MD, Vijayshree Yadav
MS and Diet: Should you eat low-fat to treat your MS?
Bring up the topic of complementary and alternative treatments for multiple sclerosis and you just might start a controversy. However, what’s so controversial about maintaining a low-fat diet? Sounds like a good dietary recommendation to me.
One approach to managing MS is through the use of diet, in addition to, or in place of traditional treatments. So why aren’t we all on a strict regimen and measuring our dietary intake against a widely publicized recommendation?
A simple reason may be that there is more than one “MS Diet.” Another reason may be that there is little clinical research into the the impact of diet on MS progression and symptoms. But soon that will change.
Researchers at Oregon Health & Science University (OHSU) are launching a first-of-its-kind research study aimed at determining whether a low fat diet is beneficial to patients with multiple sclerosis. In addition to tracking each patient’s MS symptoms and examinations by a neurologist, researchers will try to determine the physical impacts of a low fat diet on the brain through the use of MRI.
“Low fat diets are popular among MS patients who believe they are beneficial,” explained Vijayshree Yadav, M.D. “However, there is little research on hand which demonstrates whether this is true and how exactly diet impacts the symptoms of MS. Through this study, we hope to quantify the impacts of diet on MS.”
The research project (see the clinical trial listing) is currently recruiting 54 multiple sclerosis patients. Half of these patients will take part in a 10-day intensive dietary training program in Santa Rosa, California where they will learn about preparing low fat foods prescribed within the specialized diet. They will then follow the diet guidelines for the following 12 months as their progress is measured. The other half of the study patients will be observed as a control group and then enrolled in the same dietary training program at the conclusion of the study.
The diet being studied is called the McDougall Diet which is a whole food vegetarian diet with no added oil, eggs, or dairy products. It features starches such as potatoes, corn, rice, beans, pastas, breads, fruits and vegetables. Meat and fish are not included. Sample meals would include oatmeal and hash brown potatoes for breakfast, soups and sandwiches for lunch, and spaghetti, bean burritos, chili, or oriental rice for dinner.
In the article “Treating Multiple Sclerosis with Diet: Fact or Fraud?” Dr. McDougall concludes, “I’ve been very gratified by the results of this dietary treatment, not only because the progress of most of my MS patients’ disease has been halted, but also because their overall health has unquestionably improved. And everyone knows that MS sufferers need every bit of help they can get.” Read more about Dr. John A. McDougall.
Previous research in the 1950’s by OHSU’s own Dr. Roy Swank led to the belief that low fat dieting may benefit MS patients. In fact, one of Dr. Swank’s studies, a 50-year dietary study of MS patients, was recently completed. That study, which tracked a group of 144 MS patients, suggested that dieting may positively impact both the symptoms of the disease and an individual patients’ survivability. However, like other studies, the results failed to determine why this appears to be the case. Read more about the Swank Diet.
In reading further, I came across the January 2009 McDougall Newsletter which is titled “The Multiple Sclerosis and Diet Saga.” At the beginning of the newsletter, we learn that the OHSU clinical trial is sponsored by the McDougall Research and Education Foundation in the amount of $750,000. When asked – Why spend the money to study the treatment of MS with your diet? – McDougall writes:
“For me, stopping multiple sclerosis with the cost-free, side-effect-free McDougall Diet is equivalent to throwing the biggest rock I can find at the biggest picture window in town. The shatter will be heard around the world. If diet can effectively treat a disease as mysterious and deadly as MS, then diet has to be a medical miracle—and could easily be capable of bringing to an end diseases long accepted as due to diet, like type-2 diabetes, heart disease, and common cancers. A simple cure for MS would startle even the most unconscious medical doctors into awakening. Plus, I owe this study, and much more, to my mentor Roy Swank, MD for his friendship, guidance, and pioneering work.”
In an exploratory study just published in Nutrition Journal, investigators studied whether variations in dietary intake were related to the severity of disease course in multiple sclerosis. Using a food diary during 14 days, the dietary intake of 23 nutrients and vitamins was measured in patients with primary progressive (n = 21), secondary progressive (n = 32), and benign multiple sclerosis (n = 27) and compared to each other. The intake measured was also compared to the intake of the Dutch population and to the recommended daily allowance.
Compared to the other MS groups, the secondary progressive MS patients had a lower intake of magnesium, calcium and iron. The total group of MS patients had, compared to the Dutch population, a lower intake of folate, magnesium and copper and a lower energy intake. Compared to the daily recommended allowance, the MS patients had a lower than recommended intake of folic acid, magnesium, zinc and selenium.
The conclusion was that magnesium, calcium and iron intake may possibly be related to MS disease progression, and should receive further attention. An important observation because no effective neuroprotective treatment for MS patients is available.
The Multiple Sclerosis and Diet Saga
The End and a New Beginning
People often ask me: Why are you spending $750,000 from the McDougall Research and Education Foundation to study the treatment of multiple sclerosis (MS) with your diet? Why not carry out research on a more common problem, like obesity, heart disease, or diabetes?
Most people can’t even pronounce “multiple sclerosis”—so they just call it MS. It is likely you don’t personally know anyone with this disease; after all, only 350,000 people in the United States and one million worldwide have it. You may have heard of it because a few famous people have made their disease public, like: lead anchor on Fox News Channel Neil Cavuto, former Mouseketeer Annette Funicello, singer Lena Horne, comedian Richard Pryor, and talk show host Montel Williams. Only 10,000 new cases are diagnosed in the United States annually, compared to half a million new major cancers and 1.25 million fresh heart attacks. So why pick MS?
For me, stopping multiple sclerosis with the cost-free, side-effect-free McDougall Diet is equivalent to throwing the biggest rock I can find at the biggest picture window in town. The shatter will be heard around the world. If diet can effectively treat a disease as mysterious and deadly as MS, then diet has to be a medical miracle—and could easily be capable of bringing to an end diseases long accepted as due to diet, like type-2 diabetes, heart disease, and common cancers. A simple cure for MS would startle even the most unconscious medical doctors into awakening. Plus, I owe this study, and much more, to my mentor Roy Swank, MD for his friendship, guidance, and pioneering work.
The first part of the saga of the treatment of MS with a low-fat diet ended less than 2 months ago on November 16, 2008 with the death of Dr. Swank at age 99. The saga begins anew with the approval of “A randomized, controlled study of diet and multiple sclerosis” by the Oregon Health & Science University Research Integrity Office on January 15, 2009. This landmark approval only happened after years of hard work by many of us. You have made important financial contributions to the McDougall Research and Education Foundation (a nonprofit, 501(c) (3) corporation) over the past 5½ years. Raising sufficient funds allowed me to make my first contact with the Neurology Department of the medical school at the University of Oregon on September 15, 2007. After nearly a year and a half of working with a few of the top people at the medical school, especially Vijayshree Yadav, MD, we are ready to begin.
MS is an autoimmune disease—one in which the body attacks itself—in this case the immune system attacks the tissues of the brain and spinal cord (more specifically, the myelin sheaths surrounding the nerve fibers). Isolated areas become intensely inflamed with sores. In time, the damaged tissues heal, but often leave thickened, fibrous scars (scleroses), which doctors commonly call “plaques.”
The diagnosis is most often made between the ages of 15 and 50, with women three times more likely than men to develop MS. The initial and subsequent attacks can last one to three months. During an attack the patient experiences visual disturbances, weakness, clumsiness, spasticity, fatigue, numbness, tingling, problems with thinking, slurred speech, pain, depression, difficulty swallowing, bladder and bowel incontinence, and/or sexual difficulties. Rather than on any fancy tests, the diagnosis is based upon a patient’s history and the physician’s examination. Apparently random damage to the nervous system—as if an inexpert marksman shot bullets at the brain and spine—is the hallmark of MS. Sophisticated technologies, like magnetic resonance imaging (MRI) of the brain and associated areas, can help with the diagnosis and show the size and location of active lesions and plaques.
Patients are most often classified as having one of two forms of MS: “relapsing-remitting” characterized by intermittent attacks; and “primary-progressive” with a steady, but usually slow, decline. Actually these “doctor-invented” subtypes are just different stages of the same disease. Usually (80% of the time) at the beginning of the disease the attacks seem to come and go, but in time most cases become progressive. Those patients who appear to start with a progressive decline (20%) have simply skipped the more common initial appearance of relapse and remittance.1 These artificial categories can be counterproductive, leading to false reassurance and unwarranted despair, and do not predict the prognosis or improve the chances of an effective treatment for the patient.1,2 Even with the use of the most modern medications, costing $20,000 a year, the future prospect is dismal with half of those people afflicted with MS unable to walk unassisted, bedridden, wheelchair bound, or dead within 10 years of diagnosis.2-6 The absolute advantage for slowing disability with the use of the most popular medications (interferon beta) is clinically small (8%), and the costs and side effects are huge.7,8 The lack of substantial benefits from current drug therapies is one more important reason I picked MS to study.
Worldwide, multiple sclerosis is common in Canada, the United States and northern Europe; and rare in Africa, Japan, and other Asian countries. This difference most likely reflects the populations’ different diets (animal- vs. starch-based). Scientists have found a very strong positive correlation when consumption of cow’s milk is compared with the incidence of MS worldwide.9,10 One theory proposes that cow’s milk consumed in infancy lays the foundation for injuries to the nervous system that appear later in life.11 Cow’s milk contains one fifth as much of an essential fat, called linoleic acid, as does human mother’s milk. Children raised on a linoleic acid-deficient, high-animal fat diet—as are most kids in our modern affluent society—are quite possibly starting life out with a damaged nervous system, susceptible to insults and injuries in later life. The possible sources of injury that can precipitate the attacks of multiple sclerosis in mid-life are suspected to be viruses, allergic reactions, and/or disturbances of the flow of blood to the brain caused by a high-fat diet.
The most commonly held theory these days proposes an autoimmune basis for this disease. MS has much in common with autoimmune type-1 diabetes mellitus, including nearly-identical ethnic and geographic distribution, and genetic factors.12,13 The damage to the nervous system may occur through a process known as molecular mimicry. In susceptible people, cow’s milk protein may enter the bloodstream from the intestine. The body recognizes this as a foreign protein, like a virus or bacteria, and makes antibodies against it. Unfortunately, these antibodies are not specific only to the cow’s milk protein; they find similar proteins in the nervous system (the myelin). The antibodies attach to these nerve tissues and destroy them. In the case of diabetes, the antibodies looking for cow’s milk protein attack the insulin-producing cells of the pancreas.
Roy Swank, MD—My Mentor
There are many people whose shoulders I stand on and the founder of the Swank Diet for MS was one of my most important teachers. In 1977, I was on my neurology rotation for my Internal Medicine Residency at the University of Hawaii. I was given an assignment to present a conference to fellow doctors on any subject of my choosing. My trip to the library that afternoon led me to the discovery of Dr. Swank’s work.
Swank devised his low-fat diet and began treating MS patients at Montreal Neurological Institute in 1948. He recommended not more than 40 to 50 grams of total fat (compared to 150 to 175 grams in the American/Canadian diet) and 0 to 15 grams of saturated fat (compared to 140 to 165 grams). There was no limit on the amount of carbohydrate from starches, vegetables, and fruits. Polyunsaturated fats were increased a little (from 15 to 25 to 20 to 35 grams). Dr. Swank believed MS patients were unique in that they had a heightened sensitivity to saturated fats.
His research soon showed that with adherence to the diet relapses decreased by about 70 percent in the first year of treatment (from 1 relapse per year to 0.2 per year). Then after the first year there were continued improvements (about 5% fewer relapses per year for the next 2 years). For the first 16 years of treatment with a low-fat diet the rate of exacerbation (new attacks and/or decline) was decreased by 95%. (Compare this to the dismal results of drug therapy, mentioned above, where half of patients are in serious trouble within 10 years.)
For outstanding results, patients have to follow the Swank Diet strictly because even small amounts of fat make a huge difference. In the study he published in the medical journal, the Lancet, in 1990, Dr. Swank found that a difference of eight grams of saturated fat intake daily resulted in a threefold increased chance of dying from multiple sclerosis.14 (That means daily consumption of as little as one ounce of pork sausage at 10 grams, one medium cooked hamburger at 14 grams, an additional three ounces of porterhouse steak, or two ounces of cheddar cheese at 12 grams, significantly increases the risk of dying.)
Early cases are expected to do especially well on the diet.14-17 As the years with the disease accumulate then the response to diet is expected to be less dramatic, but there are exceptions with some advanced cases responding very well. If a person begins the program with limited disability and follows the Swank Diet carefully he or she has less than a 5% chance of dying from MS over the next 34 years—those who do not follow the diet have an 80% chance of dying.14 If patients go off of the diet for a month or so they will get into trouble. Dr. Swank states, “Our figures show that at least 95% of people with MS that follow a low-fat diet show no progression of disease.” However, with normal aging there is deterioration of the nervous system even when the MS disease is not active.
According to Dr. Swank, about one in 500 people will have a downhill course even when they follow the diet strictly. About 50% of his patients followed the Swank Diet really well, whereas 25% were a little over on fat intake and another 25% were a lot over. Dr. Swank said to me, “I tell people that they have to have persistence and a real desire to get well or be well or there is no point on going on this (the diet). If they are not devoted to taking care of their health then they are going to have trouble; and finally, I tell them to be optimistic, it’s very helpful.”
You can listen to a free podcast of a radio interview I did with Roy Swank in 1995.
The Swank vs. The McDougall Diet
The Swank Diet focuses on drastically reducing saturated fats, which are abundant in red meats and high-fat dairy products. Included in his diet are low-fat dairy foods (skim milk, fat-free cheese, fat-free ice cream, etc.), egg whites, skinned white-meat chicken, white fish and shellfish. Meats with significant amounts of saturated fats are allowed only in very small amounts.
Dr. Swank also included additional vegetable and fish oils in his diet. He explained to me that he did this mostly because he believed that this addition would make the diet easier to follow. He found that when people ate more polyunsaturated oil they then ate less saturated fat. He also felt the patients’ skin was better with a little oil added, and that they felt more energetic. As far as the fundamental course of the disease was concerned, he did not believe adding the vegetable or fish oil made any real difference—as he explains, “It just makes it easier to follow the diet.”
Dr. Swank approved of The McDougall Diet for the treatment of MS, and said so many times. The McDougall diet is very low in saturated fats. As an internist concerned about all aspects of a patient’s health I prescribe a stricter and, I believe, a much more effective (and tastier) diet. Even low-fat dairy and meat products are a health hazard causing infectious diseases, allergic reactions, as well as delivering high loads of animal protein (causing osteoporosis, kidney stones, liver, and kidney damage) and environmental chemicals. These animal foods are completely deficient in dietary fiber and low in carbohydrate. Although lower in fat and cholesterol, low-fat meats and dairy products can still contain substantial amounts of both harmful ingredients.
The dairy proteins are of particular concern to me because they are the leading cause of autoimmune diseases. As I mentioned above, MS is an autoimmune disease and has substantial similarities to another autoimmune disease, type-1 diabetes, which an abundance of scientific research says is caused by dairy protein.18
I do not add “free” vegetable or fish oils because they are, at best, medicines, and at worst, toxins. At the very least they can produce weight gain—“the fat you eat is the fat you wear.” These polyunsaturated oils “thin the blood,” contributing to the risk of bleeding, say, following an auto accident. These fats also suppress our immune system— we need our immune system functioning at full capacity to fight off infections and cancer.19
Why Is Diet-therapy for MS Virtually Unknown?
Dr. Swank told me, “One problem is culture: we are a meat and potatoes society. Most importantly there is an economic problem, there is really not much money in a diet. Nutrition has not been taught in medical school for many years now.”
More than 20 years ago, during one of my many visits with Dr. Swank at his Oregon medical school office, I asked him, “Why is it that when MS patients ask their doctors about changing their diet, they are told this is quackery? And why does the MS Society offer a similar message? You have published in the world’s most respected scientific journals that a simple, cost-free diet can stop this disease. Yet, they summarily dismiss you and your work.”
He leaned back in his chair, took a moment for thought, and then explained, “You know, most people in this country expect to be cured by a pill, and to have a cure that is almost instantaneous. With the low-fat diet, the people actually have to work to get better, and have to cure themselves. And as far as the MS Society is concerned, John, they don’t mention it because they didn’t discover it. It wasn’t their research dollars that found this treatment. So they’re not going to tell anybody. I discovered it in my small office here, in the basement of the University of Oregon Medical School.”
So it is not just money that keeps people from highly effective dietary cures; egos are also involved—the well-known business doctrine, “Not Invented Here,” is working to keep you and your family sick. Self-centered people think, “If I didn’t invent it then there is no real reason for me to promote it, especially when there is no fame or fortune in it for me.”