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Journal ArticleDOI

Multiple sclerosis: twenty years on low fat diet.

01 Nov 1970-JAMA Neurology (American Medical Association)-Vol. 23, Iss: 5, pp 460-474
TL;DR: The author's experience in treating cases of multiple sclerosis with a low fat diet for more than 20 years is assessed, both in treatment of the data and in conclusions.
Abstract: THIS paper assesses the author's experience in treating cases of multiple sclerosis with a low fat diet for more than 20 years. Previous reports of these studies 1-5 were preliminary in intent. The present paper is intended to be final, both in treatment of the data and in conclusions. Materials and Methods Patient Material.— Evaluation and discussion of the materials and methods were presented in detail in a previous paper. 4 The more pertinent points, however, will be included here. From December 1948 to April 1954, 264 patients with multiple sclerosis were examined at the Montreal Neurological Institute; 108 were seen only a few times. The remaining 156 patients maintained contact to and beyond April 1954, and no patients were added after this date. Two were rejected because of uncertain diagnosis, and eight were lost during the ensuing years. The remaining 146 patients are included in this report of
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Book ChapterDOI
TL;DR: Increased turnover of phospholipid fatty acids, following lymphocyte stimulation, requires a transferase to incorporate new fatty acids and a means of generating lysophosphatides and free fatty acids as substrates for this enzyme.
Abstract: Publisher Summary This chapter discusses fatty acids and immunity. Like all mammalian cells, lymphocytes contain a variety of fatty acids, some of which, the essential fatty acids, must be supplied to the cells because they are unable to synthesize them. Of the essential fatty acids, linoleic acid and the derivative arachidonic acid are major components of the phospholipids of lymphocyte membranes, while α-linolenic and its derivatives are only minor components. A wide variety of fatty acids produce effects on both the lymphoid and reticuloendothelial systems; the actual effects produced depend on the method of administration and the chemical nature of the fatty acid. Arachidonic acid is an immediate prostaglandin precursor and plays a central role in lymphocyte activation. Membrane phospholipid fatty-acid composition alters when lymphocytes are stimulated, either by antigen or by mitogens, such as phytohaemagglutinin or concanavalin A. Increased turnover of phospholipid fatty acids, following lymphocyte stimulation, requires a transferase to incorporate new fatty acids and a means of generating lysophosphatides and free fatty acids as substrates for this enzyme.

221 citations

Journal ArticleDOI
31 Mar 1973-BMJ
TL;DR: Relapses tended to be less frequent and be significantly less severe and of shorter duration in the linoleate-supplemented group than in those receiving the oleate mixture, but clear evidence that treatment affected the overall rate of clinical deterioration was not obtained.
Abstract: Seventy-five patients in London and Belfast with multiple sclerosis were given daily supplements of a vegetable oil mixture containing either linoleate or oleate for two years in a double-blind control trial Relapses tended to be less frequent and were significantly less severe and of shorter duration in the linoleate-supplemented group than in those receiving the oleate mixture, but clear evidence that treatment affected the overall rate of clinical deterioration was not obtained

190 citations

Journal ArticleDOI
TL;DR: Patients who adhered to the prescribed low-fat diet showed significantly less deterioration and much lower death rates than did those who consumed more fat than prescribed.

183 citations

Journal ArticleDOI
TL;DR: It is suggested that fish oil supplementation given together with vitamins and dietary advice can improve clinical outcome in patients with newly diagnosed MS.
Abstract: Objective - To investigate whether supplementation with fish oil given together with dietary advice and vitamin supplementation influenced the clinical outcome in newly diagnosed multiple sclerosis (MS) patients. Material and methods - Sixteen consecutive, newly diagnosed patients with multiple sclerosis were recruited to an open intervention study. They were given dietary advice and supplemented with 0.9 g/day of long-chain marine fatty acids and vitamins. The patients were followed for 2 years with respect to dietary habits, blood parameters and neurological assessment including exacerbation rate. Results - There was a significant reduction in the mean annual exacerbation rate and the mean Expanded Disability Status Scale (EDSS) as compared to pre-study values. The plasma total phospholipid n-3 fatty acids increased and n-6 fatty acids decreased significantly. Conclusions - The results suggest that fish oil supplementation given together with vitamins and dietary advice can improve clinical outcome in patients with newly diagnosed MS.

170 citations

Journal ArticleDOI
TL;DR: PUFAs seem to have no major effect on the main clinical outcome in MS (disease progression), but they may tend to reduce the frequency of relapses over two years, however, the data that are available are insufficient to assess a real benefit or harm from PUFA supplementation.
Abstract: Background Clinical and experimental data suggest that certain dietary regimens, particularly those including polyunsaturated fatty acids (PUFAs) and vitamins, might improve outcomes in people with multiple sclerosis (MS). Diets and dietary supplements are much used by people with MS in the belief that they might improve disease outcomes and overcome the effectiveness limits of conventional treatments. This is an update of the Cochrane review "Dietary intervention for multiple sclerosis" (first published on The Cochrane Library 2007, Issue 1). Objectives To answer MS patients' questions regarding the efficacy and safety of dietary regimens for MS. Can changes in dietary habits be an effective intervention for MS patients? Are the potential side effects of these interventions known, and have they been measured? Are potential interactions between dietary interventions and other curative or symptomatic treatments known and have they been studied? Search methods We searched the Cochrane Multiple Sclerosis and Rare Diseases of the Central Nervous System Group Specialised Register (November 2011), CENTRAL (The Cochrane Library 2011, Issue 4), MEDLINE (PubMed) (1966 to November 2011), EMBASE (embase.com) (1974 to November 2011) and reference lists of papers found. Selection criteria All controlled trials (randomised controlled trials (RCTs) and controlled clinical trials (CCTs)) on a specific dietary intervention, diet plan or dietary supplementation, except for vitamin D supplementation, compared to no dietary modification or placebo were eligible. Data collection and analysis Two review authors independently selected articles, assessed trial quality and extracted data. Data were entered and analysed in RevMan. Dichotomous data were summarised as relative risks (RR) with 95% confidence intervals (95% CI) using a random-effects model in the presence of heterogeneity (I² > 60%). Continuous data were analysed using weighted mean differences, determined by the difference between the pre- and post-intervention changes in the treatment and control groups. Main results Six RCTs that investigated PUFAs emerged from the search strategy, accounting for 794 randomised patients. PUFAs did not have a significant effect on disease progression at 24 months. Omega-6 fatty acids (11 to 23 g/day linoleic acid) didn't show any benefit in 144 MS patients (RR 1.04, 95% CI 0.66 to 1.63). Linoleic acid (2.9 to 3.4 g/day) had no benefit in 65 chronic progressive MS patients (RR 0.78, 95% CI 0.43 to 1.42). Omega-3 fatty acids had no benefit in 292 relapsing remitting MS patients (RR 0.82, 95% CI 0.65 to 1.03, P = 0.08). Slight potential benefits in relapse outcomes were associated with omega-6 fatty acids in some studies, however these findings were limited by the reduced validity of the endpoints. No judgements about safety or patient-reported outcomes were possible. In general, trial quality was poor. No studies on vitamin supplementation and allergen-free diets were analysed as none met the eligibility criteria, mainly due to lack of clinical outcomes. Authors' conclusions PUFAs seem to have no major effect on the main clinical outcome in MS (disease progression), but they may tend to reduce the frequency of relapses over two years. However, the data that are available are insufficient to assess a real benefit or harm from PUFA supplementation because of their uncertain quality. Evidence on the possible benefits and risks of vitamin supplementation and antioxidant supplements in MS is lacking. More research is required to assess the effectiveness of dietary interventions in MS.

158 citations

References
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Journal ArticleDOI
TL;DR: The investigation of the distribution of cases of multiple sclerosis in Switzerland between the years 1918 and 1922 seems to have established that the frequency of this disease can vary greatly in different geographic locations.
Abstract: THE investigation of the distribution of cases of multiple sclerosis in Switzerland between the years 1918 and 1922 seems to have established that the frequency of this disease can vary greatly in different geographic locations.1 The subsequent studies by Gram2 in Denmark and more recent investigations in the United States3 , 4 leave little doubt that these variations may be real and not due to technical errors in diagnosis, methods of collecting the data and so forth. In another study, Swank5 has suggested the possibility that these variations are related directly to the amount (and possibly the nature) of the fat consumption. . . .

279 citations

Journal ArticleDOI
TL;DR: Since men with known multiple sclerosis were ineligible for military service in World War I, those so diagnosed during service provide a sample of the disease in its earlier phases, which cannot be reliably constructed outside a complete medical care program such as the armed services provided.
Abstract: After a century of investigative effort the etiology of multiple sclerosis (MS) remains unknown and no specific therapy is available. Variability in course as well as possible multiplicity of cause suggest the need for more careful studies of natural history. Epidemiologic studies of the disease have produced evidence that incidence depends on geographic and climatic factors, but these relationships have not been specific enough to stimulate investigation on more fundamental levels. Such studies have been hampered by difficulties in acquiring series of adequate size and representativeness and in making parallel, concurrent observations on suitable controls. The U S . veteran population is an exceptional resource ( 3 ) for epidemiologic investigations, since it comprises an enumerable population, well-indexed at many points of medical interest. Its potential for longterm follow-up is better than that of any comparably large segment of the U.S. population. For investigations of multiple sclerosis there are other advantages as well. Since men with known multiple sclerosis were ineligible for military service in World War I1 ( 1 2 ) , those so diagnosed during service provide a sample of the disease in its earlier phases. Such a sample cannot be reliably constructed outside a complete medical care program such as the armed services provided. A t entry into service, before multiple sclerosis was diagnosed, extensive

150 citations