International Journal of MS Care 199 From the Department of Physical Therapy, D’Youville, Buffalo, NY, USA (LEB); Departments of Exercise and Nutritional Sciences (PJH, TCR), Rehabilitation Science (SEB), Neurology (BW-G), and Biotechnical and Clinical Laboratory Sciences (RWB), University at Buffalo, Buffalo, NY, USA; and Department of Cancer Prevention and Control, Roswell Park Cancer Center, Buffalo NY, USA (ADR). Correspondence: Lacey E. Bromley, PhD, Department of Physical Therapy, D’Youville, 320 Porter Ave, Buffalo, NY 14201, USA; e-mail: bromleyl@dyc.edu. Note: Supplementary material for this article is available at ijmsc.org. DOI: 10.7224/1537-2073.2020-036 © 2021 Consortium of Multiple Sclerosis Centers. Three-Day Dietary Manipulation in Multiple Sclerosis Exercise and Fatigue Outcomes Lacey E. Bromley, PhD; Peter J. Horvath, PhD; Susan E. Bennett, EdD; Bianca Weinstock-Guttman, MD; Todd C. Rideout, PhD; Richard W. Browne, PhD; Andrew D. Ray, PhD Background: In persons with multiple sclerosis (MS), the effect of nutrition on exercise performance and fatigue remains unknown. The objective was to determine whether a 3-day diet high in triglycerides (FAT) compared with a 3-day diet high in carbohydrates (CARB) would improve fatigue and exercise performance in persons with MS. Methods: A randomized controlled crossover design was incorporated to study FAT versus CARB on submaximal cycling endurance (60% of peak oxygen consumption), substrate utilization, and fatigue in 12 persons with mild-to-moderate MS (Expanded Disability Status Scale score, 2.0-5.0) and 12 age- and sex-matched controls. Results: There were no differences in cycling time between diets in either group (P = .29). The MS group had no changes in fatigue between diets (P = .64); the control group demonstrated increased total mental fatigue after FAT (P = .05). The control group increased carbohydrate oxidation by 24% at rest and 13% during exercise after CARB. Similarly, the control group significantly increased fat oxidation after FAT by 22% at rest and 68% during exercise (P = .01). These changes were not seen in the MS group. Compared with controls, persons with MS oxidized approximately 50% less fat during exercise after FAT (P = .05). Conclusions: Neither CARB nor FAT altered submaximal exercise performance or baseline fatigue in the MS group. The results suggest that persons with MS are unable to adapt to dietary changes and oxidize fatty acids as efficiently as controls. Int J MS Care. 2021;23:199-205. M ultiple sclerosis (MS) is an immune-modu- lated disease resulting in fatigue, impaired mobility, and a sedentary lifestyle. 1,2 Physical inactivity acts to further potentiate the decline in muscle strength, aerobic exercise capacity, and quality of life commonly seen in persons with MS. 3-6 Interventions designed to reduce fatigue and improve exercise perfor- mance are needed to improve both short- and long-term health-related outcomes in persons with MS. In studies of athletes and untrained individuals, nutritional inter- ventions were shown to successfully improve exercise performance, 7 yet this area of research is nonexistent in persons with MS. A recent review 8 identified that specific dietary pat- terns and/or nutrients are associated with MS-related risk and symptoms. 9-11 For example, diets high in whole grains, low-fat dairy, and meats, including organ meats, as well as lactovegetarian and vegetarian diets that are high in fruits and vegetables and low in saturated fats correlate with a decrease in MS prevalence. 9,12 Despite these larger population-based studies, limited work reports how diet directly influences MS-related fatigue and/or function. 13,14 Of the limited studies, one dem- onstrated that physical inactivity combined with a diet Downloaded from http://meridian.allenpress.com/ijmsc/article-pdf/23/5/199/2941802/i1537-2073-23-5-199.pdf by guest on 05 January 2024