Pull up a chair next to the cardiologists and have a look at the menu – seems like the Mediterranean diet remains flavour of the day.

What is this Mediterranean diet?  Well, if I can take you on a ‘Cook’s tour’ (excuse the pun…it gets worse…), this diet essentially puts emphasis on extra virgin olive oil and nuts (key factors), as well as fish, fresh greens, and wholegrains, and allows both alcohol and dairy products in moderation.

In the current issue of JNNP, an article by Martinez-Lapiscina and colleagues (1) delivers interesting results on the effects of a Mediterranean diet versus a standard low fat diet on cognitive function.  Their study, called ‘PREDIMED-NAVARRA’ looks at a subset of patients from the larger, parent ‘PREDIMED’ trial.   This was a randomised, cardiovascular primary prevention trial run in Barcelona from 2005 – 2010 comparing the Mediterranean diet with a low-fat diet in a high risk population.

To get straight to the main course, Martinez-Lapiscina has published the first long-term randomised intervention aimed at changing overall dietary pattern and noting the effect on cognitive function. Over a period of 6.5 years, those on the Mediterranean diet had better global cognitive performance compared with those on the ‘low-fat’ diet.

As Scarmeas (2) discusses in his thoughtful editorial, the findings from PREDIMED-NAVARRA will need to be further investigated, replicated, and quantified before we can confidently recommend to the general public that taking a Mediterranean diet will protect them from cognitive decline.

As we reflect over dessert (perhaps the sort with nuts and extra virgin olive oil),  we are tackling the challenges faced by an ageing population.  These issues include dementia, which is significant in terms of number of people affected and the cost to the community – both socially and economically.  As yet we have no effective therapy to delay onset or slow progression of dementia.

The Mediterranean Diet already has been shown to confer benefits from a cardiovascular stand point, and Martinez-Lapiscina’s study suggests it has neuroprotective benefits too.

So, do you have a say in what your patients are eating?

And what’s on your plate?

1) Martinez-Lapiscina et al, J Neurol Neurosurg Psychiatry 2013;84:1318-1325 doi:10.1136/jnnp-2012-304792

2)  Scarmeas, J Neurol Neurosurg Psychiatry 2013;84:1297 doi:10.1136/jnnp-2013-305153

Aussie Gen Y’ers have slipped, slopped, slapped all their lives, thanks to a very successful public health campaign aimed at reducing skin cancer. Our pale generation, although less inclined to melanomas, are more likely to be Vitamin D deficient, which is linked to diseases such as osteoporosis. Not as widely noted is that lack of sun exposure in itself has been implicated in MS.

In this month’s JNNP, Zivadinov et al.1 report that sun exposure may have direct effects on MRI measures of neurodegeneration in MS, independent of vitamin D levels. Specifically, they found that increased summer sun exposure was associated with increased grey matter volume and whole brain volume.

Why is this?

Zivadinov’s group, from Buffalo, USA, postulate that this may be due to a possible immunomodulation effect from sun exposure itself.

It’s not the first study to have connected sunshine & immune diseases. Among others, an Australian study2 demonstrated that greater UV induced skin damage and higher vitamin D levels were associated with a decreased risk of the initial demyelinating event.

So where does that leave us?

Sun-bathing prescriptions – will you recommend your patients catch some rays?    How much is enough?

Do you encourage being SunSmart?

Are vitamin D supplements on the menu for your patients with MS?

Or do you feel the jury is still out on the links between the sun & immune mediated disease?

Would love to hear your thoughts and how you integrate these ideas into your day to day practice.

1 – Zivadinov R, Treu CN, Weinstock-Guttman B, et al. Interdependence and contributions of sun exposure and vitamin D to MRI measures in multiple sclerosis. J Neurol Neurosurg Psychiatry 2013;84:1075-1081. doi:10.1136/jnnp-2012-304661

2 – Lucas RM, Ponsonby AL, Dear K, et al. Sun exposure and vitamin D are independent risk factors for CNS demyelination. Neurology 2011;76:540–8.