- Many dietary components have an influence on the immune/mitochondrial function and gut microbiota diversity in those with multiple sclerosis (MS).
- Children with MS and with a high energy intake from saturated fat are at a higher risk for relapse.
- Vegetable intake may be independently protective and reduce the chances of relapse by 50%.
Children with multiple sclerosis
have a higher risk of relapse than adults. Apart from medications and physiotherapy, diet has a major role in the risk of relapse. Certain nutrients such as saturated fats and sodium increase the risk of relapse, while vegetable intake and omega-3 fats help in treating the condition.
There is a range of treatments that are recommended to reduce the severity of the MS and to slow down disease progression. Muscle relaxants, anti-depressants, steroids and physiotherapy are also recommended for the patients. Recently, there are research findings that point the importance of diet in treating MS.
Significance of Diet in Multiple Sclerosis
Apart from medications and physical therapy, diet also might have an impact on the treatment of MS. Though it remains unclear, there is evidence that the incorporation of certain nutrients can help treat the disease, especially in children.
‘Saturated fats and foods high in salt can worsen multiple sclerosis (MS), while a diet rich in omega-3 fats and fiber can reduce the severity of MS.’
A multicenter study done at 11 pediatric MS centers in the USA studied the effect of diet on relapse rate of MS in children. For the study, 219 patients with pediatric relapsing-remitting MS (RRMS) were recruited. Their disease onset was before 18 years of age and they have the disease for a duration of less than 4 years.
Using the validated Block Kids Food Screener, the diet pattern of the children was assessed a week before they were enrolled in the study.
The findings show that for each 10% increase in energy intake, the hazard of relapse increased by 56% and for every 10% increase in saturated fats, the hazard tripled.
Another study done among women found that restricting saturated fat is essential because people with MS, particularly women, are already at a higher risk of heart attack
, heart failure, stroke and atrial fibrillation
than those without MS. Food sources of saturated fats
include clarified butter (ghee), coconut oil,
vanaspati, beef fat, lard, high-fat bakery products, margarine. Foods that are prepared with butter and margarine are usually palatable and may increase the chances of overeating.
The body uses saturated fats to produce low-density lipoprotein (LDL) also known as bad cholesterol, which is harmful. Only 7% of the total calories should come from saturated fats. Those with MS should limit their saturated fat intake by reducing the consumption of red meat, bakery products, fast food and fried snacks. Sodium
Another nutrient that has to be on the check is sodium. Table salt is a major contributor to our overall sodium intake. Also, fried snacks, preserved and precooked foods have quite a lot of sodium that may not be necessary for the body, especially for those with MS.
A study done by Mauricio Farez, and team in 2015 found that individuals with high sodium intake had a 3.4-fold greater chance of developing a new lesion and the chances of relapse were also high.
Another reason to restrict sodium is that it can increase blood pressure and can trigger heart disease. Less than 2,400 milligrams (mg) of sodium a day is recommended for those with no history of heart disease and less than 1,500 mg for those with heart-health concerns. Vitamin D
Vitamin D or the sunshine vitamin is known for its vitality in bone health and calcium homeostasis. Recently, the vitamin is also gaining importance for its presence in the brain and immune cells in the form of vitamin D hydroxylating enzymes. Deficiency of Vitamin D
is also related to nervous disorders including MS, Parkinson's disease. Though the exact mechanisms remain unclear, the beneficial effects of Vitamin D depend on gender, diet, vitamin D receptor (VDR) polymorphisms and sunlight exposure. Supplementation of vitamin D in patients with low vitamin D levels below 30 ng/ml may be relevant for predictive, preventive, and personalized medicine. Swank Diet
The Swank Diet
was proposed by a neurologist Roy Laver Swank in the year 1949. The diet that is low in saturated fat, was suggested for the treatment of multiple sclerosis. Menu Pattern of Swank Diet
The diet consists of very less saturated fats, red meat, minimal intake of dairy and high intake of foods rich in omega-3 fats.
- Not more than 15gms or a tablespoon of saturated fats per day
- Unsaturated fat in the form of cooking oil, should be kept to 20-50 grams per day
- The complete omission of red meat for the first year of diagnosis. After a year, a maximum of 3 oz. (85 grams) of red meat per week
- Low-fat dairy products with 1% or less butterfat
- A good source of oily fish, flaxseed, cod liver oil and foods rich in omega-3 fatty acids
- No restriction on wheat and gluten
Swank claimed that the diet could "slow progression of the disease as well as benefit overall health" but there has been no clinical evidence on the effectiveness of the diet and so it is not suggested. Omega-3 Fats Depression is a major threat to those with MS. The patients are prescribed anti-depressants but,
29%-46% of depressed patients show a partial to no response to anti-depressant medication therapy. In such cases, omega-3 fats were found to have an impact in reducing depression.
Fish oil capsules that contain both eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), when administered to adults with MS for three months improved treatment-resistant major depressive disorder.
A healthy diet rich in whole grains, vegetables and fruits can reduce disability and symptoms in people with MS.
A study published in the journal Neurology
found that patients with MS who followed a healthy diet were 20% less likely to have more severe physical disability than people who did not follow a healthy diet.
The study also found that patients who followed the healthiest diet were 20% less likely to have more severe depression than those with the least healthy diet.
A healthy diet reduced the risk of
- Depression by 50 percent
- Fatigue by 30 percent and
- Pain by 40 percent
The National Multiple Sclerosis Society (NMSS), admits that no single diet can treat or cure MS. The symptoms of MS symptoms typically come and go, and so measuring the effectiveness of a diet is difficult. But, a low-fat, (low saturated fat ) high-fiber diet (rich in whole grains, vegetables, fruits) can reduce the symptoms and relapse of MS.
What is Multiple Sclerosis?
Multiple sclerosis is an autoimmune disease that affects the nerves and may persist all through the life.
MS affects more than a million people worldwide and
attacks young people usually in the age group of 20-40 years.
It is not a killer disease and the patient has more or less a normal lifespan but gradually as the condition worsens, the patient is totally disabled.
It has an autoimmune origin, that is,
the body begins attacking its own nerve fibers. When the fibers become scarred, they fail to convey signals to and from the brain. This can result in loss of sensation, weakness, inability to walk, see or balance oneself, depending on the particular nerve affected by sclerosis. References :
- Saeedeh Azary, Teri Schreiner, Jennifer Graves, Amy Waldman, Anita Belman, Bianca Weinstock Guttman,Gregory Aaen, Jan-Mendelt Tillema, Soe Mar, Janace Hart1, Jayne Ness, Yolanda Harris, Lauren Krupp10, Mark Gorman, Leslie Benson,Moses Rodriguez, Tanuja Chitnis, John Rose, Lisa F Barcellos, Tim Lotze, Suzan L Carmichael, Shelly Roalstad, Charles T Casper1,Emmanuelle Waubant. 'Contribution of dietary intake to relapse rate in early paediatric multiple sclerosis'. http://dx.doi.org/10.1136/jnnp-2017-315936
- Koduah P, Paul F, Dörr JM. Vitamin D in the prevention,prediction and treatment of neurodegenerative and neuroinflammatory diseases. EPMA J. 2017 Nov 15;8(4):313-325. doi: 10.1007/s13167-017-0120-8.
- Kathryn Fitzgerald. Diet and disease modification in multiple sclerosis: anutritional epidemiology perspective. http://dx.doi.org/10.1136/jnnp-2017-316375
- Kathryn C.Fitzgerald, Tuula Tyry, Amber Salter, Stacey S. Cofield, Gary Cutter, Robert Fox, Ruth Ann Marrie. Diet quality is associated withdisability and symptom severity in multiple sclerosis. Neurology, 2017; 10.1212/WNL.0000000000004768 DOI: 10.1212/WNL.0000000000004768