Food Matters in MS

Food Matters in MS

The etiology of multiple sclerosis remains unknown. Likely there are several different pathways to developing multiple sclerosis of MS. The factors which are likely playing roles in MS are the interaction of the following: 1) DNA, 2) Toxin exposures (eaten, inhaled or absorbed through skin), 3) Infection 4) Micronutrient intake (food), 5) Allergy or sensitization (to food), 6) Stress level (physical, psychological and spiritual) and 7) Insulin production each day. The cause of injury has been identified as antibody complexes which destroy myelin. The loss of myelin leads to breaks in the communication between the brain (and spinal cord) and the body. The result is weakness and or disturbed sensation (blind, dizziness, pain).

In this blog I will talk food and multiple sclerosis. There are three main ways food can get individuals into trouble. First – is toxins from the use of herbicides and pesticides. Second is micronutrient intake and third is food allergy and sensitization. Third is the effect of maintaining high insulin levels on the level of inflammation in our body. I’ll conclude the article with a brief synopsis of what I have done personally regarding food.

Toxins are present in and on the food that has been grown with the help of pesticides and insecticides. Best options to deal with this is grown your own food, or buy local organic when you can. Wash all food carefully. If you buy non-organic wash carefully. The more gently you have to wash something, such as berries, the more likely it is that you can’t get the pesticides off the food. Lettuce, berries, and celery have high amounts of pesticide residue. If you can – go organic for those.

Micronutrients have been discussed previously. The standard American diet (SAD) is below the recommended daily intake for many vitamins, minerals and phytonutrients that our brains need. We often do eat enough omega 3 fatty acids (fish & fish oil, flax & flax oil) for making a key myelin. Neither do we eat enough of the correct amino acids (especially sulfur) for making key neurotransmitters. Diets with 9 cups of fruits and vegetables, 3 of which are rich in sulfur such as the onion and cruciferous family of vegetables will greatly improve the micronutrient content of the diet.

Food allergies and sensitivities are also a contributor. Celiac disease which is gluten (found in wheat, rye and barley) sensitivity causes the body to make antibodies against gluten. The symptoms are not just belly stuff. People can have skin problems, joint problems, fatigue, personality changes, mood problems, weakness, and pain. People have come in with severe neurological problems, severe changes on their brain MRIs and have been diagnoses with multiple sclerosis. But when someone considered the possibility of gluten sensitivity and had the patient faithfully follow gluten-free diet, their neurological problems began to resolve over the next year. The brain MRI improved. The large white scars on the MRI disappeared. The patient actually had gluten sensitivity, not multiple sclerosis. That is why anyone who has been diagnosed with multiple sclerosis would benefit from eating a very stringent gluten-free diet for at least a month to help determine what role gluten-sensitivity has in their disease.

If we can have that level of damage and response in the brain to sensitivity to wheat, it is logical to consider sensitivity to other foods can likely generate similar levels of damage to the body and brain. That means that anyone with MS who is not doing well would likely benefit from considering the possibility of food sensitivities as a factor that keeps their disease active.

That is a complex issue to solve because people can end up sensitized to multiple food items. We know that in those with gluten sensitivity, 70% have their symptoms completely resolved with gluten avoidance. The other 30% have additional food sensitivities which must be identified and also eliminated to do well. So how do we figure out who is sensitive to what foods? That is not easy for several reasons. 1) The blood tests can capture some of the sensitivities, but not all, and 2) Although most reactions occur quickly, some reactions to food occur up to 72 hours after ingestion. As a result the most effective way to confirm food sensitivities is through an elimination diet, food diary and symptom diary for a minimum of one month. The next several paragraphs describe two approaches to identifying what sensitivities a person may have.

Gradual food reintroduction is the most stringent application of a food diet asks the individual to eat only the most non-sensitizing food available in America for a week, and then gradually reintroduces one food item per week. The individual keeps a symptom record. If no symptoms of any type occur in that week, the food item is identified as safe and added to the list of allowed foods. Gradually over several months food items are gradually returned to the diet. Because of the gradual process, it is possible to identify with precision what causes symptoms and eliminate that particular food from the diet. Many are not willing or capable of doing that kind of protocol. , 3) Elimination diets require planning ahead.

Elimination diets are a more moderate approach. The person with MS is advised to eliminate the most common sources of food allergy from their diet initially. These include: wheat, eggs, milk, and legumes (which includes peanuts and cashews). They are then given a chart which lays out a 4 day rotation plan and menu suggestions. The goal here is to have the individual eat from different food families every day so that you do not eat a food more frequently than every 4 days. The individual is to keep a food and symptom diary. Because symptoms occur within 72 hours, the individual who has kept their food diary knows all of the food items they have eaten in the prior 3 days. They can identify what foods have been safe in the past, and what foods were new in that time period. They are advised to eliminate that food from their diet. If the person wishes, they could try that food again in 4 to 6 months. It turns out that for some people we have a few severe food allergies that we can never eat, and others which are milder allergy. If we eliminate the mild allergy food for 6 months, the lining of our gut heals. Then if our gut sees the mild allergy food only on occasion the gut cells can tolerate it without causing a major antibody response. The other benefit of an elimination diet is that it tends to increase the variety in our food intake often improving the micronutrient content in the long run.

Books are available on the issue of food sensitivities and micronutrients to help you design menus that can work for you. These include The Worlds’ Healthiest Foods http://www.whfoods.com/, The MS Recovery Diet http://msrecoverydiet.com/ and Restoring Your Digestive Health http://www.amazon.com/Restoring-Your-Digestive-Health-Transfom/dp/07582028220 . Gluten-free diet resources can be found at http://www.celiac.com/catalog/index.php?cPath=48_50. Asthon Embry has written extensively on connections between diet and MS and has a web site http://www.direct-ms.org/bestbet.html.

Insulin is a pro-inflammatory hormone. The more insulin our bodies need to make to control our blood sugar levels, the more inflammation molecules we make. If we eat a diet that does not generate rapid climbs in blood sugar, we do not need to generate as much insulin. Sugar makes our blood sugar rise very rapidly. Eating white potatoes makes blood sugar rise rapidly. So does drinking juice that has had the pulp and fiber removed from the juice. So does eating things made with white flour like bread, pastries, and pasta. If you want to lower the insulin levels then the best diet focuses on the non-starchy vegetables, protein sources, whole fruit, and avoids or minimizes grains. Whole grains are absorbed more slowly and therefore generate less insulin.

Celiac Disease and gluten-free diets have a larger collection of books devoted to that topic. Google the terms and you will find many sources of additional information.

Eating out and processed foods are a challenge for those who are using an elimination diet. You need to read labels carefully, and ask the waiter about what food item may be included in the dish you are ordering. The simplest approach is to avoid eating processed food, or eating out, particularly while you are first going through the elimination diet.

What did I do regarding my food consumption? In 2003 I began the Paleolithic diet. I eliminated grains, milk and legumes. I continued to eat meat, poultry, fish, vegetables (including white potatoes), fruit, and eggs. By 2007 I had gone back to eating rice, and occasional beans. Summer of 2007 I took a blood test for food allergies which identified marked sensitivity to eggs, pinto beans, and milk. I eliminated those from my diet in October. I started the four day rotation diet but did not maintain it. I was not keeping a food symptom diary. November 2007 I started neurostim. At the end of December I started the intensive diet rich with 9 cups fruits and vegetables a day minimum. I ate 4-6 cups of cruciferous or onion family vegetables each day, and 3 cups of brightly colored vegetables or fruits. January 2009 I went back to creating a food, symptom diary and began the elimination diet with the four day rotation of foods.

Why was I able to go from four years dependent on a scooter, back to walking, bicycling and skiing?

Since I don’t have serial blood tests to identify how much nutritional status changed, the inflammatory status, or biological changes that were occurring it is hard to say what precisely what happened as I got stronger. I do have several theories which I’ll share.

First – the neurostimulation that I started in November 2007 coupled with exercise produced stronger larger muscles and generated growth factors in the brain which stimulates repair of myelin, and growing new connections between brain cells. That priming made my brain more ready to do the repair work. The food made it possible for the brain cells to use the growth factors.

Second – I eliminated more vigorously the foods to which I had documented food sensitivity on the blood tests in the summer of 2007.

Third – I greatly increased the intake of B vitamins, co-enzyme Q, antioxidants and organic sulfur though food. This resulted in a big boost of the micronutrients I was eating.

Fourth – I switched to entirely organic foods.

Fifth – I focused on getting every color each day.

Sixth – Because I eliminated white potatoes, grains etc, - the amount of insulin my body makes each day is quite low.

Seventh – I now keep a food / symptom diary and follow a four day food rotation.

What about supplements?

While there may be benefits in supplements – they are not without risks. Supplements are not regulated by the FDA. There are many reports of supplements not containing what they label claims to be inside. In addition there are problems with the purity and contamination. If the herbs or foods listed on the label are not grown on organic farms, there is a risk of heavy metal contamination (also present in our food). But since the food is concentrated to very high levels for the supplement – the previously trace levels of contamination can become quite high. Another important difference is that nearly every study has shown that the whole food is associated with superior outcomes to specific nutrients. That is likely because we absorb nutrients better when they are in food. Higher blood levels are consistently seen in comparison to food versus supplementation. Also we get the additional hundreds of other phytonutrients in food all of which are likely playing contributory roles in health. My recommendation is to focus first on using an elimination diet and food/ symptom diary to maximize your micronutrient intake and lower inflammation.

Summary

Food matters. If you can, grow some of your own food. Buy organic. Try eliminating the most common offenders – gluten, eggs, milk, and legumes. Keep a food, symptom diary. Try an elimination diet with a four day food rotation. Consult with a nutritionist or other healthcare provider familiar with elimination diets. Exercise can help increase the brain growth factors and speed healing. But without the needed micronutrients and lower levels of inflammation – you wont’ get far. The quality of the good and the avoidance of foods to which you are sensitive can make a big difference in your ability to improve.

Radio interview podcast

This link will take you the Iowa Public radio station which has an MP3 file of interview with Ben Kieffer on "The Exchange" December 8th, 2008.

http://www.publicbroadcasting.net/kuni/.jukebox?action=featured

Scroll down to find the pod cast for December 8.

MIcronutrients and Improved Function in MS

Progressive multiple sclerosis and micronutrients – is raw food superior to cooked food?


I am often asked whether raw food is superior to cooked food for micronutrient availability for patients with MS. The basic guide I provide is that food taken directly from the plant is the very best for you. If you cook food, the lower temper in steaming or a very low (180 degree) roast is the next best. The other key item is to eat any fluid or juice from the cooking (which is where all the water soluble nutrients have gone.


Micronutrients are critical for brain health. Unfortunately the average western diet is deficient in most vitamins, minerals, essential fatty acids and amino acids which have recommended daily allowances. The reason for this is the reliance on cheap sources of calories in grains which have most often had the germ and husk of the grain removed.
Very few vegetables are consumed. The animals are increasingly raised in high density farm factories with minimal exposure to green grass or sunshine. The consequence is that the meat has minimal omega 3 fatty acid, vitamin and mineral content.

Are nutrients lost with cooking? That depends on high the cooking temperature and how long. Immediately fresh and still raw when you eat the food means that cooking has not leached any of the micronutrients out of it. But some of the micronutrients may not be available to you because our bodies can’t digest all of the cell walls in plants. If you cook below the boiling point and drink all the juice – the food is generally more digestible and you have not lost much of the micronutrients. However – some of the compounds that are very helpful to us will gradually be lost with prolonged cooking. Cooking above the boiling point of water, particularly frying tends to oxidize many of the compounds in food. When that occurs many of the anti-oxidants in food have become oxidized – and therefore their anti-oxidant benefit to us is gone.

Bottom line – Raw retains the nutrients in the food. Cooking gently makes the nutrients more available because the food has been partially digested by cooking. Frying oxidizes many of the helpful compounds. Prolonged high temperatures cooking likewise can breakdown micronutrients. My advice is to increase your micronutrients through more vegetables and fruits. Eat them raw or cooked according to your personal preference. But if you cook, always drink the juice. Never throw it away.

Vitamin D and MS disease activity

In this blog I will comment on the role of vitamin D in multiple sclerosis. Multiple studies have demonstrated an association of low vitamin D levels and increased risk of multiple sclerosis diagnosis and greater severity of symptoms.

We also have more and more evidence that vitamin D is important to health immune function. Furthermore there is an epidemic of vitamin D deficiency. People spend less time outdoors. When they do go outside people apply sun screen to protect them from the sun to decrease the risk of skin cancer. The problem is that sun screen also blocks the skin's ability to make vitamin D. That explains why we have an epidemic of vitamin D deficiency in our children, young adults and those over sixty-five. Thus far every group that has been measured has had an alarming rate of vitamin D deficiency.

If someone has MS or has a family member with MS it is likely that they would benefit by taking supplemental vitamin D. What dose should they take? The recommended daily allowance for vitamin D has been set for only 400 international units (IU). That was when scientists had believed vitamin D's only role was related to bone health. The dose of 400IU was the dose of vitamin D which prevented spontaneous bone fractures.   However vitamin D affects more than bones. The brain is filled with Vitamin D receptors and vitamin D is important to normal immune function.

There is increasing evidence the recommended daily allowance is much too low. If one was outside during the summer long enough so that their skin was slightly pink, but not enough to have even a mild sun burn, 20,000 IU of vitamin D would have been made in the skin. Researchers have recently given MS patients higher doses of vitamin D and then examined the patients for evidence of toxicity and of decreased MS disease activity. Their conclusion was that doses of 10,000 IU each day were well tolerated. Furthermore patients who had been given 10,000 IU experienced less disease activity as measured by the ability to tasks of daily living and the molecular markers of MS related inflammation. 

Based on those study findings taking 10,000 IU per day of vitamin D is likely safe and likely beneficial. Using tanning beds to maintain a tan without burning is an alternative strategy to maintaining adequate vitamin D levels.  Having your personal physician check your calcium level would confirm that the high dose of vitamin D is not causing problems for you. Ensuring that you have sufficient vitamin D is an important strategy to minimize disease activity if one has or is at risk of having MS.

Connections Between Food, Mitochondria and Chronic Disease

In this post I will review the connection between micronutrients, mitochondria and multiple sclerosis. The link between the food you eat, the micronutrient content of that food, and multiple sclerosis is reviewed. The specific micronutrients needed for optimal mitochondrial health is reviewed and general diet recommendations are provided.

The brain and spinal cord depend entirely on mitochondria to the make the molecules of adenosine tri-phosphate or ATP which are used to drive everything that our brain cells must do to function. The chemical plant which makes ATP molecules is the mitochondria. Two important cofactors are needed to make ATP. These are B vitamins and coenzyme Q10. And like all manufacturing processes there is some left over trash at the end which is free radicals. And like any other factory, when the trash is not removed the chemical plant eventually blows up. The defense against free radicals is antioxidants. When the mitochondria are short on the B vitamins and coenzyme Q less ATP is made and more trash is made per ATP molecule generated. When less antioxidants are around free radicals are not neutralized and instead begin to damage the brain cell.

There is a growing medical literature which indicates that mitochondria are not healthy in multiple sclerosis and are contributing to the damage which is occurring, particularly in progressive MS. Eating to ensure one’s mitochondria have plenty of micronutrients is something under the individual’s control and is not going to conflict your current treatment.

It is important for cells to have a ready supply of intracellular anti-oxidants. It is the colored vegetables and fruits that have the most anti-oxidants.

Our Health= Micronutrients consumed – empty calories consumed.

Which one of those most closely describes your diet, or your children’s diet?

Chronic Disease= Few micronutrients (vegetables + fruits)- empty calories (French fries, potatoes, white bread, candy, soda, pastries etc.)

Optimal mental and physical healthy= Many fruits + vegetables, some fish, occasional organ meats – no empty calories.

The more micronutrients in your diet – the minerals like iron, magnesium, copper, manganese, calcium, vitamins both known and not yet discovered, and the antioxidants to help your cells get rid of the trash- the more easily it is for the cell to do all the things the DNA wants it to do.

I am in internal medicine- occasionally I give an antibiotic that cures someone of their infection. Mostly I give medicines that control symptoms- such as lowering blood pressure, improving blood sugar control, or lowering cholesterol. If someone wants to have optimal health- then they must provide their cells with as many micronutrients as possible.

Genes turn on and off according to our diets. That means if we eat diets poor in micronutrients- genes turn on which accelerate the degeneration of our bodies- worsening of diabetes, high blood pressure or obesity for example. If we eat diets rich in micronutrients – genes turn on that often lead to regression of disease.

Bottom line= optimal health requires optimal nutrition.

Physicians mostly can only control symptoms. For your mitochondria, your cells and your body’s to work most effectively – eat more micronutrients.

Diet recommendations: Each day maximize your micronutrients-

9 cups of vegetables and fruits 3 cups should be dark green or from the cabbage family,3 cups should be deeply colored, for example red, orange, or blue, and 3 cups of your choice but do not include potatoes or corn in the 9 cups.

Organ meats once a week or wheat germ daily for coenzyme Q

Fish or seafood three times a week

When you eat –

Have 3 cups of vegetables and fruit first, then your protein source, then whatever else it is that you want to eat. Remember –unless your are doing physical activity – your body was designed to maintain itself without any grains/ starchy potatoes. If you are physically active – then additional carbohydrates make sense. If you have any chronic disease – any calorie you eat that is not packed with micronutrients is a calorie that took you farther away from your goal of optimal health.

Activity – difficult to sustain if it is not part of your daily life. People who are most successful are those who have incorporated more walking, physicality into the their routines either before or during work hours. Moving (walking or jogging) one’s body 3 miles a day is optimal.

Sustaining the effort – people who lose weight and keep eating 9 or more cups of vegetables and fruit, and walked or jogged 20 miles in a week are the most successful at maintaining weight loss.

Supplements – Food is the best. Do not think can supplements replace the micronutrients from 9 cups of vegetables and fruits. If you cannot eat fish however –take fish oil or flax oil. If you cannot eat organ meats once a week or wheat germ daily, take coenzyme Q10 supplements. If you have chronic disease – improving the health and nutrition for your mitochondria is an excellent place to start.

Terry Wahls, MD