Intermittent Fasting, Weight Loss Surgery Have Different Outcomes in MS

Recent research suggests that bariatric surgery could have an unintended consequence of worsening MS.

Obesity in multile sclerosis has been linked to increased relapses and disease progression. In addition, elevated body-mass index (BMI) is strongly associated with an increased risk of MS, according to a 2018 study.

While intermittent fasting improved MS symptoms according to new research, another study on bariatric surgery for weight loss said the surgeries could negatively impact MS.

In a study published in Multiple Sclerosis Journal, Anna Karin Hedstrom, senior research specialist at the Karolinska Institutet in Stockholm, Sweden, and colleagues compared disease outcomes in 122 cases of MS who had undergone metabolic surgery with those of 122 cases of MS without surgery.

They found that the time to 6-month confirmed disability progression during the first 5 years post-baseline was shorter among the bariatric surgery patients (hazard ratio (HR) = 2.31, 1.09–4.90; p = 0.03).

The researchers did not observe differences in postoperative annual relapse rate (p = 0.24) or time to first postoperative relapse (p = 0.52).

“Although metabolic surgery appears to be a safe and efficient treatment of obesity in patients with MS, the clinical course of the disease might be negatively affected,” Hedstrom wrote. "Long-term nutritional follow-up after surgery and supplementation maintenance are crucial, particularly among those with preoperative deficits.”

Meanwhile, a separate study published in The Lancet found that restricting calories for two days a week reduced certain immune cells and molecules involved in lipid metabolism (processing of fats) in people with MS.

Kathryn C. Fitzgerald, assistant professor of neurology at Johns Hopkins University School of Medicine, and colleagues compared three diets: a control diet (100% of calorie needs 7 days/week), a daily calorie restriction diet (78% of calorie needs 7 days/week), and an intermittent calorie restriction diet, or intermittent fasting (25% of calorie needs 2 consecutive days/week; 100% of calorie needs 5 days/week).

Compared to the control diet, both calorie restriction diets resulted in weight loss and improvements in emotional well-being.

In addition, intermittent fasting reduced certain immune T cells (such as some involved in MS immune attacks), increased other types of T cells, and altered levels of molecules involved in lipid metabolism, the National Multiple Sclerosis Society, which sponsored the study, said in a statement.

Additional larger studies are necessary to confirm the findings and explore whether they indicate that the diet can directly reduce MS-related disease activity, the society said.