Wednesday, October 28, 2009

Is there an MS diet?

There are low-cal diets and low-carb diets, liquid diets, vegan diets, diets that claim to fight aging, arthritis, autism, and anxiety - and that's only the "A"s.

For people with MS, many doctors recommend a traditional low-cal, low-fat diet; others promote strict limits on certain food groups. Or they emphasize certain
foods such as fatty fish, apples, blueberries, broccoli or almonds.

The varied recommendations and the lack of a distinct game plan can leave people with MS just plain confused.

"While it is unlikely that a simple diet will be therapeutic in MS, recent data regarding the roles of vitamins such as vitamin D and niacin in maintaining a healthy immune and nervous system suggest that we should pay more attention to nutrition," said Dr. Peter Calabresi, who heads the Multiple Sclerosis Center at Johns Hopkins Hospital in Baltimore.

"No one is completely sure what works and what doesn't," said Dr. Heidi Crayton, director of the MS Center of Greater Washington, DC. "There are guidelines for
smart eating, but there is no fail-safe plan. I tell my patients with MS that
it's really important to have a healthy diet.

That includes two liters of water and 30 grams of fiber every day, a palate with bright, colorful foods, and foods that have high nutritional value. Decrease fats and refined sugar," Dr. Crayton added.

Some doctors who look to a more aggressive eating plan to deal with MS support the Swank Diet, a stringet low-fat diet developed by Dr. Roy Swank more then 30 years ago. It bans all dairy products, glutens (found in wheat), legumes (meaning beans and peas) and virtually all saturated fat from animal sources. It stresses fish and
fish oils.

Dr. Swank reported that 95% of patients who adopted this very low-fat diet following an early diagnosis of MS had a remarkably good chance of remaining free from
further disability.

"They have to follow the diet strictly because even small amounts of fat make a big difference," Dr. Swank said. He asserted that patients who had a daily intake of eight grams of saturated fat (one hamburger or two ounces of cheddar cheese) significantly increased their risks. Dr. Swank published his study in the British
medical periodical The Lancet in 1990. "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, people actually have to work to get better," Dr. Swank told Dr. John A. McDougall, founder and medical director of the McDougall Program, which promotes this very low-fat approach. The problem is other researchers have not duplicated Dr. Swanks results, and there is no generally accepted proof that the Swank diet really controls MS. There is anecdotal evidence from people with MS who say this diet makes them feel better.

Dr. Vijayshree Yadav, a neurologist at the Oregon Health & Science University MS Center in Portland, Oregon, said there is litde current research on the Swank diet. In fact, "diet has not been paid that much attention," she said. "But diet can make
a difference."

She advises her MS patients to go low-fat: "It's healthy. And it's such a low-risk intervention that I don't see any reason not to recommend it." She also said a new study is expected to get underway next year at the Oregon facility to take a hard clinical look at the impact of diet on MS.

"Diets have been used for MS from time immemorial. If they worked, we wouldn't be still talking about them," said Dr. Randall T. Schapiro, the director of the Schapiro Center for Multiple Sclerosis in Minneapolis. Like many other MS specialists. Dr. Schapiro recommends a healthy diet that is low in saturated fat.
Other than that, he said no specific diet has shown any long-term benefit.

According to Dr. Allen Bowling, director of the Complementary and Alternative Medicine Program at the Rocky Mountain MS Center in Englewood, Colo., it may be reasonable for some people with MS to take a fish oil supplement that includes one to
two grams of EPA plus DHA. He also notes that it's wise to beware of overstated claims either for or against specific foods or supplements. He agrees with Dr. Yadav that research on MS and diet is very limited.

All these doctors agree that while there is no concrete evidence that a specific diet controls MS, there is every good reason to eat a healthy diet and avoid things that are known to be bad for everybody. So while there is no true consensus, an MS plan might look like this:

• Cut back on saturated fat. That means avoiding highly marbled red meat, butter, cheese and other full-fat dairy products.

• Use oils from vegetables, seeds, and fish. Try butter substitutes, such as soft or tub margarine, but use sparingly and look for "0 trans fats" on the label.

• Eat fish regularly, especially salmon, herring, mackerel, tuna, sardines and lake trout.

• Eat skinless chicken or turkey, lean meats trimmed of visible fat, or go meatless with vegetable proteins from beans, lentils, soy or nuts.

• Consume five servings of fruits and vegetables a day, choosing the brightly colored fiber-rich varieties.

• Eat three to four servings of whole-grain products daily. There is no concrete evidence that gluten has any impact on MS.

• Exercise to stretch muscles affected by MS, stay in shape, manage mood, fight fatigue, promote bone health, and maintain a healthy weight.

• Be cautious with caffeine and alcohol.

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