Feasibility of improving dietary quality using a telehealth lifestyle intervention for adults with multiple sclerosis

Evidence from observational studies increasingly highlights the association between unhealthy diet and poor health outcomes in adults with multiple sclerosis (MS), but very few intervention trials for dietary change have been completed. Improving diet quality via a low glycemic load (GL) diet has demonstrated improvements in cardiometabolic risks, cognitive risks, and psychosocial variables in diseases other than MS. The purpose of this study was to test the feasibility of delivering a low GL dietary intervention implemented via telehealth in a sample of adults with relapsing remitting MS (RRMS). The secondary purpose was to explore the potential impact of the diet on MS outcomes and cardiometabolic risks.

Participants followed a low GL diet consisting of 100g of carbohydrate and GL of ≤45 points/1000 kcal daily for 12 weeks. Each participant received weekly calls from a telecoach, education and behavioral supports via weekly emails, and recorded all food intake on a mobile app. Feasibility was measured as time to recruit, retention and study completion, and intervention adherence. An a priori cut point of 80% completion was used to determine feasibility. Exploratory outcomes included the Multiple Sclerosis Functional Composite (MSFC) and patient-reported outcomes of anxiety, pain, mood, and fatigue. Cardiometabolic risks included body composition, fasting glucose, hemoglobin A1c, and blood pressure.

Twenty adults with RRMS (85% female, 50% African American) enrolled in the study and n=18 (90%) completed the intervention and follow-up measures. Participants completed 90% of scheduled calls and recorded at least one meal on 82% of intervention days (mean (SD) = 68 (25.5) days). Participants exceeded recommended daily GL reductions (recommended daily GL: 96.66 (12.97) points, reported follow-up daily GL: 90.32 (39.36) points). Timed 25-foot walk test and symbol digit modalities test both changed in the desired direction. Sleep, mood, anxiety, emotional health, and pain all moved in the expected directions, and anxiety (r=.24), pain (r=-.43), and emotional health (r=-.36) were moderately correlated with reductions in GL. Participants lost a mean of 2.93 (6.31, p=.003) kg, and had reductions in both fat and lean mass (fat mass: 1.94 (2.5) kg; lean mass: .72 (1.29) kg).

A low GL dietary intervention is feasible for adults with RRMS and may lead to improvements in MS outcomes and cardiometabolic risk. Additional research is needed with more tightly controlled feeding trials and larger sample sizes to further understand the impact of this dietary pattern on RRMS.