Multiple Sclerosis & Nutritional Therapy


Multiple Sclerosis is a disease, for the most part, of civilization. It is far more common in geographic areas where populations consume high fat and highly processed foods as compared to those populations eating more fruits, vegetables, and proteins derived from plant sources. For many years it has been known that there is a significant increase in incidence of multiple sclerosis the farther north you go. For example, the incidence of multiple sclerosis is 6-14 per 100,000 in the southern United States and southern Europe and progressively increases to 30-80 per 100,000 in the northern United States, northern Europe, and Canada. This striking geographic distribution of multiple sclerosis has long been known by research scientists but incredibly has never really been pursued. Often explanations such as "an environmental factor" or "a virus" are offered in textbooks but these explanations are not substantiated by any meaningful research.

When you take a close look at the incidence of multiple sclerosis around the world, you'll find that there are areas in northern latitudes that actually have very few cases of multiple sclerosis. Countries like China Japan, and Korea, while at a similar latitude as the United States and various European countries, have far fewer cases of MS. Taking a closer look at just one northern country, Norway, reveals that the incidence of multiple sclerosis actually varies quite dramatically in various districts just within that country.

Researcher Roy L. Swank, M.D., provided the important missing link when he published research in 1952 showing that there was direct correlation between the incidence of multiple sclerosis in various districts of Norway with the amount of dietary fat consumed by the populations of those specific areas.( 1) This important, but for the most' part unrecognized, discovery offers the first meaningful explanation as to why MS is so common in some areas and almost unheard of in others. Countries like Japan, Korea, and China have until just recently consumed diets far lower in fat than countries with high rates of MS like the United States, Canada, and most of northern Europe. Although several studies have continued to explore and confirm Swank's original hypothesis, the concept that nutrition plays any significant role in multiple sclerosis has not yet really gained a foothold in modern western medical thinking?( 2, 3)

Multiple sclerosis, like many other diseases of modern life, is a disease quite simply caused by an overactive and misdirected immune system. For reasons which are unclear, the immune system reacts against the protective insulating cover (myelin) of the nerves of the central nervous system. White blood cells called lymphocytes attack myelin as if it were some invading organism or foreign substance. When the body's immune system fails to control itself and lymphocytes attack normal body tissues, the disease process that ensues is called an autoimmune disease. Other autoimmune diseases include: rheumatoid arthritis, systemic lupus erythematosus (SLE), and even some forms of vascular disease.

The typical western medical response to these autoimmune diseases, including multiple sclerosis, is to administer potent medicines designed to turn off the overactivity of the immune system that characterizes these illnesses. Unfortunately, these potent immunosuppressant drugs, like Cortisone, Prednisone, Methotrexate, and Cytoxan reduce the effectiveness of the entire immune system and are fraught with other sometimes life-threatening sideeffects.

Somehow, in the case of multiple sclerosis the lymphocytes get their signals crossed. It's as if they receive a message which directs them to attack the brain and spinal cord. But what are the messages which control lymphocytes? Lymphocytes receive direction from a group of chemicals called prostaglandins, so named as they were first isolated from the prostate gland. Prostaglandins can be conveniently divided into three main groups, (PG1, PG2, and PG3). These three groups of prostaglandins are all derived from a special type of dietary fat called essential fatty acids. These dietary fats are not produced in the human body. They are called essential because without them we couldn't survive. The two essential fatty acids important in the production of prostaglandins are linolenic acid and linoleic acid, also known as omega 3 and omega 6 fatty acids, respectively.

The role of prostaglandins 1 and 3 is to moderate or tone down the immune response. Prostaglandins in group 2, on the other hand, signal the lymphocytes to become more active in the immune response. In normal situations a balance is achieved. Under the influence of prostaglandin 2 the white blood cells are activated but this activity is kept from getting out of hand by prostaglandins from groups 1 and 3. Interestingly, the cerebrospinal fluid, a liquid covering the brain and spinal cord, has been shown in patients suffering from multiple sclerosis to contain significantly less linoleic acid than in nonafflicted individuals. Linoleic acid is the precursor to prostaglandin 1. Prostaglandin 3 is derived from linolenic acid.

What emerges from this simplified understanding of immune function is that it may be possible to naturally gain better control over immune function in multiple sclerosis by providing dietary sources of linoleic and linolenic acids, producing more of the "good prostaglandins" - groups 1 and 3. As a matter of fact, this approach to the treatment of multiple sclerosis has been followed for decades in Europe and in Scandinavian countries. Researchers like Dr. Jan DeVries have long supported the use of essential fatty acids supplementation to not only treat the symptoms of multiple sclerosis but also reduce the frequency of new events. Any multiple sclerosis sufferer who has spent any time at all exploring nonmainstream approaches to this illness has likely discovered frequent reference to evening primrose oil. The healing power of the evening primrose plant has been known for centuries. It was used by Native Americans for a variety of skin conditions and for healing of infections. O ver the past half century this special oil has been widely recommended in Europe as a nutritional supplement for the treatment of multiple sclerosis.

But what is it about evening primrose oil that makes it so useful in multiple sclerosis? Analysis of this oil reveals that it is a very rich source of linoleic acid which as we have learend is an essential fatty acid which serves as the precursor to prostaglandin 1 critically important in controlling the immune system. Another rich source of linoleic acid is borage oil. These two supplements are now widely available in health food stores. Prostaglandin 3 is also very important in reducing the overactive immune response in multiple sclerosis. Although prostaglandin 3 is much less potent that prostaglandin 1, it nevertheless plays an important role in that as it is produced it turns off the production of the dangerous prostaglandin 2. Fortunately, prostaglandin 3 is derived from the other essential fatty acid, linolenic acid, which can also be supplemented in the diet. Oil of flaxseed for example is 50% to 60% linolenic acid.

There are dietary factors which will lead to the production of prostaglandin 2 and so likely worsen symptoms of multiple sclerosis. Perhaps the biggest trigger of prostaglandin 2 production is dietary fat, especially saturated fats and cholesterol. Alcohol also leads to prostaglandin 2 production while less prostaglandin 2 is produced in a diet supplemented with zinc, vitamin C, vitamins B3 and B6, and a good source of linolenic acid.

This is why a low-fat diet is critical for the multiple sclerosis sufferer. In one study following 146 patients for an average of 17 years on a very low-fat diet, multiple sclerosis was noted to progress much less rapidly in comparison to patients not fat-restricted. There was also a significant reduction of death rate as well as a reduction of frequency and severity of exacerbations of multiple sclerosis. As Dr. Swank indicated, "If treated early in the disease, before significant disability had developed, a high percentage of cases remain unchanged for up to 20 years."( 4)

Nutritionists, naturopaths, chiropractors, and holistically-oriented medical doctors have for years been treating multiple sclerosis with essential fatty acid supplements, vitamins and minerals, and fat-restricted diets, and have been doing so with great success. This approach to this widespread affliction is founded on the principle of strengthening the body, working with nature, and not fighting a war using the patient as a battleground, as is the case with the use of potent immunosuppressive drugs.

Clearly, modern immunosuppressive medicines may at times have a role in the treatment of acute and severe symptoms of multiple sclerosis but they should not be relied upon in an attempt to maintain good health. With proper attention to diet and lifestyle, as well as the use of specific nutritional supplements, multiple sclerosis is almost always easily brought under control and the body harmonized.

Recommendations for Multiple Sclerosis

Reduce dietary fat immediately and significantly. Total fat should be no more than approximately 18% of total calories.
Essential fatty acid supplementation. Try 1 and eventually 2 tablespoons of fresh flaxseed oil and 2 to 3 capsules of evening primrose oil or borage oil each day. These supplements are widely available at most health food stores. Flaxseed oil should be cold pressed and kept refrigerated.
Eliminate consumption of cholesterol, saturated fats, and alcohol. Without question the best diet for multiple sclerosis is totally vegetarian.
Vitamin C (Ester C), 3,000-5,000 milligrams each day.
Vitamin B-Complex, 100 milligrams twice a day.
A multi-mineral supplement supplying 50 milligrams of zinc each day.
Avoid exposure to heat. This means stay out of hot tubs and sauna baths, and avoid becoming overheated when exercising as these may worsen symptoms.
Learn a meditation or relaxation technique and practice it regularly. Regular meditation has been shown to be effective in other autoimmune diseases and so would very likely benefit the MS patient.
I recommend reading Multiple Sclerosis by Dr. Jan DeVries (Mainstream Publishing Company, Edinburgh). This very informative book can usually be found in health food stores and contains very useful information, not only about nutritional considerations in multiple sclerosis but also information about hyperbaric oxygen, homeopathy, acupuncture, dental care, and enzyme therapy.
Other information about multiple sclerosis can be obtained by contacting Multiple Sclerosis National Society, 205 East 42nd Street, Manhattan, NY 10017, telephone 212-986-3240.

David Perlmutter, M.D.

Naples Neurological Associates, P.A.

The Commons - 720 Goodlette Rd. N., #203

Naples, FL 33940-5693


Fax 813-262-5903

(1.) Swank, R.L., Lerstad, O., Strom, A., et al., Multiple sclerosis in rural Norway: Its geographical and occupational incidence in relation to nutrition. NEJM vol. 246:721-728, 1952.

(2.) Agranoff, W.B., Goldberg, David: Diet and the geographic distribution of multiple sclerosis. Lancet. Nov. 2, 1974, pp. 106166.

(3.) Alter, M., Yamoor, M., Harshe, M.: Multiple Sclerosis and nutrition. Arch Neurol. vol. 31: Oct. 1974, pp. 267-72.

(4.) Swank, R.L., Multiple sclerosis: 20 years on low-fat diet. Arch Neurol. vol. 23, Nov. 1974, pp. 60-74.

Townsend Letter for Doctors & Patients.


By David Perlmutter

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