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Belly Fat, Depression and Multiple Sclerosis Questions

May 7, 2010 Written by JP    [Font too small?]

This past week I wrote a column featuring questions sent in by regular readers of this site. That blog inspired a whole new series of questions from other interested parties. My answers to today’s inquiries will touch upon several topics including the perplexing issue of middle-aged stomach fat, a natural intervention for multiple sclerosis and a complementary therapy that may help depressed patients avoid frequent relapses.

I’m going to combine two questions into one as a starting point. Yesterday I received an inquiry about my current feelings regarding soy as a regular dietary component. Another reader recently asked me for tips about “spot reducing” fat in the abdominal region. A study that is currently in print in the American Journal of Obstetrics and Gynecology addresses both of these issues in one fell swoop.

A group of 39 postmenopausal African American and Caucasian women took part in a double-blind, placebo-controlled study. Over the course of 3 months half of the participants were given a daily soy protein supplement and the remainder received a placebo which consisted of milk protein (casein). The soy was naturally rich in phytoestrogens while the casein was completely devoid of them.

  • Adiponectin, blood glucose, body fat/body fat distribution, inflammatory markers, insulin and lectin were tested pre and post trial.
  • Changes were only noted in the soy supplemented group as to “reduced total and subcutaneous abdominal fat and interleukin-6″.

It’s interesting to note that there was a difference in how soy affected the respective groups of women. The African American females “primarily lost total body fat”. The Caucasian participants “primarily lost subcutaneous and total abdominal fat”. However, the real question is why these women lost weight at all – in comparison to those using milk protein. Hopefully future studies will determine the underlying mechanism. (1)

Lately, I’ve fielded a few questions about the protective role that Vitamin D may play in the development and progression of multiple sclerosis (MS). The trouble is that much of the research currently available is based on preliminary animal and/or observational studies. That’s beginning to change. A case in point can be found in the April 28th issue of the journal Neurology. There, a 52-week trial is described in which high-dose Vitamin D was administered to 49 patients with MS. A few key findings were registered based on this pilot trial: 1) the patients’ Vitamin D levels at baseline were above average (78 nmol/L) and were elevated to very high levels (413 nmol/L) post-intervention; 2) this dramatic jump in Vitamin D concentrations did not result in significant adverse reactions or abnormal calcium-related measures; 3) the “treatment group patients appeared to have fewer relapse events and a persistent reduction in T-cell proliferation compared to controls”. While preliminary, this study suggests that high-dose Vitamin D therapy is safe and yields beneficial, immunomodulatory effects in those with MS. (2)

Causes of Vitamin D Deficiency

Causes Example
Reduced skin synthesis Sunscreen, skin pigment, season/latitude/time of day, aging, skin grafts
Decreaseed absorption Cystic fibrosis, celiac disease, whipple disease, Crohn disease, gastric bypass, medications that reduce cholesterol absorption
Increased sesquestration Obesity
Increased catabolism Anticonvulsant, glucocorticoid, highly active antiretroviral treatment, and some immunosuppressants
Decreased synthesis of 25-hydroxyvitamin D Hepatic failure
Increased urinary loss of 25-hydroxyvitamin D Nephrotic proteinuria
Decreased synthesis of 1,25-dihydroxyvitamin D Chronic renal failure
Heritable disorders Genetic mutations causing rickets, or vitamin D resistance
Acquired disorders Tumor-induced osteomalacia, primary hyperparathyroidism, hyperthyroidism, granulomatous disorders such as sarcoidosis, tuburculosis, and some lymphomas
Source: Journal of the American Board of Family Medicine 22 (6): 698-706 (link)

Some of the most heartbreaking e-mails that are sent to me relate to addiction and/or psychological conditions. This is a difficult area to offer advice as it’s nearly impossible to know what type of alternative therapies are right for someone based on a few lines of an e-mail. That’s why this next study was a very welcome find. I was able to pass this information along and recommend sharing it with both patient and psychiatrist.

One of the most challenging problems in the long term management of depression is finding the appropriate medication/therapy that will sufficiently reduce symptoms and prevent depression relapse. A newly published trial from Geneva University Hospital in Switzerland offers a complementary modality that may improve the odds of success in this arena. Sixty “un-medicated patients in remission from recurrent depression” were randomly assigned to two forms of treatment: 1) Treatment as Usual (TAU) or 2) Mindfulness-Based Cognitive Therapy (MBCT) + TAU. During the course of a 14 month follow up period, it was determined that the MBCT + TAU patients demonstrated a much stronger resistance to relapse as compared to the Treatment as Usual group – 204 days vs. 69 days. For the record, MBCT “combines the ideas of cognitive therapy with meditative practices and attitudes based on the cultivation of mindfulness”. (3)

The current science contained in the above brief summaries helps to inform my opinions. This doesn’t necessarily mean that I think that soy protein is the best solution for reducing middle-aged belly fat or that Vitamin D and mindfulness training are appropriate alternatives in every case of MS and depression. They’re potential pieces to the wellness puzzle. Nothing more and nothing less. How and where to place them requires an individualized approach that should be made along with your health care team.

Note: Please check out the “Comments & Updates” section of this blog – at the bottom of the page. You can find the latest research about this topic there!

Be well!


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Posted in Mental Health, Nutritional Supplements, Women's Health

16 Comments & Updates to “Belly Fat, Depression and Multiple Sclerosis Questions”

  1. Nina K. Says:

    Good Morning, JP ☼

    thanks for the infos about vitamin d, especially the causes of vitamin d deficiency, very important facts.

    Wish you and yours a wonderfull weekend, see/read us soon ☻☺☻

    Nina K.

  2. JP Says:

    Good day, Nina!

    Vitamin D is quickly becoming one of the hottest topics in both alternative and conventional medicine. There’s so much solid research being published and in the works. It’s an exciting time! 🙂

    I hope you and your husband have an excellent weekend as well!

    Be well!


  3. Mark Says:

    I frequently eat tofu so it’s good to see that benefit of soy.

  4. anne h Says:

    Sometimes I wonder if here are more questions than answers.
    But it’s great that you can help search though it, JP!

  5. JP Says:


    Hopefully further studies will support these current results. But please keep in mind that this particular trial was carried out using female volunteers only.

    Be well!


  6. JP Says:


    That’s science! We often get clues rather than definitive answers. What fun would it be if we understood everything?! 🙂

    Be well!


  7. liverock Says:

    Just a warning about veggie burgers which some people may be tempted to try to obtain their soy protein.

    Recent research has discovered that non organic veggie burgers use a registered hazardous element called hexane, which is derived from petroleum, in the manufacturing process.


  8. JP Says:


    You make a good point. Thank you for connecting the two issues.

    Be well!


  9. Anonymous Says:

    Vitamin D deficiency is known to have a bad effect on people with MS. It has also been found that a healthy dose of vitamin D administered to children while they grow up reduces their chances of developing multiple sclerosis later in their lives.

    The blog post was very interesting to read. Thank you for a very insightful information!

  10. Anonymous Says:

    This is indeed and inspiring article,for people with MS and not only.

    I do believe that what everybody, healthy or with MS should learn from this is that you can take your life into your own hands, and with will, discipline and faith, you can overcome your MS disabilities!

    Nobody says that it’s easy, but with treatment, a healthy lifestyle, exercise routine and a balanced diet, you can minimize the symptoms and slow down the progression of the disease!

  11. JP Says:

    Update: Coffee use may confer protection against MS …


    “People who drink four to six cups of coffee daily may be less likely to get multiple sclerosis, according to international research out Thursday.

    “Caffeine intake has been associated with a reduced risk of Parkinson’s and Alzheimer’s diseases,” said lead author Ellen Mowry of the Johns Hopkins University School of Medicine in Baltimore, Maryland.

    “Our study shows that coffee intake may also protect against MS, supporting the idea that the drug may have protective effects for the brain,” she added.

    The findings of a US and Swedish study—released ahead of the American Academy of Neurology annual meeting in Washington—each compared more than 1,000 MS patients to a similar number of healthy people.”

    Be well!


  12. JP Says:

    Udpate 04/17/15:


    Iran J Nurs Midwifery Res. 2015 Mar-Apr;20(2):200-4.

    Comparing the effects of reflexology and relaxation on fatigue in women with multiple sclerosis.

    BACKGROUND: Fatigue is the most common and highly disabling symptom of multiple sclerosis (MS) that has negative effects on employment, the process of socialization, compliance with the disease, and other factors effective on activities of daily living. The usage of complementary and alternative medicine methods in MS patients is higher than in the general population. However, there is no scientific evidence to support their effectiveness. Therefore, this study aimed to compare the effects of reflexology and relaxation on fatigue in women with MS.

    MATERIALS AND METHODS: This study is a single-blinded randomized clinical trial that was done on 75 patients with MS who referred to the MS Clinic of Ayatollah Kashani Hospital (Isfahan, Iran). After simple non-random sampling, participants were randomly assigned by minimization method to three groups: Reflexology, relaxation, and control groups (25 patients in each group). In the experimental groups, the interventions foot reflexology and relaxation (Jacobson and Benson) were performed for 4 weeks, twice a week for 40 min in each session, and the control group received care and routine medical treatment as directed by a physician. Data were collected through a questionnaire and the fatigue severity scale before, immediately after, and 2 months after interventions from all three groups. Data analysis was performed by SPSS version 18 using descriptive and inferential statistical methods.

    RESULTS: Findings obtained from analysis of variance (ANOVA) showed that there was no significant difference in the mean fatigue severity scores in the pre-interventions between the three groups (P > 0.05), but there was significant difference immediately after and 2 months after interventions between the three groups (P < 0.05). Findings obtained from repeated measures (ANOVA) showed that there was significant difference in the mean fatigue severity scores during different times between the three groups (P < 0.05), while this difference was not significant in the control group (P > 0.05). Furthermore, least significant difference post-hoc test revealed that the mean scores of fatigue severity immediately after intervention was lower in the reflexology group than in the other two groups and were lower in the relaxation group than in the control group; 2 months after interventions, the mean scores of fatigue severity were lower in the reflexology group than in the other two groups, but there was no significant difference between the two groups of relaxation and control (P > 0.05).

    CONCLUSIONS: It seems that both interventions were effective in reducing fatigue, but the effects of reflexology on reducing fatigue were more than those of relaxation. Hence, as these two methods are effective and affordable techniques, they can be recommended.

    Be well!


  13. JP Says:

    Updated 09/14/15:


    Mult Scler. 2015 Sep 11.

    Higher intake of omega-3 polyunsaturated fatty acids is associated with a decreased risk of a first clinical diagnosis of central nervous system demyelination: Results from the Ausimmune Study.

    BACKGROUND: There is contradictory evidence for a role of dietary fat in risk of multiple sclerosis (MS).

    OBJECTIVES: To examine the association between usual fat intake (total, saturated, monounsaturated (MUFA), polyunsaturated (PUFA), omega-3 and omega-6) and risk of a first clinical diagnosis of CNS demyelination (FCD).

    METHODS: Multi-centre incident case-control study in four regions of Australia during 2003-2006. Cases were aged 18-59 years and had a FCD; controls were matched to a case on age, sex and location. Dietary data were collected using a validated food frequency questionnaire.

    RESULTS: In 267 cases and 517 controls with dietary data, higher intake (per g/day) of omega-3 PUFA (adjusted odds ratio, AOR=0.61 (95% CI 0.40-0.93)), and particularly that derived from fish (AOR=0.54 (95% CI 0.31-0.93)) rather than from plants (AOR=0.75 (95% CI 0.39-1.43)) was associated with a decreased risk of FCD. Total fat intake and intake of other types of fat were not associated with FCD risk.

    CONCLUSIONS: There was a significant decrease in FCD risk with higher intake of omega-3 PUFA, particularly that originating from fish. There was no evidence to indicate that the intake of other types of dietary fat or fat quantity in the previous 12 months was associated with an altered risk of FCD.

    Be well!


  14. JP Says:

    Updated 06/26/16:


    J Complement Integr Med. 2016 Jun 23.

    Effect of integrated Yoga and Physical therapy on audiovisual reaction time, anxiety and depression in patients with chronic multiple sclerosis: a pilot study.

    BACKGROUND: Multiple sclerosis (MS) is characterized by a significant deterioration in auditory and visual reaction times along with associated depression and anxiety. Yoga and Physical therapy (PT) interventions have been found to enhance recovery from these problems in various neuropsychiatric illnesses, but sufficient evidence is lacking in chronic MS population. The aim of this study was to assess the effect of integrated Yoga and Physical therapy (IYP) on audiovisual reaction times, depression and anxiety in patients suffering from chronic MS.

    METHODS: From a neuro-rehabilitation center in Germany, 11 patients (six females) suffering from MS for 19±7.4 years were recruited. Subjects were in the age range of 55.45±10.02 years and had Extended Disability Status Scores (EDSS) below 7. All the subjects received mind-body intervention of integrated Yoga and Physical therapy (IYP) for 3 weeks. The intervention was given in a residential setup. Patients followed a routine involving Yogic physical postures, pranayama, and meditations along with various Physical therapy (PT) techniques for 21 days, 5 days a week, 5 h/day. They were assessed before and after intervention for changes in audiovisual reaction times (using Brain Fit Model No. OT 400), anxiety, and depression [using Hospital Anxiety and Depression Scale (HADS)]. Data was analyzed using paired samples test.

    RESULTS: There was significant improvement in visual reaction time (p=0.01), depression (p=0.04), and anxiety (p=0.02) scores at the end of 3 weeks as compared to the baseline. Auditory reaction time showed reduction with borderline statistical significance (p=0.058).

    CONCLUSIONS: This pilot project suggests utility of IYP intervention for improving audiovisual reaction times and psychological health in chronic MS patients. In future, randomized controlled trials with larger sample size should be performed to confirm these findings.

    Be well!


  15. JP Says:

    Updated 08/31/16:


    Diabetes Metab. 2016 Aug 23.

    High-intensity interval training reduces abdominal fat mass in postmenopausal women with type 2 diabetes.

    AIM: This study compared the effect of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) for 16 weeks on whole-body and abdominal fat mass (FM) in postmenopausal women with type 2 diabetes (T2D).

    METHODS: Seventeen women (69±1 years; BMI: 31±1kg.m-2) were randomly assigned to either a HIIT [60×(8s at 77-85% HRmax, 12s of active recovery)] or MICT (40min at 55-60% of their individual HRR) cycling program for 16 weeks, 2 days/week. Dual-energy X-ray absorptiometry was used to measure whole-body and regional FM content, including abdominal adiposity and visceral adipose tissue. Plasma cholesterol, HDL, LDL, triglycerides, glucose and HbA1c levels were measured. Levels of nutritional intake and physical activity were evaluated by 7-day self-reports.

    RESULTS: Dietary energy (caloric) intake, physical activity level and total body mass did not vary in either group from the beginning to the end of the training intervention. Overall, total FM decreased and total fat-free mass significantly increased over time (by around 2-3%). Total FM reduction at the end of the intervention was not significantly different between groups. However, significant loss of total abdominal (-8.3±2.2%) and visceral (-24.2±7.7%) FM was observed only with HIIT. Time effects were noted for HbA1c and total cholesterol/HDL ratio.

    CONCLUSION: With no concomitant caloric restriction, an HIIT program in postmenopausal women with T2D (twice a week for 16 weeks) appeared to be more effective for reducing central obesity than MICT, and could be proposed as an alternative exercise training program for this population.

    Be well!


  16. JP Says:

    Updated 10/28/16:


    Dtsch Arztebl Int. 2016 Sep 30;113(39):645-652.

    Yoga in Women With Abdominal Obesity a Randomized Controlled Trial.

    BACKGROUND: Abdominal obesity is a major risk factor for morbidity and mortality. The aim of this study was to investigate the effect of yoga on waist circumference and other anthropometric and self-reported variables in women with abdominal obesity.

    METHODS: 60 women with abdominal obesity (waist circumference ≥ 88 cm; body-mass index [BMI] ≥ 25) were randomly allocated in a 2:1 ratio to either a 12-week yoga intervention (n = 40) or a waiting list (n = 20). The waist circumference was the primary endpoint. Secondary (exploratory) endpoints included the waist/hip ratio, body weight, BMI, body fat percentage, body muscle mass percentage, blood pressure, health-related quality of life, self-esteem, subjective stress, body awareness, and body responsiveness, and the safety of the intervention. The persons assessing the outcomes were blinded to the group to which the patients belonged.

    RESULTS: The patients in the yoga group participated in a mean of 30.2±9.2 (maximum, 42) hours of supervised yoga practice. Their abdominal circum – ference was significantly reduced in comparison to the participants on the waiting list, with an intergroup difference of -3.8 cm (95% confidence interval [-6.1; -1,.5]; p = 0.001). There were further, moderate intergroup differences in the waist/hip ratio, body weight, BMI, body fat percentage, body muscle mass percentage, mental and physical well-being, self-esteem, subjective stress, body awareness, and trust in bodily sensations (all p<0.05). There were no serious adverse events. None of the participants embarked on a low-calorie diet while participating in the study.

    CONCLUSION: The 12-week yoga intervention had moderately strong positive effects on anthropometric and self-reported variables in women with abdominal obesity. Yoga is safe in this population and can be recommended as a technique for combating abdominal obesity in women.

    Be well!


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