Recommendations

The following recommendations for nutritional changes are based on the robust and diverse scientific data which link various nutritional factors to MS onset and progression. It is important to completely avoid some foods, significantly reduce the consumption of others and to greatly increase the intake of others.

Eliminate
A. Foods that contain proteins which have the potential to cause autoimmune reactions. These are: 1. All dairy products (e.g. milk, cheese, yoghurt) 2. Foods containing gluten grains (e.g. wheat, rye or barley) 3. Legumes (e.g. beans, soy, peanuts. peas) B. Any food that causes an allergic reaction as determined by a body reaction or a blood test. These foods can cause increased intestinal permeability (a leaky gut) and increased immune reactions. C. Candy, soft drinks and foods with a high sugar content. These foods alter the gut flora which in turn can cause a leaky gut and problematic immune reactions.

Reduce
A. Foods that contain saturated fat. Eat red meat (lean cuts) only once a week. B. The intake of omega 6 polyunsaturated fat which are found in margarine, salad oils and many baked goods. Use olive oil (monounsaturated fat) for fat supply C. Non-gluten grains such as corn and oats. Use mainly rice for grain products and eat these in moderation. D. Alcohol consumption. At best, drink wine in moderation and completely avoid beer.

Increase
A. Eat skinless chicken breast, game meat and fish for protein content. Fish such as salmon and mackerel also contain omega 3 polyunsaturated fat, which is very beneficial. B. Eat lots of vegetables and fruits for carbohydrates and fiber. C. Take a variety of supplements to bolster immune regulation, to increase anti-oxidant capacity and to avoid

deficiencies. The recommended supplements are listed on the Supplement Page.

Supplements
A daily regimen of supplements is an important part of the nutritional strategies for MS. The basic recommendations below are completely safe and have the potential to be of significant benefit.

Basic Supplements - Essentials

Vitamin D3: 6000-8000 IU o This is best gotten from pills not associated with any vitamin A. Omega 3 Essential Fatty Acids: 5 g of EPA+DHA o This is best gotten from fish oil such as salmon oil (.3 grams EPA + DHA per 1 gram capsule). 1-2 tablespoons of cod liver oil is also an option but ensure that vitamin A content does not exceed 5000 IU. The addition of 1 tablespoon of flax oil can be of value because it contains alpha linolenic acid, a precursor to EPA and DHA. Calcium: 1000-1200 mg Magnesium: 500-600 mg

Basic Supplements - Vitamins

Vitamin A: 5000 IU Vitamin B complex: 100 mg No flush Niacin (B3): 2 g Folic acid: 400 mcg Vitamin B12: 1-2 mg Vitamin C: 1 g Vitamin E (natural): 400 IU

Basic Supplements - Minerals

Zinc: 25-50 mg Copper: 1-2 mg Selenium: 200 mcg Manganese: 20 mg Iodine: 200 mcg

Basic Supplements - Antioxidants

Grape Seed Extract: 2-4 capsules Ginkgo Biloba: 120 mg Alpha Lipoic Acid: 1200 mg

Coenzyme Q10: 60-90 mg EGCG Max (epigallocatechin-3-gallate): 2 capsules (700 mg each) Quercetin: 400 mg Bromelain: 400 mg

Basic Supplements - Probiotics

Acidophilus - 6 to 9 capsules (2 to 3 with each meal)

Designer Supplements
Some special supplements are also potentially of value. These can be quite expensive and thus they are included in a separate list.

N acetyl cysteine (NAC): 500 mg This supplement can increase glutathione level which increases antioxidant capacity. Inosine: 2g o This supplement increases uric acid level which neutralizes perioxynitrite. Note that gout can occur if ones uric acid level is too high. The trick is to have ones uric acid level as high as possible without inducing gout.

Paleolithic Nutrition
The Paleolithic lasted from about 200 000 years ago to about 12 000 years ago and was characterized by a hunting and gathering lifestyle for humans. During this time the food supply consisted almost exclusively of lean wild meats, fish, vegetables and fruits. These provided all the nutrients necessary for a very active lifestyle which involved far more exercise than our current way of living. Most importantly, because humans slowly adapted to this food supply over 2 000 000 years, the human genome was very compatible with all the various types of proteins, fats, carbohydrates and micro-nutrients found in these foods as well as various anti-nutrients that the plants and animals evolved to discourage their consumption. Thus it is very unlikely that the normal constituents of the food supply (excluding bacteria etc) would have caused any common biochemical malfunctions (ie disease) because those not compatible with such foods would have been naturally selected from the gene pool over the hundreds of thousands of years this food supply was consumed. Thus a diet of lean meat, fish, fruits and vegetables is now considered to represent a Paleolithic Diet and such a diet is basically that to which humans are genetically adapted. With the rapid increase of the human population and a consequent dwindling of the standard foods, humans added new foods to their diet and these included grains (cultivated grass seed) and milk and meat products from domesticated animals. This change to a "grow your own" food supply of the agricultural revolution began about 12 000 years ago in the Middle East and slowly spread westward, reaching Scandinavia and the British Isles about 6 000 years ago. There can be little doubt that in the early days of agriculture there must have been a broad spectrum of genetic incompatibilities with these new foods which contained a great variety of new, never-seen-before proteins as well as a much greater abundance of saturated fat than the Paleolithic foods. Such incompatibilities likely varied from very high to minor. Over the last 6000 years most of the genes which were very incompatible with the new foods were probably eliminated from the gene pool because of the

biochemical failures (illnesses) which would have hit those with such genes before the age of reproduction. However those with lesser genetic incompatibilities and who were not affected by adverse reactions until after the age of reproduction (~18-30) have passed on such genes to our current generations. Thus most diseases associated with the new foods of dairy, grains and high saturated fat meats do not appear until later in life. These include heart disease, stroke, some cancers (prostate, breast, colon), many autoimmune diseases and a variety of chronic degenerative diseases (eg Parkinsons, Alzheimers). Notably a few of these disease do occur in young people and include juvenile diabetes and arthritis. These "exceptions to the rule" most likely relate to the very recent practice of supplementing babies with the new foods (milk, wheat, soy) in the first year of life. Such a practice will identify another group of individuals with very specific food incompatibilities and who would have probably been fine for a long time if they had not had such an early exposure to the problematic foods. In summary it only makes sense that if our genes are compatible with a supply of a great variety of chemicals from lean meat, fish, fruits and vegetables that any deviation from this is going to have a negative effect on part of the gene pool. Thus it is not surprising that epidemiological studies have shown that the more dairy, grains and high fat meats a society eats the greater the prevalences of all the various non-infectious, "lifestyle" diseases which were listed above. The fact that the people of the outports of Newfoundland who eat mainly fish and home grown vegetables have one tenth the amount of multiple sclerosis than do genetically similar Albertans whose diet is dominated by red meats, grains and dairy products is a fine example of the relationship between disease prevalence and dietary habits. If your car was built for diesel fuel, dont be surprised if you have a variety of malfunctions when you start filling it with high octane gasoline! It can be instructive to compare a Paleolithic diet with a standard North American one to understand where the main problems lie. Protein-In a Paleolithic diet protein makes up about 25-30% of calories and is derived almost exclusively from lean meats and fish. This contrasts with the NA diet which consists of only 10-15% protein which is derived from high fat meats, grains, dairy products and legumes. Thus both the amount and sources vary greatly between the two dietary practices. Proteins play a major role in autoimmune disease and thus these new sources of proteins (dairy, grains, legumes) which present the immune system with completely new protein fragments, are very problematic. Celiac disease is a fine example of an autoimmune disease driven by these novel proteins. These newly introduced proteins also play a major role in MS, rheumatoid arthritis, Crohns and type 1 diabetes. Carbohydrates-Paleolithic carbohydrates were gained mainly from fruits and vegetables which have a low glycemic index and which are associated with abundant micro-nutrients and fibre. They made up about 30-35% of the calorie intake. Once again the contrast with the NA diet is huge. In the NA diet carbohydrates are derived mainly from grains and refined sugars with fruits and vegetables being a minor supply. Furthermore carbohydrates make up 50-60% of calories, nearly twice that of the Paleolithic diet. These new sources of carbohydrates have a high glycemic index and this, in combination with the great increase in intake, significantly stresses the glucose-insulin system. This results in a myriad of diseases most often led by type 2 diabetes. These new carbohydrates also have much less fibre and micro-nutrients which also has a very negative health effect. FATS-Fats comprise about 35-40% of Paleolithic calories and consisted mainly of monosaturated and polyunsaturated fats. In the polyunsaturated fats substantial amounts of omega 3 EFAs were included such that the omega 6/omega 3 ratio was less than 4. Saturated fats made up less than 40% of fat supply. The main sources of fat were lean wild animals, fish and nuts. Currently the NA diet contains similar amounts of fat (35-40%) but the amounts of the various types of fats are very different. The main fat types

eaten today are saturated fat from fatty red meats and dairy products and trans fatty acids from margarines and processed baked goods. Omega 3 fats are almost non existent in the diet and the ratio of omega 6 to omega 3 EFAs exceeds 10. The overabundance of saturated fat, the introduction of an entirely new fat type (trans fatty acids) and a major deficiency in omega 3 EFA have resulted in major health problems including heart disease, stroke, hypertension, cancer and chronic degenerative diseases. Micronutrients-The Paleolithic diet contains many more micronutrients (vitamins, minerals, antioxidants) than does the NA diet. Vitamin consumption was about three times that of today in the Paleolithic due to the high intake of fruits and vegetables. Similarly intake of Zn, Ca, K and Fe was much higher in the Paleolithic. Only sodium and perhaps iodine are consumed much more today. Sodium consumption is about eight times that of the Paleolithic and this overabundance of Na along with an very low consumption of most minerals and vitamins not surprisingly has serious consequences for health. In summary our current diet is very different from that consumed in the Paleolithic and with which humans are genetically compatible. These major differences are having a major effect on the health of the NA population and MS is just one of a broad spectrum of lifestyle diseases driven by our radically new dietary habits. Below are a few links to sites which add more information and insight into Paleolithic Nutrition. The Eaton paper and the Cordain interview are excellent reviews of Paleolithic nutrition by the leading experts in the field. The Challem article is a laymans summary and both the Wiss site and the Nicholson site contain a number of useful links to other sites which discuss Paleolithic nutrition. Eaton Article Challem Article Ward Nicholson Site Wiss Site

Medline Abstracts Stone agers in the fast lane: chronic degenerative diseases in evolutionary perspective.
Am J Med 1988 Apr;84 (4):739-49 Eaton SB, Konner M, Shostak M Department of Anthropology, School of Medicine, Emory University, Atlanta, Georgia 30322. From a genetic standpoint, humans living today are Stone Age hunter-gatherers displaced through time to a world that differs from that for which our genetic constitution was selected. Unlike evolutionary maladaptation, our current discordance has little effect on reproductive success; rather it acts as a potent promoter of chronic illnesses: atherosclerosis, essential hypertension, many cancers, diabetes mellitus, and obesity among others. These diseases are the results of interaction between genetically controlled biochemical processes and a myriad of biocultural influences--lifestyle factors--that include nutrition, exercise, and exposure to noxious substances. Although our genes have hardly changed, our culture has been transformed almost beyond recognition during the past 10, 000 years, especially since the Industrial Revolution. There is increasing evidence that the resulting mismatch fosters "diseases of civilization" that together cause 75 percent of all deaths in Western nations, but that are rare among persons whose lifeways reflect those of our preagricultural ancestors.

Balanced intakes of natural triglycerides for optimum nutrition: an evolutionary and phytochemical perspective.
Med Hypotheses 1997 Sep;49 (3):247-61 Broadhurst CL 22nd Century Nutrition, Inc., Herbal Vineyard, Inc., Cloverly, MD 20905-4007, USA.cleigh@cais.com Natural whole foods contain fats as structural components, and have a balance of polyunsaturated fat, monounsaturated fat, and saturated fat. Since we are still a Paleolithic species, adapted to eating only wild foods, it is difficult to justify the consumption of anything other than an overall balance of triglyceride/phospholipid types in an evolutionary sense. No natural fats are intrinsically good or bad--it is the proportions that matter. Variety is recommended in dietary lipid structure, degree of saturation, and chain length. Pathological n-3/n-6 polyunsaturated fat imbalance, obesity, and progressive glucose intolerance are consequences of adopting cereal grain based diets by both humans and livestock. Food processing and refining amplify these problems. Excessive concerns regarding polyunsaturated fat peroxidation in vivo are not warranted when triglycerides are balanced and normal diets are consumed. Numerous phytochemicals present in unrefined oils, fruits, vegetables, and herbs afford significant protection from lipid peroxidation and chronic disease.