Forget what you thought you knew and see where nutritional therapy may have the answers. (Ben Brown IHCAN July 2019)
Multiple Sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) and and involves the motor, sensory, visual and autonomic systems.
Two stages of the disease are recognised: Relapsing – remitting MS (RRMS) and Primary – progressive MS (PPMS) RRMS can present with optic nerve dysfunction, double vision, dizziness and weakness or numbness of an extremity with episodes of relapse.
PPMS presents with slow progressive symptoms including gait disorder, bladder/bowel dysfunction, blindness or lack of dexterity in a hand.
Given the diverse clinical presentations, it has been argued that demyelination may in fact be a common endpoint originating from different aetiologies.
Evidence suggests that an integrative approach may not only slow MS progression but might also be able to reduce fatigue, increase mental and physical quality of life, enhance mood and cognitive function, increase exercise capacity and in some cases reverse the disease and induce remission.
Modified Paleolithic diet
(Dr Cordain’s modern version is meat, vegetables and fruits; excluding grains, night shade family, dairy and legumes for RA)
Benefits to fatigue, mental and physical quality of life have been recorded but the addition of nutritional supplements, stress reduction techniques, a progressive exercise programme and neuromuscular electrical stimulation makes it difficult to determine the effects of the diet on its own.
Low saturated fat diet
A low fat diet (also referred to the Swank diet) in patients with RRMS has reported less frequent and severe exacerbations over a 34 year follow up.
Two studies found intermittent fasting or calorie restriction lead to significant improvements in emotional well being and depressive symptoms after 8 weeks. A fast mimicking diet for 7 days followed by a Mediterranean diet for 6 months or a ketogenic diet in a small pilot study also achieved improvements in physical and mental well being and a mild reduction in disability scores.
Supplementation with Vitamin A (25,000 iu ) daily of retinyl palmitate for 6 months followed by 10, 000iu daily for another 6 months was found to improve some clinical scores of MS severity and significantly reduce fatigue and depression. It did not however influence relapse rate.
Optimisation of vitamin D levels with supplements plays an important role in disease prevention and management.
Vitamin D deficiency may increase the risk of an individual going on to develop MS after their first neurological incidence – known as a clinically isolate syndrome (CIS)
Supplementation of vitamin D (50,000iu a week) for 12 months in vitamin D deficient people with CIS reduced the likelihood of developing MS by 68%
Importantly, patients with MS show a poorer response to supplementation compared to healthy controls and therefore follow up of their serum levels is important.
Monitoring serum levels and maintaining a range between 75 – 125nmol is important to avoid hypercalcaemia which can come about from doses ranging from 8000iu to 150,000iu daily.
Vitamin B12 and Folate
Vitamin B12 deficiency symptoms are strikingly similar to those of MS and patients with MS have been found to have low B12 levels and elevated homocysteine levels.
Vitamin B12 and folic acid as a combined therapy has been studied : ( Patients with RRMS were given 5mg Folic acid daily and 3 doses 1000mcg B12 via injection. At 2 months physical and mental dimensions of quality of life had improved compared to placebo.
Conflicting results. One trial found 300mg biotin daily resulted in a sustained reversal of MS related disability in 12.6% of patients with progressive MS while another trial found no clinical benefits.
NB Biotin supplements can interfere with common lab tests particularly thyroid panels so patients should abstain from taking biotin supplements for 48 hours before tests.
Lower blood levels of CoQ10 and higher levels of oxidative stress have been observed in patients with MS compared with controls. A trial where patients took 500mg daily for 12 weeks showed significant improvements in faitigue and depression.
Omega 3 fatty acids
One study using EPA and DHA along with vitamin A and E sig reduced relapse rate and disability after 2 years. Another study using 200mg fish oil and vit D ( 50,000 iu biweekly) for 12 weeks demonstrated sig reductions in disability. However a study assessing the effects of EPA/DHA on depressive symptoms in patients with MS found no benefit after 3 months.
Overall it seems that nutritional therapy may offer hope for a successful non toxic management strategy.
This article has been provided by our Nutritional Therapist, Nicky Seabrook.
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