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 Fats 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 fat 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 saturated fat 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.