Multiple Sclerosis Centers of Excellence
Diet and Multiple Sclerosis: Is There a Relationship?
Vijayshree Yadav, MD, MCR, FANA, FAAN
When people are diagnosed with MS, a common question asked is “What can I do to make myself not be affected much by MS?” We do not fully understand why MS occurs but increasingly, research points towards a connection between environmental factors such as diet, exposure to sunlight, low vitamin D levels, and initial exposure to viruses, bacteria, and other microbes during childhood. Recent studies also suggest a possible connection between dietary habits and our digestive system bacteria that in turn can affect our immune systems, and the development of autoimmune diseases such as MS.
A report published in 2008 that surveyed people with MS from around the world, (“Atlas of MS” by the World Health Organization and MS International Federation) indicated that diet change and nutrition were the most commonly used non-conventional approaches for treating MS symptoms. Another survey done in 2008 by the Central Institute of Health at the University of Hedielberg in Germany, looked at 1,573 people with MS and found that up to 40% of Americans with MS use some form of diet modification after diagnosis. Based on these results, people with MS appear interested in dietary approaches for MS management.
The neurologist Dr. Roy Swank, conducted one of the pioneering studies examining the role of diet in MS in the late 1940’s, an era when no medications for MS were available. He believed that diets rich in saturated animal fats could be bad for MS. He devised the “Swank Diet” as an MS treatment, which consists of no more than 10 to 15 grams of total saturated fat a day, fish and chicken as primary protein sources, and only dairy products containing 1% or less fat. He supplemented this diet with cod liver oil, which is enriched in omega-3 fatty acids. Dr. Swank studied the effects of this diet on survival and disability in 144 people with MS over a span of 50 years. The study included two groups of people with MS: 70 “good dieters” who followed a strict low-fat diet, consuming less than 20 grams of fat per day, while 74 “bad dieters” consumed more than 20 grams of fat per day.
Thirty-four years into the study, it was found that “bad dieters” had a death rate that was more than double that of the “good dieters.” By 2000, 15 of the original participants in the study were alive, all of them belonging to the “good dieters” group with the majority of these participants (13 out of 15) still ambulatory. Although this study has been criticized for inadequate scientific proof, it remains a unique long-term study of an intervention showing possible benefits on survival and disability in people with MS.
Recent research involving approximately 9,000 people with MS suggests a relationship between MS related disability and vascular disease risk factors such as high blood pressure, high blood fats, and heart disease. This study found that the presence of one or more of these diseases increased the risk and onset of walking disability in MS and the risk increased with the number of each vascular condition.
In a recent two-year study, researchers studied blood fat (lipid) levels and compared them to MS-related disability and brain imaging (MRI) outcomes. It was found that higher low-density lipoprotein, or “bad” cholesterol, and total cholesterol levels were associated with higher MS disability and higher high-density lipoprotein, or “good” cholesterol, was associated with lower inflammatory disease activity on the brain MRI.
Researchers at the MS Center at Oregon Health and Science University in Portland, OR are studying a very low-fat vegan diet developed by Dr. John McDougall. Within this diet, meat, fish, poultry, and animal products are eliminated, total fat is less than 20% of daily intake, and refined flour is restricted. This study includes 61 people with relapsing-remitting MS and the goal of the study is to measure the effects of diet on brain MRI, MS relapse, disability, and blood-brain barrier disruption (neuroaxonal degeneration) in MS.
Upon review of the research, there appears to be a pattern supporting the idea that healthy dietary changes can be beneficial for MS and can decrease MS disability progression. So, what is a person with MS to do? First, there is no evidence that following a low-fat diet is a “cure” for MS and it should not be used in place of appropriate use of disease modifying therapies. Second, it is reasonable to follow a healthy, low fat diet, such as that recommended by the American Heart Association. Third, for those who are motivated to adhere to a more stringent, well-balanced low-fat diet, following the Swank Diet or a well-balanced vegan diet, such as the McDougall Diet, is safe and may be beneficial. More research needs to be done to determine whether a low-fat diet is actually a partial treatment for MS. Until then using common sense is prudent. If you would like additional information on these low-fat diets, visit www.swankmsdiet.org, www.drmcdougall.com, or www.americanheart.org.
