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Food for thought

1 October 2015

Like many others who are newly diagnosed, I have undertaken some research into, and been the recipient of generously provided advice regarding the various diets that claim to bring benefit to those with MS. However, I have quickly realised this is murky territory with a vast array of wide-ranging yet often conflicting options to explore. Furthermore, many such dietary-based interventions are touted, if rigorously followed, to cure or “overcome” the condition which does rather up the ante somewhat. It can be overwhelming to process all recommendations on offer, so I thought I’d summarise my findings in this easy-to-digest (yes, pun intended) recap of the highlights of my investigations.

Firstly, let’s look at the macronutrients:

Fats: If you have had your head buried in sand for the last two decades, you may still subscribe to the myth that all fats are created equal. (Spoiler alert: they are not.) Their reputations run the gamut from miraculous cure-all to evil scoundrel. Generally accepted medical opinion deems trans fats to be the worst culprits, condemning them for being devoid of anything beneficial, clogging arteries and demyelinating neurons. These toxic substances are found in almost all processed foods and fast foods, so you can kiss goodbye to McDs and all its brethren. At the other end of the spectrum, you can liberally douse your food with unadulterated extra virgin olive oil seeing as this high quality source of polyunsaturated fatty acids is as pure as Mary herself. Just make sure you don’t subject it to high temperatures i.e. fry with it, in which case it will suddenly morph into a vile substance poised to wreak havoc on your precious DNA. Another word of warning, EVOO’s miraculous benefits don’t apply if you are an apostle of Esselstyn’s “prevent or reverse heart disease” diet (or are from China), in which case studies have shown that you should not eat fat. Period. The pendulum can swing either way with saturated fats too, particularly coconut oil, and these will either be demonised or deified depending on whether you are a card-carrying cardiologist, a Paleo-protagonist and various other seemingly random factors such as the current positioning of Venus or whether a butterfly flapped its wings in Argentina.  

Protein: Eating protein is important because it helps maintain muscle strength and promote repair, so make sure you include a source of protein in each and every meal. Protein is best in the morning so eat it for breakfast and lunch but not dinner. Animal protein is high in saturated fat, which has been known to cause heart disease and has been linked with disease progression in MS, so best to eliminate it. Plant-based protein (beans and pulses) are generally low-fat and are considered a much healthier alternative, but before shouting hooray for hummus, be mindful they are contaminated by a number of so-called “anti-nutrients” (phytic acid and lectins). These pesky little devils will either bind to important micronutrients, preventing your body from absorbing them properly, or else will destroy the lining of your intestine, allowing food particles to leak through. Either way you are screwed unless you take extra measures to soak, sprout or ferment your legumes. Should the lengths required to circumvent such health hazards be too great, simply pitch those pesky proteins and move on to a safer food group.

Carbohydrates: If you have now dutifully excluded the culinary criminals listed above, it will be a relief for you to know that eating whole grains has been shown to help protect against MS. However, our Paleo pals will argue that grains have only been added to the human diet relatively recently, during the agriculture revolution over the last 10,000 years. Advocates of Cordain’s caveman diet claim our guts have not yet adapted to metabolise grains, thus rationalising their exclusion. Even those of us who aren’t of the Paleo persuasion may still cut carbs in order to “keep in ketosis”, as per the Grain Brain hypothesis, particularly seeing as preserving long-term neurological function hits rather close to home. Regarding simple carbohydrates, it practically goes without saying that eating sugar should be shunned. It promotes inflammation, increases glucose resistance, rots your teeth and contributes to weight gain and chronic diseases. Nuff said. Other than it also tastes really, really good and my children will do anything for it.

Food picture

Now, let’s consider some other dietary suggestions…

Dairy: People with MS are prone to developing osteoporosis, so it is important to consume adequate calcium and dairy foods are an excellent source of calcium. Be mindful though that low fat dairy foods are full of sugar, so steer clear of the skim stuff. Full fat dairy is fine, so have as much as you like. However, there is a high correlation between cow’s milk consumption and MS and the protein in cow’s milk causes brain lesions. Any food containing these should therefore be avoided if you value your myelin.  The same goes for sheep’s milk and goat’s milk, as well as soy substitutes, as the protein in them is structurally similar to that found in cow’s milk. Unicorn milk is fine and has been purported to have many health benefits, so long as it is organic, free-range, locally-sourced, non-pasteurised, un-homogenised and has been hand-milked by a Greek goddess.

Beverages: Anything sugar-laden is out, but so are the sugar-substitutes, so sideline those soft drinks. Caffeine exacerbates MS symptoms, therefore say sayonara to Starbucks. Tea is OK as it has less caffeine. Just don’t contaminate it with casein-containing cow’s milk. Green tea deserves an honourable mention as it contains compounds shown to slow MS disease progression. Nut milks are highly processed with ingredients you grandmother wouldn’t be able to pronounce so only consume if you make them yourself from pesticide-free hand-picked non-rancid nuts stored in the fridge and suitable de-chemicalised, de-contaminated and de-ionised dihydrogen oxide.

Dark chocolate: This does, in fact, qualify as its own food group, in our household at least. Low in sugar, full of anti-oxidants, cholesterol-lowering and an excellent source of energy but gosh-darnit, it contains truckloads of saturated fat, so eat only minute amounts. A mere shaving on top of your decaffeinated organic green-tea almond-milk cappuccino will do you for a month.

Nuts: Nuts are nutrient-dense--full of good fats, fiber, and magnesium, all of which have important roles in regulating inflammation, so you can eat as many as like. They do have significant amounts of saturated fat so don’t consume more than 4-5 times a week. They also contain antioxidants. Some antioxidants can stimulate the immune system and MS is an autoimmune disease, meaning that parts of the immune system are already too active. It is theoretically possible that increasing immune activity by using antioxidants can stimulate MS disease activity. Therefore, don’t eat nuts.

Gluten: Well-known with its link to coeliac disease, it’s also been suggested that antibodies directed against gluten may play a role in the pathogenesis of MS by affecting the permeability of the blood-brain barrier. However, the jury is still out on this because evidence for beneficial effects of a gluten-free diet for MS patients has been inconsistent. Seeing as you have already conscientiously boycotted grains (see Carbohydrates above), the point is moot anyway.  

Fish: You should eat boatloads of fish because they contain lots of omega-3 fatty acids which are great for your arteries, your brain and for lowering inflammation. Don’t eat fish with mercury in it, as mercury is a neuro-toxin and will cause neurodegeneration and inflammation. Mercury and PCBs are in all types of farmed fish, so just eat fish that are sustainably sourced. Mercury occurs naturally in the environment and accumulates in the aquatic food chain, including fish, as methyl-mercury and all fish have some mercury so don’t eat fish. Ever.

Fruit: An excellent source of many vitamins and minerals. Unfortunately contains sugar, so don’t overdo it. Alternately, cut out completely if you are aiming for Atkins or have settled in South Beach. 

Vegetables: At last, a food group you can knock yourself out on! Full of vitamins and minerals, minus the evils of sugar. But hang on a second. Unfortunately all those good micronutrients aren’t well absorbed unless you have some fat with them (which you shouldn’t do if you value your arteries and astrocytes). Furthermore, lurking within the most seemingly uber-healthy of all entities, the “greens”, is oxalic acid, another so-called anti-nutrient, poised to rob your cells of compounds vital to their functioning. Finally, you will need to consume bushels in order to meet your daily calorie requirements. Speaking of which…

Total calories: Getting adequate calories is important to provide energy, heal wounds, and fight infection. However, you’ll need to weigh up (yes, another terrible pun, I can’t help it) the relative merits of these versus the neuroprotective and anti-inflammatory adaptations due to chronic calorie restriction (at least if you are a mouse and have experimental autoimmune encephalomyelitis, which is how MS is studied in the lab). If cutting out 40% of your daily recommended food intake doesn’t tempt you, an alternate approach is to adopt the 5+2 diet, whereby you only need to starve yourself two days a week (although to a much greater extent – on those days you’ll need to forgo 75% of your usual fare). Either way, you’ll be spending a fair bit of time ruminating on how hungry you are, but let’s look on the bright side here. As there are very few universally endorsed food groups still on the table, this almost makes life easier. Rather than figuring out whether to cut carbs, pass on proteins or forgo fats – hey, ditch the lot of them!

Salt: Deficiencies in iodine have been associated with MS and iodized salt is an excellent way to obtain iodine. Unfortunately, reports in medical literature indicate the more salt in MS patients had in their diet, the more likely they were to relapse and have a greater risk of developing new lesions. Moreover, there does appear to be a mechanistic link whereby high salt conditions favour the induction of a particularly unhelpful type of inflammatory cell that contributes to a more severe phenotype (if you are a mouse). The best bet may be to nix the NaCl where you can.     

Iron: Given its crucial role in facilitating oxygen transport from the lungs to your hard-working cells, it is important to maintain optimum iron levels by consuming adequate iron from your diet. However, good luck to you in terms of finding an approved source. Animal protein (particularly red meat) has oodles of iron and it is of a form that is easily absorbed, but we’ve already vetoed it due to the sins of saturated fat. Plant protein has some too, but it is similarly unsanctioned. If you are worried about not consuming enough, there are iron supplements, but even these are not without controversy as iron has been shown to accumulate in demyelinating brain lesions and is generally thought to be detrimental.  

Vitamin D: A discussion on MS and dietary supplements would not be complete without mentioning this particular compound. Research is increasingly pointing to a reduced level of vitamin D in the blood as a risk factor for developing MS, and studies are underway to determine if vitamin D levels influence MS disease activity. However, how much to take is still a matter of debate, as is what an optimum level is, and many neurologists are completely indifferent with regards to supplementation. Thankfully, people with MS tend to be veterans when it comes to dealing with uncertainty. One approach is to toss up a handful of tablets, open wide and however many fall into your mouth is that day’s dosage.

So in summary, each MS diagnosee wins the lucky task of assessing the scientific evidence to date and deciding whether or not to take a chance and eat such foods listed above, or to play it safe and avoid them until further scientific insights irrefutably condemn particular foods as foe or completely vindicate them. As playing it safe involves lots of vegetables, possibly some fruits and very little else, best to make good friends with your green grocer and avoid eye contact with the butcher, baker and pretty much every eating establishment. Alternately, you may well choose to ditch the baby, bathwater and barrage of advice and eat ad libitum. Either way, it is imperative that you, above all else, DON’T STRESS about how, when and what you chew or eschew. Stress causes inflammation, and will stop your disease-modifying drugs from working properly, increase your blood pressure and if the MS doesn’t get to you first, then a heart attack or stroke will.

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