Patients adopting a Prudent diet also showed a trend toward a lower subsequent risk of MS conversion, but this association was not statistically significant.1
The term “Prudent diet” originally described the fat- and cholesterol-controlled diet followed by subjects participating in the anti-coronary program of the New York City Department of Health since 1957. This diet limits the intake of eggs, whole milk, and whole milk-based dairy products, liver, shellfish, and commercial pastry products. Lean meats are permitted but preference is given to fish which is recommended for use at least four or five times a week.2 There are similarities to the Mediterranean diet although the prudent diet calls for less olive oil.
Recognizing that dietary patterns and their association with the subsequent clinical course had not been well studied in early MS, investigators at the University of Tasmania and University of Melbourne, AU among other institutions sought “to describe dietary patterns in people in 5 years following first clinical demyelination and assess associations with MS conversion and relapse.” Note that the first clinical presentation of the disease is usually a single episode of typical symptoms and signs and is typically designated a “first clinical demyelinating event” (FCDE).
The study included among its methods completion of a dietary intake questionnaire and assessment of MS conversion and relapse risks adjusted for lifestyle factors such as age, gender, supplement use and other items.
In cases with a FCDE, scientists identified three major dietary patterns: “Prudent, High- Vegetable and Mixed.” Fruits, vegetables, fish, wholegrains and nuts were “loaded” on the Prudent pattern, starchy vegetables and legumes on the High-Vegetable pattern, and meats and alcohol on the Mixed pattern. Diet factor scores were not associated with MS conversion risk. The reported results: “Those with baseline Prudent scores above the median had significantly lower relapse risk and was associated with a lower relapse risk in the five years following the first FCDE.”
What can we learn about the right dietary plan for patients?
As the research team originally noted, there was not a great deal of existing data regarding the relationship of diet and MS disease relapse or progression so ideally we’ll see more studies conducted to further evaluate the connection. But we do know that certain types of food are absolutely inflammatory in their properties and contribute to disease initiation or progression.
We’ve also written about the importance of our gut microbiome in MS. Gut microbiota significantly influences human gut homeostasis - as well as the central nervous system - via various mediators including lymphocytes in the intestines. Remembering that we have 70 percent of our autoimmune function in our gut, it’s clear that diet can impact our general wellbeing and our brain health either positively or negatively depending on what we eat.
There are a number of diets that have been reported to be instrumental in reducing harmful inflammation that exacerbates symptoms, not just in MS, but also in many neuroimmune and autoimmune conditions. We generally find that the Wahls Protocol® is an excellent option for patients with its focus on science-based principles of sound nutrition and the power of food as a healing tool. Dr. Terry Wahls’ own MS journey was the incentive to develop and make this program available for others who have also achieved such great support through its dietary and lifestyle principles.
The Swank Diet (http://www.swankmsdiet.org/the-diet) offers another option for balanced eating based on sound nutrition, with basic guidelines that include fresh, whole foods (not processed), healthy fats, and limited red meat consumption (actually no red meat is recommended for the first year).
The Autoimmune Paleo Diet (AIP) works to heal the immune system AND the gut by eliminating triggers that can cause inflammation although meat is allowed on this plan. In addition, the diet recommends adequate sleep, stress management and exercise to work in tandem with your revamped eating habits. Research published last year found that this type of diet can help patients suffering from inflammatory digestive disorders so this news was indeed promising for application in other types of autoimmune diseases.4
At the very least, we advise based on each patient’s specific needs and health issues an individualized, low-inflammatory diet that eliminates gluten, dairy and sugar, includes organic, fresh food as accessible, grass-fed and free-range lean poultry as well as high quality unsaturated fats. Our focus is also on improving gut health and boosting the all-important microbiome so other recommendations are carefully tailored to these goals as well! The benefit of integrative medicine is that it allows us to consider the many variables that affect each of our MS patients, from lifestyle factors to comorbidities, and design a plan of healing action that is as personalized is it is medically comprehensive.
Some foods to keep in mind to fight inflammation include:
• Berries, broccoli, beets and avocados along with other fresh vegetables and fruit.
• Unprocessed whole foods, preferably organic if available.
• Lean protein; reduce your consumption of red meat and choose grass-fed meat whenever possible.
• Healthy fats like those found in tuna and salmon as well as flaxseed and nuts
• Peas, lentils and other legumes
• Whole grains and products made from whole (not refined) grains, eliminate gluten.
• Omega 3 supplements can be helpful too if you aren’t able to get your good fats in whole food form (or you just really don’t like fish).
Always consult a physician for guidance specific to your health needs and if necessary, seek a referral to a dietitian if you are unsure of how to plan a nutritionally balanced meal plan – remember that you don’t need to have a disease like MS to benefit from eating well in a healthy manner. And your loved ones will reap the rewards too! If you have any questions or would like to schedule an appointment, remember we’re always here to help.
Dr. Suzanne Gazda
References and resources
1 Simpson-Yap, S., Oddy, H.W., Taylor, B. et al. “High Prudent diet factor score predicts lower relapse hazard in early multiple sclerosis.” Multiple Sclerosis Journal. (2020 July 23)
2 Harvard Health Publishing, Harvard Medical School
3 MS Research Australia
4 Joy Lee, Christian Pedretti, Gauree Konijeti, Clinical Course and Dietary Patterns Among Patients Incorporating the Autoimmune Protocol for Management of Inflammatory Bowel Disease (P12-010-19), Current Developments in Nutrition, Volume 3, Issue Supplement_1, June 2019, nzz035.P12–010–19, https://doi.org/10.1093/cdn/nzz035.P12-010-19doi.org/10.1093/cdn/nzz035.P12-010-19
For more information about the Autoimmune Paleo Diet see:
Dr. Suzanne Gazda, Integrative Neurology