The topic for this post came from a request from a friend looking to help her family member with Multiple Sclerosis. As is my wont, I began searching research for some lifestyle and nutrition/supplementation tactics to ease the inflammation associated with this disease. Thankfully, there is a decent amount of research regarding this topic and inflammation in general. Also, many of these guidelines and tips can be applied to the rest of us suffering from various levels of inflammation due to the "friendliness" of these suggestions. What is Inflammation and Why should I Care?
Good question and I am glad you (I) asked! Inflammation, in most basic terms is the body's immune response to a stimulus. This can be anything from bacteria, viruses, chemicals, burns, punctures, scrapes, food and even our own cells. Typical signs of inflammation are redness, swelling pain, heat and loss of function. But what if our inflammation, as in MS, is coming from within our own bodies? This can be anything from a genetic predisposition to our ingestion of certain foods. For instance, some people who are intolerant, but not "allergic" to certain foods experience bloating and puffiness after eating it. This is a relatively benign, but unwelcome response from the body. What is happening is the increase in inflammatory mediators, like histamine, which serve to allow more permeability of blood vessels for increased immune cell passage and expansion of blood vessels. This also results in a local increase in extra-cellular fluid, the fluid outside of the actual cells. EC fluid is 92% water and this contributes to that bloated, puffy, watery look when inflamed.
What is one experience most of us have had similar to this phenomena? Eating spicy food. The capsaicin in hot peppers and chili's are the plants inherent defense mechanism and causes some local inflammation when we eat it. And what do we experience? Redness around the mouth, puffiness around the mouth and eyes, excess mucus, watery eyes and maybe some swelling in our throat. Now imagine eating a food every single day that elicits one or some of those effects.....you might not even notice after a while that you do not look and feel your best.
For most of us, we can simply avoid substances and foods that cause these reactions in our bodies; that could be avoiding dairy if it gives you issues, washing your hands after handling hot peppers or using all-natural cleaners instead of harsher chemicals. For people with autoimmune diseases they do not have this simple luxury and therefore need to A. Make lifestyle changes and B. Supplement to combat these chronic inflammatory effects.
Fortunately, these recommendations are also pretty useful to the rest of us and are inexpensive, easily implemented and straight up good for you! I've done my best to translate the research into suggestions any of us can use, but don't assume you need to implement all of these (like the ketogenic diet) as they may not pertain to you.
General Research Conclusions
1. I've read a few different studies that found very low-carbohydrate diets helped reduce symptoms in patients with MS. These are basically ketogenic diets which means you end up burning so much body fat as fuel in the absence of carbohydrates that excess gycerol(part of a triglyceride) is converted to ketones. Diets like this are actually used often in children with epilepsy and other seizure related diseases, and to be honest the research isn't conclusive on why this works but it has been found to be quite effective.
One interesting thing about ketones is that they are "cleaner burning" fuels than carbohydrates and present with less oxidative damage when being used as fuel by the body. Since patients with MS are often suffering from lots of inflammation due to attack on their nervous system, this could be part of the benefit of the diet. If you are healthy and lean, limiting carbohydrates may not be necessary but if you are overweight and inflamed (fat tissue stores toxins so they are not released into general circulation), then lowering carbohydrates and ingesting more antioxidants is a good move.
2. HOWEVER, other studies suggest that diets low in saturated fat are more protective against MS. Since most ketogenic diets contain a large amount of saturated fat, the research seems to be inconsistent, but who knows how much saturated fat the patients on the ketogenic diets were actually eating...it didn't say. Either way, they claim that saturated fats may not be able to enter capillaries and thus cause inflammation in capillaries. They also theorize that since saturated fat decreases cell membrane fluidity that it can interfere with normal cell function like insulin sensitivity. I would note though, that they claim a high-fat AND high-carbohydrate diet is pro-disease and obviously ketogenic diets are very low-carbohydrate. I would never recommend a very high-fat and high-carbohydrate diet anyways, so this may be a moot point for most of us.
3. So this is confusing, I know. What is generally agreed upon is that eating a low-inflammation diet with support from antioxidants and polyphenols is really protective against nervous system inflammation. Also, avoiding dairy was suggested because one of the key proteins in cow's milk actually has inflammatory effects on the nervous system, and this has been linked to autism. If this starts to sound sort of Paleo, I was thinking the same as they recommend no dairy and eating a low-inflammation diet but defining how you eat with a moniker like Paleo is sort of silly. I'd rather just say, I eat the way I need to.
4. Now to the ways they suggest eating a low-inflammation diet with polyphenols, carotenoids and general anti-oxidants:
A. Quercetin – Apples, onions, wine and citrus
B. Resveratrol – Wine, chocolate, peanuts, grapes and berries
C. Curcumin – Active ingredient in Turmeric or you can buy a supplement
D. EGCG – Green tea, also can be purchased in supplement form
A. Lycopene(100x stronger than vitamin E) – Tomatoes, watermelon and pink grapefruit
A. Olive Oil – good free radical scavenger
B. Vitamin C – Another free radical scavenger
C. Melatonin – A really powerful antioxidants(I actually researched this a lot in one of my other articles on my blog and melatonin is hugely antioxidant and anticancer etc.)
D. Vitamin D – Considered one of the most promising antioxidants against MS, and recommended for almost everyone by almost everyone(I made myself laugh here).
A. Fish oil – the brain is largely DHA (an omega-3) and fish oil has been shown to be neuroprotective and anti-inflammatory. Research has shown people with MS to be deficient in DHA. Omega-3's help increase cell permeability too, which is important for insulin sensitivity and it helps thin the blood(if that is something you need).
B. Coconut Oil – Although this is almost entirely saturated fat, coconut oil has some unique properties in not being metabolized like other fats and being healing to the digestive system. Coconut oil is basically rancid-resistant so this is a good oil to cook with. Olive oil is good to eat but as a cooking medium it is prone to quick oxidation because of its low smoke point. Coconut oil is also rich in Medium-Chain-Triglycerides which do not need to be processed by the liver for use as energy making them a quicker burning fuel; also can easily be converted to ketones, which are a secondary fuel for the brain.
A. It is recommended to not eat too many carbohydrates with this type of diet because they raise insulin levels which promote inflammation through several pathways( arachadonic acid and eicosanaoids). As I have noted above, this is a good general recommendation for people who need to lose bodyfat. The carbs I suggest lowering would be highly-processed and wheat based. A little rice, squash or potatoes is not going to kill you though, so relax.
A. Since exercise helps reduce bodyfat and normalize blood glucose levels, this is highly recommended to assist in reducing overall inflammation. Really intense exercise will actually be oxidatively damaging temporarily in the body. To this I think walking for an hour or so is great as it burns body fat primarily and doesn't cause a huge oxidative stress on the body, but I still think weight training is the best exercise you can do for body composition, muscle mass, bone density and confidence and quality of life.
This is a lot of info so I will summarize it for you. Even though saturated fat is potentially “bad” on this diet, if we are reducing carbohydrates, it probably won't lead to fat storage and inflammation as the fat will just be burned for fuel.
A. Reduce overall carbohydrate consumption-this mainly includes starchy carbs like bread, pasta, rice and potatoes - eat the right amount for YOU. If you exercise, you can get away with more, if you sit in an office all day, you'll need less.
B. Increase overall consumption of non-starchy carbs like greens, squash, tomatoes, onions, broccoli, cauliflower, cabbage, rutabaga, turnips, green beans, carrots, peppers and so on
C. Cook with fats with higher smoke points like coconut oil and possibly some grass-fed butter
D. Use Extra virgin olive oil but drizzle it on foods and avoid cooking with it as much as you can
E. Exercise, like walking as often as tolerated and safe weight training
F. Include quality berries, onions, citrus, green tea in your diet
G. Take fish oil, melatonin at night and possibly a curcumin and Vitamin D/Vitamin C supplement
None of these recommendations are that difficult and just require a little smarter shopping. You may want to discuss taking vitamin D, melatonin and curcumin with you doctor but it's unlikely someone is going to tell you not take fish oil, eat more veggies and berries, exercise, reduce carbs and drink green tea. I have read more about curcumin and it really seems like a great supplement, even as effective as NSAIDS without any side-effects and helps with total-body inflammation.
Here's to looking and feeling better, inside and out!!