Background: Multiple sclerosis (MS) is a chronic disabling disease which affects over 2.5 million people in the world and approximately 500 000 people in the United States. MS is an inflammatory demyelinating disease affecting the central nervous system (CNS) and thought to be autoimmune in nature. Current disease modifying therapy (DMT) is only partially effective in relapsing-remitting MS and ineffective in progressive forms of MS, thus many patients try complementary and alternative medicine (CAM) in addition to DMTs. Omega-3 fatty acid supplements and a reduced fat diet are among the most promising CAM approaches and believed to have anti-inflammatory and neuroprotective properties. Does the combination of a reduced-fat diet and omega-3 fatty acid supplementation have an effect on exacerbations of multiple sclerosis?
Methods: An exhaustive search of available medical literature was conducted using Medline-OVID, CINAHL, and Web of Science using the keywords: multiple sclerosis, reduced-fat diet, and omega-3 fatty acid. Articles which met the clinical question and inclusion criteria of studies evaluating human participants and articles written in the English language were evaluated for quality using Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Results: Two studies met inclusion criteria and the clinical question and thus were included in this systematic review. A double-blind, randomized controlled trial demonstrated that both the treatment (fish oil group) and the placebo (olive oil group) had a decrease in the number of relapses per year and the Expanded Disability Status Scale (EDSS) score improved in the treatment group and worsened in the placebo group. An open, uncontrolled intervention trial resulted in a decrease of the mean annual exacerbation rate after two years and an improvement in EDSS score compared to the pre-study rate.
Conclusion: Omega-3 fatty acids and a reduced-fat diet have individually shown effectiveness in being anti-inflammatory and neuroprotective in multiple sclerosis. In combination there were possible benefits demonstrated, but from studies of very low quality. Further research needs to be performed on the combination of a reduced-fat diet and omega-3 fatty acid supplementation in studies of higher quality. The benefits of the intervention outweigh the risks of the therapy and the disease.
Keywords: multiple sclerosis, fat-restricted diet, omega-3 fatty acid, human
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