Is One Diet Better Than Another?

Diet is one of the, I think, the biggest areas of interest for people with MS. Whenever we do seminars, it's one of the questions that always comes up. And the honest answer is, we don't know that there is a specific diet that is best for people with MS. Every five years or so something will come up in social media that says this is the diet for a person with MS.

And this has been going on since the 1950s. We have a diet called the Swank diet, or the MS diet, that's been around for many, many decades. Right now, one that many people are interested in is the Wahls Protocol, which is a diet plus a lot of lifestyle changes. And it's challenging and we really don't know that there is a specific diet. I like to look at it from a broader health perspective.

So, people with MS generally have a normal life expectancy. People with MS tend to die of heart disease, cancer, and stroke. People don't die from their MS. typically. So, if we put it in that frame and think about things that are good for your health overall, chances are, they're probably going to be good for your MS as well. I think most MS researchers would agree that a diet that is higher in fruits and vegetables, lower in saturated fats, fatty meats, probably something that looks like a Mediterranean type diet, is probably the best overall in terms of just health management.

We think those types of diets that are lower in saturated fats are probably less inflammatory and MS is an autoimmune disease. It is a problem with excessive inflammation directed at the brain and spinal cord. So, diets that would be more inflammatory are probably beneficial for people with MS.

We generally say we would like for people, as much as possible, to get their nutrients and vitamins from foods and not from pills. That diets that are higher in fruits and vegetables are probably best. It gets difficult when you get into different specific supplements and vitamins. I think that we can say that vitamin D has good data to support keeping normal vitamin D levels.

So, we do check 25-hydroxy vitamin D levels in everyone with MS. We find that about 85% of individuals with MS are vitamin D deficient. So, we would like to see a 25-hydroxy vitamin D level generally in the 50-70 range. Vitamin D is a fat soluble vitamin.

So, A, D, E and K, your fat soluble vitamins, those are the vitamins that we can't just randomly take bucketfuls off. You can hurt yourself by taking excessive amounts of the fat soluble vitamins. So, with vitamin D, if we have excessive amounts of vitamin D, you're actually at risk for ectopic calcification. You can start depositing calcium in places in your body where you don't want calcium, like your kidneys.

You could have a higher risk of kidney stones. You can actually have a higher risk of heart disease because you're depositing calcium in your coronary arteries. So, there's a sweet spot with vitamin D levels and so we don't want to just randomly mega dose everyone with MS with vitamin D. We want to know where they're starting at and custom tailor their vitamin D dosing based upon what their blood levels are.

Research is pretty strong and showing that getting vitamin D levels up into that good 50-70 range seems to be associated with a lower risk of MS relapses and a lower risk of new lesions on MRI. Outside of vitamin D, the research starts getting a little bit thinner. And so we get a lot of questions on other specific supplements and it's just things like turmeric, which does appear to be inflammatory. Animal models of multiple sclerosis would suggest that turmeric does have a calming inflammatory effect.

It's a little bit harder to find good human data. So, sometimes we don't have the research that we would really like to have and so what we come back to is more of a practical, common sense approach and say, well, what do we know about a specific supplement or vitamin? If there's not hard research, why would this thing be good or harmful in theory? And then, is it reasonable to add it in and expect that maybe there could be some benefit, even if there's no hard research?

And is there little potential for harm? And have conversations with your health care team. Tell us what your thoughts are. Tell us what you're reading online. Again, there's a lot of stuff. I feel badly sometimes for people with MS. There's just this avalanche of information coming out. I feel like sometimes individuals are trying to drink from a fire hose. And so, sometimes you've got to have a little bit of a filter and ask for help and advice. Social media can be a great place to get information and support. It can also be confusing and a source of bad information. So, talk to your health care team about diet issues.

If you're specifically interested in whether something is helpful or not helpful, if you have specific non-MS challenges. You're interested in weight loss or weight gain, talk to your team. A lot of MS centers have nutritionists and dietitians on board that can help us navigate through these sometimes confusing waters.