The Best Bet diet was pioneered by a Canadian scientist, Dr Ashton Embry, whose son has MS. He believes some of the protein foods that form part of the modern Western diet can trigger an immunological response in those people with a genetic susceptibility to MS and lack of sufficient vitamin D also contributes to the problem.
Dr Embry started by looking at the geographical spread of the disease. Research shows that the incidence of MS is dependent on distance from the equator. The populations with the highest proportion of MS cases are those furthest away from the equator, and this applies even within the same country (for instance, there are more people with MS in the north of Scotland than in the south of England). This seems to suggest that MS might be linked with lack of sunshine, which is our main source of vitamin D3. Although there are areas that have low sunshine levels and a low rate of MS, these tend to be areas where the population eat a lot of oily fish – the other main source of vitamin D. Dr Embry began to wonder if vitamin D might play a part in protecting people against MS.
He also believes that MS has been triggered by the agricultural and industrial changes of the recent past. Some 5,000 years ago, our ancestors spent most of their lives in the open air and ate a diet of freshly caught meat, fish and wildfowl, together with nuts, seeds, fruits and edible plants. This is known as the Paleo diet. Since then, we have kept farmed animals and poultry and cultivated grains such as wheat and barley. All this has happened in a relatively short space of time in evolutionary terms, and it is possible that some people cannot cope very well with these more ‘modern’ foods. More recently still, we have moved from living mainly in the countryside to living mainly in towns and cities and have begun to eat large quantities of manufactured processed foods.
These environmental changes suggest that the main factors affecting MS could be:
•the introduction of new proteins into our diets, such as cow’s milk, gluten grains and legumes;
•deficiencies in vitamin D, caused by spending less time outside in the open air than in the past;
•a deficiency in omega-3 fatty acids and antioxidants, due to not eating enough fish and plant foods.
According to the theory behind the Best Bet diet, the MS process starts when particles of undigested food escape through the gut walls and into the bloodstream (known as ‘leaky gut syndrome’). The immune system sees the food particles as invaders and starts attacking them. However, the protein molecules in certain foods are similar to the myelin that sheathes the nerves. This is called molecular mimicry and it causes the immune system to attack the myelin as well as the food particles.
Various proteins from cow’s milk, gluten and legumes have been shown to be molecular mimics of the protein in myelin. Gluten is already known to be at the root of two autoimmune diseases, coeliac disease and Dermatitis herpetiformis, and the highest incidence of MS occurs in areas where a lot of gluten is consumed. There is a similar correlation between MS and milk consumption.
There are three main components of the diet:
•avoiding foods such as dairy products, gluten grains and legumes that are molecularly similar to myelin and activate the immune reaction;
•taking a range of supplements to help dampen down the autoimmune reaction, aid healing of the ‘leaky gut’ and ensure adequate nutrients;
•detecting any additional food sensitivities, so that these foods can be either rotated or avoided altogether (foods you are sensitive to can make a leaky gut worse and increase immune reactions).
The science behind the Best Bet diet
Ashton Embry believes MS may be a deficiency disease caused by lack of vitamin D, and suggests it could be eliminated by supplementing children with vitamin D in the same way rickets (another deficiency disease) was banished in the last century by giving children cod liver oil. Recent research seems to support this theory.
There has also been some research into the sensitivity of people with MS to proteins such as cow’s milk and gluten. Scientists have observed that mice – who have a similar immune system to ours – get an MS-type illness if injected with milk proteins. Now researchers in Canada have found that the protein in cow’s milk is an important risk factor in the development of both MS and another autoimmune disease, type 1 diabetes. Both diseases share genetic similarities and similar patterns of geographical distribution. Both have a long period of ‘silent illness’ before initial symptoms appear. If this research can be duplicated on a larger scale, it could suggest that for people who are particularly at risk, a milk-free diet might prevent later development of both diseases.
Trials of the Best Bet diet
A scientific trial of the Best Bet diet, funded by Ashton Embry’s charity DIRECT-MS, took place at Ninewells Hospital in Dundee in 2007–8. This pilot study was a randomized controlled single-blind test to compare the Best Bet diet to the healthy eating diet in patients with relapsing–remitting MS. The object was to see whether the Best Bet diet (a) delayed progression and (b) controlled symptoms. There were 22 participants, 11 on the Best Bet diet and 11 on the healthy eating diet, and the trial lasted for a year. The results showed that after 12 months, those on the Best Bet diet had a lower rate of brain shrinkage, less change in disability and significantly better scores on MS function and vision tests. It is difficult to draw conclusions from such a small study, but it does suggest that it would be well worth carrying out a larger trial in the future to confirm these results.
Foods you should avoid completely
You should avoid any foods that contain gluten, the protein found in wheat, rye and barley. This means avoiding most shop-bought bread, cakes, biscuits, pies, pizza and so on, which all contain wheat flour, plus many other products that contain hidden cereals (see Table 5.1 for a list of foods that you should suspect contain wheat or gluten). For the purposes of this diet, refined and unrefined gluten grains are equally bad for you so read food labels carefully (see Table 5.2). Oats, which contain proteins similar to gluten, may be a problem for some people, so go cautiously with them.
Table 5.1 Foods and products that may contain wheat or gluten
Baked beans
Baking powder
Beer
Biscuits
Burgers
Cakes and muffins
Chocolate bars
Chutney and pickles
Communion wafers
Cornflakes
Curry powder
Dry roasted nuts
Food cooked in breadcrumbs
Instant oat breakfast cereals
Malt vinegar
Margarine (may contain wheatgerm oil)
Medicines (wheatflour is used as a binder)
Mustard
Noodles
Pasta sauces and sauce mixes
Pâtés
Processed meat
Ready-made soups
Salad dressings and mayonnaise
Sausages
Soya sauce
Spice mixes
Stock cubes and gravy powder
Sweets
Vitamin tablets
White pepper
Table 5.2 Ingredients listed on food labels that may contain wheat and gluten
Bran
Cereal
Corn or cornflour, cornstarch
Couscous
Durum flour
Edible starch
Filler
Flour (type unspecified)
Food starch
Malt
Modified starch
MSG (often made from wheatstarch)
Rusk
Textured vegetable protein (TVP)
Semolina
Spelt flour (an ancient type of wheat)
Thickener
Triticale (a wheat–rye hybrid)
Also avoid all dairy products, including cow’s milk, sheep’s milk and goat’s milk, and all products made from them, such as cheese, yogurt, butter, ice-cream and dairy chocolate, even the low-fat varieties, plus all products that contain hidden dairy products (see Table 5.3 for terms for milk products that can be found as ingredients on food labels and a list of foods that often contain milk).
Terms for ingredients that indicate contents may include milk
Cassein/casseinate
Curds
Ghee
Lactic acid
Lactose
Whey
Foods that often contain milk
Acidopholus
Biscuits
Cakes and muffins
Chocolate bars
Chorizo
Custard powder
Gluten-free bread, cakes and biscuits
Margarines
Mayonnaise
Medicines and food supplements
Muesli
Pasta sauces and sauce mixes
Pastry
Pâtés
Ready-made soups
Sweet and savoury pies and pastries
Sweets, particularly caramel and fudge
Avoid all legumes, including peas, beans, lentils and peanuts, and all products made from legumes, such as soya milk, soya sauce, tofu, bean curd (see Table 5.4 for a full list of legumes).
Table 5.4 Plants classified as legumes
Legumes are the fruits or seeds of anything that comes in a pod.
•All types of beans, including cocoa beans and coffee beans
•All types of lentils
•All types of peas, including chickpeas
•Gram flour, which is derived from chickpeas and is used to make poppadoms
•Alfalfa (often sold as sprouting seeds)
•Carob
•Chocolate (made from cocoa beans)
•Guar gum (a stabilizer used in gluten-free baking)
•Liquorice
•Peanuts
•Tamarind (used in Asian cooking)
•Vanilla (small amounts may be used in recipes, but don’t use every day)
Obviously, also avoid any food to which you are sensitive. (See pages 21–2 for details of how to identify food intolerances.)
Foods that are restricted
Fats
There are two types of fat: saturated and unsaturated. Saturated fats are the ones you need to cut down on drastically. In the Best Bet diet, you are allowed a maximum of 80 g (16 tsp) of fat per day, of which no more than 18 g (3 tsp) should be saturated fat. Saturated fats are found in red meat such as lamb, beef and pork; animal fats such as lard, dripping and suet; processed meat such as sausages and salami; dairy products; some poultry, such as duck and geese; some nuts; and some vegetable fats, such as coconut milk and palm oil. In addition, any fat labelled as ‘hydrogenated’ is saturated.
Unsaturated fats are the omega fats. (For a fuller explanation of omega fats, see page 49.) You should aim to eat more omega-3 fats (found in oily fish) and omega-9 fats (found in olive oil) and less of the omega-6 polyunsaturated fats (found in margarines and seeds). A daily intake of unsaturated fat of 20–65 g (4–13 tsp) is allowed. To achieve a proper balance of the fat types, the suggested amounts per day of the four types are:
•40 g (8 tsp) monounsaturated fat
•18 g (2½ tsp) saturated fat
•14 g (2 tsp) omega-6
•8 g (1 tsp) omega-3.
As with the low-fat diet, because of the difficulty of achieving this ratio with diet alone, supplementation with fish oil and flaxseed oil is recommended (see ‘Supplements for the Best Bet diet’, pages 65–6). However, note that this ratio of fats is different from that suggested for the low-fat diet.
Meat
To help limit fat consumption, only one portion of red meat (beef, lamb, pork, liver or kidneys) is allowed per week. This should be either grilled or roasted using a rack, so that any excess fat can be poured away. Ham and bacon, both processed meats, should also be restricted.
Eggs
Eggs have a high fat content and are highly allergenic, so should be eaten no more than twice a week. Avoid products that contain egg, and replace battery eggs with organic free-range eggs for their increased EFA content.
Yeast
Yeast is another highly allergenic food. Although there are small quantities of yeast in such products as stock cubes and tinned soups, most of the yeast in your diet is likely to come from bread. You can restrict your yeast intake by making gluten-free (GF) soda breads (see page 132), which are much easier and quicker to make than yeasted breads. You should also avoid yeasted spreads such as Marmite or Vegemite.
Non-gluten grains
It is recommended that you eat only moderate quantities of non-gluten grains such as rice, as these grains also contain relatively ‘new’ proteins, which may disagree with some people. They can also increase gut permeability.
Sugars
Avoid sugar where possible. Eat honey or maple syrup instead.
Alcohol
Beer contains gluten and wine has a high sugar and yeast content, while spirits are distilled from grains. On the plus side, red wine does contain valuable antioxidants, so red wine (in moderation) is probably your best option.
Foods you can eat freely
•Fish All types of freshwater and deep sea fish.
•Seafood Prawns, cockles, mussels, lobster, crab, squid (unless you know you have a problem with shellfish or your cholesterol level is high).
•Poultry Chicken and turkey breast, but not the skin. The other parts of these birds also have a higher fat content, but may be eaten occasionally.
•Game Examples are rabbit and venison (but avoid frozen rabbit from other countries as it may be of poor quality).
•Dairy-free spreads For example, Pure Sunflower Spread. (Check they are also soya- and wheat-free and contain no hydrogenated or trans fats.)
•Milk Rice milk and nut milk.
•Gluten-free foods Bread and bread mixes, cakes, biscuits and crackers, so long as they contain no soya, dairy products, eggs, sugar or yeast.
•Nuts Walnuts, almonds, pine nuts, chestnuts, hazelnuts, cashews and pistachios; also spreads made out of these nuts, such as almond butter. Avoid the high-fat nuts, such as Brazil and macadamia, and peanuts, which are a type of legume.
•Seeds Pumpkin, sesame, sunflower, flax seeds (linseeds) and chia seeds.
•Vegetable protein foods Quorn products that are milk- and gluten-free, but not textured vegetable protein, which contains soya and may also contain gluten.
•Oils Olive, sunflower, flaxseed, walnut and sesame oils.
•Gluten-free whole grains Rice, wild rice, millet, buckwheat, quinoa, polenta.
•Fruit All kinds.
•Vegetables and herbs All kinds.
•Flours Rice, millet, buckwheat, potato, tapioca and maize flours, arrowroot and amaranth and gluten-free cornflour.
•Seasonings The following may be used if gluten-free: all types of vinegar except malt vinegar, Worcestershire sauce, tomato purée, garlic purée or garlic in oil, mustard, curry powder, ground spices, salt and black pepper (not white pepper).
Supplements for the Best Bet diet
The following supplements are designed to work in conjunction with the Best Bet diet. This is an abridged list to give you an idea of the range of suggested supplements (you can find the full list at <www.direct-ms.org.). It would be wise to discuss the regime with a qualified nutritional therapist or healthcare professional before you start in order to check that none of the supplements will interact with any medication you are taking.
Essential supplements
•6,000–8,000 iu vitmin D3 (for more information on how to work out how much vitamin D you need, and how to take it, see page 15).
•5 g omega-3 fatty acids EPA and DHA from salmon oil capsules
•1 tbsp flaxseed oil
•1,000–1,200 mg calcium
•500–600 mg magnesium
•5,000 iu vitamin A (note that this is the maximum safe daily dose from all sources)
•100 mg vitamin B complex
•1–2 mg vitamin B12
•1 g vitamin C
•400 iu vitamin E
•25–50 mg zinc
•200 mcg selenium
•200 mcg iodine
•120 mg Ginkgo biloba
•60–90 mg co-enzyme Q10
•1,200 mg alpha-lipoic acid
•2–3 acidopholus capsules with each meal (different makes vary in strength – see guidance on page 18)
Choosing gluten-free and dairy-free products
Finding food products that are free from gluten, wheat, dairy, egg, yeast and soya can be quite challenging. It is getting easier, though, partly through new EU laws on food labelling and partly through manufacturers’ growing awareness of food sensitivities.
Coeliac UK, the charity that represents those who cannot eat gluten, publishes an invaluable directory of gluten-free products, updated yearly. Be aware, though, that you will still have to check the labels on gluten-free products to see if they contain other foods you wish to avoid. There are now many companies manufacturing gluten-free foods. Some are available in supermarkets and health shops and some can be ordered direct from specialist internet retailers (see Useful addresses).
Confusingly, not all gluten-free products are also wheat-free. Some are made from a form of wheat flour that has had the gluten removed. Look for the products that are clearly labelled ‘wheat-free’ and ‘gluten-free’ (see Table 5.1, page 60). Tables 5.2 and 5.3 (page 61) show lists of ingredients you should look out for when buying food items because they indicate that either gluten or dairy may be present.
Bread
Most gluten-free breads use yeast as a raising agent, but there are a few that use an alternative raising agent. The best of these, I have found, is Orgran bread mix, which can be made successfully in both a conventional oven and a breadmaker. Orgran is an Australian company that makes a whole range of organic gluten-free foods such as bread, pasta, flour, pastry and pizza mixes, porridge and muesli. For details of UK suppliers, see page 148.
Margarines
Most margarines contain whey powder from milk, or wheatgerm oil, but Pure Sunflower Spread (available from health food shops and larger supermarkets) is milk-free and has the added bonus of being made from unhydrogenated oils.
Other products
Marigold Vegetable Bouillon Powder is a stock powder that contains no yeast. An alternative is Kallo Organic Vegetable Stock Cubes.
Xanthan gum, Orgran No Gluten, and GF baking powder are all useful in gluten-free baking, and Doves Farm make a good range of gluten-free flours.