Multiple sclerosisBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4470 (Published 26 November 2009) Cite this as: BMJ 2009;339:b4470
All rapid responses
A major problem for those GPs trying to improve the quality of life
of MS people is that the pathophysiology of the disorder is unexplained.
In 1987 we published a paper which recorded that blood samples from a
small group of MS people was poorly filterable, had increased blood
viscosity and showed changes in the shape populations of red cells. Blood
samples from MS people in Oregon, sent by Professor Swank, showed the same
changes. In 1983, Swank et al had reported that in MS patients, cerebral
blood flow was impaired. That finding was consistent with the expected
effects of poorly filterable blood. This implies that changes in the
physical properties of the blood are a major factor in the pathophysiology
While these changes in blood rheology were repeated in a larger study
involving more than 200 MS people in New Zealand, 3 neurology journals
rejected the report, which remains unpublished. Also unpublished are the
results of a placebo-controlled, double-blind study of the effects of 4.5
grams daily of evening primrose oil, vs a placebo oil, in 50 MS people.
The study lasted for 3 months. At the conclusion of the 3 months, all
participants completed a simple questionnaire which involved 3 questions.
1. During the 3 months of the study, did your symptoms get worse, stay
the same, or improve ? Tick one.
2. If your symptoms got worse, list
3. If your symptoms got better, list those symptoms.
The results showed that those taking the evening primrose oil reported
improvements in a wide range of symptoms.
It should be noted that the objective of taking evening primrose oil
was to increase the blood levels of prostaglandin E1 (PGE1). In 1974 it
was reported that PGE1 improved the fluidity of the red cell membrane. In
the following year a different group reported that PGE1 improved blood
filterability. Thus the oil supplement was taken with the objective of
improving blood flow.
Because of the low fat content, Swank's low-fat diet would lead to a
low blood viscosity, and Swank's time-related reports are unparalleled, as
some participants were assessed after 50 years on the diet. Given the
finding that those who had not persisted with the diet died earlier than
those who did persist with the diet, it is difficult to understand why, in
general, physicians ignore the potential benefit of the low fat diet in
favour of a variety of pharmaceuticals.
Although in his book, Professor Jelinek recommends the Swank diet,
the contents of the book provide no basis for the recommendation. Nor is
there evidence that he was familiar with the general trend of Professor
Swank's published papers. The introduction of meditation as a treatment
option is consistent with the general lack of science in the contents of
As the "areas of brightness" shown by MRI are probable manifestations
of the effects of altered blood rheology on blood flow in small
capillaries, treatments should be aimed at improving the physical
properties of the blood. As smoking increases blood viscosity, smoking
should stop. If it is not possible to adopt the low-fat diet, then it is
important to reduce the intake of saturated fat and increase the intake of
oily fish. A daily supplement of 4 grams of evening primrose oil or 6
grams daily of fish oil will improve capillary blood flow.
Competing interests: No competing interests
Dr Leedham correctly states that "it's the role of Drs to look for
solutions" and that we "should seek the best possible for our patients".
It is worth noting the work of Prof Jelinek, an Emergency Physician, who
is doing interesting work in this area. He reminds us that 20 years ago
Swank published a paper that showed following a low saturated fat diet
dramatically reduced the rate of progression of the disease. Almost 40
years after Goldberg proposed his Vitamin D hypothesis we have had the
first RCT of Vitamin D supplementation which showed a marked reduction in
There continue to be calls for the routine supplementation
of MS patients with Vitamin D. Jelinek suggests combining these dietary
changes with lifestyle changes such as meditation. We know from Ornish's
work that such changes can benefit CHD and prostate cancer and it has been
shown that psychological methods can endogenusly modulate levels of
interferon (refs 44 and 45 in jelineks primary care paper).
It is of great reassurance to MS patients that these promising areas are
finally being combined and followed up.
Jelinek G & Hassed C. Managing multiple sclerosis in primary care: are
we forgetting something?
Swank RL, Dugan BB. Effect of low saturated fat diet in early and late
cases of multiple sclerosis. Lancet 1990; 336:37-39
Vitamin D rct was presented at American Academy of Neurology 2009 and is
in submission (personal contact with author):http://www.webmd.com/multiple
Ornish (et al) Can lifestyle changes reverse coronary heart disease? The
Lifestyle heart trial- Lancet 1990 Jul 21 ; 336(8708):129-33
and intensive lifestyle changes may affect the progression of prostate
cancer - J Urol 2005 sep; 174(3)1065-9
I have MS and have benefited from the changes suggested by jelinek.
Competing interests: No competing interests