Neuroscience applied to Multiple Sclerosis’ diet
With a prevalence ranging from 33 to 80 %, patients with Multiple Sclerosis (MS) make use of Complementary Alternative Medicine (CAM) in conjunction with or in lieu of, the prescribed standard therapy. (1,2)
This is due a significant need of improving quality of life (QOL), which has been ranked poor, due the inadequacy of current treatment options to reverse the progression of the disease, nor to treat efficiently the disabling symptoms of MS, which include pain, stiffness, spasms, cognitive impairment, fatigue, depression, bladder and bowel dysfunction, imbalance, tremor, and insomnia. (3)
Complementary and Alternative Medicine (CAM) is commonly used by patients to find symptomatic relief, and its effectiveness has been evaluated by a growing number of exploratory studies, showing consistently that dietary changes and mind-body approach offer substantial benefit. (1, 2)
Many patients are using Cannabis or cannabinoids derivatives such as Sativex to manage many of these symptoms, as we discussed in “Why are cannabis based medications used to treat Multiple Sclerosis” and “A review of clinical evidences for use of cannabinoids in Multiple Sclerosis” and “A guide on Sativex“.
Today, I would like to tackle another fundamental aspect of disease pathology, mostly considering the CAM nutritional protocol wrote for the Raw study (You can find more about that in Our Projects section).
The biological benefits of a low-fat plant-based diet
Several positive associations are found between diets with a total fat content lower than 15% of daily caloric intake and vitamins supplementation (vegetables & fruits), with slower MS disease progression and significant clinical benefits (reduction of relapse rate, Expanded Disability Status Scale –EDSS- score improvement, and moderate improvement of quality of life -QOL). (6, 7, 8)
Substantial evidence show that diets high in saturated animal fats and trans-unsaturated fatty acids adversely affect cognition due insulin dysregulation. (9,10)
Insulin resistance was positively linked to impaired medial temporal lobe function, reduced hippocampal synaptic plasticity (and spine density) and overall impairment of cognitive functions (10, 11, 12).
The medial temporal lobe consists of structures that are vital for declarative or long-term memory (such as semantic & episodic memory). One of the most critical sub-structure of the medial temporal lobe for memory formation and learning is the hippocampus.
Impairments at these regions are linked with mood changes, which the patient may be unaware of, including poor attention span and aggressive behaviour towards themselves and/or others.
Moreover, damages at these areas are linked to loss of speech, inability to read and/or write, loss of vocabulary and overall degeneration of motor ability.
If you are experiencing any of the above, we recommend you to check out our articles on “The influence of Yoga over memory” & “Boost your Memory with Yoga practice” to apply along the nutritional advice we post here.
Insulin-induced changes of adipocyte (fat-storing cells) metabolism dysregulates leptin and ghrelin production, key hormones in energy balance, thus contributing to further impair cognitive functions. (11,12, 13, 14)
Thus, low-levels of plant-based saturated fat and low glycemic index carbohydrate foods are associated with better cognitive functions and lower levels of neuroinflammation. (9, 15)
Accordingly with literature, and the clinical evidences of the low saturated fat Swank diet for MS, the macronutrient content percentage of the diet advised to Multiple Sclerosis patients, is shown as following:
Table 1: Macronutrients % Low-fat plant-based diet
Essential fatty acids: the neuroprotective effects of certain fats
Accordingly with literature, daily supplementation of PUFAs is neuroprotective and have been showing consistently to reduce the secretion of pro-inflammatory cytokines. (1,3,6,7,8,16,17,18)
PUFAs and their metabolites trigger multiple cascades which act at several cellular levels in order to reduce inflammatory infiltrates in the brain, prevent relapses and attenuate MS progression. (17, 19)
Table 2: Polyunsaturated Fatty Acid recommended
|Omega-3 fatty acids α-Linoleic acid (ALA)||Omega-6 fatty acids
|α-Linoleic acid (ALA)||Linoleic acid (LA)|
|Eicosapentaenoic acid (EPA)||γ-linolenic-acid (GLA)|
|Docosahexaenoic acid (DHA)|
- ALA is present in high % in Flaxseeds, hemp seeds, chia seeds and broccoli.
- Find GLA in hemp oil and spirulina algae.
- DHA & EPA are present in hempseeds, seaweeds, cauliflowers, greens, red & pinto beans & walnuts.
What is the mechanism by which more Omega-3 are beneficial to MS patients?
EPA and GLA have both found to decrease Blood Brain Barrier (BBB) permeability, via upregulation of the tight junction protein occludin, which in turn sequesters immune cells and toxic agents outside the brain parenchyma. (20,21)
Basically, when EPA and GLA are present in the body, they switch on a system that starts to produce “molecular putty”, protecting the brain from toxic agents. Often, in autoimmune disorder such as MS, some cells of the immune system at the periphery of the body become hyperactive and, once they pass through the brain, start to initiate a series of events which lead to pathophysiology of MS: degeneration of protective myelin sheath and further death of neuronal cells.
DHA has been consistently found to reduce pro-inflammatory secretion of cytokines (IL1, IL2, Tumor Necrosis Factor-α and IFN-γ) and inhibit CD4+ T cells proliferation (hyper-activated white blood cells that play a prominent role in inflammatory disorders), paralleled by a reduction of motor function deficits. (16,17,24).
EPA improves clinical scores and increases expression of peroxisome proliferator-activated receptors (PPAR) via a similar mechanism of action to DHA by an overall reduction of cytokines (IFN-γ, IL17) and decreasing CD4+ cells both in the CNS. (16,23,25)
Moreover, α-Linoleic acid (ALA) protects from spasms via activation at TWIK-related potassium channel-1 (TREK1) and decreases production of adrenaline and cortisol, aiding sleep and mood disorders. (22,23)
Observational studies of diet rich in fruit and vegetables with daily supplementation of DHA and EPA, showed significant reduction in the mean annual exacerbation rate and EDSS striking results both on better mobility, mood and overall quality of life. (8)
Nutraceutic is the study of nutrients with pharmacological benefits, it is evidence-based science and it should play a prominent role in medicinal approach. Although it is often overlooked by several physicians (and mostly by neurologists), it is one of the single daily factors that feeds or alleviate disease progression.
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