This article summarizes the most popular diet plans in MS for easier use in your clinical practice.
Traditional nursing and medical education curricula do not include comprehensive teaching on nutrition. While we were all required to take a course as a part of our undergraduate pre-requisites, we did not learn how to integrate nutrition into our clinical practice beyond “low-fat, low cholesterol”, “diabetic”, “renal”, or “regular” in our advanced studies, and certainly did not learn to the extent that the public demands. In this article, I will give a brief overview of the most popular “diets” associated with Multiple Sclerosis (MS).
Patients are increasingly asking about appropriate nutrition. A Google search of “diet and Multiple Sclerosis” revealed over 5 million hits. There is a lot of misinformation on the internet. The bottom line is, there is no “diet” that will cure MS, in spite of the claims made. However, making diet changes, even small ones, to improve health, can certainly help people living with MS feel better.
Better nutrition results in increased energy, better bowel and bladder function, better immune function, and increased health in multiple domains. It is important to prevent other chronic medical conditions in MS, such as diabetes, hypertension, hyperlipidemia, and overweight/obesity, and healthy diet changes provide a way to reduce modifiable risk factors for these problems, as well.
Studies regarding diet and MS have not proven there to be a diet that modifies the disease, and this includes diets high in omega 3s. It is difficult to control for all dietary factors in a study, and a study large enough to look at the breadth of the effects of micro- and macronutrients on MS would be extremely expensive and complicated. Summarizing the current data regarding this research is outside of the scope of this article.
The most common diets discussed in MS are 1) The Swank Diet; 2) The Wahl’s Protocol; and 3) The Gold Coast Cure. I will discuss each of these here in an understandable manner that can be easily implemented into your practice. The nitty-gritty details of these programs are available from their sources at http://www.swankmsdiet.org, in book or e-book form (The Gold Coast Cure), and at terrywahls.com. I will comment on these diets based on my own experience and study.
It is worth mentioning that I have a certificate in Plant-Based Nutrition. While I do not try to drive my patients in that direction, I feel confident that it is a safe and healthy choice for people living with MS, and will guide them that way if they choose. I also do not believe in elimination diets. For example, I am often asked if a gluten-free diet would be good for a person living with MS. My answer is that the wheat we eat in America is seriously modified and processed. Eating “whole grain” mass-produced bread may not really be a great “whole food” choice.
So, rather than suggest gluten freedom, unless a person has Celiac disease or a true gluten intolerance, I suggest switching to breads and pastas made with sprouted grain. Additionally, in my opinion, the gluten-free craze is becoming similar to the fat-free craze 20 years ago. Packaged gluten-free foods are very high in sugar, as the fat-free packaged foods are. Americans got fatter as they ate more fat-free packaged food. If people choose a gluten free diet, they need to do so with minimal packaged/prepared foods.
So, here we go:
The Swank Diet:
The Swank Diet (quick reference): an extremely low fat diet, stringent, and often thought to be difficult to follow. My criticism of the Swank diet is that the consistent use of low-fat and no-fat products may result in the ingestion of more “fake” or processed foods. For example, “butter sprays” are allowable.
a. No processed foods containing saturated fat and/or hydrogenated oils.
b. Saturated fat should not exceed 15 grams per day. Unsaturated fat (oils) should be kept to 20-50 grams/day. Any food that contains oil, including fruits/vegetables such as avocados and olives, nuts & nut butters, and fatty fish must be counted in this amount.
c. Fruits and vegetables are permissible in any amount. (2 fruits and 2 cups of vegetables are recommended daily).
d. No red meat for the first year, including pork. After the first year, 3 oz. of red meat is allowed once per week.
e. White-meat poultry (skinless) (4 oz is a serving size) and white fish (any amount) are permissible, but avoid dark-meat poultry and limit fatty fish to 50 grams (1.75 oz)/day. Three eggs per week are allowed, but no more than one per serving.
f. Dairy products must contain 1% or less butterfat unless otherwise noted. Use egg whites only, no yolks. 2 servings per day recommended.
g. Cod liver oil (1 tsp. or equivalent capsules) and a multi-vitamin and mineral supplement are recommended daily. Also recommended is Vitamin C 1000mg per day, and Vitamin E 400IU per day. This Vitamin C recommendation is actually considered to be excessive, with recommended doses of this being no more than 120mg per day given the fact that high doses of vitamin C may theoretically stimulate the immune system. People living with MS should be able to get enough Vitamin C from food. Vitamin E supplementation remains controversial, as well.
h. Whole-grain breads, rice, and pastas are encouraged, however, any bread, rice, and pasta is permissible.
i. Daily snacks of nuts & seeds are good sources of natural oil, and help maintain a good energy level.
The Wahl's Protocol:
The Wahl’s Protocol (She also has videos on YouTube, including a TEDx talk), currently being studied with primary outcome of perceived fatigue, and secondary quality of life and physical measures, and biomarkers, and primary and secondary outcome measures, respectively).
The Wahl’s protocol is based on a Paleo type diet. She used herself as an initial subject, eliminating gluten, legumes, and dairy products. There is a small amount of certain legumes allowed in the protocol on a weekly basis. All foods must be organic, including meats and seafood. Below is an example of goods included on the Wahl’s Protocol:
a. 3 cups of cruciferous and dark greens
b. 3 cups intensely coloured: 1 cup red vegetables / fruit, 1 cup blue black vegetables / fruits, 1 cup yellow/orange vegetable / fruits
c. 3 cups others including: 1 cup mushrooms / onion family (for organic sulphur), and seaweed for iodine and trace minerals. (Note: 1 cup = raw vegetables chopped = 1/2 cup cooked, an apple sized fruit, or 2 cups leafy greens)
d. Include spices and herbs.
e. Omega 3 rich foods, green leaves and animals fed green leaves, wild fish and seafood. And you could add fish oil.
f. Eat organ meats once per week
g. Regular bone broth
h. Fermented foods or a probiotic
i. Many supplements are recommended, and I would suggest her book for more information on these.
Gold Coast Cure:
The Gold Coast Cure (Larson & Larson, 2005, Deerfield Beach, FL: Health Communications, Inc.), written by a woman living with MS, Ivy Larson, and her physician-husband, Andy Larson, this plan focuses on the importance of nutrition and exercise in improving the general health of one living with MS, and now, for inflammatory conditions in general.
Some consider it a “modified-Swank” protocol. You can eat a daily “sweet treat” on this program as it is “all natural.” It may contain refined flour or sugar, though nothing else during the day may contain these ingredients. It may not contain hydrogenated or partially hydrogenated oil, margarine, or vegetable shortening. You may use condiments in small quantities, and you may use Splenda or Stevia. I prefer Stevia, as it is a more natural sugar substitute.
a. Eliminate trans fats
b. Eat more whole carbohydrates: whole wheat breads and pastas, brown rice, oatmeal, beans, fruits, vegetables
c. Limit saturated fat intake to 15 grams per day if you have an inflammatory condition
d. Eat anti-inflammatory essential fats, with an appropriate balance of omega-6 (sources such as soybeans, whole grains, nuts) to omega-3 (sources such as fish, shellfish, walnuts, flaxseed and oil, canola oil)
e. Switch from using mass-market vegetable oils to “properly prepared, unheated omega-3 oils”
f. Eat fiber in high quantities, their rule is 2-3g fiber / 25g carb
g. “Eat a wide variety of whole foods to obtain optimal amounts of micronutrients”
As a general neurologist, MS specialist, or advanced practice clinician practicing in MS, it is important to do due diligence with investigating nutrition. People living with MS are asking about nutrition more and more. They want details, and they can either get misinformation on the internet, or you can act as a guide to provide them with plan that will improve their general health.
Again, diets do not take the place of disease modifying therapies, but improved nutrition certainly improves the body’s ability to function. If you have further interest in nutrition and supplements in MS, I would encourage you to go to the sources of these plans, and to review Dr. Allan Bowling and Thomas Stewart’s book, Dietary Supplements and Multiple Sclerosis (Bowling & Steward, 2004, New York, NY: Demos Medical Publishing Inc.).
In addition to discussing the above diets, my general rules for clients are as follows: shop the perimeter of the grocery store; buy packaged foods minimally; packaged foods should have no more than 5 ingredients, and if there is an ingredient that can’t be pronounced, put it back on the shelf; if affordable, buy organic and non-GMO products as much as possible; shop locally and seasonally, at farmer’s markets, etc.; be picky about where fish and animal protein sources, and look for hormone- and antibiotic-free, free range, grass fed meat and dairy products; start slowly so you don’t set yourself up for failure; enjoy your food; and use spices. Arming patients with resources to live a full, well, and hopeful life with MS is one of our greatest gifts.