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Dietary Approaches to Treat Multiple Sclerosis-Related Fatigue Study (Waves)

Primary Purpose

Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting

Status
Active
Phase
Not Applicable
Locations
United States
Study Type
Interventional
Intervention
Swank Diet
Wahls Elimination Diet
Sponsored by
Terry L. Wahls
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Multiple Sclerosis focused on measuring Fatigue, Quality of Life, Diet

Eligibility Criteria

18 Years - 70 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Willing to allow your neurologist to sign a letter confirming multiple sclerosis diagnosis and criteria used in diagnosis
  • Relapsing-Remitting Multiple Sclerosis as documented by the McDonald Criteria confirmed by their treating neurologist
  • Fatigue as documented by a Fatigue Severity Scale score of greater than or equal to 4
  • Between the ages of 18 and 70
  • Body Mass Index greater than or equal to 19
  • Ability to shop for and prepare or have someone in the family shop for and prepare home cooked meals according to study diet guidelines
  • Willingness to keep detailed food records
  • Willing to eat a diet that includes more vegetables and excludes many comfort foods such as those made with white flour,
  • Willing to eat a diet that eliminates red meat (beef, pork, lamb, veal) and saturated fats (butter, coconut oil, margarine, hydrogenated oils found in processed foods) to 1 tablespoon per day
  • Must not be pregnant or planning to become pregnant in the next year
  • Willing to eat meat (eg, chicken, turkey, fish)
  • Willingness to follow either the Wahls Elimination diet or the Swank diet
  • Individuals who have had gastric bypass surgery have obtained a signed statement from their physician indicating they are weight stable and a suitable candidate for this study
  • Normal or mild cognitive impairment as measured by the Short Portable Mental Status Questionnaire
  • Willing to have blood drawn
  • Be able to walk 25 feet without support, or with only unilateral support (i.e. cane in one hand)

Exclusion Criteria:

  • Taking insulin or Coumadin
  • Relapse within past 12 weeks
  • Treatment for a cancer (other than skin cancer) currently or in the prior 12 months
  • Diagnosis of heart failure, liver cirrhosis, angina, history of kidney stones, psychiatric disease likely to make adherence to the study interventions more difficult including eating disorders, but excluding depression and anxiety
  • Body Mass Index less than 19
  • Moderate to severe mental impairment as measured by the Short Portable Mental Status questionnaire
  • Inability to shop for and prepare home cooked meals by the subject or a companion
  • Unwillingness to eat meat
  • Participation in another research study that involves multiple sclerosis or other medications, diet, supplement, exercise or other treatments
  • Inability to keep food records with sufficient detail to asses dietary intake or complete study questionnaires
  • Unwilling to have blood drawn
  • Pregnant or planning to become pregnant in the next year

Sites / Locations

  • University of Iowa Hospitals and Clinics

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Experimental

Arm Label

Swank Diet

Wahls Elimination Diet

Arm Description

Individuals randomized to this arm will follow a low saturated fat diet starting at week 12.

Individuals randomized to this arm will follow a modified paleolithic diet that eliminates all grains, dairy, eggs, legumes, and nightshade vegetables/spices starting at week 12.

Outcomes

Primary Outcome Measures

Change in participant perceived fatigue severity
Participant questionnaire asking about fatigue: Fatigue Severity Scale score - a 9-questions scale ranging from 1 (complete disagreement with the question) to 7 (complete agreement with the questions)
Change in participant perceived fatigue severity
Participant questionnaire asking about fatigue: Fatigue Severity Scale score - a 9-questions scale ranging from 1 (complete disagreement with the question) to 7 (complete agreement with the questions)
Change in the impact of fatigue on daily life
Modified Fatigue Impact Scale score: Participant questionnaire asking about impact of fatigue impact daily life: Modified Fatigue Impact Scale score. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning. The MFIS consists of 21 items. Scoring is based upon a sum of the responses. Total score ranges from 0 to 84.
Change in the impact of fatigue on daily life
Modified Fatigue Impact Scale score: Participant questionnaire asking about impact of fatigue impact daily life: Modified Fatigue Impact Scale score. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning. The MFIS consists of 21 items. Scoring is based upon a sum of the responses. Total score ranges from 0 to 84.

Secondary Outcome Measures

Change in participant walk speed
6 Minute Walk Test
Change in participant walk speed
6 Minute Walk Test
Change in gait (walk)
25 foot Walk Test
Change in gait (walk)
25 foot Walk Test
Change in fine motor function
Pegboard test
Change in fine motor function
Pegboard test
Change in nutrient intake based on the recommended daily allowance (RDA)
Nutrient intake calculated from 3-day weighed food records and Food Frequency Questionnaire and Participant blood measurements of insulin, glucose, hemoglobin A1C, Vitamin K, homocysteine, lipids, fatty acid profile and vitamin D.
Change in nutrient intake based on the recommended daily allowance (RDA)
Nutrient intake calculated from 3-day weighed food records and Food Frequency Questionnaire and Participant blood measurements of insulin, glucose, hemoglobin A1C, Vitamin K, homocysteine, lipids, fatty acid profile and vitamin D.
Change in cognitive function
Symbol Digit Modalities Test - oral. An oral test of sequencing symbols. •Participant substitutes a number for meaningless geometric shapes based on a key that assigns a specific number to each shape. Scoring is based on the number of correct substitutions.
Change in cognitive function
Symbol Digit Modalities Test - oral. An oral test of sequencing symbols. •Participant substitutes a number for meaningless geometric shapes based on a key that assigns a specific number to each shape. Scoring is based on the number of correct substitutions.
Change in steps per day
Measured by accelerometer
Change in steps per day
Measured by accelerometer
Change in participant Quality of Life (QoL) - General Health
Multiple Sclerosis 54 Quality of Life Questionnaire. A series of questions about quality of life and social functioning. Score 0 to 100.
Change in participant Quality of Life (QoL) - General Health
Multiple Sclerosis Quality of Life Questionnaire. A series of questions about quality of life and social functioning. Score 0 to 100.
Change in participant Quality of Life (QoL) - Mental Health
Multiple Sclerosis Quality of Life Questionnaire A series of questions about quality of life and social functioning. Score 0 to 100.
Change in participant Quality of Life (QoL) - Mental Health
Multiple Sclerosis Quality of Life Questionnaire A series of questions about quality of life and social functioning. Score 0 to 100.
Change in total sleep time
Total sleep time is measured in hours and minutes and tracked by accelerometer worn by participants throughout the study
Change in total sleep time
Total sleep time is measured in hours and minutes and tracked by accelerometer worn by participants throughout the study
Change in perceived anxiety
Perceived anxiety is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Change in perceived anxiety
Perceived anxiety is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Change in perceived depression
Perceived depression is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Change in perceived depression
Perceived depression is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.

Full Information

First Posted
September 13, 2016
Last Updated
July 11, 2023
Sponsor
Terry L. Wahls
Collaborators
National Multiple Sclerosis Society
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1. Study Identification

Unique Protocol Identification Number
NCT02914964
Brief Title
Dietary Approaches to Treat Multiple Sclerosis-Related Fatigue Study
Acronym
Waves
Official Title
Dietary Approaches to Treat Multiple Sclerosis-Related Fatigue Study
Study Type
Interventional

2. Study Status

Record Verification Date
July 2023
Overall Recruitment Status
Active, not recruiting
Study Start Date
August 2016 (Actual)
Primary Completion Date
January 26, 2020 (Actual)
Study Completion Date
January 26, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor-Investigator
Name of the Sponsor
Terry L. Wahls
Collaborators
National Multiple Sclerosis Society

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this study is to compare the effect of the Swank Diet (low saturated fat) and the Wahls Elimination Diet (modified paleo) on fatigue levels in individuals with relapsing-remitting multiple sclerosis who have documented fatigue. Participants will follow their usual diet for 12 weeks and then be randomly assigned to follow one of the two diets for 24 weeks.
Detailed Description
The purpose of this study is to compare the effect of the Swank Diet (low saturated fat) and the Wahls Elimination Diet (modified paleo) on fatigue levels in individuals with relapsing-remitting multiple sclerosis who have documented fatigue. Participants will follow their usual diet for 12 weeks and then be randomly assigned to follow one of the two diets for 24 weeks. Individuals will continue with their current treatments in addition to following the study diet. The study requires four visits to the University of Iowa Hospitals and Clinics in Iowa City, Iowa. Visits will be 12 weeks apart. Study activities include fasting blood draws, weighed food records, motor and cognitive testing, physical activity assessment, questionnaires, and daily diet checklists while following the study diet. Some reimbursement available.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multiple Sclerosis, Multiple Sclerosis, Relapsing-Remitting
Keywords
Fatigue, Quality of Life, Diet

7. Study Design

Primary Purpose
Treatment
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
100 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Swank Diet
Arm Type
Experimental
Arm Description
Individuals randomized to this arm will follow a low saturated fat diet starting at week 12.
Arm Title
Wahls Elimination Diet
Arm Type
Experimental
Arm Description
Individuals randomized to this arm will follow a modified paleolithic diet that eliminates all grains, dairy, eggs, legumes, and nightshade vegetables/spices starting at week 12.
Intervention Type
Behavioral
Intervention Name(s)
Swank Diet
Intervention Description
A Registered Dietitian Nutritionist (RDN) skilled in motivational interviewing will provide nutrition counseling to study participants to assist them in following the Swank Diet at home. An in-person counseling session will occur at study visits 2 and 3. Five telephone counseling calls will occur between visits 2 and 3. The study participant may contact the RDN with questions at any time during the intervention.
Intervention Type
Behavioral
Intervention Name(s)
Wahls Elimination Diet
Intervention Description
A Registered Dietitian Nutritionist (RDN) skilled in motivational interviewing will provide nutrition counseling using to study participants to assist them in following the Wahls Elimination Diet at home. An in-person counseling session will occur at study visits 2 and 3. Five telephone counseling calls will occur between visits 2 and 3. The study participant may contact the RDN with questions at any time during the intervention.
Primary Outcome Measure Information:
Title
Change in participant perceived fatigue severity
Description
Participant questionnaire asking about fatigue: Fatigue Severity Scale score - a 9-questions scale ranging from 1 (complete disagreement with the question) to 7 (complete agreement with the questions)
Time Frame
12-24 weeks
Title
Change in participant perceived fatigue severity
Description
Participant questionnaire asking about fatigue: Fatigue Severity Scale score - a 9-questions scale ranging from 1 (complete disagreement with the question) to 7 (complete agreement with the questions)
Time Frame
12-36 weeks
Title
Change in the impact of fatigue on daily life
Description
Modified Fatigue Impact Scale score: Participant questionnaire asking about impact of fatigue impact daily life: Modified Fatigue Impact Scale score. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning. The MFIS consists of 21 items. Scoring is based upon a sum of the responses. Total score ranges from 0 to 84.
Time Frame
12-24 weeks
Title
Change in the impact of fatigue on daily life
Description
Modified Fatigue Impact Scale score: Participant questionnaire asking about impact of fatigue impact daily life: Modified Fatigue Impact Scale score. This instrument provides an assessment of the effects of fatigue in terms of physical, cognitive, and psychosocial functioning. The MFIS consists of 21 items. Scoring is based upon a sum of the responses. Total score ranges from 0 to 84.
Time Frame
12-36 weeks
Secondary Outcome Measure Information:
Title
Change in participant walk speed
Description
6 Minute Walk Test
Time Frame
12-24 weeks
Title
Change in participant walk speed
Description
6 Minute Walk Test
Time Frame
12-36 weeks
Title
Change in gait (walk)
Description
25 foot Walk Test
Time Frame
12-24 weeks
Title
Change in gait (walk)
Description
25 foot Walk Test
Time Frame
12-36 weeks
Title
Change in fine motor function
Description
Pegboard test
Time Frame
12-24 weeks
Title
Change in fine motor function
Description
Pegboard test
Time Frame
12-36 weeks
Title
Change in nutrient intake based on the recommended daily allowance (RDA)
Description
Nutrient intake calculated from 3-day weighed food records and Food Frequency Questionnaire and Participant blood measurements of insulin, glucose, hemoglobin A1C, Vitamin K, homocysteine, lipids, fatty acid profile and vitamin D.
Time Frame
12-24 weeks
Title
Change in nutrient intake based on the recommended daily allowance (RDA)
Description
Nutrient intake calculated from 3-day weighed food records and Food Frequency Questionnaire and Participant blood measurements of insulin, glucose, hemoglobin A1C, Vitamin K, homocysteine, lipids, fatty acid profile and vitamin D.
Time Frame
12-36 weeks
Title
Change in cognitive function
Description
Symbol Digit Modalities Test - oral. An oral test of sequencing symbols. •Participant substitutes a number for meaningless geometric shapes based on a key that assigns a specific number to each shape. Scoring is based on the number of correct substitutions.
Time Frame
12-24 weeks
Title
Change in cognitive function
Description
Symbol Digit Modalities Test - oral. An oral test of sequencing symbols. •Participant substitutes a number for meaningless geometric shapes based on a key that assigns a specific number to each shape. Scoring is based on the number of correct substitutions.
Time Frame
12-36 weeks
Title
Change in steps per day
Description
Measured by accelerometer
Time Frame
12-24 weeks
Title
Change in steps per day
Description
Measured by accelerometer
Time Frame
12-36 weeks
Title
Change in participant Quality of Life (QoL) - General Health
Description
Multiple Sclerosis 54 Quality of Life Questionnaire. A series of questions about quality of life and social functioning. Score 0 to 100.
Time Frame
12-24 weeks
Title
Change in participant Quality of Life (QoL) - General Health
Description
Multiple Sclerosis Quality of Life Questionnaire. A series of questions about quality of life and social functioning. Score 0 to 100.
Time Frame
12-36 weeks
Title
Change in participant Quality of Life (QoL) - Mental Health
Description
Multiple Sclerosis Quality of Life Questionnaire A series of questions about quality of life and social functioning. Score 0 to 100.
Time Frame
12-24 weeks
Title
Change in participant Quality of Life (QoL) - Mental Health
Description
Multiple Sclerosis Quality of Life Questionnaire A series of questions about quality of life and social functioning. Score 0 to 100.
Time Frame
12-36 weeks
Title
Change in total sleep time
Description
Total sleep time is measured in hours and minutes and tracked by accelerometer worn by participants throughout the study
Time Frame
12-24 weeks
Title
Change in total sleep time
Description
Total sleep time is measured in hours and minutes and tracked by accelerometer worn by participants throughout the study
Time Frame
12-36 weeks
Title
Change in perceived anxiety
Description
Perceived anxiety is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Time Frame
12-24 weeks
Title
Change in perceived anxiety
Description
Perceived anxiety is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Time Frame
12-36 weeks
Title
Change in perceived depression
Description
Perceived depression is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Time Frame
12-24 weeks
Title
Change in perceived depression
Description
Perceived depression is measured by the Hospital Anxiety and Depression Scale (HADS), a 14 question scale ranging from 0-3 with zero being being low or no occurrence and 3 being high occurrence.
Time Frame
12-36 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
70 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Willing to allow your neurologist to sign a letter confirming multiple sclerosis diagnosis and criteria used in diagnosis Relapsing-Remitting Multiple Sclerosis as documented by the McDonald Criteria confirmed by their treating neurologist Fatigue as documented by a Fatigue Severity Scale score of greater than or equal to 4 Between the ages of 18 and 70 Body Mass Index greater than or equal to 19 Ability to shop for and prepare or have someone in the family shop for and prepare home cooked meals according to study diet guidelines Willingness to keep detailed food records Willing to eat a diet that includes more vegetables and excludes many comfort foods such as those made with white flour, Willing to eat a diet that eliminates red meat (beef, pork, lamb, veal) and saturated fats (butter, coconut oil, margarine, hydrogenated oils found in processed foods) to 1 tablespoon per day Must not be pregnant or planning to become pregnant in the next year Willing to eat meat (eg, chicken, turkey, fish) Willingness to follow either the Wahls Elimination diet or the Swank diet Individuals who have had gastric bypass surgery have obtained a signed statement from their physician indicating they are weight stable and a suitable candidate for this study Normal or mild cognitive impairment as measured by the Short Portable Mental Status Questionnaire Willing to have blood drawn Be able to walk 25 feet without support, or with only unilateral support (i.e. cane in one hand) Exclusion Criteria: Taking insulin or Coumadin Relapse within past 12 weeks Treatment for a cancer (other than skin cancer) currently or in the prior 12 months Diagnosis of heart failure, liver cirrhosis, angina, history of kidney stones, psychiatric disease likely to make adherence to the study interventions more difficult including eating disorders, but excluding depression and anxiety Body Mass Index less than 19 Moderate to severe mental impairment as measured by the Short Portable Mental Status questionnaire Inability to shop for and prepare home cooked meals by the subject or a companion Unwillingness to eat meat Participation in another research study that involves multiple sclerosis or other medications, diet, supplement, exercise or other treatments Inability to keep food records with sufficient detail to asses dietary intake or complete study questionnaires Unwilling to have blood drawn Pregnant or planning to become pregnant in the next year
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Terry L Wahls, MD, MBA
Organizational Affiliation
University of Iowa
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Linda Snetselaar, PhD, RD,
Organizational Affiliation
University of Iowa
Official's Role
Principal Investigator
Facility Information:
Facility Name
University of Iowa Hospitals and Clinics
City
Iowa City
State/Province
Iowa
ZIP/Postal Code
52242
Country
United States

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
30728736
Citation
Bisht B, Darling WG, Shivapour ET, Lutgendorf SK, Snetselaar LG, Chenard CA, Wahls TL. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2015;5:19-35. doi: 10.2147/DNND.S76523. Epub 2015 Feb 27. Erratum In: Degener Neurol Neuromuscul Dis. 2015 Sep 10;5:91.
Results Reference
background
PubMed Identifier
24476345
Citation
Bisht B, Darling WG, Grossmann RE, Shivapour ET, Lutgendorf SK, Snetselaar LG, Hall MJ, Zimmerman MB, Wahls TL. A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. J Altern Complement Med. 2014 May;20(5):347-55. doi: 10.1089/acm.2013.0188. Epub 2014 Jan 29.
Results Reference
background
PubMed Identifier
14771073
Citation
SWANK RL. Multiple sclerosis; a correlation of its incidence with dietary fat. Am J Med Sci. 1950 Oct;220(4):421-30. No abstract available.
Results Reference
background
PubMed Identifier
13836031
Citation
SWANK RL. Treatment of multiple sclerosis with a low-fat diet. J Am Diet Assoc. 1960 Apr;36:322-5. No abstract available.
Results Reference
background
PubMed Identifier
12996138
Citation
SWANK RL. Treatment of multiple sclerosis with low-fat diet. AMA Arch Neurol Psychiatry. 1953 Jan;69(1):91-103. doi: 10.1001/archneurpsyc.1953.02320250097011. No abstract available.
Results Reference
background
PubMed Identifier
14375427
Citation
SWANK RL. Treatment of multiple sclerosis with low-fat diet; results of five and one-half years' experience. AMA Arch Neurol Psychiatry. 1955 Jun;73(6):631-44. doi: 10.1001/archneurpsyc.1955.02330120035004. No abstract available.
Results Reference
background
PubMed Identifier
13373189
Citation
SWANK RL. Treatment of multiple sclerosis with low-fat diet: result of seven years' experience. Ann Intern Med. 1956 Nov;45(5):812-24. doi: 10.7326/0003-4819-45-5-812. No abstract available.
Results Reference
background
PubMed Identifier
5471652
Citation
Swank RL. Multiple sclerosis: twenty years on low fat diet. Arch Neurol. 1970 Nov;23(5):460-74. doi: 10.1001/archneur.1970.00480290080009. No abstract available.
Results Reference
background
PubMed Identifier
1804476
Citation
Swank RL. Multiple sclerosis: fat-oil relationship. Nutrition. 1991 Sep-Oct;7(5):368-76.
Results Reference
background
PubMed Identifier
13774215
Citation
SWANK RL, BOURDILLON RB. Multiple sclerosis: assessment of treatment with a modified low-fat diet. J Nerv Ment Dis. 1960 Dec;131:468-88. No abstract available.
Results Reference
background
PubMed Identifier
1973220
Citation
Swank RL, Dugan BB. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet. 1990 Jul 7;336(8706):37-9. doi: 10.1016/0140-6736(90)91533-g.
Results Reference
background
PubMed Identifier
12591551
Citation
Swank RL, Goodwin J. Review of MS patient survival on a Swank low saturated fat diet. Nutrition. 2003 Feb;19(2):161-2. doi: 10.1016/s0899-9007(02)00851-1. No abstract available.
Results Reference
background
PubMed Identifier
12714108
Citation
Swank RL, Goodwin JW. How saturated fats may be a causative factor in multiple sclerosis and other diseases. Nutrition. 2003 May;19(5):478. doi: 10.1016/s0899-9007(02)01099-7. No abstract available.
Results Reference
background
PubMed Identifier
34377527
Citation
Wahls TL, Titcomb TJ, Bisht B, Eyck PT, Rubenstein LM, Carr LJ, Darling WG, Hoth KF, Kamholz J, Snetselaar LG. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021 Jul 31;7(3):20552173211035399. doi: 10.1177/20552173211035399. eCollection 2021 Jul-Sep.
Results Reference
derived
PubMed Identifier
29866196
Citation
Wahls T, Scott MO, Alshare Z, Rubenstein L, Darling W, Carr L, Smith K, Chenard CA, LaRocca N, Snetselaar L. Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial. Trials. 2018 Jun 4;19(1):309. doi: 10.1186/s13063-018-2680-x.
Results Reference
derived
Links:
URL
http://redcap.icts.uiowa.edu/redcap/surveys
Description
screening survey; enter code JMJPYEJHP

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Dietary Approaches to Treat Multiple Sclerosis-Related Fatigue Study

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