Diet
SOURCE:
msrc.co.uk
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SOURCE: The New York Times
Copyright 2008 The New York
Times Company (11/03/08) Some With Multiple Sclerosis Put Their Hopes
in a Diet
What you are about to read is not an endorsement of any
particular diet as a therapy for multiple sclerosis. Nor is
it a suggestion to forgo established medical treatments.
But so long as it is part of a medically approved
treatment program, the diet described here is unlikely to
hurt, except perhaps to make meal planning a challenge. And
on the testimony of those who have followed it, the plan may
be worth trying, despite the lack of scientific evidence to
support it.
The diet has not been subjected to a placebo-controlled,
randomized clinical trial, the gold standard for determining
the value of any therapy. But Ann D. Sawyer and Judith E. Bachrach, co-authors of “The MS Recovery Diet,” say
this should not dissuade people struggling with the
debilitating
symptoms
of the degenerative disease.
The diet they outline extends one developed decades ago
by
Dr. Roy L. Swank,
an emeritus professor of neurology at Oregon Health Science
University.
It severely restricts saturated fat and increases
essential fatty acids like fish and vegetable oils, measures
endorsed by the National Multiple Sclerosis Society as part
of a healthy diet.
In 2003, Dr. Swank reported that among 144 patients
placed on his diet 34 years earlier, two-thirds of the 70
who carefully followed it survived, compared with one-fifth
of the 74 who were “poor dieters.”
Dr. Allen C. Bowling, a neurologist and nutrition expert
at the Rocky Mountain MS Center in Colorado, wrote that
“no well-designed clinical trial has been conducted to
determine whether decreasing dietary sources of saturated
fat improves outcomes in MS.” “The whole area of diet has
been a loose thread in MS studies — the evidence is
tantalizing but not definitive,” he said. “Making
reasonable changes in diet is not going to hurt, but at the
same time it’s important for people with MS to take
advantage of what conventional medicine has to offer and
optimize their treatment options every single day.”
Besides saturated fat, Ms. Sawyer and Ms. Bachrach
suggest that other potential dietary culprits include dairy,
grains with gluten, legumes, eggs and yeast. “Beyond the
five usual suspects, each person may have very individual
food sensitivities to herbs, spices or food in any
category,” they write. Each patient would have to
determine personal sensitivities through trial and error. In
an interview, Ms. Sawyer said: “This approach is simple,
it doesn’t cost anything and nobody is making money from it.
We’re not saying the diet is a cure; it’s a way to control
the symptoms of MS. Walking around watching what you eat is
a lot better than sitting in a wheelchair.”
Before she started the diet, Ms. Bachrach, a former
dancer and movement instructor, could not even use a
wheelchair because her upper body had become too weak to
manipulate it. She was 35 when she learned she had MS; by
49, she was mostly bedridden. Then, in 2006, she met Ms.
Sawyer and decided to try the diet she suggested. “After
one week on this diet, I regained feeling in my toes,”
she wrote. “After about six weeks, I also gained
incrementally in terms of endurance and muscular rebound. I
was even able to walk back down to the waterfall on my land,
to carry firewood, to empty the ash bucket, to make a
spaghetti sauce and to stay up to greet my husband on his
late return from a trip, all in one day, and still felt just
fine. “There is no doubt that on this diet, my good days are
definitely better. I continue to gain new sensations,
mobility, strength and endurance every month.”
Hers is one of nearly a dozen dietary “success
stories” recounted in the book. Several other patients
reported that they remained well as long as they stuck to
the diet, then relapsed when they got careless about food,
only to improve once more when they went back on the diet.
Why, you may wonder, isn’t everyone with MS on this diet?
The answer lies partly in the complex nature of the disease.
Multiple sclerosis is a highly variable autoimmune
disorder in which the body’s own immune system attacks the
myelin
sheaths that protect
axons, which transmit nerve signals in
the brain. The most common form is called
relapsing-remitting: patients are well for a time, then their symptoms return,
only to subside again sometime later, with or without
treatment. Thus, it is hard to know whether any improvement
is due to diet.
Patricia O’Looney, vice president for biomedical research
at the Multiple Sclerosis Society, said in an interview:
“There’s a strong placebo effect in MS. With any change a
person makes — in diet or whatever — they’re likely to feel
better because they’re taking some action. Eating less
saturated fat and more fish oil is good for all of us. But
we’d never suggest changing one’s diet in place of taking a
therapy approved by the Food and Drug Administration."
The theory behind the “recovery diet” is that in
susceptible people, partly digested proteins stimulate an
allergy-like immune response, resulting in antibodies that
mistake myelin for the offending protein. These antibodies
can then enter the brain and attack the myelin sheath,
disrupting nerve conduction and eventually causing death of
the axons. The goal the authors suggest is to identify and
eliminate culprit foods from the diet to quiet the immune
response.
There are several problems involved in trying to test
this or any other dietary regimen scientifically. As
Rosalind Kalb, an associate vice president of the MS
society, explained, the cyclical nature of the disease means
that studies must be long term. “Over an extended period
people have to follow an exact diet,” she said in an
interview, and the findings among them must be compared with
people on ordinary diets.
Documenting adherence to a strict regimen like the
recovery diet is challenging in itself. And since there may
be individual sensitivities, there are too many variables,
and it is hard to know what to exclude from the test diet.
It is one thing to examine a single nutrient like omega-3
fatty acids or vitamin D, but much more difficult to test a
diet in which many different nutrients are involved.
“Thus far, no researcher has been interested in taking this
on,” Dr. Kalb said. “The medications seemed to show
more promise.”
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