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. 2025 Mar 27;17(7):1163.
doi: 10.3390/nu17071163.

Effects of a Multimodal Lifestyle Intervention on Cardiometabolic Markers in People with Progressive Multiple Sclerosis: A Secondary Analysis of a Pilot Study

Arturo S Martinez  1 , Alyanne J Bastian  1 , Farnoosh Shemirani  1 , Tyler J Titcomb  1   2 , Babita Bisht  1 , Warren G Darling  3 , Murali Ramanathan  4   5 , Mujeeb Shittu  6 , Christine M Gill  7 , Linda G Snetselaar  2 , Terry L Wahls  1
Affiliations

Effects of a Multimodal Lifestyle Intervention on Cardiometabolic Markers in People with Progressive Multiple Sclerosis: A Secondary Analysis of a Pilot Study

Arturo S Martinez et al. Nutrients. .

Abstract

Background: Cardiometabolic comorbidities are common in multiple sclerosis (MS), and lifestyle interventions are effective in managing these conditions in the general population, though evidence in the MS patient population is limited. Objective: To evaluate the effect of a multimodal lifestyle intervention on serum apolipoproteins (Apo), creatine kinase (CK), glucose, and insulin in people with progressive MS (PwPMS). Methods: This study included n = 19 PwPMS who participated in a 12-month multimodal lifestyle intervention (including a modified Paleolithic diet, exercise, neuromuscular electrical stimulation, supplements, and stress reduction). Lipid profile (ApoA1, B, and E), CK, glucose, and insulin were obtained at baseline and after 12 months under fasting conditions. Results: At 12 months, there was a marginally significant decrease in ApoB (mean change: -7.17 mg/dL; 95% CI: -14.4, 0.12; p = 0.06), while no significant changes were observed for ApoA1 (mean change: -1.28 mg/dL; 95% CI: 12.33, 9.76; p = 0.80), ApoE (mean change: +0.12 mg/dL; 95% CI: -0.27, 0.52; p = 0.51), CK (mean change: +13.19 U/L; 95% CI: -32.72, 59.11; p = 0.55), Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) (mean change: -0.44; 95% CI: -1.11, 0.22; p = 0.17), and HOMA-β (mean change: +45.62; 95% CI: -95.6, 186.9; p = 0.50). A positive association was observed between changes in HOMA-IR and fatigue changes at 12 months (β = 0.81, p = 0.02), suggesting that an increase in HOMA-IR was linked to increased fatigue, which was no longer significant following the exclusion of outliers (β = 0.71, p = 0.16). Conclusions: A multimodal lifestyle intervention did not negatively impact glycemic and lipid profiles. While improvements were observed in serum biomarkers, these changes were not statistically significant, highlighting the need for stronger evidence from larger, controlled studies to confirm the cardiometabolic health benefits in PwPMS.

Keywords: apolipoprotein; cardiometabolic markers; comorbidity; diet; multiple sclerosis.

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Conflict of interest statement

T.L.W. personally follows and promotes the Wahls™ diet. She has equity interest in the following companies: Terry Wahls LLC; TZ Press LLC; The Wahls Institute, PLC; FBB Biomed Inc.; Levels Health Inc.; Foogal Inc.; and the website http://www.terrywahls.com. She also owns the copyright to the books Minding My Mitochondria (second edition), The Wahls Protocol, and The Wahls Protocol Cooking for Life, and the trademarks The Wahls Protocol®, Wahls™ diet, Wahls Paleo™ diet, Wahls Paleo Plus™ diet, and Wahls Behavior Change™. She has received grant funding from the National Multiple Sclerosis Society for the Dietary Approaches to Treating Multiple Sclerosis Related Fatigue Study. She receives royalty payments from Penguin Random House. T.L.W. has conflict-of-interest management plans in place with the University of Iowa and the Iowa City Veteran’s Affairs Medical Center. All other co-authors have no conflicts to disclose.

Figures

Figure 1
Figure 1
CONSORT diagram for the cardiometabolic marker sub-study.
Figure 2
Figure 2
Percentage of change from baseline for serum cardiometabolic markers including: (a) ApoA1, B, E, and CK; and (b) insulin, glucose, HOMA-IR, and HOMA-β, following multimodal intervention among n = 19 participants.
See this image and copyright information in PMC

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