Nutritional therapists believe that the right kinds of fats, eaten in the right amounts, keep you healthy, while a diet that contains too much of the wrong fats is one of the major causes of degenerative diseases such as MS.
A low-fat diet, therefore, does not involve cutting out fatty foods altogether. You do need to eat some fat, but it needs to be the right sort. The type of fat you should cut down on drastically is saturated fat, which is harmful if eaten in large quantities. Meanwhile, you should increase your intake of essential fatty acids, which are extremely beneficial to health.
How can a low-fat diet help MS?
In the Western world over the past 200 years, there has been a steady increase in the consumption of saturated fats, found in red meat, dairy products and processed foods. At the same time, the number of cases of MS has steadily increased. The first man to link these two facts was Professor Roy Swank who, as far back as 1948, advocated a low-fat diet for people with MS. Swank believed that some individuals were more sensitive to saturated fats than others, and that in susceptible individuals an excess of fat in the bloodstream could eventually cause a breakdown in the blood–brain barrier leading to demyelination and formation of plaques.
Professor Swank monitored a large group of people with MS over a period of more than 30 years. He found that 95 per cent of the patients in his study who started out with only minimal disability and who consistently ate no more than 20 g (4 tsp, or 0.7 oz) of saturated fat a day remained only mildly disabled. Members of the group who accidentally or intentionally increased their fat intake began to deteriorate again. On the other hand, people who managed to reduce their fat intake to 10–15 g (2–3 tsp) per day did even better than those on 20 g per day. Professor Swank also observed that the ‘good’ dieters (who ate a maximum of 20 g of fat per day) ate more polyunsaturated oils, while the ‘poor’ dieters (who ate more than 20 g of fat per day) ate less of these oils.
‘Good’ dieters reported a decrease in fatigue over time and were also better able to cope with stress without deterioration. Those who were more disabled at the start of the study reported an increased sense of well-being and either stabilization of their condition or a slowing down of deterioration. This is the largest and longest study carried out so far on the effects of diet on MS.
Another researcher who has been crucial in expanding our knowledge of good and bad fats is the German scientist Johanna Budwig, who developed techniques for separating and identifying different types of fat in a drop of blood. She then compared blood samples from sick and healthy people and investigated their fat content. She observed that healthy people’s blood always contained EFAs, while sick people lacked lipoproteins (a mixture of the EFA linoleic acid and proteins). She tried feeding an oil-protein diet to patients with chronic illnesses and some recovered completely. This led to her promoting flaxseed oil in nutritional therapy for many different chronic conditions, because it contains a good balance of omega-3 and omega-6 EFAs.
In the 1970s and 1980s more trials were carried out on diet and MS, this time with the emphasis on EFAs. In 1973, the British Medical Journal published the results of a study in which sunflower oil (a source of omega-6 EFAs) was given to people with the relapsing–remitting type of MS. Results suggested that the frequency, severity and duration of attacks were reduced in the group who took the sunflower oil.
In 1978 another trial, led by Dr David Bates, took place at Newcastle University. This trial involved 116 people with MS, divided into four groups. Group A were given evening primrose oil capsules; Group B took olive oil capsules; Group C were given sunflower margarine; and Group D got a placebo. After two years, the only difference in outcome in the four groups was that those taking the sunflower margarine reported shorter and less severe MS attacks. The evening primrose oil did not perform as well as expected in this trial. One reason could be that the subjects were not told to cut down on saturated fat, and it is now known that saturated fats can prevent proper metabolism of EFAs.
One trial that set out to correct this problem was that carried out at the Central Middlesex Hospital in the 1980s. The trial lasted three years and involved 83 people with MS. They were told to eat less saturated fat and more omega-3 and omega-6 EFAs. They were also given advice on vitamin and mineral supplementation and fibre intake. This ‘optimum nutrition diet’ produced a clear distinction in outcome between those who stuck faithfully to the diet, who did not get significantly worse, and those who lapsed from the diet, who did.
Professor Bates then investigated fish oil (an omega-3 EFA) as a treatment for MS. The results were less clear-cut, but still suggested people might benefit from eating food that contained both omega-3 and omega-6 oils.
Analysis of the results of the most significant trials involving EFAs and MS suggests that the lower the level of disability at the start of the trial, the higher the chance the person can prevent deterioration by taking polyunsaturated fats. If this is true, then those who alter their diet as soon as possible after diagnosis have the best chance of stabilizing their condition, though this should not put you off trying a diet if your diagnosis is some way behind you.
The MS diet trials to date are considered by many doctors to be too few and too small to prove the case. Undoubtedly, more work needs to be done, particularly since most of the subjects so far have had relapsing–remitting MS rather than the progressive form of the disease. However, the existing studies do – at the very least – suggest that a low-fat diet could be a promising self-help option for people with MS, and certainly this is backed up by anecdotal evidence.
The science behind the diet
Why are EFAs especially important for people with MS? EFAs are the main components of the membranes that surround all cells. They form part of the nucleus of each cell, which is the area containing the genetic ‘master plan’ for our bodies. EFAs are involved in oxidation, the ‘burning’ of food to produce energy, and govern our growth, mental state and sex hormones.
People with MS have been shown to have abnormalities in their red and white blood cells, but these can be corrected within one year if EFA supplements are taken.
EFAs form roughly 60 per cent of the brain; they are the building blocks of the central nervous system and essential for brain function. EFAs are also necessary for the manufacture of prostaglandins, hormone-like substances that help promote healing, dampen down an over-active immune system and enhance immune efficiency, thus improving resistance to infection.
There are several different families of unsaturated fatty acids. The most important are omega-3 and omega-6. Both are essential to human health but cannot be manufactured in the body. This is why they are called essential fatty acids (EFAs).
The omega-3 family – super-unsaturated fatty acids
•Alpha-linolenic acid (ALA or LNA) – the richest source of LNA is flax seeds (also known as linseeds). Half the EFA in flax seeds is LNA. It is also found in soya beans, walnuts and dark-green leaves.
•Stearidonic acid (SDA) is found in blackcurrant seeds.
•Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are found in oily fish such as salmon, trout, mackerel and sardines, which contain up to 30 per cent EFAs.
The omega-6 family – polyunsaturated fatty acids
•Linoleic acid (LA) is found in safflower oil, sunflower oil, soya beans, walnuts, pumpkins and sesame and flax seeds.
•Gamma-linolenic acid (GLA) is found in borage oil (also known as starflower oil), blackcurrant seed oil and evening primrose oil.
•Dihomo-y-linolenic acid (DGLA) is found in breastmilk.
•Arachidonic acid (AA) is found in meat.
The omega-9 family – monounsaturated fatty acids
•Oleic acid (OA) is found in olive oil, almonds, avocados, peanuts, pecans, cashew nuts and macadamia nuts. Oleic acid has a neutral effect on us. It is not an essential fatty acid because – unlike the omega-3 and omega-6 fatty acids – it can be produced by the body.
The EFA pathway
Omega-3 and omega-6 fatty acids are metabolized in the body into more complicated unsaturated fatty acids, which are the ones needed by the brain. This is called the EFA pathway. Things that can interfere with the EFA pathway include:
•too much saturated or hydrogenated fat
•too much sugar
•too much alcohol
•a lack of vitamins and minerals (especially B6, zinc and magnesium)
•exposure to pollution
•smoking.
It has been suggested that people with MS may have difficulty converting the original fatty acids into their more complex forms. One solution could be eating more of those foods that already contain the more complex fatty acids, such as evening primrose oil, oats, liver, kidneys, fish and seafood.
Why saturated fats are a problem
As well as interfering with the EFA pathway, saturated fats can cause other problems. For instance, they have a tendency to stick together to form sticky platelets that can turn into blood clots and lead to strokes or heart disease. Because the blood is stickier, it doesn’t flow as well through our veins and arteries and this in turn decreases the supply of oxygen to our tissues.
However, it’s not just the saturated fats we eat directly in the form of meat or dairy products that we need to worry about. The sugar we consume also turns to saturated fat in our bodies, and starchy foods turn into glucose (another form of sugar) as they are digested. Refined starches such as white flour or white rice are more likely to end up as saturated fats than whole grains such as wholemeal flour or brown rice.
Processed fats
Hydrogenation was invented in the 1930s, paving the way for the first margarines. Unsaturated fats and oils are reacted with hydrogen at high temperatures to create a product that is convenient to use and has a very long shelf life. Unfortunately, as well as removing almost all the nutrients from the product, hydrogenation can also produce toxic substances such as trans-fatty acids. Like saturated fats, trans-fatty acids make blood more sticky. They also inhibit EFAs from doing their job effectively. Most UK supermarkets have now removed hydrogenated oils from their own brands, and current UK regulations require that hydrogenated and trans-fats should be declared in the ingredients list of all products.
The following diet is based on that pioneered by Professor Roy Swank.
The diet
Cut down on saturated fat
Eat a maximum of 15 g (3 tsp) saturated fat per day. These fats are hard at room temperature and are found in:
•red meat (beef, lamb and pork, for example; a maximum of 85 g (3 oz) per week is allowed, after the first year);
•animal fats such as lard, dripping and suet;
•processed meats such as sausages, bacon and salami;
•full-fat dairy products such as full-cream milk, hard cheese and butter (skimmed milk, low-fat cheeses, such as cottage cheese and quark, and low-fat yogurt are permitted);
•fatty poultry such as duck and geese;
•some nuts (Brazil nuts, peanuts, macadamia nuts and coconuts);
•some vegetable fats (coconut oil and palm oil);
•manufactured foods such as crisps, cakes, chocolate, pies, biscuits;
•eggs – buy organic free-range rather than battery-farmed eggs if you can, as they contain beneficial EFAs, and eat a maximum of three eggs per week, no more than one egg in any one day (egg whites are virtually fat-free so are unrestricted).
Cut out processed fats and oils
This means eliminating any food that contains hydrogenated fats or trans fats and refined cooking oils. Margarines are the main culprits for hydrogenated fats, but the label won’t always tell you this. It’s easier to search out the products that state clearly, ‘Does not contain hydrogenated fats’. Examples are Bertolli margarine (made from olive oil) and Pure Vegetable Spread (made from sunflower oil). Alternatively, you could do as the Italians do and spread olive oil instead of margarine on bread.
When choosing oils for cooking or using in salad dressings, buy the ones that are labelled ‘cold-pressed’ or ‘unrefined’ oils. These oils will not have been subjected to the same high temperatures and chemical processes as off-the-shelf cooking oils, and retain their original health benefits. Olive oil has a different labelling system from the other oils: the pure unrefined variety is called ‘extra virgin’ and you can buy it in supermarkets, but other unrefined oils such as sunflower or sesame seed are usually only stocked in health food shops.
Don’t use unrefined oils to cook food at very high temperatures, as this destroys their nutrients and creates toxic substances. Stir-frying over a high heat is acceptable, because it’s a very quick process. Otherwise – when cooking onions, for instance – ‘sweat’ foods in oil in a covered pan over a very low heat for up to 10 minutes. Never deep-fry food. This process changes the molecules from the unsaturated type into the saturated trans-fatty acids that are so bad for your health.
Table 4.1 shows the fat content of some common foods.
Table 4.1 Fat content of common foods
Each of these quantities of food is equivalent to 1 tsp (5g) unsaturated fat.
•90 g (3 oz) tuna in oil, drained
•60 g (2 oz) trout
•60 g (2 oz) salmon
•30 g (1 oz) sardines in oil, drained
•30 g (1 oz) herring or mackerel
•2 tsp unhydrogenated peanut butter
•2 tsp tahini spread
•45 g (1½ oz) avocado
•3 medium black olives
•6 medium green olives
Oils (i.e. sunflower, olive or flaxseed oil) are pure unsaturated fat, so 1 tsp oil = 1 tsp unsaturated fat.
Eat more EFAs
On the low-fat diet, you need to make sure you get enough omega-6 and omega-3 EFAs. However, while there is general agreement that it is important to take the right ratio of omega-6 to omega-3, there seems to be some dispute among professionals as to what exactly is the right ratio. Three parts omega-6 to one part omega-3 is the ratio normally recommended for a low-fat diet. Dr Ashton Embry, promoter of the Best Bet diet, advocates a ratio nearer 2:1. Udo Erasmus, author of Fats that Heal, Fats that Kill, uses a 1:1 ratio in his oils, the balance found in flaxseed oil, which Johanna Budwig believed to be so beneficial to health. The most recent research into EFAs and MS, carried out in Cyprus in 2013, also suggested a ratio of 1:1 omega-3 to omega-6. If you are unsure which ratio to go for, why not ask the advice of a nutritional therapist?
It is difficult to achieve the right balance of EFAs by diet alone, so supplementation with EFA capsules is recommended (see ‘Supplements for the low-fat diet’, page 56). In addition, include all the following foods in your diet – these are the low-fat superfoods that will boost your EFA intake naturally:
•linseeds, pumpkin seeds, sunflower seeds, sesame seeds
•walnuts, almonds, pine nuts
•avocados and dark-green leafy vegetables
•oily fish such as herring, tuna, salmon, mackerel and sardines
•unrefined oils such as sunflower oil and flaxseed oil.
Try also to eat regularly those foods that contain the more complex fatty acids: oats, liver, kidneys, white fish, seafood.
You need to monitor your intake of unsaturated fats as well as saturated ones. The allowance of unsaturated fats is 20–50 g (4–10 tsp) per day. See Table 4.1 (page 52) for the fat content of some common foods. Try and spread your fat allowance throughout the day, and if you eat a high-fat food at one meal, balance it with a low-fat dish at the next meal. Any oil used in cooking should be measured out carefully; alternatively, use an oil spray and a non-stick pan. Remember – moderation is the keyword, even with beneficial fats.
Foods containing EFAs need to be stored carefully. Unrefined oils such as sunflower oil or extra virgin olive oil should be kept in a cool dark place, such as a cupboard or larder. Flaxseed oil, which is particularly vulnerable to light and air, should be kept in an opaque sealed container in the fridge and used within three weeks.
Keep nuts in a sealed plastic container in the freezer for up to a month to stop them going rancid. Seeds also need to be kept in sealed containers in a cupboard and eaten within a month.
Replace refined starchy foods with whole grains
There are several reasons for this. Both sugars and refined starchy foods turn into saturated fats in our bodies (see ‘Why saturated fats are a problem’ on page 50), whereas wholegrain foods are absorbed more slowly and are less likely to turn into fats. Whole grains also contain nutrients that are used in the EFA conversion process and fibre, which helps our digestive system function properly.
Identify food intolerances
If you have a sensitivity to dairy products, eating the low-fat varieties won’t make you feel better. Likewise, if you are wheat intolerant, eating wholemeal bread may actually make you feel worse than eating refined white bread. It is wise, therefore, to identify any food intolerances before you start your diet (see ‘Finding out if you have food intolerances’, pages 21–2).
The vegan option
A vegan diet (no meat, poultry, fish or dairy products) is the vegetarian version of the low-fat diet. Many of the foods vegans eat every day – such as nuts, seeds, whole grains – contain the EFAs that are a crucial part of a low-fat diet. Remember, though, that if you are underweight or regularly undertake strenuous exercise, a vegan diet may not provide you with a sufficiently wide range of protein foods.
You should eat as wide a range of vegan protein foods as possible. These include nuts, seeds and nut milk; pulses (peas, beans, lentils); mushrooms; tofu; Quorn; and quinoa.
You can also eat:
•all fruit and vegetables – as wide a range as possible
•whole grains – rice, millet, buckwheat, bulgur wheat, couscous
•bread and pasta made from unrefined flours
•unrefined oils
•dairy-free margarines and vegan cheese made from sunflower and soya
•soya, rice and oat milk, soya yogurts, soya ice-cream
•non-dairy chocolate or carob.
Vegan superfoods
When you have cut out a whole food group such as animal protein, you need to ensure that the foods you do eat are as packed with nutrients as possible. These vegan superfoods should be eaten two or three times a week for maximum benefits.
•Mushrooms These help decrease inflammation in the body. They contain sulphur, antioxidants, vitamin D, B vitamins and other nutrients. Sulphur helps create neurotransmitters and removes toxins from the body. Gilenya, the first oral drug for relapsing–remitting MS, is derived from a type of mushroom.
•Sea vegetables (seaweed) These contain more minerals than any other food source. Some contain up to ten times as much calcium as milk and eight times as much iron as beef. Sea vegetables come in several different varieties and are available in health food shops and some supermarkets. An easy way to eat them is to add them to soups and stews.
•Sprouted seeds These are young green plants germinated from seeds. They contain high concentrations of antioxidant vitamins and minerals, which help fight free radicals. They are also full of protein, enzymes, fibre and nucleic acids, which are anti-ageing factors. The salad cress you can buy in punnets are sprouted seeds and so are the beansprouts used in Chinese cooking. Eat them raw in salads or add them to stir-fries just before serving, as cooking destroys their vital nutrients.
•Quinoa Pronounced ‘keenwa’, this is a South American grain that contains all nine essential amino acids normally only found in animal products, as well as many minerals. It is a complete low-fat protein and is easier to digest than meat.
•Seeds and berries Three plant foods that have only recently become readily available are goji berries, acai berries and chia seeds. Both types of berries contain omega-3 fatty acids (otherwise found mainly in fish). Goji berries, like quinoa, are a complete source of protein and contain all the amino acids. Chia seeds also contain fibre, protein and minerals. For tasty ideas on how to incorporate these superfoods into your diet, I recommend Deliciously Ella by Ella Woodward, who overcame a chronic illness by changing to a vegan diet.
Supplements for the low-fat diet
EFAs
You should be taking both GLA (omega-6), in the form of evening primrose oil (EPO) or starflower oil, and fish oil (omega-3) The recommended dose varies, but you could start with 4–6 g (1 tsp) EPO (or 2–3 g starflower oil) and 1–2 g fish oil per day. Choose fish oils made from high-fat cold-water fish such as salmon. This is better than cod liver oil, which is high in vitamin A, may contain toxic substances and is subject to pollution. Vegans can substitute flaxseed oil for evening primrose oil and fish oil, as it contains both omega-3 and omega-6.
Additional vitamins and minerals are required to help metabolize EFAs into prostaglandins:
•zinc |
•15 mg per day |
•magnesium |
•600 mg per day |
•calcium |
•1,200 mg per day |
•biotin, vitamin B3 and B6 |
•1 x vitamin B complex per day |
•vitamin C |
•1,000 mg per day |
Vegans should also take 1,000 iu of vitamin B12 per day and additional iron.