Diet & MS Research

[ElliotB]

Perhaps the most important message from this study is that diet effects people with MS, something we probably already knew. Which diet is best is another story. Because ultimately if identical studies were done on all the different MS diets, the results for each diet would likely be the similar, because most people do well regardless of the diet they follow, especially if they are at the RRMS and likely SPMS stages.

But what is interesting is that this study included twenty ambulatory patients. But the results are not specific as to what the effect of diet was to this specific group.

Another oddity of this study is that a second variable, increased intake of the micronutrients cholesterol, folate, iron, and magnesium, was introduced. Usually when a study is done, there is only one variable that changes. Was it the diet or micronutrients that caused the improvement, or both?

There is ample evidence the a high good fat diet is likely a good diet to follow and additional studies will hopefully be done. Meat with good fats (high in EFAs/Omega 3s (whether from red meat, poultry or seafood) should likely be part of a healthy diet.

[jimmylegs]

i don't believe there was anything 'introduced' or experimental about the micronutrients.

i haven't reviewed in fine detail, but my understanding is that they recruited via convenience sample, calculated nutrient intakes from subects' three day diet diaries, measured performance on various tests, and looked for any status quo patient nutrient intake correlations with performance, that achieved significance.

if i had time i'd be checking what the authors mean by higher and lower in absolute rather than relative terms. eg what if 'lower fat' means negligible/deficient daily fat intake, and 'higher fat' in this study context means 'adheres to healthy sat fat and total fat grams per day'...

[Zyklon]

Whatever diet makes us happy...

I believe specialized diets for MS are overrated. We are not different than non-MS people. Science, please prove me that I am wrong.

[jimmylegs]

i don't have the impression that study subjects were adhering to any specific diet. just that the researchers measured components of their status quo diet and noted which elements correlated to better health indicators.

pretty sure diets that make people happy (especially where happiness is measured in terms of convenient quieting of a growling belly with minimal time and effort) are a huge contributor to chronic health issues in developed nations

i agree that specialized 'ms' diets are overrated. there's a case to be made for specialized 'individual' diets.

not having spent much time on it to date, nutritgenomics has a distinct flavour of big brother - so far anyway. but genetics do tend to be a limiting factor where my capacity to help others with 'joe public' nutritional info is concerned.
https://www.sciencedirect.com/science/a ... 4415301400

[jimmylegs]

Comparing the Impact of Saturated Fatty Acids from Different Dairy Sources on LDL Particle Size Phenotype (2018)
https://www.fasebj.org/doi/abs/10.1096/ ... ment.966.5

abstract excerpt:

Abstract
Background
Low-density lipoproteins (LDL) constitute a heterogeneous class of lipoproteins among which small and dense LDL may be more atherogenic than large LDL particles, independent of cholesterol concentrations. The aim of this study was to examine how consumption of saturated fat (SFA) from different dairy sources modifies the LDL particle size phenotype compared with other dietary fats ...

Consumption of the BUTTER diet significantly increased LDL mean size compared with CHO (p=0.021) and MUFA (p=0.005). ...

Conclusions
Results from this full-feeding study suggest 1- that SFA from butter and cheese have similar effects on features of the LDL particle size phenotype, and 2- that consumption of SFA from butter may be associated with less atherogenic LDL particles. These data are partly consistent with the fact that consumption of cheese and butter are not associated with an increased risk of cardiovascular disease.

[jimmylegs]

still love this one speaks my language in spades.

[jimmylegs]

Dietary approaches to treat MS-related fatigue: comparing the modified Paleolithic (Wahls Elimination) and low saturated fat (Swank) diets on perceived fatigue in persons with relapsing-remitting multiple sclerosis: study protocol for a randomized controlled trial (2018)
https://trialsjournal.biomedcentral.com ... 018-2680-x

Abstract

Background
Fatigue is one of the most disabling symptoms of multiple sclerosis (MS) and contributes to diminishing quality of life. Although currently available interventions have had limited success in relieving MS-related fatigue, clinically significant reductions in perceived fatigue severity have been reported in a multimodal intervention pilot study that included a Paleolithic diet in addition to stress reduction, exercise, and electrical muscle stimulation. An optimal dietary approach to reducing MS-related fatigue has not been identified. To establish the specific effects of diet on MS symptoms, this study focuses on diet only instead of the previously tested multimodal intervention by comparing the effectiveness of two dietary patterns for the treatment of MS-related fatigue. The purpose of this study is to determine the impact of a modified Paleolithic and low saturated fat diet on perceived fatigue (primary outcome), cognitive and motor symptoms, and quality of life in persons with relapsing-remitting multiple sclerosis (RRMS).

Methods/design
This 36-week randomized clinical trial consists of three 12-week periods during which assessments of perceived fatigue, quality of life, motor and cognitive function, physical activity and sleep, diet quality, and social support for eating will be collected. The three 12-week periods will consist of the following:

1. Observation: Participants continue eating their usual diet.

2. Intervention: Participants will be randomized to a modified Paleolithic or low saturated fat diet for the intervention period. Participants will receive support from a registered dietitian (RD) through in-person coaching, telephone calls, and emails.

3. Follow-up: Participants will continue the study diet for an additional 12 weeks with minimal RD support to assess the ability of the participants to sustain the study diet on their own.

Discussion
Because fatigue is one of the most common and disabling symptoms of MS, effective management and reduction of MS-related fatigue has the potential to increase quality of life in this population. The results of this study will add to the evidence base for providing dietary recommendations to treat MS-related fatigue and other symptoms associated with this disease.

hmm i guess although you're including an array of supplements, vit d3 and calcium are the only serum nutritional indicators worth tracking?

[NHE]

Interesting, there are no results yet. The full paper just describes what will be done, i.e., what's planned for the study. This is a first. Well, hurry up and do the study. Let's see the results!

[jimmylegs]

yup. plenty of protocol write ups out there. i'll have issues with the results obtained via this protocol as described.

[ElliotB]

This study is flawed in many ways and the results will have minimal value.

[jimmylegs]

Nutrition and Health Literacy: A Systematic Review to Inform Nutrition Research and Practice (2012)
https://www.sciencedirect.com/science/a ... 2311015082

Abstract
Health literacy is defined as the degree to which individuals obtain, process, and understand basic health information and services to make informed health decisions. Health literacy is a stronger predictor of health than age, income, employment, education, and race. Although the field has grown during the past decade, most health literacy research does not explicitly focus on food or nutrition, and dietetics practitioners often remain unaware of patients' health literacy level. The purpose of this systematic review was to summarize the literature on nutrition and health literacy to enhance dietetics practitioners' awareness of the importance of health literacy in practice and research. Of the 33 studies reviewed, four focused on measurement development, 16 on readability assessments, and 13 on individual literacy skills assessments. Collective evaluation revealed four noteworthy gaps, including the need to use more comprehensive assessment approaches that move beyond readability and numeracy to address the full spectrum of health literacy factors; the need to apply more robust experimental studies to examine the effectiveness of health literacy interventions among individuals, communities, health care providers, and health care systems; the need to explore the moderating and mediating roles of an individual's health literacy status on nutrition outcomes; and the need to examine long-term effects of health literacy interventions on nutrition outcomes. This article defines health literacy gaps and opportunities in nutrition research and practice, and calls for continued action to elevate the role of dietetics practitioners in addressing health literacy.

i had no idea. makes all the sense.

amusing excerpts from full text:

"The Frequency of Gobbledygook (FOG) Index (47) assesses sentence and word length to determine the number of years of formal education needed to understand text on a first reading. ... The Simplified Measure of Gobbledygook (SMOG) (50) is one of the most commonly used readability formulas; it focuses on word length in passages of text and estimates the years of education needed to understand that text."

[jimmylegs]

a very interesting read:

Busting the (Whole) Grain Myth
https://ucdintegrativemedicine.com/2016 ... gs.tE_sDjo

This is the first article in our new Controversies series where we plan to tackle some of the biggest nutritional myths swirling around the three macronutrients—carbohydrates, fats, and proteins.

Today’s topic?

Whole grains.
The subject of a lot of negative press, whole grains have been a staple of the human diet for centuries.
From the Aztecs and the Incas who ate amaranth and quinoa (a pseudograin), to rice in Asia and wheat and rye in Europe, whole grains have been with us a very long time.
And yet today, whole grains emerge as an enormous nutritional controversy.

Those opposed to whole grain believe it is the enemy, bad for our health and our waistlines. Whole grain proponents argue the exact opposite, believing this group of carbohydrates is a powerful health promoter.

Let’s explore the truth about grains together.

What Is a Grain?
When we refer to grains, we normally talk about cereal grains, which are members of the grass family Poaceae.

Here are some of the most common cereal grains: barley, brown rice, maize, millet, oat, rye, sorghum, spelt, and wheat.

Also included in the definition are pseudocereal grains, which come from broadleaf plant families and include: amaranth, buckwheat, chia, and quinoa.

And What Does ‘Whole Grain’ Mean?
A whole grain is a grain in which all components of grain (the bran, the germ, and the endosperm) remain intact.

Interestingly, a grain can be considered ‘whole’ even when ground into flour.

Whole grain bread, whole grain cereal, and whole grain pasta are all examples of foods that contain ground whole grains. And while these foods are still good for you, eating the whole grains themselves will always be better.

How to Read a ‘Whole Grains’ Label
When it comes to evaluating whether or not a product contains whole grains, you need to read the label carefully. Here are a few guidelines:

Make sure that whole grains (versus sugar!) are among the first few ingredients listed.
Verify that there are at least 2-3 grams of fiber per serving.
Ignore any ‘whole food stamp’ on the box (read the food label carefully instead!)
Examine the ratio between grams of carbohydrates and grams of dietary fiber; an ideal ratio will be 5:1 or less.
Avoid products using words like these: enriched flour, white flour, enriched wheat flour, enriched bleached flour, and all-purpose flour.
Look for the following words instead: whole, rolled, stone ground, sprouted, cracked. For example, whole grain flour, rolled oats, ground-on-stone whole-wheat flour, cracked wheat berries, and bulgur cracked

Why Whole Grains Promote Health
Current scientific evidence associates whole grains with these health benefits:

Treatment of Hypertension. The daily consumption of whole grains (as part of a healthful, plant-based diet) may be as powerful as high blood pressure medications in battling hypertension. While an analysis of randomized drug trials showed that blood pressure lowering medication reduces the risk of suffering a heart attack by 15 percent and stroke by 25 percent, another study reveals you might get similar results by eating three portions of whole grains a day!

Protection Against Arterial Plaque Build-up. A study measured the amount of plaque in the carotid arteries of 1000 people over five years. Those who ate whole grains had a slower progression of atherosclerotic disease.

Reduction in Risk of Premature Death. Using data from 45 studies, researchers calculated that eating 90 grams of whole grains per day reduced the risk of all-cause mortality by 17 percent. A second meta-analysis, which used the data from 14 studies (788,076 participants), showed that those who ate the most whole grains enjoyed a 16 percent reduced risk of all-cause mortality and an 18 percent reduced risk of cardiovascular-related mortality.

The Three Pillars of the Whole Grain Debate
The debate about whole grains rests on the following three claims:

Claim 1: Whole grains are bad for us because humans are not biologically adapted to eat them. Homo sapiens are 200,000+ years old while the agriculture that produces whole grains is much younger (10,000 years). According to those who are opposed to the consumption of grains, before agriculture came about, humans lived healthfully on a diet of fruits, vegetables, tubers and wild animals. Therefore, we should continue eating like our ancestors and forego whole grains altogether.
Claim 2: Whole grains are bad for us because they contain phytates, which bind to minerals (iron, zinc, manganese) and therefore ‘steal’ nutrients from our bodies.
Claim 3: Whole grains are bad for us because they make us fat. Whole grains contain carbohydrates, which the body turns into sugar and then stores as fat. We use grains to fatten livestock, and eating grains will do the exact same thing to you.
Let’s counter these points one by one.

Claim 1: Humans are not biologically adapted to eating grains.
The hypothesis here is that we have only been eating grains for 10,000 years and, as a result, our bodies are incapable of processing grains.

The premise of this pillar does not seem to be true. As a matter of fact, it appears that people who lived in what is now Mozambique may have eaten a diet based on sorghum as far back as 105,000 years ago, Neanderthals apparently consumed grains 44,000 years ago, and there is evidence to suggest that grains were consumed in Europe over 30,000 years ago.

And even if we take this claim at face value, we must extend its logic to other foods. For example, chickens were first domesticated 10,000 years ago in China. Equally, the earliest evidence of domestication of turkeys by Native Americans date to 200 B.C. (far less than 10,000 years ago). Cattle were also domesticated between 8,000 to 10,000 years ago. For this argument to hold up, therefore, those opposed to eating grains should not be eating beef, chicken or turkey either.

Claim 2: Grains are bad for you because of their phytate content.
As we will see, the exact opposite is true.

One of the most fascinating bioactive food compounds around, phytates are naturally found in whole plant foods and are plentiful in whole grains.

Phytates are considered an anti-nutrient because they bind to minerals (e.g. zinc, calcium, and magnesium) and prevent their absorption. However, when analyzed carefully, the ‘anti-nutrient’ effect of phytates seems only to appear when a large quantity of phytates are consumed in conjunction with a nutrient-poor diet. Also, cooking, boiling, fermenting, soaking or germinating whole grains will inactivate phytic acid and free minerals up for absorption by the body.

The consumption of whole grains in recommended amounts seems to have no adverse effect on mineral status whatsoever.

Far from being bad for you, phytic acid appears to be beneficial for our health.

As a powerful antioxidant, phytic acid may reduce blood sugar, insulin, cholesterol, and triglycerides and thus it can be instrumental in reducing the risk of heart disease, diabetes, and obesity.

Despite initial concerns that phytate consumption might lead to calcium deficiency and weakened bones, studies show that it may actually protect against osteoporosis.

Finally, and most famously, phytates may protect our bodies against cancer.

Quickly absorbed from the digestive tract, dietary phytates appear to be taken up by the body’s cancers cells and are shown to inhibit the growth of a variety of cancer cells – e.g. leukemia, colon, breast, cervical, prostate, liver, pancreatic, skin, and muscle.

Even better, phytates seem to fight only cancerous cells, leaving the normal cells intact.

Why are phytates so effective in battling cancer?

Through a combination of antioxidant, anti-inflammatory and immune-enhancing activities, phytates block the formation of new blood vessels that might feed the tumors and disrupt pre-formed capillary vessels.

So, the claim that we should not eat whole grains because of their phytate content simply does not stand up; phytates are a powerful health-promoting ally, not the enemy.

Claim 3: Whole grains make you fat.
This pillar is based on the idea that carbohydrates cause obesity because they elevate insulin levels and therefore increase fat storage.

The logic behind this theory assumes that:

Insulin plays a primary role in making us fat.
Only carbohydrates elevate insulin levels.

Let’s examine these claims together.

For starters, research shows that body fat is regulated by the brain—not by fat tissue itself or an insulin-secreting pancreas.

The primary role of insulin is to manage the concentrations of nutrients.

When insulin suppresses fat burning, it is normally because there is an abundance of glucose. In other words, insulin ‘tells’ storage tissues to stop burning fat because carbohydrates are available as fuel.

However, if you eat a diet high in fat (and low in carbohydrates), insulin ‘instructs’ your body to burn fat instead of carbohydrates, but it will not dip into your fat stores any more (or any less) than if your diet was based on carbohydrates. As long as the calories consumed are close to or in excess of what you need, fat storage will remain the same.

Another problem is that the carbohydrate-insulin theory also presumes that carbohydrates have some unique relationship with insulin causing the latter to spike.

However, when you examine the insulinogenic index (a measure of how much eating food increases insulin per unit calorie), you see that protein-rich foods like beef increase insulin secretion as much as carbohydrate-rich foods like pasta.

In the end, 3 billion people on the planet live on grain-based diets with little or no obesity.

The reason?

Whole grains are low in calories (particularly when compared to animal foods), low in fat and high in satiating carbohydrates.

While it is true that a few people are sensitive to some types of whole grains and should avoid them, for most of us whole grains are a health-promoting addition to our diet, especially when the diet is already based on the consumption of whole plant foods.

having experienced the sensitivities and unpleasantness that can accompany at least grain if not phytate consumption also, in context of a past nutrient-sparse (and plant-based) diet, i now find i can and do enjoy whole grain foods - but in moderation and in the context of an otherwise nutrient dense diet. that has been the way to go for me.

[ElliotB]

Interesting article but they omit a couple of important facts Modern grains likely do not resemble ancient grains when it comes to nutrition. Also, modern grains are loaded up with pesticides, not only during the growing process but possibly even more significantly after harvesting. This cannot possibly be a good thing when it comes to our health, and although the food industry will tell you that the pesticides are not harmful because they are in low dosages, I am not convinced and not willing to take a chance if I don't have to.

There is ample scientific evidence regarding the negative effects of consuming gluten - but there is also some evidence that for those without Celiac disease that going gluten free can have harmful health effects. Most people seem to be able to tolerate gluten so who knows. But many people also report many improvements to their health after following a gluten free diet.

[jimmylegs]

pesky ol science

Whole grain consumption and risk of cardiovascular disease, cancer, and all cause and cause specific mortality: systematic review and dose-response meta-analysis of prospective studies (2016)
https://www.bmj.com/content/353/bmj.I2716.full

This meta-analysis provides further evidence that whole grain intake is associated with a reduced risk of coronary heart disease, cardiovascular disease, and total cancer, and mortality from all causes, respiratory diseases, infectious diseases, diabetes, and all non-cardiovascular, non-cancer causes. These findings support dietary guidelines that recommend increased intake of whole grain to reduce the risk of chronic diseases and premature mortality.

tangential debate

Myths: Busted--Clearing Up the Misunderstandings about Organic Farming
https://blogs.scientificamerican.com/gu ... c-farming/

footnote on toxicities:

table salt........LD50.....3 g/kg (rat, oral).
glyphosate......LD50....5.6 g/kg (rat, oral).

[jimmylegs]

yup. i remember when my academic advisor tried to get me to consider balance vs extremism. took me quite a few years and this dx to get over my ideological bs.

Healthy Dietary Patterns for Preventing Cardiometabolic Disease: The Role of Plant-Based Foods and Animal Products
https://academic.oup.com/cdn/article/1/ ... 89/4772172

Abstract
"Diets rich in plant foods are increasingly recommended to lower the risk of cardiometabolic diseases because of strong evidence that fruit, vegetables, legumes, whole grains, nuts, and seeds are protective. Although some animal products, such as unprocessed lean red meat, poultry, eggs, and dairy products, are recommended in dietary patterns to prevent cardiometabolic diseases, many health professionals advocate for exclusively plant-based dietary patterns. The aim of this article was to review recent evidence on the relative contributions of plant-based foods and animal products to a healthy dietary pattern. Secondary aims were to discuss current consumption patterns and adherence to dietary recommendations. Epidemiologic evidence suggests that a higher intake of plant-based foods is associated with a lower risk of cardiometabolic disease, whereas a higher meat intake increases the risk of cardiometabolic disease and the replacement of small quantities of animal protein with plant protein is associated with lower risk. Randomized controlled studies show that nutrient-dense diets containing animal protein, including some unprocessed lean meats, improve cardiovascular disease risk factors. Therefore, it is likely that the consumption of animal products, at recommended amounts, in the context of a dietary pattern that meets recommendations for fruit, vegetables, whole grains, nuts, seeds, and legumes, and does not exceed recommendations for added sugar, sodium, and saturated fat, may not increase cardiometabolic risk. Currently, adherence to these recommendations is suboptimal. Therefore, rather than debating the merits of healthy dietary patterns that are exclusively plant-based or that include animal sources in recommended amounts, the focus should be on improving overall eating patterns to align with dietary guidelines. Registered Dietitian/Nutritionists (RDNs) have the requisite nutrition expertise to facilitate change at the individual and population levels to promote adherence to healthy dietary patterns. Importantly, advocacy activities are urgently needed to create a healthier food environment, and all health professionals, including RDNs, must play a role."

related: somebody i know needs to stay out of the cookie aisle JUS SAYIN

also - haha from farther down the text:

"Two other trials conducted in free-living populations have also shown that DASH diets including lean red meat (beef or pork) improve blood pressure. Sayer et al. (49) observed that blood pressure was lowered to a similar extent with a DASH diet that included 55% of total protein from lean pork compared with a DASH diet that included the same amount of protein from lean chicken and fish after 6 wk in healthy men and women with hypertension."

i had no idea

"Similarly, a DASH diet containing lean red meat (six 100-g servings/wk) was more effective at lowering blood pressure in postmenopausal women after 14 wk than a healthy reference diet (50). However, it should be noted that the healthy reference diet in this study included <2 servings red meat/wk, less fruit and vegetables, and more fats and oils, refined carbohydrates, and sodium than the DASH group. Therefore, it is likely that the blood pressure–lowering effects observed in the study by Nowson et al. (50) was due to the higher fruit and vegetable consumption and lower sodium intake in the DASH group compared with the reference diet."

yep that is quality study design right there lol :S