University of Iowa researchers, using an innovative therapy involving intensive nutrition, progressive exercise, and neuromuscular stimulation, have observed evidence of improvement in patients with secondary progressive multiple sclerosis (SPMS).

This treatment approach, described as radical by the researchers, was selected as a “Hot Topic” at the Neuroscience 2011 annual meeting — presented by the Society for Neuroscience — in Washington, D.C. Babita Bisht, a Ph.D. student in the Department of Health and Human Physiology, is the study’s first author and presented the research at the Nov. 13 meeting.

Terry Wahls, a clinical professor of internal medicine at the UI Carver College of Medicine and the Iowa City VA Medical Center, is the study’s senior author and living proof this treatment plan’s effectiveness. SPMS patients report disabling levels of fatigue and progressive muscle weakness.

Different treatments, including drugs and physical therapy, are available to delay the progression of the disease. However, no cure or treatment to reverse progression is currently available.

Wahls was diagnosed with SPMS in 2003 and soon became dependent upon a tilt-recline wheelchair. After developing and using this protocol, she has regained mobility and is now able to walk through the hospital and commute to work by bicycle.

“My scientific colleagues thought I was completely incorrect creating a protocol that is this complicated, because if you got people better you wouldn’t know why,” Wahls says. “But we’re doing this based on my own personal experience. The first question was whether other people with MS would be willing to adopt such a complex regimen. Then if they did, what happens?”

For the study, the researchers worked with eight patients, who completed a three-month intervention that included an intensive nutrition food plan—nine cups of fruits and vegetables, protein rich foods, and nutritional supplements—a customized exercise program to strengthen weak muscles of the trunk and legs, and customized neuromuscular stimulation to strengthen weak muscles.

At the end of three months, seven patients showed very good compliance, and one showed fair compliance. Two patients showed an abatement of symptoms. These patients were severely disabled at the beginning of the study. They could tolerate only minimal amounts of electrical stimulation current and perform only minimal exercise.

The other six patients showed improvement in their level of fatigue. On the seven-point Fatigue Severity Scale these patients averaged 5.6 before the intervention and 3.25 afterward. (On this scale, lower numbers indicate less fatigue.) The six patients in this group also experienced an improvement in their gait—a 29-percent average increase in mean walking speed. One subject who initially walked with a cane is now walking three miles a day unassisted. Another subject who was unable to walk upstairs a single step is now able to walk upstairs seven steps holding onto railings and with minimal assistance from the caregiver.

Reported side effects were weight loss, nausea, and gastric problems associated with the supplements.

“Unless you try something, you can’t say whether it’s effective. Dr. Wahls’ example was good enough to tell you that it works in one person,” says Bisht, a physical therapist who administers the subjects’ motor assessments. “If it can work on one human being, it’s worth trying in others.”

The researchers are planning to publish the preliminary findings of this study and also conduct a randomized controlled clinical trial to test the hypothesis that the combination of treatments involving major lifestyle changes results in a more rapid stabilization and reversal of disease symptoms than using a single treatment modality.

“At some point, we would like to try to break things out and see how each part contributes,” says Warren Darling, professor of health and human physiology and second author on the study. “We absolutely think the exercise contributes, and it’s not just the diet. And neuromuscular stimulation has contributions, as well.”

The research was funded by DIRECT-MS of Calgary, Alberta, Canada.