Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic

Abstract

The precise etiology of multiple sclerosis (MS) is unknown but epidemiologic evidence suggests this immune-mediated, neurodegenerative condition is the result of a complex interaction between genes and lifetime environmental exposures. Diet choices are modifiable environmental factors that may influence MS disease activity. Two diets promoted for MS, low saturated fat Swank and modified Paleolithic Wahls Elimination (WahlsElim), are currently being investigated for their effect on MS-related fatigue and quality of life (NCT02914964). Dr. Swank theorized restriction of saturated fat would reduce vascular dysfunction in the central nervous system (CNS). Dr. Wahls initially theorized that detailed guidance to increase intake of specific foodstuffs would facilitate increased intake of nutrients key to neuronal health (Wahls™ diet). Dr. Wahls further theorized restriction of lectins would reduce intestinal permeability and CNS inflammation (WahlsElim version). The purpose of this paper is to review the published research of the low saturated fat (Swank) and the modified Paleolithic (Wahls™) diets and the rationale for the structure of the Swank diet and low lectin version of the Wahls™ diet (WahlsElim) being investigated in the clinical trial.

Nutrient Composition Comparison between a Modified Paleolithic Diet for Multiple Sclerosis and the Recommended Healthy U.S.-Style Eating Pattern

“…Saturated fats are inflammatory and may also lead to gut dysbiosis [120]. However, Dr. Wahls does not restrict saturated fat unless clinically warranted and prefers animal fats or coconut oil for cooking because they are heat stable [27]. Paleo diets need not be high in saturated fat.…”

“…The DRI and DGA recommend reducing sodium intake to <2300 mg per day [42] to reduce risk for high blood pressure. The need to restrict sodium intake specifically for pwMS is controversial and more research is needed [27]. Although the menu sodium level (1350 mg/1000 kcal; 1350 mg/4184 kJ) exceeded the UL at some energy levels it was lower than the mean (SE) sodium intake of US individuals ≥20 years: 4107 (64.1) mg/day for males and 3007 (38.5) mg/day for females [76].…”

“…The dietary guidelines are described in Table 1. A clinical trial of the WahlsElim diet is underway [25,26] and a review of the rationale for this diet was published [27].…”

A Review of Various Antioxidant Compounds and their Potential Utility as Complementary Therapy in Multiple Sclerosis

“…In the available literature on the type of diet and supplementation, there are two main trends, which are derived from two researchers. Dr. Wahls based her theories on the hypothesis that the restriction of lectins would reduce intestinal permeability and CNS inflammation; furthermore, an increment of intake of specific food nutrients is key to neuronal health [134]. The Wahls diet was designed to reduce oxidative stress and excitotoxicity, nourish the mitochondria, prevent nutrient deficiencies, activate anti-inflammatory genes, and increase nerve growth factors [135].…”

Nutrient Composition Comparison between the Low Saturated Fat Swank Diet for Multiple Sclerosis and Healthy U.S.-Style Eating Pattern

“…These patients exhibited less disability and lower mortality [17] especially when the diet was started early in the disease course [10,11,15,17]. However, his study has been criticized for comparing good versus poor diet adherents which biases the data towards positive results, for lacking a control group, blinded assessors, brain imaging data [20,21] and standardized dietary intake assessment and for missing data that is not missing at random [22].…”