Paleolithic diet

The Paleolithic diet is a dietary regime which some people believe to be effective in treating multiple sclerosis. The diet was first popularised by film writer Roger MacDougall. MacDougall was diagnosed with MS in 1953. His condition progressed steadily until he changed his diet to one which is essentially the same as what is now called the Paleolithic diet.

At the nadir of his disability, MacDougall was "was unable to use my legs, eyes, and fingers ... even my voice was affected, and I was quite unable to stand erect, even for a few seconds". By 1975, after several years on the diet, a neurologist pronounced his reflexes, muscle control, gait, and movements to be normal and could only detect a slight nystagmus in one eye.

The Diet

The broad basis of MacDougall's diet is:

• No foods that contains gluten. This means avoiding all cereals - wheat, barley, rye and oats - and foodstuffs containing them such as:

  • breakfast cereals

  • pasta

  • bread

  • beer, whisky and many other alcoholic beverages

  • cakes, biscuits and other foods containing flour

• No foods that contain dairy produce:

  • liquid milk and cream

  • butter

  • cheese

• Low sugars, in particular, no refined sugar. MacDougall recommends using honey and fruit sugars to sweeten food.

• Low animal fats. High unsaturated fats. This means avoiding beef, pork, lamb, goose and duck. Wild and free-range meats are preferred to meats that come from modern agriculture.

• No foods to which you are allergic.

• Vitamin and mineral supplements to counter any deficiencies. MacDougall put together this list for his own use:

  • Vitamin Bl: 25 mg

  • Vitamin B2: 15 mg

  • Vitamin B6: 75 mg

  • Vitamin B12: 250 mcg

  • Vitamin C: 300 mg

  • Vitamin E: 200 iu

  • Chlorine Bitartrate: 120 mg

  • Calcium Gluconate: 900 mg

  • Calcium-D-Pantothente: 150 mg

  • Folic Acid: 200 mcg

  • Lecithin from flax: 300 mg

  • Magnesium Carbonate: 900 mg

  • Nicotinamide: 500 mg

  • Inositol: 120 mg

  Nowadays, many people with MS would add a form of Vitamin D, called 1,25-dihydroxyvitamin D3, to this list.

MacDougall emphasises that everyone is different and that it's not necessarily the case that what works for one person will work for everyone. He advocates finding out what works for you.

He also states that you have to follow the diet for a while before results can be seen.

Clearly, MacDougall's diet is radically different to a typical Western diet. It's important to have a balanced diet and you must take care to ensure that you're getting all the basic foodstuffs that you need. Many people have developed recipes that adhere to MacDougall's diet. Perhaps the best place to start if you're looking for culinary ideas is Ashton Embry's MS-Direct web site. Embry is the father of a person with MS and has spent a great deal of time researching dietary strategies to fight this disease.

The Theory behind the diet

MacDougall's diet has become known as the "Paleolithic Diet", and is based around a theoretical framework which derives from evolutionary biology.

In essence, the theory goes as follows:

• Humans evolved in the forests and savannahs of the late Pliocene and Pleistocene ages - two and a half million years ago until 11,000 years ago. Because this period coincides with the appearance of stone tools, it is called the Paleolithic which derives from the greek "palaios" meaning old and "lithos" meaning stone - hence the old stone age. As far as any one can tell, the Paleolithic corresponds with the birth of our genus, homo.

• During this period, early humans lived a hunter-gatherer lifestyle and ate meat which they hunted or scavenged, fish which they caught and fruit, nuts, berries and other vegetable matter which they harvested from naturally growing resources. They would have supplemented this diet with foodstuffs from a wide variety of other sources such as honey, grubs and insects. Essentially, their diet was pretty similar to that of modern day hunter-gatherers and did not include the products of agriculture such as cereal crops, dairy produce, high fat meat and refined sugar.

• At the end of the last glaciation, around 11,000 years ago, fully modern humans began to cultivate naturally occurring high-yield grass mutations and to domesticate goats, sheep and cows. This agricultural revolution caught on and spread around the old world very rapidly and today it provides the dietary basis for the vast majority of the world's population.

• The argument goes that our bodies have evolved over two and a half million years to deal with a hunter-gatherer diet. Conversely, they have not evolved to deal with the products of modern agriculture which has only been around for the last 11,000 years or so - a mere flash in the pan in relation to this vast time span. In particular, our bodies have not evolved to digest cereals (especially wheat), dairy produce and high-fat meat.

• Advocates of the Paleolithic diet maintain that, because our bodies are not evolved for it, a modern diet is inappropriate for our bodies and the root of a whole gamut of diseases. These diseases include not only the more obvious ones like celiac disease (gluten intolerance - gluten is a constituent of wheat), lactose intolerance (lactose is a constituent of milk) and diabetes but also multiple sclerosis and other autoimmune conditions.

Whether or not one ascribes any validity to the evolutionary tenets of the argument, it is still possible to maintain that diet may very well play a role in the cause or treatment of multiple sclerosis. It is known that dietary elements are involved in other autoimmune diseases (for example, type 1 diabetes and celiac disease), so it is not absurd to postulate that the same may be true of MS. There is some solid evidence that certain proteins found in wheat and dairy produce could play a part in the etiology and/or pathogenesis of multiple sclerosis.

Gluten

Neuropathic Coeliac Disease (CD) is a manifestation of gluten intolerance that can present with central nervous system white matter abnormalities not altogether dissimilar to the lesions caused by multiple sclerosis [Kieslich et al, 2001]. In some individuals, these abnormalities are observed without the digestive problems that are typical of the disease.

Recent research has shown genetic similarities between people with CD and some other autoimmune diseases including multiple sclerosis [Ref]. It is also possible that a proportion of people with multiple sclerosis represent a misdiagnosed group of people with CD.

Whey Proteins

There is some good evidence that the incidence of multiple sclerosis is higher in areas of high cow's milk consumption [Malosse and Perron, 1993], [Malosse et al, 1994], [Sepcic et al, 1993], [Butcher, 1986] and [Butcher, 1992].

More recently, detailed immunological studies have been carried out by Michael Dosch's team in Ontario, Canada. They have looked at potential triggers for multiple sclerosis and type-1 diabetes focusing on dairy proteins especially those in whey [Dosch et al, 2001] and [Dosch et al, 2001]. One particular milk protein, butyrophilin, has been presented as a potential antigen which may be similar enough to Myelin Oligodendrocyte Glycoprotein (MOG) to spur the immune system to attack myelin in a process known as molecular or epitopic mimicy. Independent studies by a group in Germany have reached similar conclusions [Stefferl, Schubart et al, 2001].

Interestingly, the German group have used heavy doses of butyrophilin on mice with an experimental model for multiple sclerosis called EAE. They have found that this strategy, called immune tolerance, reduces the effects of the disease.

Studies

Ashton Embry's Direct MS organisation is funding a very small study of the Paleolithic diet to begin next year (2002). As I understand it, limited funds will restrict the study population to 12 people with relapsing-remitting multiple sclerosis. It will be hard to draw many firm conclusions from a study of this size. However it is to be hoped that they will achieve positive results and spur larger, richer organisations to fund larger research projects.

One of the difficulties in analysing the Paleolithic diet is that it is a very broad based diet involving several foodstuffs. Even if Embry's group do find the diet therapeutic, it will be hard to know which elements of the diet were beneficial and which were superfluous. Even if the study does not achieve positive results, that does not mean that diet has no bearing on the disease.

What is urgently required are some well-designed, large population studies on the dietary intake of individual proteins such as butyrophilin. For some reason and in the face of pressures from many people with MS and a few researchers, diet has largely been ignored by those who fund research into the disease. This is perhaps understandable in the case of pharmaceutical companies but it rather a perverse line for the NMSS to take given that they claim to be representing the interests of people with MS.

As things stand, no one knows the cause of MS except that it involves the interaction between a person's genes and one or more unknown environmental factors. It is as reasonable a hypothesis as any that one or more dietary elements might be among those factors.

Paleolithic diet links:

My Fight Against Multiple Sclerosis, by Roger MacDougall

DIRECT-MS

MS Dietary Home Page

MS-Diet Support Group

Campaign for Research into Diet and Multiple Sclerosis