A research team from the University Medical Center Mainz has found that a diet containing wheat can increase the severity of multiple sclerosis (SM). This is due to amylase-trypsin inhibitors (ATI), natural wheat proteins, while gluten proteins did not influence the inflammatory reaction.
The results of research have been published in the journals Gut and Therapeutic Advances in Neurological Disorders.
Wheat diet can exacerbate the severity of multiple sclerosis
Studies confirm that diet and gut health can influence the course of chronic inflammatory diseases, including multiple sclerosis. The peculiarity is that a specific food, in this case a defined ingredient, can promote this inflammation.
The research findings were published in the journals Gut and Therapeutic Advances in Neurological Disorders. The research team now wants to investigate to what extent a wheat-free diet can improve drug therapies for multiple sclerosis.
Multiple sclerosis is an autoimmune disease of the central nervous system. The immune system overreacts to healthy nerve cells, causing them to continually die. The most common early symptoms are temporary sensory disturbances, visual disturbances and muscle paralysis.
Around 2.8 million people worldwide are affected by MS, including over 250,000 in Germany. The prevalence is increasing significantly, especially among young adults and women. The disease is triggered by a combination of several factors. In addition to genetic factors, environmental factors such as diet can also influence the course of chronic inflammatory disease.
It is known that some wheat proteins can cause inflammatory reactions. Among these is celiac disease, which affects approximately 1% of the population. This is an inflammatory reaction of the small intestine to gluten, a wheat protein. The new thing is that other wheat proteins can generally contribute to inflammation,” explains Prof. Dr. Detlef Schuppan, director of the Institute for Translational Immunology at the University Medical Center Mainz and professor of medicine at Harvard Medical School.
“Until now, however, there was no clear evidence that a wheat-containing diet could also influence inflammatory diseases of the central nervous system. We have now been able to demonstrate, both in an animal model and in a clinical pilot study, that the ATI proteins in wheat can increase the severity of multiple sclerosis. These ATI proteins play a broader role in inflammation than gluten proteins.”
Trypsin amylase inhibitors (ATIs) are natural proteins found in grains such as wheat, barley and rye. ATI proteins are difficult to digest and cause mild inflammatory reactions in the intestine. But they don't just act in the gut: inflammatory cells and soluble inflammatory mediators activated by ATI can also be transported from the gut to other parts of the body via the bloodstream.
As the scientists discovered, ATI proteins promote existing inflammatory processes in organs such as the liver or lungs and, new, also in the central nervous system. As a result, ATI proteins can exacerbate the symptoms of multiple sclerosis.
The research team's initial study in an animal model showed that a diet containing 25 percent wheat significantly worsened multiple sclerosis symptoms compared to an otherwise identical diet without wheat. These results could be reproduced even with a minimal amount of ATI protein (0.15% of feed weight), but not with a large amount of gluten protein (5% of feed weight).
The research team was then able to confirm the results of the animal model in a pilot clinical study. Patients with moderately severe and mildly active multiple sclerosis took part in this study. One study group followed a wheat-restricted diet for three months, while the other group continued the wheat-containing diet.
After the three months, the groups switched to the other diet for another three months. Multiple sclerosis patients reported significantly less pain while on the wheat-free diet. Fewer inflammatory immune cells were also measured in their blood.
Our studies show how important diet, its interactions with the intestinal microbiome and the intestinal immune system are for health. A wheat-free diet can reduce the severity of multiple sclerosis and other inflammatory diseases. Further studies combining a wheat-free diet with other drugs Therapies are expected, among other things,” says Professor Schuppan.
Pain can come in many forms for people battling multiple sclerosis, and one type can interfere with exercise.
One class of pain experienced by MS patients is what the authors of the new study call nociceptive, caused by specific tissue damage. Another form is neuropathic pain, caused by loss of the protective myelin sheath around
the nerves that is a hallmark of the disease.
Exercise is still possible with these two types of pain, but a third type, called “diffuse pain with nociplastic features,” or WPNF, could get in the way of therapeutic exercise for people with multiple sclerosis, reports a team from the University of Michigan.
“WPNF is a chronic, widespread pain that can be difficult to localize or describe accurately,” explained lead study author Libak Abou. He is a research assistant professor in physical medicine and rehabilitation at Michigan Medicine.
“In a person with multiple sclerosis, this type of pain results from impaired signal processing within the central nervous system,” Abou explained in a university press release.
“There is a growing need to consider what type of pain MS patients experience before giving them an exercise program,” Abou said. “The concept of considering WPNF when creating exercise programs for multiple sclerosis is newer, but it could help many patients achieve a level of activity that will help relieve their symptoms without causing them severe pain.”
He hopes that doctors and physical therapists who care for people with MS can customize exercise programs to better help people combat WPNF pain.
“The ultimate goal is to help people with multiple sclerosis maintain their functional independence,” Abou said. “It is also important to remember that these patients will likely need additional support from their physical therapy team to keep them on a path with less pain.”
“Diffuse pain with nociplastic features is chronic, widespread pain that can be difficult to localize or describe accurately,” said Libak Abou, Ph.D., research assistant professor and lead author of the paper.
“In a person with multiple sclerosis, this type of pain results from impaired signal processing within the central nervous system. This is opposed to pain that results from specific tissue damage, classified as nociceptive pain, or pain related to demyelination and axonal damage, classified as neuropathic pain.”
Abou and fellow researchers interviewed MS patients to see whether those with an increased indication of widespread pain with nociplastic features were more likely to be insufficiently active or sedentary than their multiple sclerosis counterparts without chronic pain, nociceptive pain, or neuropathic pain.
Each of the participants self-reported their data.
The survey results showed that those who experienced WPNF in addition to MS were not active enough due to the chronic pain they experienced.
“There is a growing need to consider what type of pain MS patients experience before giving them an exercise program,” Abou said.
“The concept of considering widespread pain with nociplastic characteristics when creating exercise plans for multiple sclerosis is newer, but it could help many patients achieve a level of activity that will help relieve their symptoms without causing them severe pain.”
Going forward, Abou hopes that doctors can begin screening for underlying pain mechanisms in multiple sclerosis patients who have difficulty staying active to help further tailor their physical routine to their personal needs.
“The ultimate goal is to help people with multiple sclerosis maintain their functional independence,” Abou said.
“It is also important to remember that these patients will likely need additional support from their physical therapy team to keep them on a path with less pain.”
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