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.
Keywords: low saturated fat diet, Paleolithic diet, multiple sclerosis, modified Paleolithic diet, Swank diet, Wahls diet, Wahls Elimination diet
1. Introduction
Multiple Sclerosis (MS) is a chronic, inflammatory, immune-mediated condition that damages nerve fibers and the myelin sheath and affects the brain, spinal cord and optic nerve [1]. The cause of MS is unknown, however, it is believed to be a result of complex interaction between genetic and environmental exposures, including diet [2]. Treatment consists of disease-modifying therapies [1,3], symptom and relapse management and support from physical and occupational therapists [4] and dietitians [5]. Clinical disease course is unpredictable and may result in significant disability including unemployment due to disease progression [6,7,8].
Because modifiable lifestyle factors such as diet quality may impact the disease course [7,8,9,10,11], dietary guidelines for persons with MS (pwMS) have the potential to reduce MS-related symptoms. Potential mechanisms by which diet quality may influence disease course in MS patients include epigenetic changes in gene expression [12] and shifts in the composition of the gut microbiome [13] both of which may result in down regulation of inflammation. Diet quality may also influence the sufficiency of nutrients required for neuronal structure [14,15].
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