Diet and Supplements in MS: A Reasonable Approach

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Diet and Supplements in MS: A Reasonable Approach

Postby Melody » Thu May 04, 2006 5:09 pm

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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John was diagnosed Jan 2005. On lipitor 20mg .On Copaxone since July 4,2005. Vitamin D3 2000iu-4000iu (depending on sunshine months)June 10 2005(RX::Dr. O'Connor) Omega 3 as well Turmeric since April 2005. Q10 60mg. 1500mg liquid Glucosamine Nov 2005.
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Postby Axiom » Sat May 06, 2006 9:43 am

“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.”

“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,”

“In terms of treatment, however, vitamin D has never been studied rigorously among people with MS in a direct way,”

“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,”


“For those who prefer to use only absolutely proven treatments, there’s no diet or supplement to use."


So what absolutely proven treatment IS there?

I'd love to see some more comprehensive, well-designed studies on nutritional strategies.

I asked the neurologist about making dietary changes early on and got:
no good studies to support it...
won't effect the course of the disease one way or the other...
Being generally healthy might help with complications...
etc, etc.

It would sure be nice not to have to weed through a myriad of studies and take little snippets here and there and then try to figure out how everything may or may not work together on your own.

Nothing is easy with this disease!
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Postby Melody » Sat May 06, 2006 8:39 pm

Axiom diet makes sense. Removing toxins makes sense. Limiting allergens makes sense. IMO there are so many scenarios that we need to each look for the answers that apply to our own case. It sucks in one way but it gives you power in another. I have so much to write here but I've discovered I can't it seems unbelievable but the answers IMO are there in what makes sense. Just pick a plan and stick with it. Tweak it with supplements(IMO) and stay on the path. No smoking, caffeine or aspartame for starters will help. Limit fat for sure. Have your allergies checked. Vitamin D Dr. O'Connor says is a must and I have other's I believe work. There are also boundaries to be played with. Do you believe in suppressing the immune system or boosting it? There are debates on both sides. You might straddle the fence like John and I as we seem to be doing both. John went with Copaxone and although it scares me I support his decision. He supports me by eating what I tell him I think will help and taking his supplements. Not saying it is right but at least we have a game plan. So far so good.
John was diagnosed Jan 2005. On lipitor 20mg .On Copaxone since July 4,2005. Vitamin D3 2000iu-4000iu (depending on sunshine months)June 10 2005(RX::Dr. O'Connor) Omega 3 as well Turmeric since April 2005. Q10 60mg. 1500mg liquid Glucosamine Nov 2005.
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copaxone

Postby notasperfectasyou » Sat May 06, 2006 8:59 pm

Is John RR, SP or PP? Has he been on INF's? What was the key criteria in choosing Copaxone? There is a lot of research out on copaxone that is quite favorable, however, I think I'd go with an INF for RR. napay
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Postby Melody » Sun May 07, 2006 6:12 am

Dr.O'Connor said John was PP and offered him the retuximab study and told him to take 2000-4000iu of Vitamin D3 daily depending on sun exposure. We didn't care for that DX :wink: so we changed to the MS clinic at Sunnybrook and went with DR. Lee and he said RR so we picked that. :D To be fair to Dr. O'Connor John had seen no improvement in his condition since his first attack in 1998 so hence the DX. Funny thing was John noted the improvements starting within days of seeing O'Connor. That was just before he started on copaxone. Now the only sign of MS is his optic neuritis but even that is showing improvement. By the time we saw Dr.Lee 2.5 weeks after O'Connor the numbness John had suffered from for 11 months just left and never came back. His restless leg syndrome disappeared as well as his eczema. This was due to supplements,diet and reducing toxins and allergens IMO. We had started tweaking that four months before We didn't like the sounds of the INF'S for a number of reasons and copaxone seems to tolerate quite a few alternates which I liked the idea of.
John was diagnosed Jan 2005. On lipitor 20mg .On Copaxone since July 4,2005. Vitamin D3 2000iu-4000iu (depending on sunshine months)June 10 2005(RX::Dr. O'Connor) Omega 3 as well Turmeric since April 2005. Q10 60mg. 1500mg liquid Glucosamine Nov 2005.
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vitamin d abstracts

Postby jimmylegs » Sat May 13, 2006 7:26 am

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diet and ms

Postby jimmylegs » Mon Jun 05, 2006 6:02 am

i'm reading this for the second time and it's making me pretty angry. the part about vitamin D doesn't even mention its usefulness to the immune system. and it has been studied in people with ms. omg who is this person kidding?
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