Is Diet an Alternative Treatment for Multiple Sclerosis?

The Role of Nutrition in Multiple Sclerosis

Multiple Sclerosis (MS) is a chronic disabling disease of the central nervous system (CNS), which often leads to severe disability and a host of symptoms to add insult to injury. The condition has an unpredictable intermittent course of exacerbation (relapse) and remission. You could say, MS Bites.

You would be forgiven if you chose to use spicier language to (more artfully) describe how much MS Bites. I have been known to do so on occasion.

Although research into Multiple Sclerosis continues to progress, MS remains a disease with no known cause or cure. There is an expanding variety of disease-modifying therapies (DMTs) which, according to the National MS Society, “have been found through clinical trials to reduce the number of relapses, delay the progression of disability, and limit new disease activity (as seen on MRI).” Severe relapses are often treated with corticosteroids. There are also a wide variety of therapies to manage the long list of symptoms associated with MS.

All of these DMTs, therapies, and clinical specialists who treat multiple Sclerosis and help us navigate all of the baggage that comes with it are brought to us by conventional medicine.

Conventional Medicine and MS

Conventional Medicine: Also called allopathic medicine, biomedicine, mainstream medicine, orthodox medicine, and Western medicine. Conventional medicine includes your whole MS care team:

Neurologist
Nurse, Nurse practitioner
Physician Assistant
Physical Therapy
Occupational Therapy
Pharmacist
Behavioral Health Specialist, Neuropsychologist
Speech Language Pathologist
Physiatrist
Urologist
Infusion Nurse
Clinical Registered Dietitian Nutritionists (RDNs)

Despite continued progress in understanding MS and the growing availability of medications to impact the disease process and manage symptoms, it is essential to note that ALL of these therapies come with additional baggage, including expense, risks, side effects, and what can feel like a never-ending list of pharmaceuticals. This fact, the often erratic and disruptive course of the MS disease process, and the lack of a cure contribute to dissatisfaction with currently available conventional treatments.

In short, people with Multiple Sclerosis (MS) are increasingly interested in alternative treatment options

What therapies fall under this category?

Acupuncture and acupressure
Aromatherapy
Chiropractic
Cannabis
Low Dose Naltrexone
Massage and Body Work
Mindfulness
Pilates
Reflexology
Exercise
Yoga
Tai Chi
And finally, Nutrition: diets, supplements, herbal remedies

But is any kind of diet an alternative treatment for Multiple Sclerosis? A more natural way to “treat” the disease?

Conventional medicine says no. For what it’s worth, so do I.

Is diet an alternative treatment for MS?

However, unconventional nutrition modalities feature prominently in the toolboxes of unconventional practitioners, including Functional Medicine, Holistic, Chiropractic, Ayurvedic, Homeopathy, Naturopathic, and others. These folks frequently encourage very rigid diets, food sensitivity (and other expensive and unnecessary) tests, boatloads of (unregulated) supplements, and on and on.

Many wax poetic about the importance of an individualized treatment plan and then tell everyone to avoid the same things—usually gluten, dairy, carbohydrates, nightshades, and sugar with no evidence for the efficacy of these interventions, at least not in the treatment of MS.

So, what is unconventional medicine?

Unconventional Medicine: Unconventional, alternative, or unorthodox therapies are difficult to define because they encompass a broad spectrum of practices and beliefs. And many practitioners disagree with each other.

How are these different from conventional medicine? It’s hard to say since each provider describes what they do differently. However, unconventional medicine arose because they questioned the foundation or premise of conventional medicine. They claim to offer a personalized treatment plan based on the “root causes” of disease.

Conventional medicine uses the word etiology in place of “root cause.”

Regardless of whether you prefer the phrase etiology or root cause, remember that the cause of multiple Sclerosis remains elusive. Unknown. Unelucidated. Food didn’t cause MS. Food cannot heal, beat, or reverse it either.

Despite this, many unconventional practitioners promote various “diets” to treat MS.

But do they?

The MS "diets"

You may have heard of one or all of these diets. I am asked about them all of the time. I have provided my very brief thoughts on each below:

Wahls Protocol– (all versions, all levels) anecdotal evidence. She was the only person in the study that spawned her book. There were also additional variables that may have contributed to any outcomes.

Swank– is essentially a heart-healthy eating pattern. Any outcomes in MS have yet to be replicated, which is a problem from a research perspective.

OMS– is essentially a very low-fat, heart-healthy diet. There is no evidence to support the efficacy of this diet in treating MS.

OMS makes unsupported claims about food and MS. In particular, their recommendations to avoid milk which they base on mouse studies. So, if you are a mouse with the mouse version of MS experimental autoimmune encephalomyelitis (EAE), do not inject milk protein(s) into your veins; it will not end well. If you are a human with human MS, do not inject milk protein(s) into your veins. Consume it the old-fashioned way, by mouth. If you are a human, this mouse research does not apply to you at all. If you abstain from dairy for any reason, make sure to select an alternative that is fortified with vitamin D and calcium. Your bones will thank you.

Ketogenic– a therapeutic approach for children with refractory epilepsy. No evidence of efficacy in MS.

AIP– There are over 100 autoimmune conditions. Each has a different etiology and manifestation. No nutrition intervention will address all of them. No evidence of efficacy in MS.

Anti-inflammatory is a buzzword, not an actual nutrition intervention or dietary pattern. So, no evidence of anything really except that it is an effective phrase for marketing lots of things.

So, none of these diets are helpful for MS?

It depends on what sort of help you are looking for.

Current research shows no nutrition intervention, diet, supplement, herbal remedy, regimen, or protocol will impact the MS disease process.

So, if that is what you were hoping for, no, not helpful.

But as I mentioned above, MS Bites.

Receiving a diagnosis can be extremely difficult to process. Some of the folks who adopt one of the diets listed above report that doing so gives them a feeling of control, which is understandably important given all of the control that MS has taken away. Many of the “diets” are actually promoted as a way to regain or take back control.

Some find comfort in the rigidness of diets with an abundance of rules, good foods and bad foods, MS-friendly foods, etc. The complexity distracts from all the tough things that MS throws our way. It provides something to focus on and work towards.

I am not suggesting that distraction and control are harmful coping mechanisms. Our brains are wired to protect us. These things offer helpful temporary relief, but If we don’t eventually transition to coping mechanisms that will serve us better in the long run, we run the risk of racking up some unintended consequences.

Diets are not risk free interventions

Nutrient deficiencies or malnutrition can arise from restricting or avoiding large quantities of foods, which is the human body’s preferred source of nutrients.

Binge eating behaviors can arise from focusing on restriction and other external food rules rather than recognizing internal cues for eating.

Orthorexia Nervosa is when eating healthy goes too far. It is a pathological obsession and preoccupation with eating only “clean,” “pure,” or other approved safe foods. Orthorexia can become a life-consuming process of detailed planning, shopping, and preparation of approved foods.

To sum up: All of the MS “diets” are unnecessary. None are therapeutic.

Eating healthy really requires balance, variety, and flexibility to provide adequate nutrients. And it really must be both physically and emotionally nourishing. If a “diet” is causing you to sacrifice emotional health for physical health, it is truly not serving your health.

What is a therapeutic diet?

A therapeutic diet is a clinical nutrition intervention/diet that controls the intake of certain foods or nutrients. They are part of treating a medical condition and are typically prescribed by a physician and planned by a dietitian. These clinical interventions are a part of conventional medicine and nutrition.

Therapeutic diets are modified for:

Nutrients (sodium, fiber, electrolytes, consistent carb, etc.)
Texture (food and or beverage) due to dysphagia
Food allergies/intolerances (celiac, lactose intolerant)
Alternate route feeding enteral (in place of or in addition to oral meals) parenteral feeding.

Therapeutic nutrition interventions take a problem→intervention→outcome approach, much like when medications are prescribed. This approach ensures the intervention will address the specific problem and improve health outcomes. You don’t get prescribed flu medication to treat cancer, right?

Therapeutic nutrition interventions are also targeted at a specific problem and intended to affect an outcome.

A few examples of therapeutic diet include:

Low sodium diet for hypertension.
Consistent carbohydrate diet for glucose control
Renal diet for chronic kidney disease
Gluten-Free diet for Celiac Disease.
Dysphagia Pureed diet (Dysphagia Level I) for dysphagia
Enteral feeding via Jejunostomy tube when the oral route cannot be accessed for nutrition
Total parenteral nutrition (TPN) when bypassing the gastrointestinal tract is necessary.

Let’s take a closer look at one of these therapeutic diets. For example, a healthy diet for folks with kidney disease aims to consume the most balanced, varied, flexible, and adequate nutrition while modifying the intake of electrolytes and protein that damaged kidneys may not tolerate. One of the jobs of our kidneys is to remove wastes and extra fluid from the body. Because kidney disease can impair kidney function, the modifications of a renal diet are specifically intended to keep the levels of electrolytes, minerals, and fluid in your body balanced and limit the buildup of waste products in the body.

Multiple Sclerosis does not require any such dietary modification. Unlike the examples listed above, MS is not a nutrition-related disease. Based on current evidence, no nutrition intervention impacts the MS disease course. There is some limited evidence that interventions may impact symptoms like fatigue. Whether the reported improvements are due to an intentional focus on variety, balance, flexibility, and more consistently including foods that help us meet nutrient needs and allow our body to function better or something more specific remains unknown.

Put it to the test

Before changing your diet dramatically or adding lots of supplements to your daily routine, why not subject them to a quick test by answering these questions:

What specific problem are you targeting?
What specific intervention will you implement? In other words, how will you modify your diet?
What outcome are you hoping for? Is this a realistic expectation?
Does any research suggest this intervention will impact the problem?

Let’s use the therapeutic nutrition intervention for hypertension to help illustrate the idea further:

Specific Problem: Hypertension as evidenced by144/93 blood pressure
Specific Intervention: Reduced sodium dietary pattern
Expected Outcome: Improved blood pressure
Is expecting improved blood pressure with a reduced sodium diet realistic? Yes.
Is there any research to suggest this intervention will impact hypertension? Yes.

Unconventional providers take a different approach

Unconventional practitioners don’t follow the problem→ intervention →outcome approach described above. The problem (autoimmunity, inflammation, brain fog) is usually vague, but the interventions are generally very specific. Often, they involve complicated food rules, restrictive eating patterns, requiring copious supplements, and unnecessary tests, among other things.

Consider this example:

Specific Problem: Multiple Sclerosis
Specific Intervention: Specific and exacting food rules, including things like removing entire food groups from the diet, taking copious supplements (presumably to replace nutrients no longer provided by food)
Expected Outcome: Heal, beat, reverse [or other terms that vaguely mean improvement] MS
Is there any research to suggest this intervention will impact the MS disease course? No.
Is it realistic to expect that modifying your diet in this way will heal, beat, or reverse MS? No, not in any clinical sense.

The language used here is intentionally vague, so it is difficult to know what they even mean in the context of a disease with no known cause and no known cure.

My doctor told me to follow a Mediterranean diet. Isn't that therapeutic?

No.

The Mediterranean Sea Region is the largest semi-enclosed sea in Europe. Twenty-two countries surround it with a coastline stretching for about 28,000 miles. This region is home to around 480 million people in Africa, Asia, and Europe. As you might imagine, mealtime means something different depending on where you are in an area with this amount of regional and cultural diversity.

But their eating patterns all embrace some similar components:

Include more (as well as a variety of) plant foods: vegetables, fruits, whole grains, nuts seeds, and heart-healthy oils like olive, avocado, and others
Include fewer animal products and meat
Include fish and seafood at least twice a week

The broad components of the Mediterranean Dietary pattern listed here align nicely with the specific guidance offered by Dietary Guidelines for Americans (DGA). While these guidelines advise us on what to eat and drink to meet nutrient needs, promote health, and prevent disease, they are not considered therapeutic. If you were in a hospital and your doctor wanted you to have a Mediterranean Diet or one that represents the DGA, you would have a generally healthy diet ordered for you because that is precisely what the Mediterranean dietary pattern is. A generally healthy (but not therapeutic) diet.

So, is diet an alternative treatment for multiple sclerosis?

Food is essential to being a healthy human, so eat to support health. However, food is not an alternative treatment for MS. There is no need to adopt any of the MS “diets” to eat well with MS. And no eating pattern can make up for being sleep-deprived, stressed out, or sedentary. So, engage in other behaviors to help you live well with MS.

An uncomfortable truth

Many alternative practitioners vastly over-promote nutrition’s role in living well with Multiple Sclerosis. Problems or frustrations with conventional medicine and/or big pharma do not mean alternative or unconventional medicine will work.

Coming to terms with MS Starts with learning to practice acceptance.

Have you accepted your diagnosis?

Take a moment to reflect on how acceptance may help you pursue your personal and health goals, food choices, and other eating behaviors.

What if you reclaimed “control” over the energy that has been directed at trying to deny MS or micromanage your food habits in a way that Dr. Google assures you will heal, beat, reverse, or even cure MS?

Acceptance is not quitting or admitting defeat. It is not a failure of any kind. Acceptance provides freedom from the pressure to be at war with your body. It helps you stop fighting your body and helps you learn to work with the ever-changing new normal which is multiple sclerosis. Acceptance is strength and resistance. It allows for all kinds of possibilities. Including joy.