Dr. Jonathan White writes about the evidence for diet in MS.
If anyone knows anything about Overcoming MS, it is probably that it involves “a diet”. Not a short-lived, fit into your new swimsuit kind of protein shake, but rather a wholesale change of eating patterns, and your relationship with food. It means shifting away from the highly-processed, ultra-refined and altered fats foodstuffs that so many of us consume daily; to a wholefood, plant-based diet, with seafood, if you so wish. For many OMSers, including myself, this change is so revolutionary to our health and happiness that we wouldn’t go back to our old habits, even if our MS disappeared tomorrow.
But for more than 20 years, the dietary changes championed by Prof. George Jelinek – that became the cornerstone of the Overcoming MS Program – have been largely ignored by healthcare professionals, and the message has consequently gone unheard by the vast majority of people living with MS.
And what’s worse, if an individual had embarked on a quest for knowledge, determined to take control of their health, and found the all-important evidence, then they may have had all hope dashed on the rocks of “there is no evidence for diet in MS” when speaking to certain healthcare professionals. I heard that phrase (or something very similar) myself soon after diagnosis, and that “no-cebo” effect; the negative placebo, a sense of having all positivity and optimism torn from you, is a deeply palpable one. It can also be directly damaging to your health, creating pro-inflammatory changes in the immune system, not to say anything of the effects on one’s mental wellbeing.
The courage and conviction of OMSers is to be marvelled at, then. We refuse to lie-down and accept the traditional dogma, but instead firmly trust in the evidence-base, patiently waiting for that last piece of the puzzle to convince the powers that be.
You might well ask though, does it really matter if the role of diet in MS is never truly accepted. After all, we are in on the secret, we trust our own bodies, we know that we are re-building cell by cell, and very often feel considerably healthier and happier for it too?! But of course it does; all 3 million people living with MS worldwide deserve to hear this, as do those still to be diagnosed.
And then, over the horizon comes an editorial entitled “The Role of Diet in Multiple Sclerosis: Food for Thought” soon to be published in “Neurology” one of the pre-eminent journals in neurology in the world. In here is one simple, yet paradigm-shifting phrase. Are you ready for it now, it’s pretty big?! O.K. here we go…
“there is sufficient evidence to recommend a healthy diet as an adjunct intervention in MS”.
Fifteen words that I hope and trust can change the hearts and minds of many healthcare professionals working in MS, and therefore the long-term trajectory of the condition and general health for very many people around the world.
This is the journal of the American Academy of Neurology after all, not some glossy magazine. The evidence behind this wonderful statement comes from eleven studies, examining a range of dietary approaches that included low-fat, modified Mediterranean, ketogenic, anti- inflammatory, modified paleolithic, fasting, calorie restriction and control diets.
One clear theme emerged amongst all the differences between the various approaches; that a healthy diet is superior to a standard American (Western) diet in terms of MS fatigue, mental quality of life and physical quality of life.
Commonalities between the highest scoring diets include high intake of fruits, vegetables, fish/seafood, nuts/seeds, and healthy fats and avoidance of high-fat meats and ultra-processed foods which contain added sugar, sodium, and hydrogenated fats – does that sound a bit familiar to anyone?!
The authors go on to say that the only question that remains to be answered is: which MS diet is best? For that we ideally need prospective, high-quality, head-to-head trials. As luck would have it, we already have substantial evidence; the Dutch MS Study and the HOLISM study.
Published in 2022 in “Nutritional Neuroscience”, Dutch researchers looked at the diet quality of 728 people living with MS, and again found those with the highest quality diets had a significantly higher physical and mental quality of life. They also found that the “Jelinek diet” or Overcoming MS diet obtained the highest quality score of all MS specific diets (using the validated Dutch Healthy Diet Index), some ten points higher than those not following a specific regimen (with a maximum total score of 80).
This has more recently been validated by research published as part of the HOLISM Study, which confirmed that the Overcoming MS diet was the MS diet of highest quality, higher than two other MS specific diets (Swank or Wahls).
So to summarise, we know that the evidence base is now at a level that demands clinicians recommend healthy eating as part of MS management. Whilst ideally more work needs to be done on testing specific diets against each other, we already have substantial evidence confirming that the Overcoming MS diet is of the highest quality. It, of course, has the additional bonus of being a delicious, exciting and sustainable way of eating, and also offers protection against many of the common conditions that cause so much morbidity and mortality in or communities.
I believe this to be an all-round win for the Overcoming MS program, and vindication of the pioneering work done by Prof. Jelinek some twenty plus years ago.
Now all we have to do is spread that message far and wide – here is to 2023!!