MS Diet and Nutritional Approaches to Treatment
What we eat can affect how we feel. Healthy foods feed the body with wholesome nutrients while low-quality foods can lead to heart disease and ill-health.
Is there an MS diet?
Considerable controversy surrounds the topic of diet and MS. The official recommendation of the National MS Society is to eat a well-rounded, heart-healthy diet and that diet alone cannot treat MS. But diet can be used as complementary therapy in conjunction with other traditional approaches. Since there is so much conflicting information available, let’s take a closer look at the various approaches to food, nutrition, and MS diets.
How might diet have an effect on MS?
What you eat may have a direct effect on the immune system. The National MS Society shares that “recent immunological research has shown that metabolism plays an important role in the function of several types of immune cells,” with receptors for dietary metabolites, such as vitamin D or fatty acids, found on immune cells. Food may have an indirect effect on the immune system through modulation of gut flora, shifting the immune system towards a pro- or anti-inflammatory state.
Research is investigating the effects of diet and altered metabolism on the central nervous system. Various foods and diets are being studied for their effects on cellular components of the central nervous system such as neuron and glial cells. Diets could have a beneficial role by providing factors that could protect these important cells.
The theory behind the Paleo diet is that our bodies are poorly equipped to handle the modern diet and that we should eat the types of foods that would have been consumed by our ancestors in a hunter-gatherer lifestyle. The Wahls Protocol, an approach promoted by Dr. Terry Wahls, features a paleolithic approach to food, as does the Best Bet Diet proposed by Dr. Ashton Embry.
The Paleo diet focuses on eating natural foods while avoiding highly processed food, especially those that significantly raise blood sugar or contain gluten. It emphasizes the intake of game (non-domesticated) meats and plant-based foods besides cereals, including fruits, roots, legumes and nuts. Animal protein should provide about 30-35% of the daily caloric intake and consumption of lean game meats will help one get recommended amounts of polyunsaturated fatty acids (PUFA). In the Paleo diet the ratio of saturated fats to PUFA is between 1.4-2:1 – unlike the modern diet in which the ratio is closer to 10:1. The Paleo diet is high in fiber (45-100 g/day) that is derived from non-cereal plant sources. While some sources advocate avoiding potatoes and legumes, others do not.
Modified guidelines for the Paleo diet include the following recommendations:
- Consume 3 servings each day of green leafy vegetables, sulfur rich vegetables and intensely colored fruits or vegetables.
- Consume 2 tablespoons of omega-3 oils; 4 oz. or more each of animal protein and plant protein; only non-lactose containing milks; no more than 2 servings per week of gluten-free grains or starchy foods.
- Do not consume any dairy, eggs or gluten containing grains.
A strict Paleo diet may result in deficiencies in folic acid, thiamine and vitamin B6 (due to reduced intake of cereals), calcium and vitamin D (due to lack of dairy intake) and insufficient caloric intake without appropriate nutritional advice.
The Mediterranean diet is highly touted for cardiovascular health. It is somewhat similar to the Paleolithic diet, but may be easier to follow. There are several versions of the Mediterranean Diet which generally share the following components: high intake of whole grains, vegetables, fruits, legumes, olive oil and fish; a low intake of saturated fats (butter and other animal fats), red meat, poultry, dairy products; and a regular but moderate intake of ethanol mainly consisting of red wine during meals.
There is currently no data regarding a Mediterranean Diet and MS, however a meta-analysis of 17 randomized controlled trials demonstrated a positive effect on inflammatory markers. There is evidence for benefit in type 2 diabetes, cardiovascular disease prevention and possibly cancer prevention. No specific nutritional deficiencies would be expected from following the Mediterranean Diet.
The McDougall diet is a low-fat, high carbohydrate, moderate sodium, vegan diet which is based on the premise that the rich Western diet is the cause of several chronic diseases. It focuses on eliminating animal-based food and vegetable fats and replacing them with low-fat plant based foods.
The basic components of the McDougall diet are plant sources of complex carbohydrates and starch (refined flour or white rice are excluded). The suggested staples of the diet include wheat flour products, corn, rice, oats, barley, quinoa, potatoes, sweet potatoes, beans, peas, and lentils. Fresh fruits and non-starch green or colored vegetables can be added to the diet in any quantity. A low sodium intake is encouraged and small amounts of sugar and spices may be used to flavor foods. No animal-derived foods are allowed; therefore dairy, eggs, meat, poultry and fish are excluded. In addition, oils are not allowed (including vegetable oils).
No evidence currently exists for use of the McDougall diet in MS or other autoimmune diseases. It is possible that the McDougall diet could result in deficiencies in iron, vitamin B12, vitamin D, calcium and ω3-fatty acids.
A Gluten-free diet completely eliminates foods derived from gluten containing cereals, such as wheat, barley, rye and triticales (a cross between wheat and rye). Gluten is a protein that combines with starch in wheat, rye and barley, and is a major component of the proteins found in wheat. Gluten sensitivity is a feature of celiac disease for which a gluten-free diet is a common treatment. Besides celiac disease, gluten sensitivity has also been noted in a condition called non-celiac gluten sensitivity (NCGS), which can also lead to gastrointestinal symptoms.
To follow a gluten-free diet, you must avoid all food containing any derivatives of wheat, barley, or rye. And to be aware of how foods are handled to avoid cross-contamination with these components. In looking for appropriate products to consume, it is important to remember that “wheat-free” is not the same as “gluten-free.” As long as gluten-free breads and cereals are substituted in the diet, no nutritional deficiencies would be expected.
Gluten-free diet is a treatment for celiac disease and dermatitis herpetiformis, but there is no evidence for a role of gluten-free diet in patients with MS or other autoimmune conditions such as rheumatoid arthritis.
The Swank diet, essentially a low-fat diet that focuses on reducing both saturated and unsaturated fats, was first described by Dr. Roy Swank in the 1950’s and used by him to treat patients with MS for several years. Details on the diet are available at the Swank MS Foundation website.
To follow the Swank diet, saturated fat intake should not exceed 15 grams/day, while unsaturated fat (oil) intake should be kept below 20-50 grams/day. No processed foods containing saturated fats should be consumed. Similarly dairy products must contain less than 1% fat. Whole grain cereals and pastas are recommended, as are two cups each of fruits and vegetables each day. No red meat is allowed for the first year of following the Swank diet after which 3 oz. of red meat is allowed weekly. White fish and shellfish are permissible in any amount. Skinned trimmed poultry meat is okay. Cod liver oil (1 tsp. or equivalent capsule) and multivitamin supplement are recommended.
Though no definite deficiencies would be expected to develop from this diet, a recent study showed that those following this diet were consuming less than the recommended levels of vitamins A, C, E and folate.
See more helpful articles:
Diet and Multiple Sclerosis by Pavan Bhargava, MD. National MS Society. Accessed January 5, 2016.