NUTRITIONAL MANAGEMENT OF MULTIPLE SCLEROSIS A Practical Clinical Approach Dr. Teri A. Jaklin ND, IFMCP

Diet and Nutrition are the historic bedrock of naturopathic medicine and now also find a fundamental role in emerging science and medicine. It is the most essential element in your health, and one of the Cornerstones to Recovery.

There is so much information available today regarding nutrition – to the point of overwhelm! Optimally dietary intervention builds on well understood generalities to provide a diet that is as individual as you are. Yes, there will be new ideas, concepts and foods – AND it is all about improving and learning along the way. At the end of the day diet and nutritional change is about healing, not deprivation.

Science now recognizes the role that inflammation plays in chronic illness, the precious role of enzymes and membranes (to name a few) in healthy cellular function and the anti-processes that deplete the body of the vitality it needs to continue to function. It is also understood that the first step in successfully managing health is in healing the gut, and creating a diet that not only decreases inflammation (and all its reprecussions), but also delivers nutrients that promote healthy biochemistry, efficient detoxification and optimal metabolic function, enabling tissues to correct and repair damage. Long held naturopathic nutritional interventions are now, and continue to be, validated in the evidence base. Changing your diet to change your health has never been more widely accepted and it echoes the words of Hippocrates, the father of modern medicine…

Let food be your medicine and medicine be your food.

An abundance of nutritional information and research specific to improving chronic/autoimmune illness exists. From Dr. Roy Swank’s pioneering research (The Swank Diet) to more current work by neurologist Dr. David Pearlmutter MD (Grain Brain) and researcher Dr. (and MS patient) Terry Wahls MD (The Wahls Protocol). Dr. Ashton Embry PhD (ms_direct.com), himself a researcher, has also contributed significantly to this field. One of the oldest naturopathic nutritional interventions is an elimination diet which has been revived by one of my functional medical colleagues Tom Malterre MS,CN we will talk about that in more detail later.

The following recommendations gather the most salient points from current research and combine them with naturopathic nutritional knowledge, my own clinical observation as well as my own personal experience.

Dr. Teri A. Jaklin ND, IFMCP Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com www.terijaklin.com Nutritional Management of MS

Healing Nutrition; An Overview

MS or any other chronic illness is mediated through the delicate tissues of the gastrointestinal tract (GIT), aka the microbiome so, it makes sense that every bite we take has an impact on our health. Dr. Alessio Fasano, a renowned gastroeneterologist at Massachusetts General Hospital states three factors that predispose a person to autoimmune disease: 1. Genetic predisposition 2. Exposure to environmental triggers or proteins that cause an abnormal immune response 3. A leaky (permeable) gut that allows these triggers to access the body

Consequently, there is no such thing as neutral, your food is either adding to or taking away from your health condition. There is also no system of the body that is untouched by the state of the GIT; mediating inflammation, balancing the immune system, absorbing nutrients, creating vitamins, and impacting virtually every system in the body.

Step One: Fruits and Vegetables From a nutritional perspective you simply can’t over-eat vegetables – I double dare you to try! Vegetables provide the micronutrients we need to control inflammation, enhance detoxification and optimize metabolic function. They also contain between 2-4g of protein per serving – and are a great source of fibre and since no level of constipation is OK (and it is often a problem in MS) keep eating. Enjoy them raw, steamed or stewed. If you eat them raw remember that they take more energy to digest, so try not to large amounts of eat raw veggies after lunch time. If you eat a Standard American Diet (SAD) you are probably eating way too few veggies, so work up to the optimal “dose.” • Begin with 6 portions/6 colours (1 portion =1/2 cup cooked, 1 cup leafy) of veggies per day and work up from there. Eating steamed veggies improves the availability of the food nutrients allowing the GI mucosa to repair itself. This amount becomes easy to attain when you include veggies with each meal, and as snacks. • Here’s an idea of how easy it is to get 6 portions per day: Breakfast: 1-2 Portions, sautéed, steamed, or in a smoothie Lunch: 2-3 Portions, salad, sautéed, steamed in a smoothie Dinner: 3-4 Portions, include a small salad and 3 veggies on your plate. Snacks: 1-3 Portions nibbled on throughout the day • Always include something green with every meal. How? A kale leaf and piece of avocado in your morning shake, a salad with lunch and steamed greens with dinner! • Fruit may be included in the total count. To keep the inflammatory process down eat no more 1-3 pieces per days. Favoring dark berries and avoiding a lot of the higher sugar white fruits like bananas, apples, pears etc.

Dr. Teri A. Jaklin ND, IFMCP 2 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com Nutritional Management of MS

• The nightshade family of vegetables are pro-inflammatory and should be avoided as much as possible. This includes tomatoes, potatoes, eggplant and peppers. Clinically I see potatoes aggravate inflammation the most and should be an absolute avoid. • Eat a variety of all the vegetables (except the night shades) and try new ones often. Add your favorite herbs and spices to enhance the taste. • The best vegetables are grown locally, are organic, and eaten fresh and in season.

Fermented Foods Since a healthy gastrointestinal tract (GIT) is vital in autoimmunity and the more you balance and heal that with food, the fewer supplements you will need to take. Fermented foods (aka cultured veggies) have been around as long as wo/man has been eating. It is the most natural way to balance a healthy GIT ecology. Prepare these at home, experiment until you find ones that you like and eat about ½ cup with each meal. Fermented foods include fermented veggie combos, sauerkraut, beet kavass, kimchi etc.

There is a plethora of information on the internet and YouTube to get you started, so take a look! To get started, here is a super-simple way to start fermenting! Finely chop up your veggies - start with green cabbage as a base, add carrots, or beets add onions and garlic- these act as a fuel for the fermentation and will not bother you in fermented form even if you have problems with them normally. Add a starter or brine (2 Tbsp sea salt in 4 cups of water)

If you have particularly sensitive GI and all this fiber aggravates your digestion, start by taking a teaspoon of the brine off the veggies and gradually introduce the veggies a teaspoon at a time.

Remember, the difference between homemade and store bought is huge. Many governments require pasteurization of food. Real fermented/cultured foods must be unpasteurized. The best way is to simply ferment food a small batch in your own kitchen. BTW did you know that fermented food is the answer to stopping your sugar cravings!?

Fats; the Good, the Bad and the Ugly

Saturated The cell wall of every cell requires “good fats” (primarily Omega 3, some Omega 6) for healthy function. Good fats are also required for optimal brain function, energy production and so much more. The Standard American Diet, which continues to degrade general health and promote chronic and autoimmune conditions like MS, is full of saturated (bad), trans and hydrogenated fats (ugly), as well as an overabundance of Omega 6 oils which also promotes inflammation. ! Dr. Swank’s research recommends that we limit animal source saturated intake to no more than 15g per day.

Dr. Teri A. Jaklin ND, IFMCP 3 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com Nutritional Management of MS

! Not all saturated fats are equal. By definition is solid at room temperature. Butter and the fat marbled through a steak are examples of animal based saturated fat. These are most prevalent in red meats like beef and pork. The saturated fat in poultry seems to concentrate in the skin which can be removed. ! Coconut fat is a plant based saturated fat that consists of medium chain triglycerides which are used by the body for fuel and can be used liberally Examples of saturated fat content: 1 tsp butter = 5g. 1oz skinless chicken or turkey = 1 g. 1oz beef = 3-8g.This means a touch of butter, or a 4-5 oz portion of turkey or chicken fall well within Dr. Swank’s recommendations. Beef is a different story. A 4oz beef tenderloin would be about 12 g of saturated fat while the average 6oz burger would be 48 g of saturated fat. That’s more than a three day supply inflammatory saturated fats on a bun! ! Dr. Swanks research recommends that we limit animal source saturated fat intake to no more than 15g per day. ! Use “Better Butter” – clarified butter, add olive oil or coconut oil. ! Fish contains no saturated fat and is a rich source of anti-inflammatory Omega 3 Oils. ! What are “healthy fats?” – Fish, coconut, olive, and avocado oils are the best – coconut and avocado oils have higher heat tolerances.

Omega 3 Fats ! The omega 3 oils from fish and sea vegetation are powerfully anti-inflammatory, neuroprotective and neurorestorative. Two key components of Omega 3 oils are EPA and DHA. A daily intake of 3g+ of EPA & DHA is recommended. ! In addition to supplementing with at least 1 tsp of fish oil per day, enjoy cold water fish 1- 2x per week (Eg. Salmon, cod, mackerel, herring, sardines etc). Approx 4-5oz of oily fish provides around 1g of EPA/DHA. ! Organic flax oil, walnut oil and perilla oil provide a plant based form of Omega 3 oils (ALA) that can be converted to EPA and DHA in the body. Use them liberally in salad dressings, sprinkled on steamed veggies or grains

Butter Coconut and Other Oils ! I still feel that butter can’t be beaten for flavor and for the tiny bit we should be using, can simply be made better. For a better butter, mix one pound of butter with 1/3 to 1 cup of extra virgin olive oil (depending on the consistency you prefer). Whip at room temperature and store in the refrigerator. OR add the olive oil to clarified butter which removes the allergenic components of the butter. This provides the benefits and taste of butter and the essential fatty acids of olive oil. You may also choose to add 2 tsp of L- glutamine powder per ½ lb of butter. This tasteless white powder is powerhouse in

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gastrointestinal health. Use extra virgin olive oil or coconut oil for all other situations requiring oil.Flax oil can be added to steamed veggies, grains, shakes, or even breakfast.

Protein ! Protein is important to maintain energy, and to give the body tools for repair. A minimum of 40-60g of protein per day is recommended including approx. 15g at breakfast. The total amount will vary depending on your specific needs. Good sources of protein include skinless chicken and turkey, fish, nuts and seeds and their butters (ie almond butter), hemp hearts, avocado, seaweed, spirulina (or other blue-green algae), the grains quinoa and amaranth or good non-dairy protein powder (for your shake), preferably hemp or brown rice based. ! Include a scoop of good protein powder in your breakfast smoothie, or your exercise recovery drink.

Problematic Food Proteins ! Dairy; milk, yogurt, cheese. In our modern world commercial dairy is simply not worth eating. We lack the enzymes to digest it and any contribution by the cow is destroyed in the pasteurization process. Three components of dairy cause great aggravation to human health – whey, lactose and casein. The protein, casein, besides having other detrimental health consequences, blocks Vitamin D receptors impacting immune function.

! Gluten. The first thing to understand about gluten is that our body is incapable of completely digesting it. It is found in grains such as , spelt, rye, barley and kamut and contains lectins which increases inflammatory immune response and contributes to a leaky gut. It has an amazing ability to break down the natural defenses of the intestinal wall causing it to release zonulin, a protein that breaks the tight junctions between cells and allows toxic chemicals, pathogenic bacteria, parasites, viruses, undigested food proteins etc to get back into the body and prompt and immune response.

o When eliminating gluten it is important not to simply replace bread and flour with gluten-free (GF) products because most commercial GF products are made from refined white rice flour and contain other non-desirables like corn and potato starch which also increase inflammation. Focus your attention on reducing your consumption of refined grains (anything made with any kind of flour) as much as possible.

Dr. Teri A. Jaklin ND, IFMCP 5 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com Nutritional Management of MS

o World renowned gluten researcher Alesio Fasano says that no one on the planet digests gluten well and our immune cells mistake undigested peptides from gluten as being a dangerous bacteria – which means more inflammation and GI irritation.

! Legumes (including soy products) Legume lectins often confuse the immune system and cause it to become hyperactive. In the case of MS they can act as molecular mimics to myelin promoting further immune attack. While understood as a protein, legumes are still too high in carbs to be considered a good dietary protein over the long term.

Food Allergies and Sensitivities ! Foods can cause immunological (allergy) or non-immunological responses (sensitivity) both of which can aggravate the immune system and increase the inflammatory response. ! Once you have made some changes, you can further refine your nutritional intake by identifying foods that are detrimental to your health. These are not mutually-exclusive, consult your healthcare provider (Naturopath, Nutritionist etc) to determine the best one for you. ! Understand that there is currently no gold standard for sensitivity testing. To ensure good outcomes use a system that your practitioner has used for an extensive period of time. This way they will be able to interpret your results with confidence. ! Food allergies, intolerances and sensitivities are dynamic, that means they will continue to shift and change as inflammatory pattern, and/or exposure continues to shift and change. It is advisable to have them re-tested over time (every 8-12 mos) to gain an understanding of how your particular sensitivies shift and to be able to identify your indiviual fixed sensitivities

Food Allergy Testing Identifies foods that create a direct immune response by measuring IgE and/or IgG responses. It does not detect any other type of response. Food Sensitivity/Intolerance Testing Identifies foods that cause irritation to your system without a frank immune response. These are unique to you and can interfere with normal immune and

metabolic functioning.

These testing systems are not mutually exclusive. You will benefit from both, either way it would be recommended to get started with your food testing at your earliest convenience.

Dr. Teri A. Jaklin ND, IFMCP 6 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com Nutritional Management of MS

! In the meantime, the following foods are well recognized as highly allergenic and you can begin to avoid these now. They include:

• Eggs source of bile for o Contain an enzyme that digestion) this includes links to undigested egg bacon, lard and other white which creates a pork products. large complex that enters • Sugar, NutraSweet and all the blood and triggers an sweeteners (except honey, maple immune response. syrup and agave) • Soy products (also a legume) • Fried and Processed Foods • Citrus fruits o Damaged fats caused by o Contain compounds that frying cause damaged can alter liver enzyme cells in the gut. Processed activity permitting toxins foods include highly to linger in the body. reactive component such as nitrates, food colouring

• The alkaloids of the nightshade and other toxins. family of vegetables (tomatoes, potatoes, gojiberries, eggplant • Alcohol and peppers) o Even small amounts • Corn products cause damage to the microvilli in the small • Peanuts and peanut butter intestines which secrete • Beef digestive enzymes and o Due to it’s cross absorb nutrients. reactivity with dairy • Chocolate and Coffee proteins o Stimulate the CNS, • Pork increase cortisol levels o Reactivity to pork is which in turn irritates the greater in people with gut. Many people react to IBS. Aside from that it is both of these. the #2 contributor to gall bladder disease (the

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Excitotoxins – The Taste that Kills Excitotoxins are food chemicals that are directly related to diseases of the nervous system. They increase the excitatory neurotransmitters and stimulate neuron firing, with no off switch. This causes the neurons in the brain to fire until they die. You may be familiar with the Chinese food hangover – that’s MSG. Monosodium glutamate (MSG)- salty, and Aspartame – sweet, are two of the most notorious excitotoxins. Many other food additives also include MSG. Foods containing these additives should be strictly avoided.

Excitotoxins: The Taste That Kills by Russell L. Blaylock, MD, copyright 1994, Health Press, Box 1388, Santa Fe, New Mexico, 87504 See www.waterdownclinic.com – Hidden Sources of MSG under Patient information

Packaged and processed food. ! Remember, there is no such thing as junk food – there is FOOD and there is JUNK. These foods mostly qualify as junk, they tend to be highly refined and contain high levels of bad fats, nitrates, colors, MSG, Aspartame, sugar etc etc. ! Packaged and processed foods should be avoided. Read labels – if you can’t pronounce it or the list is long put it back on the shelf! ! When you’re shopping avoid temptation by such foods and stick to the perimeter of the grocery store. That is generally where the fresh foods are.

Avoid pro-inflammatory beverages like coffee, pop and alcohol.

Once again these wreak havoc on the intestinal barrier and promote inflammation. Favor good old water, herbal teas, or green tea. If you drink juice ensure it has no added sugar and water it down. Avoid orange/citrus juice.

Dr. Teri A. Jaklin ND, IFMCP 8 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com Nutritional Management of MS

When adjusting your diet, be sure to include:

Nuts and Seeds • Add a palm sized portion of almonds to your diet. To improve digestability, soak them in water overnight. • Grind flax, pumpkin, chia, sesame or sunflower seeds and add to steamed vegetables, cooked grains etc. • Use hemp hearts liberally. • Create a ‘salad topper’ by combining a variety of seeds and nuts in a jar to sprinkle on your salad (this increases the protein value of that salad). • Include nut and seed butters e.g. almond, cashew, sesame. Avoid peanut butter as peanuts are actually legumes –with a high saturated fat content.

Spices • Choose your favorite spices and explore new ones! A great way to change something from bland to bold and beautiful. If you don’t have much experience with herbs, go to a bulk food store and try them a little bit at a time. Or use fresh herbs liberally. • One herb that has been known to be highly anti-inflammatory for centuries (recently proven in science) is turmeric. This mild curry spice blends well into rice and quinoa dishes, stir frys and even the morning shake. I recommend you get 1-2 tsp per day.

Grains and Seeds • The emerging science show us that the hard coating, enzyme inhibitors, and lectins of grains and seeds, glutinous or not, can damage the intestinal lining and interfere with optimal digestion. • Sesame seeds are on the top 10 list of most allergenic foods in many countries. • The best way to consume grains and seeds is to soak and sprout them. If you want them crunch again dehydrate them. • See the section on gluten to understand the health hazards associated with glutinous grains. • Minimize your consumption of grains and seeds and be sure to sticktto gluten-free grains and seeds if you do. They include: basmati or brown rice, millet, quinoa, amaranth, buckwheat.

Dr. Teri A. Jaklin ND, IFMCP 9 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com Nutritional Management of MS To Drink • A minimum of 6 to 8 glasses of spring, filtered or reverse osmosis water every day. • You may also choose to drink 2 to 4 cups of herbal tea. Herbal teas are best taken in the evening and sipped slowly. These are included in the 6-8 cups. • Green tea is also known for its anti-inflammatory properties and if you discard the first steep, the caffeine goes with it! Re-steep good green tea up to 3 or more times.

• Small amounts of rice, almond or hemp milk are permitted. • For those of you with bladder problems who look at this and laugh, your bladder will adjust over time. Sip the water, don’t gulp it. And remember water is vital for the rest of your body to function well. Dehydration is also directly connected to fatigue.

The key to good eating is to focus on a whole foods diet. Dietary change requires dedication and commitment. As you continue to raise your bar, you will bring a new awareness to every meal you eat and how it affects your overall well-being.

To get started, create a supportive environment. Go through you cupboards and get rid of foods that do not support your new model. Explore health food stores with a grocery section or regular grocery stores with health food sections. Local farmers’ markets are excellent resources for fresh, local, in-season fruits and veggies. Choose organic when possible – always choose organic meat first.

When in doubt remember one thing, there is no such thing as Junk Food. There is Junk and there is Food.

Dr. Teri A. Jaklin ND, IFMCP 10 Waterdown Clinic of Naturopathic Medicine www.waterdownclinic.com