Metabolomic Changes Associated with Calorie Restriction in People with Multiple Sclerosis

Thursday, May 31, 2018
Exhibit Hall A (Nashville Music City Center)
Samantha N Roman, B.S. , Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
Kathryn C Fitzgerald, Sc.M., Sc.D. , Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
Ellen M Mowry, MD, MCR , Neurology, Johns Hopkins School of Medicine, Baltimore, MD


Fasting-mimicking diets have shown promise in ameliorating the symptoms of experimental autoimmune encephalitis (EAE), the mouse model of multiple sclerosis (MS), but whether similar dietary changes in people with MS improves clinical outcomes remains unclear. Implementing strict fasting protocols in clinical trials is difficult, and clinical changes may only be apparent after a prolonged period. Metabolite profiles may be a useful early measure of the resulting biologic changes.


To evaluate metabolomic changes in people with MS following a calorie restriction diet.


Patients with MS who were receiving monthly natalizumab infusions, had a body mass index (BMI) ≥25 kg/m2, and met other criteria were recruited to a 6-month study of calorie restriction. Patients chose to restrict calories intermittently (consume 25% daily caloric needs 2 days/week) or continuously (consume 78.6% caloric needs daily), and were instructed to record daily calorie logs in the LoseIt! Smartphone app. At months 0, 3 and 6, weight measurement, plasma samples, and LoseIt! calorie data were collected. Plasma samples were processed, stored, and then sent to Metabolon for metabolomic analysis. 


19 patients were recruited to the study, 11 in the continuous (CCR) and 8 in intermittent calorie restriction (ICR) groups. Participants were 89.5% female, 63.2% Caucasian, mean age 41.9 years and mean BMI 31.7 kg/m2. In the ICR group, 6 of 8 participants (75.0%) completed the study, with 4 patients logging calories as instructed. Median 6-month weight change for ICR participants was -3.3 kg (IQR -4.3,-1.55).  In the CCR group, 9 of 11 participants (81.8%) completed the study, all of whom submitted calorie logs. Calorie logs were completed for 58.6% of the study days. Median 6-month weight change for CCR participants was -2.2 kg (IQR -4.7, -1.6). Metabolomics data analysis is currently underway for the baseline, 3- and 6-month plasma samples and will be presented.


Fasting-mimicking diets have an interesting theoretical role in improving outcomes for people with MS, but strict fasting protocols are difficult to study. Metabolomics may offer a measure of the biological impact of fasting-mimicking diets and may shed light on the mechanisms by which dietary changes affect clinical outcomes in patients with MS.