Dietary Interventions in MS
After presenting this past weekend for the MS Society of Canada at their MS 101 event on dietary interventions, I thought this would be the perfect opportunity to create an informative blog post.
Dietary changes for the treatment of MS (Multiple Sclerosis) is an area of active research that is showing positive results. Clinically, MS patients in my practice see great benefit from dietary alterations, especially improvements in their levels of fatigue.
As Hippocrates said - “Let food be thy medicine and medicine be thy food”
Why do dietary changes have far reaching effects throughout the body?
We have over 100 trillion bacteria in our bowels; in fact more bacteria than our own cells. These bacteria make up what is called our microbiome. As a society, we are now moving towards understanding that these bugs have a greater impact on our overall health than we originally thought.
There are many factors that can influence the diversity of your gastrointestinal microbiome, such as toxin exposure (e.g., mercury, lead, pesticides), vaginal or caesarean birth, antibiotic use, as well as other prescription drugs such as acid reducers (e.g., proton pump inhibitors) and most importantly, our diet. When this ecosystem of our bacteria gets out of balance, the wrong bugs can take over.
Relevant to this discussion is the diet’s influence on our gut bugs, and when we eat a diet rich in sugary and starchy foods, this promotes the growth of sugar loving bacteria. These particular bacteria have been shown to promote inflammation in the gut and create something referred to as ‘leaky gut’. When our gut is functioning properly, there are tight barriers that control what is absorbed into our bloodstream. If there is a leaky gut, there are spaces, holes or cracks in between intestinal cells which allow partially digested food, toxins and other bugs to enter the tissues below the gut wall, creating inflammation. This inflammatory process changes the composition of the microbiome for the worse and is being correlated with many chronic health conditions, including MS.
Good news - when eating a diet rich in vegetables, especially green leafy (e.g., kale) and cruciferous veggies (e.g., broccoli) this encourages the growth of healthy bacteria and yeast!
A randomized double blind placebo controlled trial of probiotic supplementation in 60 MS patients for 12 weeks showed that there were improvements on the expanded disability status scale, general health questionnaires and depression and anxiety inventories (Kouchaki, 2016). The addition of probiotics also reduced c-reactive protein (CRP), which is a marker used to assess inflammation in the body. Unexpectedly, there were also reductions in insulin and improvements in HDL cholesterol (the good kind!).
As most of the dietary changes recommended in MS surround altering the fat content of your diet, I believe a brief review of the types of fat is necessary.
Animal fat, processed (hydrogenated) vegetable oils, coconut, and palm oils
Often solid or hard at room temperature
Both vegetable and animal products contain polyunsaturated fatty acids
Salmon, trout, sunflower, canola, corn and soybean oils are rich in this
Mainly found in vegetable and nut oils
Olive oil, avocado oil
The Swank diet was originally proposed by a neurologist named Dr. Roy Swank in 1949. The premise of this diet was a strict reduction of saturated fat (dairy products, eggs, meat), as he observed that there was a higher incidence of MS in geographical areas that consumed foods higher in saturated fats. He also observed that there was a lower incidence of MS in areas where people ate higher quantities of fish.
There is one 34-year prospective study on 144 MS patients who followed the diet and showed a positive impact on the progression of disability (Swank, 1990). Since then, there has been no research conducted to evaluate the diet’s efficacy.
The hallmarks of the Swank diet include:
No processed foods that contain saturated fats and/or hydrogenated oils.
Any saturated fat consumed should not exceed 15 grams a day.
Unlimited fruits and veggies, with daily snacks of nuts and seeds.
No red meat for the first year, after the first year 3 oz of meat are allowed per week.
White meat poultry and white fish are permitted; avoid dark-meat poultry and limit fatty fish.
Only dairy products with less than 1% of fat allowed, and egg whites.
Encourage whole grain breads, rice and pastas.
Terry Wahls is a medical doctor and researcher from the US, who was diagnosed with MS. She has worked tirelessly to find a cure and is actively doing research on her protocols.
A small 10-participant pilot study from 2014 demonstrated significant improvement in fatigue with adherence to the modified paleolithic diet (also known as the Wahl’s protocol) (Bisht, 2014).
The most recent study published in January of 2017 was with 34 participants who have relapsing-remitting MS comparing the Wahl’s protocol (Modified Paleolithic Diet) to a control diet. The control group maintained their usual diet and made no attempts to exclude intake of gluten or dairy products, while the Modified Paleolithic Diet (MPD) did not consume gluten, dairy, potatoes or legumes. The MPD group were also required to have 9 cups of vegetables a day, with some fruit, and meat protein that included organ meat. There were reductions in perceived fatigue, increases in serum vitamin K (associated with reductions in oxidative cell and mitochondrial damage), improvements in exercise capacity, mental and physical quality of life and motor function (Irish, 2017).
Key points of the diet include:
9 cups of vegetables a day.
Consuming bone broth and fermented foods daily.
High quality wild-caught or grass-fed protein for dinner.
Remove the 3 most common food triggers: gluten, dairy and eggs.
Remove all white sugar, high-fructose corn syrup, artificial sweeteners including soda.
In addition to the dietary recommendations, she also encourages various supplements, meditation, strengthening and stretching exercises, massage, and electrical stimulation of trunk and lower limb muscles.
If you are considering this diet, I highly recommend purchasing her book ‘The Wahls Protocol’ as it walks you through step by step on how best to initiate her protocol. For the most recent update as to what Dr. Terry Wahl’s research team is investigating, read her latest blog post: https://terrywahls.com/wahls-research-team-progress-update/.
Originally used with children who had treatment resistant epilepsy, the Ketogenic Diet has now become a trendy diet amongst a wide range of people, from those interested in weight loss to those wanting to optimize their brain health.
Physiologically, the ketogenic diet leads to an increase in ketone production from the liver, and a subsequent reduction in blood sugar (and insulin) levels. This encourages your brain to use fat (creating ketones) for fuel, instead of glucose.
Research is being done with the ketogenic diet in a wide variety of neurological and neurodegenerative diseases and there is mounting evidence of its broad neuroprotective properties (Strafstrom, 2012).
The most recent review of the ketogenic diet in patients with relapsing remitting MS was in 2016 and researchers compared a control diet, a fasting mimicking diet (also produces ketones through fasting instead of fat consumption) and a ketogenic diet. Results of the study found a reduction in relapse rates which were most pronounced in the ketogenic diet group. There was also an improvement in quality of life and mental health in both of the treatment groups (Choi, 2016).
Essentials of the diet are:
Protein at approximately 1 to 1.5 grams per kilogram of lean body weight.
60 grams or less of carbohydrates per day.
150-180 grams of fat per day (YES THIS IS A LOT!)
3 cups of veggies, 2 of them leafy greens.
No sugar, no processed foods, no flour products, no grains, no beans or legumes and limited nuts and seeds.
The diet is not suited if you have certain known metabolic conditions. Therefore, it is advised to consult with your physician or healthcare team prior to initiating.
The following conditions are a relative contraindication and need to be closely monitored:
Poor fat absorption
Pregnancy or lactation
Constipation or concerns with GI motility
Any history of kidney, liver, pancreatic or gallbladder disease
There are many potential side effects, most of which are temporary, but need to be monitored:
Fatigue and dizziness
Because of the potential for side effects in all of the above dietary interventions, I recommend consulting your health care team prior to initiating any changes.
If you are interested in learning more about dietary interventions in MS
book a free 15 minute meet and greet appointment.
Bisht, B., Darling, W. G., Grossmann, R. E., Shivapour, E. T., Lutgendorf, S. K., Snetselaar, L. G., ... & Wahls, T. L. (2014). A multimodal intervention for patients with secondary progressive multiple sclerosis: feasibility and effect on fatigue. TheJjournal of Alternative and Complementary Medicine, 20(5), 347-355.
Choi, I. Y., Piccio, L., Childress, P., Bollman, B., Ghosh, A., Brandhorst, S., ... & Wei, M. (2016). A diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms. Cell Reports, 15(10), 2136-2146.
Irish, A. K., Erickson, C. M., Wahls, T. L., Snetselaar, L. G., & Darling, W. G. (2017). Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degenerative Neurological and Neuromuscular Disease, 7, 1-18.
Rho, J. M., & Stafstrom, C. E. (2012). The ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in Pharmacology, 3, 59.
Swank, R. L., & Dugan, B. B. (1990). Effect of low saturated fat diet in early and late cases of multiple sclerosis. The Lancet, 336(8706), 37-39.