mmol/L) and 7.3 mg/dL (0.19 mmol/L) less, respectively, after the chickpea phase (P

Effects of a controlled diet supplemented with chickpeas on serum lipids, glucose tolerance, satiety and bowel function.

OBJECTIVE: To compare the effect of a diet supplemented with chickpeas to a wheat-based diet of similar fibre content on serum lipids, glucose tolerance, satiety and bowel function. A third, lower-fibre wheat diet provided further information on dietary fibre quantity and bowel function and satiety. METHOD: Twenty-seven free-living adults followed two randomized, crossover dietary interventions each of five weeks duration. The chickpea diet included canned drained chickpeas, bread and shortbread biscuits containing 30% chickpea flour. The wheat diet included high-fibre wheat breakfast cereals and wholemeal bread. The diets were isoenergetic to the participants' usual diet, matched for macronutrient content and controlled for dietary fibre. Following on from the second randomised intervention, a sub-group of 18 participants underwent a third, isoenergetic lower-fibre wheat diet that included low-fibre breakfast cereals and bread. RESULTS: Repeated measures ANOVA revealed reductions in serum TC of 0.25 mmol/L (p < 0.01) and LDL-C of 0.20 mmol/L (p = 0.02) following the chickpea diet compared to the wheat. An unintended significant increase in PUFA and corresponding decrease in MUFA consumption occurred during the chickpea diet and statistical adjustment for this reduced but did not eliminate the effect on serum lipids. There was no significant difference in glucose tolerance. Perceived general bowel health improved significantly during the chickpea diet although there was considerable individual variation. Some participants reported greater satiety during the chickpea diet. CONCLUSIONS: The small but significant decrease in serum TC and LDL-C during the chickpea diet compared to the equivalent fibre wheat diet was partly due to unintentional changes in macronutrient intake occurring because of chickpea ingestion. If dietary energy and macronutrients were not controlled, chickpea consumption might result in greater benefits via influence on these factors.

Effects of olive oil and tomato lycopene combination on serum lycopene, lipid profile, and lipid oxidation.

OBJECTIVE: We compared the effect of two diets (a diet high in olive oil and a diet high in carbohydrate and low in olive oil) with high lycopene content and other controlled carotenoids on serum lycopene, lipids, and in vitro oxidation. METHODS: This was a randomized crossover dietary intervention study carried out in Launceston, Tasmania, Australia in healthy free-living individuals. Twenty-one healthy subjects who were 22 to 70 y old were recruited by advertisements in newspapers and a university newsletter. A randomized dietary intervention was done with two diets of 10 d each. One diet was high in olive oil and the other was high in carbohydrate and low in olive oil; the two diets contained the same basic foods and a controlled carotenoid content high in lycopene. RESULTS: Significant increases (P<0.001) in serum lycopene concentration on both diets were to similar final concentrations. Higher serum high-density lipoprotein cholesterol (P<0.01), lower ratio of total cholesterol to high-density lipoprotein (P<0.01), and lower triacylglycerols (P<0.05) occurred after the olive oil diet compared with the high-carbohydrate, low-fat diet. There was no difference in total antioxidant status and susceptibility of serum lipids to oxidation. CONCLUSIONS: Serum lycopene level changes with dietary lycopene intake irrespective of the amount of fat intake. However, a diet high in olive oil and rich in lycopene may decrease the risk of coronary heart disease by improving the serum lipid profile compared with a high-carbohydrate, low-fat, lycopene-rich diet.