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Ketogenic diet ‘can benefit people with MS’

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Eating a ketogenic diet could help reduce fatigue and depression in people with MS and improve quality of life, a new study has suggested.

The diet – which primarily consists of meat, fish, eggs, heavy cream, butter, oils and non-starchy vegetables like pea pods, carrots, broccoli and peppers – was shown to have potential benefits for people living with relapsing-remitting MS. 

“A ketogenic diet, which is high in fats, adequate in protein, and low in carbohydrates, allows the body to utilise fat as its primary source of energy instead of sugars, thus mimicking a fasting state,” said study author Dr J. Nicholas Brenton, of the University of Virginia in Charlottesville. 

“A ketogenic diet helps lower blood sugar levels in people with type II diabetes and improve seizure control in people with epilepsy. However, it has not been well-studied in people with MS. 

“Diet changes can be an inexpensive way to improve overall health, so our study explored whether eating a ketogenic diet is safe, tolerable and beneficial for people living with MS.”

The potential benefits of a ketogenic diet for people living with MS follows a previous study which showed its positive impact among those with traumatic brain injury. 

This new premilinary study enrolled 65 people diagnosed with relapsing-remitting MS, the most common form of the disease, marked by symptom flare-ups followed by periods of remission.

Study participants consumed a ketogenic diet for six months. They were instructed to consume two to three ketogenic meals per day consisting of one to two servings of low-carbohydrate proteins such as eggs, fish or meat alongside two to four tablespoons of fat, such as butter, oil, avocado, ghee or heavy cream, and one to two cups of non-starchy vegetables such as cucumbers, leafy greens or cauliflower. 

Snacks were also allowed as long as participants followed the maximum daily carbohydrate allowance of 20 grams. 

Adherence to the diet was monitored by daily urine tests to measure ketones, a metabolite produced by the body when it is burning fats. A total of 83 per cent of participants adhered to the diet for the full study period.

Participants completed tests and surveys prior to the start of the diet and again at three and six months while on the diet to measure level of disability and quality of life.

Researchers found that not only did participants have less body fat after six months, they also had a decline in fatigue and depression scores.

On a quality-of-life survey, participants had an average physical health score of 67 at the start of the study compared to an average score of 79 at the end. They also had an average mental health score of 71 at the start of the study compared to an average score of 82 at the end.

Scores also improved on a common MS disease progression test. On a scale of zero to 10, with a score of one representing no disability, two representing minimal disability and three, moderate disability but still able to walk, average participant score at the start of the study was 2.3 compared to 1.9 at the end. 

On a six-minute walking test, participants walked an average of 1,631 feet at the start of the study compared to 1,733 feet at the end.

Researchers also took blood samples and found participants had improvements in the levels of inflammatory markers in the blood.

“Our study provides evidence that a ketogenic diet may indeed be safe and beneficial, reducing some symptoms for people with MS, when used over a six-month period,” said Dr Brenton, a member of the American Academy of Neurology. 

“However, more research is needed because there are potential risks associated with ketogenic diets, such as kidney stones, digestive issues and nutrient deficiencies. 

“It is important that people with MS consult with their doctor before making any big changes to their diet, and that they be regularly monitored by a physician and registered dietitian while on a ketogenic diet.”

MS

VR ‘could improve traditional rehab for MS patients’

VR may increase the effectiveness of traditional cognitive rehabilitation and exercise training, say scientists

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Virtual reality (VR) technology could strengthen the effects of traditional rehabilitation for people living with multiple sclerosis (MS), new research has found. 

By increasing sensory input and promoting multi-sensory processing, VR may increase the effectiveness of traditional cognitive rehabilitation and exercise training in individuals with MS, according to Kessler Foundation researchers. 

Kessler Foundation scientists are advocates for the incorporation of VR technology in cognitive rehabilitation research in MS. 

They presented a conceptual framework supporting VR as an adjuvant to traditional cognitive rehabilitation and exercise training for MS, theorising that VR could strengthen the effects of traditional rehabilitative therapies by increasing sensory input and promoting multi-sensory integration and processing.

Current pharmacological therapies for MS are not effective for cognitive dysfunction, a common consequence of MS that affects the daily lives of many individuals. 

This lack of efficacy underscores the need to consider other approaches to managing these disabling cognitive deficits.

The inclusion of VR technology in rehabilitation research and care for MS has the potential not only to improve cognition, but to facilitate the transfer of those cognitive gains to improvements in everyday function, according to Dr Brian Sandroff, senior research scientist in the Center for Neuropsychology and Neuroscience Research at Kessler Foundation. 

It also builds on previous Kessler Foundation research which highlighted the positive impact of VR in stroke recovery.

“With VR, we can substantially increase engagement and the volume of sensory input,” he said.

“And by promoting multi-sensory integration and processing, VR can augment the effects of the two most promising non-pharmacological treatments – cognitive rehabilitation and exercise.”

Virtual environments are flexible and varied, enabling investigators to control the range and progression of cognitive challenges, with the potential for greater adaptations and stronger intervention effects. 

VR also allows for the incorporation of cognitive rehabilitation strategies into exercise training sessions, which may support a more direct approach to improving specific cognitive domains through exercise prescriptions.

The application of VR to stroke research has shown more improvement in motor outcomes compared with traditional therapy, as well as greater neural activation in the affected area of the brain, suggesting that greater gains may persist over time.

Dr. Sandroff emphasised the largely conceptual advantages for the use of VR to treat cognitive dysfunction in individuals with MS. 

“More clinical research is needed to explore the efficacy of combining VR with cognitive rehabilitation and/or exercise training, and the impact on everyday functioning on individual with MS,” he said. 

“The conceptual framework we outline includes examples of ways immersive and interactive VR can be incorporated into MS clinical trials that will form the basis for larger randomised clinical trials.” 

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MS

Support for MS symptoms ‘must be offered at diagnosis’

Non-pharmaceutical help from clinicians should not be delayed, new research recommends

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Clinicians should offer non-pharmaceutical help for symptoms like pain, fatigue, depression or anxiety at the time of diagnosis for patients with multiple sclerosis (MS), rather than wait, new research has recommended. 

A new study has shown that clinically-significant levels of pain,  experienced by 50 per cent of patients; fatigue for 60 per cent; depression for 47 per cent; and anxiety for 39 per cent were regularly seen for patients within the first year after diagnosis. 

“The take home was that we found these symptoms, pain, fatigue, depression and anxiety quite prevalent at the point of diagnosis,” said Dr Kevin Alschuler, principal investigator of the UW Medicine study. 

“We want to address this immediately, rather than five or 10 years down the road.”

The findings also indicated that prompt screening was necessary if quality of life was to be maintained and optimised.

Globally, more than 2.3million people have been diagnosed with MS, a disease for which there is no cure and results from the body’s immune system attacking the brain and spinal cord, damaging the myelin which disrupts signals to and from the brain. 

In a further study from UW Medicine, the quality of life for MS patients was explored immediately after, at two months, three months, six months, nine months and then a year after diagnosis. 

The results of the study showed that, on average, quality of life was largely stable throughout the year – a finding that surprised researchers.

“Patients who are newly diagnosed have to deal with the emotional impact of the diagnosis, as well as numerous tests and treatment decision-making,” noted Dr Alschuler, who was lead author on the study.

“Results showed that, on average, if they came in and were doing great at diagnosis, they had a tendency to stay that way throughout the first year.

“If they were struggling, they also tended to stay that way.”

Many times, patients had been dealing with the symptoms years before a formal diagnosis, both noted.

“Through symptom self-management, including cognitive behavioral therapy, we help patients become empowered with coping skills, especially in the areas of fatigue and pain,” said Dr Dawn Ehde, a co-author on the quality of life study.

“We teach them how to use strategies such as relaxation or mindfulness meditation techniques, as well as how to pace themselves to decrease fatigue and better manage stress. 

“Patients who learn these skills often find that not only do their pain and fatigue go down, they are able to do more of what is important to them despite their MS.”

The next step for the team is to explore options for early interventions to help newly diagnosed patients.

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MS

‘Promote aquatic exercise for MS patients’

Barriers to participation must be reduced to ensure the wellbeing of people with Multiple Sclerosis, a report recommends

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Barriers to exercise – and particularly aquatic exercise – for patients living with Multiple Sclerosis (MS) should be reduced, a study concluded. 

Many people with MS report difficulties engaging in traditional land-based physical activity due to heat sensitivity and physical disability, meaning aquatic exercise is often a suitable alternative. 

In new Kessler Foundation research, 100 per cent of people with MS who had tried aquatic exercise said they preferred it to land-based alternatives. 

However, their participation has been impacted by the COVID-19 pandemic. 

The study found that while 56 per cent of people participated in exercise during the restrictions, only seven per cent took part solely in aquatic exercise. 

Although that was the preferred option by individuals with experience with this type of exercise, lack of access to pools and the costs associated with access were significant barriers.

Now, as we move on from the pandemic, the study’s authors have urged barriers to be removed from MS patients’ participation in aquatic exercise. 

“Clinicians should encourage their patients with MS to resume exercising as pandemic restrictions ease,” said Dr Helen Genova. 

“Given the benefits of aquatic exercise for people with MS, and the finding that it was preferred, it is worthwhile to look at reducing barriers to this type of exercise. 

“Encouraging community organisations and health and wellness programs to sponsor affordable aquatic exercise activities for people with MS would lower the barriers for participation, especially for the economically disadvantaged.”

Available treatments for MS have limitations in terms of symptomatic relief of the array of physical and cognitive symptoms experienced by many individuals, which has spurred interest in the role of health-related behaviours in minimising MS-related disability. 

As a health-related behaviour with known benefits on gait, balance, mood, and fatigue, exercise is a key topic in providing some antidote. 

In the study, researchers conducted an online survey of 179 individuals with MS about their exercise activities from October 2020 to April 2021, which established a general decrease in levels of activity, but also highlighted the importance of water-based activity in people’s lives. 

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