Raising Levels of High-Density Lipoprotein May Reduce MS-Related Fatigue

Dietary interventions that raise levels of high-density lipoprotein, or good cholesterol, may affect fatigue symptoms in multiple sclerosis.

Dietary interventions could have an impact on symptoms of fatigue in patients with multiple sclerosis (MS), according to a new study published in PLOS ONE.

Fatigue, a frequent and debilitating symptom of MS, can greatly affect patients’ quality of life. Because pharmacological options for treating fatigue are limited, non-pharmacologic options, such as dietary changes, may help patients in need of relief.

By raising levels of high-density lipoprotein (HDL), or good cholesterol, in the body, the Wahls diet could be a potential solution for reducing fatigue in patients with the disease. The Wahls diet, created by Terry Wahls, MD, clinical professor of internal medicine and neurology, is high in fruits and vegetables and encourages the consumption of meat, plant protein, fish oil, and B vitamins. The diet does not include gluten, dairy, and eggs.

For the pilot trial, 18 patients with progressive MS underwent an integrative 12-month diet-based multimodal intervention including the study diet, exercise, neuromuscular electrical stimulation, and stress reduction for their fatigue symptoms. Fatigue was measured on the Fatigue Severity Scale.

The researchers examined changes in body mass index (BMI), calories, total cholesterol, HDL, triglycerides, and low-density lipoprotein (LDL).

Overall, patients who adhered to the diet consumed fewer calories and experienced decreases in BMI and triglyceride and LDL levels. According to the researchers, higher levels of HDL had the greatest effect on fatigue, which may be due to the role of HDL in stimulating glucose uptake and increasing respiration in cells to improve physical performance and muscle strength. Although patients also engaged in home-based exercise programs, neuromuscular stimulation, and stress relief interventions, the researchers noted that adherence to the diet was the primary factor associated with reduced fatigue.

“Fatigue in people with multiple sclerosis has been viewed as a complex and difficult clinical problem with contributions from disability, depression, and inflammation,” lead study author Murali Ramanathan, PhD, professor in the UB School of Pharmacy and Pharmaceutical Sciences, said in a press release. “Our study implicates lipids and fat metabolism in fatigue. This is a novel finding that may open doors to new approaches for treating fatigue.”

The researchers concluded that larger studies are needed to confirm the findings, but the results indicate that lipid monitoring may potentially become useful for guiding fatigue treatment decisions in MS.


Vegetable-rich Wahls diet lowers fatigue in multiple sclerosis patients by raising good cholesterol [news release]. University of Buffalo. http://www.buffalo.edu/news/releases/2019/08/013.html. Accessed August 15, 2019.

Maxwell KF, Wahls T, Browne RW. Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based interventions: Results from a pilot study. PLOS ONE. 2019. Doi: https://doi.org/10.1371/journal.pone.0218075

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