Multiple Sclerosis Nutritional Protocol
Most patients that employ complementary treatments for MS do so as an accompaniment with conventional drug treatments and find both classes of therapy to provide clinical benefits.72 The following section outlines key details and evidence-based findings concerning the latest complementary approaches to treating MS.
As previously mentioned, mainstream medicine has overlooked a critical missing link in MS management—vitamin D. This hormone-like vitamin is capable of safely interacting directly with the genome to modulate a variety of physiological functions, including aspects of immune function involved in autoimmune diseases like MS.
Two human clinical trials demonstrated that individuals with MS using vitamin D tended to have fewer relapses and less inflammation.17,73,74 In a year-long Vitamin D study, recurrence rate of MS "attacks" was 27% lower compared to baseline.74 In another large-dose Vitamin D trial, MS patients given 28,000‒280,000 IU weekly were found to have fewer active lesions during the 28-week long study.75 In light of the accumulating epidemiological and clinical evidence of the importance of vitamin D in this disease, supplementing the diet with vitamin D appears to be a low cost means to address this risk.
Omega-3 Fatty Acids
Omega-3 fatty acids (FAs) are polyunsaturated FAs which cannot be synthesized in humans and therefore must be provided via dietary sources. Both plant and animal foods are potential sources of omega-3 FAs. For example, linolenic acid, found in flaxseed, flaxseed oil, and preferably, fish and fish oils have very high levels of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).
A small study looking at the effects of omega-3 FAs on MS found that immune cells from treated patients and healthy controls produced significantly fewer pro-inflammatory cytokines after three months of treatment with 6 grams of fish oil per day.76 One double-blind placebo-controlled study exists to date looking at the effect of omega-3 FAs on MS disease progression. In this study 312 patients were given either fish oil or olive oil placebo for two years. The results of this trial exhibited a trend toward decreased disease severity in the omega-3 FA group when compared with control.77 More recent studies have shown that MS patients given 10 grams of fish oil per day for three months exhibited significantly reduced levels of matrix metalloproteinase-9 (MMP-9), a factor correlated with disease progression, and also had greater concentrations of omega-3 FAs in their red blood cell membranes.78 Other work has shown that MS patients, while on a low-fat diet with omega-3 FA supplementation, experienced significantly reduced fatigue and lower relapse rates.79 Based upon clinical data and patient accounts, omega-3 FAs appear to be well tolerated and safe with no reports of adverse events.
Linoleic Acid and Omega-6 Fatty Acids
Linoleic acid is converted to gamma-linolenic acid (GLA), a beneficial omega-6 FA, after it is taken orally. However, this conversion is occasionally impaired, especially during inflammatory disease states.48,80 GLA has been shown to quell inflammation and research involving an animal model of MS has demonstrated that GLA administration significantly improved clinical outcomes when compared with control treatment.81
Some studies have shown significantly reduced relapse rates and disease progression scores, while others have found no differences between treatment and control groups.81-83 A closer look at data from these trials revealed that patients with lower levels of disability at the beginning of the trial exhibited a smaller increase in disability over the study period than did controls. In addition, linoleic acid was found to reduce the severity and duration of MS episodes in patients at all levels of disease severity.84
Selenium and Vitamin E
Patients who have MS tend to have abnormally low levels of glutathione peroxidase, a powerful endogenous antioxidant.85,86
Researchers in Denmark conducted a small study in which patients with MS were given an antioxidant mixture containing about 2,000 mcg selenium, 2 grams vitamin C, and 480 mg vitamin E once daily for five weeks. Although glutathione peroxidase levels were initially lower in patients with MS than in normal control subjects, after five weeks of antioxidant therapy, levels of this antioxidant enzyme increased five-fold and reported side effects were minimal.85 "[O]xidative stress plays an important role in pathogenesis of multiple sclerosis. This finding also suggests the importance of antioxidants in diet and therapy of MS patients."87
An effective strategy for increasing the body's supply of the powerful antioxidant glutathione is taking the oral supplement N-acetylcysteine (NAC), a potent antioxidant that serves as a precursor to glutathione.48,88 NAC's potential benefit in the context of MS has been noted by some researchers.48,89
In a rodent MS model, NAC was able to diminish clinical symptoms and pathological evidence of CNS injury, and attenuate inflammation.90
Lipoic acid (LA) is a dietary supplement with antioxidant properties and has been studied specifically in MS. Reactive oxygen species (ROS), generated primarily by immune cells, are implicated as mediators of demyelination and nerve damage.91,92 Known to cross the blood-brain barrier, LA decreases the activity of intercellular adhesion molecule-1 (ICAM-1), which is thought to play a role in the pathogenesis of MS. It is believed that ICAM-1 and other adhesion molecules are responsible for allowing certain pro-inflammatory immune cells, like T-lymphocytes, to enter the CNS, paving the way for induction or exacerbation of inflammation and tissue damage.93-95
In an animal MS model, LA produced a significant reduction of demyelination and infiltration of the CNS by T lymphocytes.96-98 Other researchers have followed up on these studies. In a pilot clinical trial, 37 patients with MS were randomly assigned to receive various doses of LA (up to 2,400 mg/day) or placebo. After two weeks, patients were assessed for levels of ICAM-1 and tolerability of high-dose LA. In addition to being well tolerated by patients, LA treatment was associated with reduced ICAM-1 levels and reduced T-cell migration into the CNS.99
Coenzyme Q10 (CoQ10) is an antioxidant that is an essential part of healthy mitochondrial function and energy production with potential usefulness in treating MS. Decreased levels of CoQ10 are associated with many disease states, including heart disease, cancer, and neurodegenerative diseases.100,101 CoQ10 was low in patients with MS.102 Several clinical trials of CoQ10 have been performed in neurodegenerative disease, such as Parkinson's disease, Huntington's disease, Alzheimer disease, Friedreich's ataxia, and amyotrophic lateral sclerosis.103 CoQ10 is a powerful lipid-soluble antioxidant that is also capable of regenerating the antioxidant capacity of vitamin E in the body. Based upon clinical evidence, CoQ10 appears to be well tolerated and safe with potential usefulness in the management of MS.
Some data suggest patients with MS have abnormally low levels of vitamin B12 in their cerebrospinal fluid, blood serum, or both.104 In fact, clinical vitamin B12 deficiency and MS share remarkably similar characteristics, occasionally rendering correct diagnosis difficult.105 Notably, vitamin B12 plays a key role in the generation of myelin and thus, for decades, integrative physicians have prescribed B12 injections for patients who have MS.
Data suggest patients given vitamin B12 supplements have experienced clinical improvements in their symptoms.48 For example, in the United Kingdom, researchers investigated the effects of six months of vitamin B12 (1 mg/week injection) on 138 patients with MS. The researchers concluded that the clinical course of patients with MS improved after beginning vitamin B12 treatment.106
Ginkgo biloba extracts are primarily composed of flavonoids and terpenoids and have been reported to have properties that can influence neural activity and improve cognitive performance. While controlled trials of the effects of ginkgo biloba on cognitive function have generated inconsistent findings, more recent studies found encouraging results for patients with MS.107-109 In one study, patients received 120 mg of ginkgo biloba extract or placebo twice per day for 12 weeks. Those patients taking ginkgo biloba exhibited improved measures of attention and reported fewer difficulties with memory.
Green Tea (Epigallocatechin-3-Gallate)
Epigallocatechin-3-gallate (EGCG) is one of many active ingredients of green tea that have been reported to have beneficial effects on the nervous and immune systems. In an animal study of MS, ECGC was found to prevent severity of clinical signs by decreasing inflammation and protecting nerve cells.110 According to animal research, green tea has the ability to significantly increase regulatory T cells which are critical to providing balance to the immune system and suppressing autoimmunity.111
Curcumin is an active component of turmeric, a popular Indian spice. Laboratory studies have demonstrated that curcumin has potent anti-inflammatory effects.112 A research group carrying out animal studies has demonstrated exciting findings that curcumin treatment results in a significant reduction in disease severity and a reduction in duration of acute attacks.113 In a follow-up study, laboratory researchers found curcumin not only suppressed disease severity, but also was associated with reduction of levels of IL-17 a cytokine that has been directly implicated in the progression of MS.114
Biotin, a water-soluble B-complex vitamin, is sometimes referred to as vitamin B7. Biotin participates in biochemical reactions catalyzed by decarboxylase enzymes, supporting energy production and fatty acid and myelin synthesis.115,116 The Adequate Intake for biotin is 30 micrograms, and low-to-moderate amounts are common in multivitamin supplements.117,118 Biotin's role in neuron functioning is evidenced by its therapeutic effect in a rare genetic disease known as biotin-thiamine responsive basal ganglia disease.118 Children affected by this disease experience progressive neurological dysfunction, including speech and motor dysfunction, mental retardation, seizures, and possibly death. Early treatment with biotin and thiamine (vitamin B1) appears to prevent progression in most cases.119,120 More recently, researchers have been exploring biotin's potential benefits in patients with MS.
In the first clinical trial to demonstrate the potential of high-dose biotin in MS therapy, 23 patients with progressive MS were treated with 100–300 mg biotin daily for an average of 9.2 months. While improvements were not seen for two to eight months after initiating biotin therapy—suggesting biotin may instigate a slow and progressive repair of MS-related nerve damage—vision improved in all four participants with MS-related optic nerve injury, and motor function and overall disability improved in 16 of 18 participants (89%) with prominent spinal cord involvement.116,118
In a randomized controlled trial, 154 patients with progressive MS received either 100 mg biotin three times daily or placebo for 12 months. Thirteen (12.6%) of the biotin-treated subjects versus none of the placebo subjects exhibited improvements in measures of MS-related disability after nine months that persisted through the end of the trial. In addition, only 4.2% of biotin-treated subjects compared with 13.6% of placebo subjects had progressively worsening disability scores at nine months. At the end of the 12 months, placebo subjects were switched to high-dose biotin, and overall stabilization of disability was seen in all subjects at a 24-month follow-up.121
Biotin levels in the cerebrospinal fluid of MS patients have been observed to be lower than those of healthy people, leading to speculation that low biotin availability may contribute to the pathology of MS.122 Although the mechanism of biotin's ability to prevent or repair nerve damage is unknown, biotin may prevent progressive demyelination by improving mitochondrial function, increasing brain energy production, supporting myelin production by increasing lipid synthesis, and affecting gene expression.118,123
Biotin is excreted through the urinary system, and high doses appear to be well tolerated in trials to date.118,124 However, high doses of biotin may interfere with certain lab tests, including thyroid function tests, leading to misdiagnosis of thyrotoxicosis.117,125,126 In addition, the possibility of teratogenicity has been suggested by animal research124; therefore, the safety of high-dose biotin in pregnancy is not established.
Dr. Roy Swank first proposed a connection between increased consumption of saturated animal fat and the incidence of MS in 1950.127 He conducted a study which enrolled 208 patients with MS in the early 1950s, all of whom had experienced at least two acute relapses, and followed their progress over 34 years.128 In this study, patients maintained the now termed Swank diet, which consists of: less than 15 grams/day of saturated animal fat, 10‒15 grams/day of vegetable oil, 5 grams/day of cod liver oil, and one multivitamin. Long-term follow-up results from this study indicate that the patients adhering to the Swank diet experienced reduced MS disease activity and progression of disability when compared to patients that did not follow the regimen. While these results are encouraging, this trial is criticized for its lack of a proper control group and un-blinded design. Nevertheless, the Swank diet remains one of the most popular complementary approaches to treating MS.
Swank Low-Fat Diet: Detailed Guidelines
- Saturated fat should remain less than 15 grams per day
- Unsaturated fat should be approximately 20‒50 grams per day
- No red meat should be consumed during the first year
- After the first year, a maximum of 3 oz. of red meat per week
- Dairy products must have 1% butterfat or less
- Processed foods containing saturated fat should not be eaten
- A source of omega-3, a multivitamin, and a mineral supplement are recommended daily
- Wheat, gluten or dairy product quantities are not restricted, unless they are foods which cause allergies or reactions.