Diet and Supplements in MS: A Reasonable Approach
In some respects, the role of diet and dietary supplements in multiple sclerosis (MS) is controversial. The most conservative, mainstream approach purports that, because the evidence is inconclusive, dietary strategies should not play a significant part in MS treatment plans. At the other end of the spectrum, some have claimed that a particular diet or supplement can cure the disease.
“Both views are overstated and are not helpful to people with MS,” says Allen C. Bowling, MD, PhD, Associate Medical Director at the Rocky Mountain Multiple Sclerosis Center in Englewood, Colorado and an authority on alternative medical approaches to MS.
“For those who prefer to use only absolutely proven treatments, there’s no diet or supplement to use. For people interested in low-risk, possibly effective dietary strategies, there are a few options,” he adds. “Such approaches should be used in addition to, rather than instead of, FDA-approved disease-modifying therapies.”
Proper Nutrition is Key
The main point when discussing dietary approaches, however, says Nancy Caldis-Coutris, RD, a clinical dietitian with the Multiple Sclerosis Clinic at the Winnipeg Health Sciences Center in Canada, is to realize that nutrition alone is not an alternative approach. “Nutrition plays an integral role in maintaining good health as well as preventing and treating many of the secondary complications of MS,” Ms. Coutris says.
“There is no magic diet that will cure this disease,” she adds. “The most important advice I offer people with MS is to follow a balanced diet. People with MS commonly experience secondary complications associated with the disease, such as fatigue, changes in mobility, changes in bowel habits, or difficulty swallowing,” she notes. “Nutrition intervention is a critical component to the treatment and prevention of these complications.”
Good and Bad Fats
A study conducted many years ago by Roy Swank, MD, suggested that decreasing saturated fats improves outcomes in MS. The “Swank diet” severely restricts saturated fats and increases polyunsaturated fats.
“Dr. Swank’s study was long-lasting, but poorly designed by today’s standards,” Dr. Bowling comments. As of yet, he adds, “no well-designed clinical trial has considered whether decreasing dietary sources of saturated fats improves outcomes in MS.” However, there is some basis to the reasoning that limiting saturated fats can be beneficial in MS.
Saturated fats are solid at room temperature and are generally found in animal sources such as meat, dairy, and eggs. They are also found in coconut oil and palm kernel oil.
Polyunsaturated fats (omega-3 and omega-6) may be more beneficial than saturated fats. “The reason these fats are so important is because they are considered essential, which means that the body cannot synthesize them. We therefore must obtain them from the diet,” Ms. Coutris explains. According to Dr. Bowling, because the average American diet is relatively high in omega-6 fatty acids and low in omega-3 fatty acids, the most reasonable strategy for improving one’s health may be to increase omega-3 intake.
Fatty fish is probably the best food source from which to obtain omega-3 fatty acids; this includes Atlantic herring, Atlantic mackerel, bluefin tuna, sardines, and cod. Flaxseeds, walnuts, and eggs also contain omega-3 fatty acids.
“There is some evidence that increasing polyunsaturated fats and decreasing saturated fats mildly suppresses the immune system,” Dr. Bowling says. “In theory, that should be helpful in MS because the disease involves an immune system that is overactive in specific ways.” Also, evidence obtained from population studies shows that MS is less common in countries where dietary intake of omega-3 acids is relatively high.
“Although no single study of omega-3 fatty acids conclusively demonstrates a favorable effect in MS, the body of evidence, considered as a whole, is quite suggestive,” he adds.
Vitamin D and Calcium
Several recent studies have linked deficiencies in vitamin D to a higher risk of MS. The incidence of MS appears to increase with latitude, or distance from the equator, notes Dr. Bowling. Sunlight is needed to convert a precursor to the biologically active form of vitamin D. It has been theorized that populations living in areas where there is low exposure to sunlight are prone to vitamin D deficiencies and hence to higher incidences of MS.
“In terms of treatment, however, vitamin D has never been studied rigorously among people with MS in a direct way,” says Dr. Bowling.
Regardless of its possible role in treating MS, vitamin D, along with calcium, is recommended for the treatment and prevention of osteoporosis (loss of bone mass which makes bones susceptible to breaking). People with MS have an increased risk of osteoporosis because immobility, lack of weight-bearing activities due to fatigue, and corticosteroid use increase the risk, explains Ms. Coutris.
The recommended daily calcium intake for adults is between 1,000 and 1,200 mg. The recommended daily intake of vitamin D is 400 international units (IU), but recent studies suggest it should be higher. However, at high doses vitamin D can be toxic. The upper limit of vitamin D, or the highest dose at which it is thought to be safe, is currently set at 2,000 IU.
Dietary sources of calcium include low-fat diary products, fish, almonds, and certain types of beans.
Are There Any Risks?
People with MS should consult with their health care provider before taking any supplements or drastically modifying their diets. In addition, they should be sure to find out about any possible warnings or side effects, stresses Dr. Bowling. Increased polyunsaturated fat intake, for instance, may increase the risk of bleeding in people with bleeding disorders or in those taking blood-thinning medications.
These fats may also deplete vitamin E, warns Dr. Bowling. He recommends that people supplementing with fish oils or other polyunsaturated fats slightly increase their vitamin E intake.
And some supplements may be harmful for people with MS. “Supplements that are known to stimulate the immune system may, theoretically, be harmful, especially in high doses or when used for extended periods of time. These include vitamins A, C, and E, and herbs such as Echinacea, ginseng, and alfalfa, among others.
Supplements that may stimulate the immune system include vitamins A, C, and E, and herbs such as Echinacea, ginseng, and alfalfa, among others. “Although it is possible that some of these supplements may be harmless, or may even offer some benefits, none have ever been carefully studied in people with MS to assess safety,” he points out.
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