I have been following a keto diet since I was diagnosed with MS in Dec 2018.i have had no relapses since then, and now I look at food in a totally different way. Yes, I have the occasional lapse esp when potatoes or parsnips are on offer, my weakness, but overall I have persisted in this. I am also going thru menopause, which doesn't help my brain fog, but I have kept my job as a nurse, which involves a LOT of thinking, and I think it works for me. So that's my story. I am also getting infusions of Tysabri every 6 weeks. I have RRMS, and I know I don't know what life holds for me in the future, but I can only try.
It's no wonder there is so much conflicting information on a one fits-all diet, they dont exist. Checking your DNA with promothease isn't too bad, it will tell you if you have a methyl-folate deficiency for example or a vitamin d deficiency(probable if you have MS). You can get a gut microbiome test done at microba.com, it will give you some insight on how well you can digest oxalates, fats or if you have bacteria involved in mitophagy(mitochondrial renewal). If you cant get a hold of metformin, berberine may be just as good or even better and doesn't need a prescription. You can also get a continuous glucose monitor if you'd like to track which foods spike your insulin(they are different for different people), the Apple watch series 7 may have this built-in, here's to hoping :)
When I was diagnosed in 2019 I read lots about diet.
I was never a big meat eater and just basically adapted my lifestyle to the diet I felt I could stick to most, I chose OMS and I cut meat, dairy and gluten which I stick to… not fun at parties! I did try 16/8 for a while (as I follow the blog) I also tried keto & vegan combined but I sorely lacked protein in absence of meat, and I really missed my evening cup of tea and something to nibble on… I think I will try 16/8 again!
I think you illustrate two points that (1) diets are highly individual and (2) eating is social. Any diet that prevents you from socialising with friends and family can't be good for you. Preparing and eating alone is lonely and should not be recommended. We are social animals and socialising affects our brain positively in ways we are only beginning to understand. Eat Social!
too bad eating social in western society means eating rubbish food(guess it depends on your friends), living with MS would be a lot easier if our society was interested in being healthy even before becoming ill.
I totally agree and for the most part I do not feel deprived. I still go for meals and find many places accommodate when I ask for adapted dishes, although I do feel like a royal pain on the behind, and I sincerely empathise for those who actually avoid food groups for intolerance/allergy issues, I don’t think eating out would be worth the risk
Yes, I would recommend everyone reads the diet myth. Another good author to read when it comes to food is Gary Taubes, particularly 'Good Calories, Bad Calories' and his other books on sugar and keto.
Thank you for this. I feel validated in following your principles . I try to follow Dr Kousmine principles which are basically what you say. I have been a vegetarian (piscarian really)for years and stopped most dairy when I was diagnosed. Being French I also think preparing a lovely meal with fresh ingredients and sharing it, is a wonderful thing.I tried more restrictive MS diets and was miserable.
I was doing caloric restriction for weight loss up until a few weeks ago, and I didn't feel like it was making me feel better (except for the improvement in my GERD). Then I simultaneously started eating more chocolate (Easter!) and saw an Aaron Boster video about how sugar is terrible for fatigue...and I gotta say, I'm convinced! Considering returning to the caloric restriction, but am a little befuddled because I'd like to incorporate more strenuous exercise and I know from experience that restricting intake and increasing output will really make you feel like shit if you are not careful.
I've been drinking matcha green tea for years, even before my diagnosis. Is it a good habit to drink a cup a day, or, contrary to what you think, can it create problems for MS?
Hi, I really do feel a huge part of addressing a variety of chronic illnesses from
MS to heart disease, is to get a better omega 3 to omega 6 balance…we have far too much omega 6 in the western diet…much of which is coming from ultra processed foods (so it makes sense to recommend completely cutting these out). I would really recommend looking at ‘The Queen of Fats’ by Susan Allport, and also a recent publication by Kimberley Wilson ‘How to Build A Healthy Brain,’ who has looked in particular at the lack of DHA in the western diet and how this is potentially contributing to the accelerating rates of dementia and depression in the UK.
I am Italian and until today I followed the Mediterranean diet, also on a suggestion from my first neurologist.
I avoid red meat, eggs, cheeses, sweets. I prefer white meat, blue fish, wholemeal pasta and rice, legumes, low-fat yogurt, vegetable milk and oat flakes, lots of fresh fruit, dried fruit and vegetables, olive oil. In addition to vitamin D, take a PUFA supplement. I avoid salt and alcohol consumption.
Now I have read your articles about the ketogenic diet that I did not know and I went to read some articles. But it seems to overturn what I knew up to now about the diet to be followed to ensure general well-being.
It is best to avoid starchy vegetables, legumes and fruit (really?) With the exception of red fruits and avocados, cereals (therefore also rice and oats), while green light for eggs, meat and whole milk.
I knew that meat, especially red meat, is to be consumed very sparingly because it is pro-inflammatory.
Prof Giovannoni, I don't understand… what did I miss? :)
I would recommend you read the 'Big Fat Surprise'. In the book, Nina Teicholz exposes the Mediterranean diet as being created as a marketing campaign by the Olive Oil industry. Sadly, there is no ore or specific Mediterranean diet.
Low carbohydrate high-protein high-fat diets are one of the diets used to treat metabolic syndrome and type 2 diabetes. if you don't have metabolic syndrome you don't need these diets.
Similarly, ketogenic diets are the extreme end of these diets and are used to treat certain types of epilepsy. Basic science suggests these diets may be neuroprotective hence the current interest in exploring these diets as an adjunct to the treatment of MS.
There are other ways of getting to this endpoint other than what you eat; this is why intermittent fasting is so appealing.
I am not suggesting the Mediterranean diet is wrong, but there is too much dogma around diet, which is why I have taken an evolutionary approach to understand diet and health. You have to also realise that evolution has built into our metabolism dietary resilience, i.e our bodies can cope with most diets.
Thank you for this. I started to eliminate foods that would cause MS like symptoms.
Found out:
-chicken
-coffee
-garlic
-ginger
-dairy
We’re causing me to have have MS symptoms. Did a good allergy/sensitivity test. Those 5 exact components came out.
I do agree with Giovanni when he talks about guy microbe. Sometimes I’ll notice a change in my gut microbe and have a change in bowel habits. Usually happens when I eat a good amount of the identified foods and that will take about 2 weeks to get back in track with feeling well when a avoiding those specific foods.
It is hard sometimes to control what they put on restaurants, which is why sometimes if the food has some garlic I’ll eat it and will get a transient symptom.
I’ve noticed that in dish would not change my entire gut bacteria, if I do several days of bad eating, then it’ll take some time to get back in track.
Very informative and great advice. Since moving to Germany from Ireland I've had much better access to seasonal and locally produced veg and fruit. It is also much cheaper here as we have a subscription with a local farm that supplies us with produce weekly. I am mostly vegetarian and even followed a popular MS diet years ago but following a severe relapse I reaccessed things and realised the pressure I was putting on myself to follow it perfectly and not being able to eat out with friends in many places was far more toxic to my health as my stress levels went up. Now I eat as local and unprocessed as possible and I focus on managing my stress levels and as a result my health has really turned around. There is also a lot of interesting research now into how the perfect diet is different from person to person and how we process many foods is based on what our ancestors mostly ate. Thanks for a very informative read as always
Thanks Prof G, love this advice. I wondered how we can tell if we are in Ketosis. I follow most of your principles, no UPF, very low PF, low simple carbs, but as a vegetarian I do of course eat carbs in my vegetables and wholegrains. I do daily 16/8 but more usually 18/6 as well as R/C of around 800-1000 for a very small amount of weight loss over time (I’m short so this isn’t that low for my height) but I don’t follow a Keto diet specifically as I don’t eat meat, am I likely to be experiencing any ketosis this way?
I am not sure you are correct. There are many biohacking websites that explain how to eat a vegetarian keto diet. But eating a ketogenic diet is hard and is not for everyone.
Vegetarian keto possible but I don't think there is space for complex carbs as it is usually understood (whole grains etc) aside of whatever carbs are hidden in veggies if you need to stay below 50g carbs per day.
But I may well be biased because I hardly manage to get enough calories that way even with meat....
Yes agreed, I’m not eating a vegetarian keto diet, although no simple processes carbs my diet is otherwise full of veg although focussed on the lower glycemic ones and exercising when in the fasting window. Maybe not enough for Keto but all the benefits of loosing and maintaining weight and sustainable. I love your mention of seasonal eating as it indicates that a ketogenic diet would have been seasonal only. Beyond Ketosis, what are your thoughts on a CR/IF lifestyles and the research on stem cell activation to reduce inflammation/disease activity with alternative day fasting? The thing I find most tricky with understanding the bio hacking ideas are the measures of how much and how long and how to tailor so it’s effective for a specific body!
Yes, the insulin metabolic programme is designed for weight gain and may have been driven by having excess carbs at the end of summer and autumn, i.e. eat more than you require to have some fat for the long winter. A type of metabolic hibernation programme. However, this all changed when we learnt how to preserve foods for winter; drying, fermenting (wine), etc. I will do another newsletter on diet to cover these aspects.
That’s good to know, thanks Nellie, I might check with dipsticks just out of interest. On an 800 cal restriction I don’t eat much of anything and so I might calculate what the percentage of carbs actually is. It’s always a balance of getting enough fibre, vitamins, fats and protein which I think I’d prioritise over strict keto anyway! X
Nellie it sounds like you are doing great 💪 I totally agree that taking action to be in control of the things that we can influence is so important for pwMS, we have so much that we can’t have control of and never know what to expect. Keep going! The odd polenta cake is good for the soul 👌
Is there enough evidence to say how long people need to be in ketosis to have a significant benefit? To stay in a ketotic state can be quite difficult. And what about longer term increased risk of cancers with a ketotic diet. What are your thoughts?
Animal studies show intermittent ketosis is sufficient, which is what intermittent fasting does. However, you can live being ketotic mos of the year many indigenous tribes did so (e.g. Inuits and possibly the Massi men) without problems. We also treat some children with epilepsy with a ketotic diet and they seem to do okay.
This is why I state upfront that "What you eat is about personal choices and has to be compatible with your cultural background and your social and economic circumstances", please note economic factors.
Saying this the average cost of an MS DMT is probably in the order of £15,000 per annum in the UK and may $75,000 p.a. in the US. If we accept these costs and can afford them should we not be spending more on our diets?
I have been following a keto diet since I was diagnosed with MS in Dec 2018.i have had no relapses since then, and now I look at food in a totally different way. Yes, I have the occasional lapse esp when potatoes or parsnips are on offer, my weakness, but overall I have persisted in this. I am also going thru menopause, which doesn't help my brain fog, but I have kept my job as a nurse, which involves a LOT of thinking, and I think it works for me. So that's my story. I am also getting infusions of Tysabri every 6 weeks. I have RRMS, and I know I don't know what life holds for me in the future, but I can only try.
Thanks for sharing. I think very few people with MS use biohacking to help manage their MS.
It's no wonder there is so much conflicting information on a one fits-all diet, they dont exist. Checking your DNA with promothease isn't too bad, it will tell you if you have a methyl-folate deficiency for example or a vitamin d deficiency(probable if you have MS). You can get a gut microbiome test done at microba.com, it will give you some insight on how well you can digest oxalates, fats or if you have bacteria involved in mitophagy(mitochondrial renewal). If you cant get a hold of metformin, berberine may be just as good or even better and doesn't need a prescription. You can also get a continuous glucose monitor if you'd like to track which foods spike your insulin(they are different for different people), the Apple watch series 7 may have this built-in, here's to hoping :)
When I was diagnosed in 2019 I read lots about diet.
I was never a big meat eater and just basically adapted my lifestyle to the diet I felt I could stick to most, I chose OMS and I cut meat, dairy and gluten which I stick to… not fun at parties! I did try 16/8 for a while (as I follow the blog) I also tried keto & vegan combined but I sorely lacked protein in absence of meat, and I really missed my evening cup of tea and something to nibble on… I think I will try 16/8 again!
I think you illustrate two points that (1) diets are highly individual and (2) eating is social. Any diet that prevents you from socialising with friends and family can't be good for you. Preparing and eating alone is lonely and should not be recommended. We are social animals and socialising affects our brain positively in ways we are only beginning to understand. Eat Social!
too bad eating social in western society means eating rubbish food(guess it depends on your friends), living with MS would be a lot easier if our society was interested in being healthy even before becoming ill.
I totally agree and for the most part I do not feel deprived. I still go for meals and find many places accommodate when I ask for adapted dishes, although I do feel like a royal pain on the behind, and I sincerely empathise for those who actually avoid food groups for intolerance/allergy issues, I don’t think eating out would be worth the risk
Yes, I would recommend everyone reads the diet myth. Another good author to read when it comes to food is Gary Taubes, particularly 'Good Calories, Bad Calories' and his other books on sugar and keto.
Thank you for this. I feel validated in following your principles . I try to follow Dr Kousmine principles which are basically what you say. I have been a vegetarian (piscarian really)for years and stopped most dairy when I was diagnosed. Being French I also think preparing a lovely meal with fresh ingredients and sharing it, is a wonderful thing.I tried more restrictive MS diets and was miserable.
I was doing caloric restriction for weight loss up until a few weeks ago, and I didn't feel like it was making me feel better (except for the improvement in my GERD). Then I simultaneously started eating more chocolate (Easter!) and saw an Aaron Boster video about how sugar is terrible for fatigue...and I gotta say, I'm convinced! Considering returning to the caloric restriction, but am a little befuddled because I'd like to incorporate more strenuous exercise and I know from experience that restricting intake and increasing output will really make you feel like shit if you are not careful.
So why not try a low-carbohydrate/high-fat/high-protein diet or intermittent fasting? Neither of these diets requires caloric restriction.
I may! thanks!
If ketosis works via a similar mechanism as DMF, would you expect ketosis to also be associated with the increased infection risks that come with DMF?
No, I am not aware of ketosis causing long-term immunosuppression.
I've been drinking matcha green tea for years, even before my diagnosis. Is it a good habit to drink a cup a day, or, contrary to what you think, can it create problems for MS?
No, not that I am aware of. There are a lot of potential health benefits from green tea, but very difficult to study in the clinic.
Hi, I really do feel a huge part of addressing a variety of chronic illnesses from
MS to heart disease, is to get a better omega 3 to omega 6 balance…we have far too much omega 6 in the western diet…much of which is coming from ultra processed foods (so it makes sense to recommend completely cutting these out). I would really recommend looking at ‘The Queen of Fats’ by Susan Allport, and also a recent publication by Kimberley Wilson ‘How to Build A Healthy Brain,’ who has looked in particular at the lack of DHA in the western diet and how this is potentially contributing to the accelerating rates of dementia and depression in the UK.
I am Italian and until today I followed the Mediterranean diet, also on a suggestion from my first neurologist.
I avoid red meat, eggs, cheeses, sweets. I prefer white meat, blue fish, wholemeal pasta and rice, legumes, low-fat yogurt, vegetable milk and oat flakes, lots of fresh fruit, dried fruit and vegetables, olive oil. In addition to vitamin D, take a PUFA supplement. I avoid salt and alcohol consumption.
Now I have read your articles about the ketogenic diet that I did not know and I went to read some articles. But it seems to overturn what I knew up to now about the diet to be followed to ensure general well-being.
It is best to avoid starchy vegetables, legumes and fruit (really?) With the exception of red fruits and avocados, cereals (therefore also rice and oats), while green light for eggs, meat and whole milk.
I knew that meat, especially red meat, is to be consumed very sparingly because it is pro-inflammatory.
Prof Giovannoni, I don't understand… what did I miss? :)
I would recommend you read the 'Big Fat Surprise'. In the book, Nina Teicholz exposes the Mediterranean diet as being created as a marketing campaign by the Olive Oil industry. Sadly, there is no ore or specific Mediterranean diet.
https://thebigfatsurprise.com/
Low carbohydrate high-protein high-fat diets are one of the diets used to treat metabolic syndrome and type 2 diabetes. if you don't have metabolic syndrome you don't need these diets.
Similarly, ketogenic diets are the extreme end of these diets and are used to treat certain types of epilepsy. Basic science suggests these diets may be neuroprotective hence the current interest in exploring these diets as an adjunct to the treatment of MS.
There are other ways of getting to this endpoint other than what you eat; this is why intermittent fasting is so appealing.
I am not suggesting the Mediterranean diet is wrong, but there is too much dogma around diet, which is why I have taken an evolutionary approach to understand diet and health. You have to also realise that evolution has built into our metabolism dietary resilience, i.e our bodies can cope with most diets.
Thank you for this. I started to eliminate foods that would cause MS like symptoms.
Found out:
-chicken
-coffee
-garlic
-ginger
-dairy
We’re causing me to have have MS symptoms. Did a good allergy/sensitivity test. Those 5 exact components came out.
I do agree with Giovanni when he talks about guy microbe. Sometimes I’ll notice a change in my gut microbe and have a change in bowel habits. Usually happens when I eat a good amount of the identified foods and that will take about 2 weeks to get back in track with feeling well when a avoiding those specific foods.
It is hard sometimes to control what they put on restaurants, which is why sometimes if the food has some garlic I’ll eat it and will get a transient symptom.
I’ve noticed that in dish would not change my entire gut bacteria, if I do several days of bad eating, then it’ll take some time to get back in track.
Thank you
Nice post ...Prof Giovannoni
Nice post
Very informative and great advice. Since moving to Germany from Ireland I've had much better access to seasonal and locally produced veg and fruit. It is also much cheaper here as we have a subscription with a local farm that supplies us with produce weekly. I am mostly vegetarian and even followed a popular MS diet years ago but following a severe relapse I reaccessed things and realised the pressure I was putting on myself to follow it perfectly and not being able to eat out with friends in many places was far more toxic to my health as my stress levels went up. Now I eat as local and unprocessed as possible and I focus on managing my stress levels and as a result my health has really turned around. There is also a lot of interesting research now into how the perfect diet is different from person to person and how we process many foods is based on what our ancestors mostly ate. Thanks for a very informative read as always
Thanks Prof G, love this advice. I wondered how we can tell if we are in Ketosis. I follow most of your principles, no UPF, very low PF, low simple carbs, but as a vegetarian I do of course eat carbs in my vegetables and wholegrains. I do daily 16/8 but more usually 18/6 as well as R/C of around 800-1000 for a very small amount of weight loss over time (I’m short so this isn’t that low for my height) but I don’t follow a Keto diet specifically as I don’t eat meat, am I likely to be experiencing any ketosis this way?
Sounds good. It's horses for courses with diets. Biohackers use urine dipsticks or breathalyser for monitoring ketosis. Not sure if this is necessary.
I would think ketosis to be unlikely with intake of complex carbs.
It's surprisingly hard to get there and basically your entire (small!) carb budget gets used up by veggies
I am not sure you are correct. There are many biohacking websites that explain how to eat a vegetarian keto diet. But eating a ketogenic diet is hard and is not for everyone.
Vegetarian keto possible but I don't think there is space for complex carbs as it is usually understood (whole grains etc) aside of whatever carbs are hidden in veggies if you need to stay below 50g carbs per day.
But I may well be biased because I hardly manage to get enough calories that way even with meat....
Yes agreed, I’m not eating a vegetarian keto diet, although no simple processes carbs my diet is otherwise full of veg although focussed on the lower glycemic ones and exercising when in the fasting window. Maybe not enough for Keto but all the benefits of loosing and maintaining weight and sustainable. I love your mention of seasonal eating as it indicates that a ketogenic diet would have been seasonal only. Beyond Ketosis, what are your thoughts on a CR/IF lifestyles and the research on stem cell activation to reduce inflammation/disease activity with alternative day fasting? The thing I find most tricky with understanding the bio hacking ideas are the measures of how much and how long and how to tailor so it’s effective for a specific body!
Yes, the insulin metabolic programme is designed for weight gain and may have been driven by having excess carbs at the end of summer and autumn, i.e. eat more than you require to have some fat for the long winter. A type of metabolic hibernation programme. However, this all changed when we learnt how to preserve foods for winter; drying, fermenting (wine), etc. I will do another newsletter on diet to cover these aspects.
That’s good to know, thanks Nellie, I might check with dipsticks just out of interest. On an 800 cal restriction I don’t eat much of anything and so I might calculate what the percentage of carbs actually is. It’s always a balance of getting enough fibre, vitamins, fats and protein which I think I’d prioritise over strict keto anyway! X
Nellie it sounds like you are doing great 💪 I totally agree that taking action to be in control of the things that we can influence is so important for pwMS, we have so much that we can’t have control of and never know what to expect. Keep going! The odd polenta cake is good for the soul 👌
Is there enough evidence to say how long people need to be in ketosis to have a significant benefit? To stay in a ketotic state can be quite difficult. And what about longer term increased risk of cancers with a ketotic diet. What are your thoughts?
Animal studies show intermittent ketosis is sufficient, which is what intermittent fasting does. However, you can live being ketotic mos of the year many indigenous tribes did so (e.g. Inuits and possibly the Massi men) without problems. We also treat some children with epilepsy with a ketotic diet and they seem to do okay.
This sort of diet is expensive and most people with MS will not have the means to eat like this. What do you suggest?
This is why I state upfront that "What you eat is about personal choices and has to be compatible with your cultural background and your social and economic circumstances", please note economic factors.
Saying this the average cost of an MS DMT is probably in the order of £15,000 per annum in the UK and may $75,000 p.a. in the US. If we accept these costs and can afford them should we not be spending more on our diets?