Fat and MS

There are diets out there that claim to do wonders to halt the progression of MS centred on modifying fat in the diet e.g. the Swank diet.  The central principle is strictly limiting saturated fat and eating more polyunsaturated fats, maybe taking supplements.

It is quite logical to consider that fats may play a role in managing MS since the myelin sheath (that insulates the nerves in a similar way to the plastic that covers electric wires) has very high fat content, as does the human brain.  This fat is very high in long chain polyunsaturated fats and in particular essential fatty acids – fatty acids that we have to obtain from the diet.  Good sources of these fats are nuts, seeds and oily fish.

In addition, inflammation, controlled in the body via a complex ‘cytokine’ system where fats are crucial, is an important part in auto-immune diseases such as MS.  Inflammation is a necessary part of the immune  system however in auto-immune diseases, excessive or unnecessary inflammation can be a contributory factor in the symptoms. During active phases of MS, inflammation along the myelin sheath is believed to contribute to damage resulting in MS symptoms.

It is believed that how fats act within this cytokine system results in different effects on inflammation with animal fats considered to be pro-inflammatory and fats found in nuts, seeds and fish considered anti-inflammatory.

So what is the evidence – can modifying the fat in the diet help MS?

Studying the effect of any component of diet in MS progression is very difficult.  The pattern of MS progression varies incredibly between individuals and happens over a long time period.  The frequency of relapses, the duration of both relapses and periods of remission, disability scores and how these change are all used to assess treatments and interventions but the baseline, with no interventions at all, vary incredibly between individuals.

When looking at the effect medicines have on disease progression, definite doses are given and compared with a control group who are given a placebo in blinded trials (no-one knows who is getting the treatment until it is time to analyse the results) and no other aspect of what the person is doing changes.  This allows clear comparison between the treatment and non-treatment group.

When we look at diet, it is hard to ‘blind’ people to the trial. It is likely that changing one aspect of diet is going to result in other dietary changes.  When getting people to change the way they eat then compliance is hard to achieve across the whole test group and there can be a higher rate of drop outs, especially when good trials would need to be fairly long in duration to ensure reliable results.  Other lifestyle factors like stress can affect the progression of MS and these factors have to be controlled for if studying the effects of diet.

As a result, to get a real picture of how any one aspect of diet might affect MS progression, studies need to be very well designed, be quite long in duration and require lots of people to stick with the study, following up those who drop out.  There are not enough studies that meet the strict criteria to say for definite that modifying fat does, definitively, slow the progression of the disease.

A really good summary in easy to read language can be found at:

http://www.neurologycare.net/diets-and-fatty-acid-supplements.html

Does the evidence support following a strict diet such as the Swank diet?  I would say no, there is insufficient evidence of benefit that balances the risk associated with the difficulty in maintaining a good balance of foods and nutrients on such a restrictive diet.  Supplements would be necessary and it may be hard to get sufficient protein and energy.  This could have negative effects on health and well-being.

However, taking some of the principles of the Swank diet may be beneficial.  Eat less red and processed meat, eat more nuts, seeds, fish and polyunsaturated oils, eat plenty of fruit and vegetables and whole grain cereals, choose lower fat dairy products and taking a fish oil supplement with vitamin D could be beneficial.

This advice is very similar to general eating well advice with a focus on the mixture of fat in the diet.

Following a specific diet can give a sense of taking control over the disease and may give some people benefits.  Always discuss with a health professional if you want to embark on a special diet.  Treat with caution diets that are:

• very restrictive;
• that are communicated alongside selling of products (supplements for example);
• that sound too good to be true;
• make it very hard to maintain some normality and enjoyment at meal times;
• are very costly.

Diet can’t cure or halt MS but eating well and taking care of your body alongside conventional treatment has the potential to reduce the severity of relapses and lengthen periods of remission.

I saw this recipe which is a mix of oily fish and nuts and seeds – it seemed appropriate and is very tasty.

Salmon with a Dukkah Crust:

Dukkah is an Eygptian blend of nuts, seeds and spices.  There are lots of recipes, this is a basic one which you can adapt to taste with other nuts and seeds and spices.

Toast a mixture of nuts in the oven until they are golden – hazelnuts, pistachios, almonds for example.  Dry fry some coriander and cumin seeds for a few minutes.  Then grind the spices and nuts with maybe some pepper and dried chilli flakes if you like some heat.  Stir in sesame seeds and maybe pumpkin or sunflower seeds.  You can freeze it as it is hard to make in small quantities.

Use this mix to make a crust on a piece of salmon and bake in the oven.

Dukkah is also used as a dip – dip some flatbread into a quality oil and then dip into the Dukkah.  A little different and very tasty.

Enjoy.