Der Nervenarzt

, Volume 76, Issue 2, pp 131–142 | Cite as

Multiple Sklerose und Ernährung

Übersichten

Zusammenfassung

Einflüsse der Ernährung auf Inzidenz und Verlauf der Multiplen Sklerose (MS) sind nicht sicher bewiesen. Es gelten die allgemeinen Empfehlungen zugunsten einer ausgewogenen Ernährung. Mangel-, Über- oder Fehlernährung sind häufig und verschlechtern potenziell die neurologische Symptomatik. In besonderen Situationen kann die Ernährungssituation durch eine individuelle diätetische Beratung und andere Maßnahmen verbessert werden. Epidemiologische Studien deuten darauf hin, dass der Konsum tierischer Fette mit einem erhöhten Erkrankungsrisiko assoziiert ist. Es gibt zahlreiche Hinweise, dass ungesättigte Fettsäuren, insbesondere ω-3-Fettsäuren, sich auf den Krankheitsverlauf der MS günstig auswirken. In mehreren Therapiestudien konnte jedoch kein positiver Effekt von ungesättigten Fettsäuren nachgewiesen werden. Die Einnahme von Vitamin D ist wahrscheinlich mit einem geringeren Erkrankungsrisiko assoziiert. Für eine Behandlung mit Vitamin D gibt es zurzeit noch keine ausreichende Basis. Wegen der hohen Prävalenz von Osteoporose bei Patienten mit MS sollte die Indikation zu einer präventiven Therapie mit Vitamin D und Kalzium weit gestellt werden.

Schlüsselwörter

Ernährung Multiple Sklerose Ungesättigte Fettsäuren ω-3-Fettsäuren Vitamin D 

Diet and multiple sclerosis

Summary

Beneficial effects from any particular diet have not been proven in multiple sclerosis (MS). Therefore, the general guidelines on nutrition should be followed. Obesity and various forms of malnutrition worsening the MS symptoms are frequently observed. There is some evidence from epidemiological studies that a high consumption of saturated animal fat is associated with an increased incidence of MS. The findings from such studies indicate that supplementation with unsaturated fatty acids, in particular ω-3 fatty acids, could positively influence the course of MS. However, controlled studies did not show clear beneficial effects from polyunsaturated fatty acids. The intake of vitamin D is associated with a lower incidence of MS. In contrast, the effects of therapy with vitamin D on the course of MS have not been ascertained. Patients with MS carry an enormous risk of osteoporosis, and therefore the indication for a preventive therapy with vitamin D and calcium should be established in every postmenopausal woman or after repeated steroid treatments.

Keywords

Nutrition Multiple sclerosis Fatty acids Vitamin D 

Literatur

  1. 1.
    Agranoff BW, Goldberg D (1974) Diet and the geographical distribution of multiple sclerosis. Lancet 2:1061–1066CrossRefGoogle Scholar
  2. 2.
    Albert CM, Campos H, Stampfer MJ et al. (2002) Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med 346:1113–1118CrossRefGoogle Scholar
  3. 3.
    Alling C, Vanier MT, Svennerholm L (1971) Lipid alterations in apparently normal white matter in multiple sclerosis. Brain Res 35:325–336CrossRefPubMedGoogle Scholar
  4. 4.
    Alter M, Yamoor M, Harshe M (1974) Multiple sclerosis and nutrition. Arch Neurol 31:267–272Google Scholar
  5. 5.
    Alter M, Yamour M (1973) Multiple sclerosis prevalence and nutritional factors. Trans Am Neurol Assoc 98:253–254PubMedGoogle Scholar
  6. 6.
    Antonovsky A, Leibowitz U, Smith HA (1965) Epidemiologic study of multiple sclerosis in Israel. I. An overall review of methods and findings. Arch Neurol 13:183–193PubMedGoogle Scholar
  7. 7.
    Arnetoli G, Pazzagli A, Amaducci L (1969) Fatty acid and aldehyde changes in choline- and ethanolamine-containing phospholipids in the white matter of multiple sclerosis brains. J Neurochem 16:461–463PubMedGoogle Scholar
  8. 8.
    Baker RW, Thompson RH, Zilkha KJ (1963) Fatty-acid composition of brain lecithins in multiple sclerosis. Lancet 1:26–27CrossRefPubMedGoogle Scholar
  9. 9.
    Bates D, Cartlidge NE, French JM et al. (1989) A double-blind controlled trial of long chain n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry 52:18–22PubMedGoogle Scholar
  10. 10.
    Bates D, Fawcett PR, Shaw DA et al. (1978) Polyunsaturated fatty acids in treatment of acute remitting multiple sclerosis. Br Med J 2:1390–1391PubMedGoogle Scholar
  11. 11.
    Berr C, Puel J, Clanet M et al. (1989) Risk factors in multiple sclerosis: a population-based case-control study in Hautes-Pyrenees, France. Acta Neurol Scand 80:46–50PubMedGoogle Scholar
  12. 12.
    Bowling AC, Stewart TM (2003) Current complementary and alternative therapies for multiple sclerosis. Curr Treat Options Neurol 5:55–68PubMedGoogle Scholar
  13. 13.
    Butcher J (1976) The distribution of multiple sclerosis in relation to the dairy industry and milk consumption. N Z Med J 83:427–430PubMedGoogle Scholar
  14. 14.
    Calder PC (1999) Dietary fatty acids and the immune system. Lipids 34 [Suppl]:137–140PubMedGoogle Scholar
  15. 15.
    Calder PC (2001) Polyunsaturated fatty acids, inflammation, and immunity. Lipids 36:1007–1024PubMedGoogle Scholar
  16. 16.
    Cantorna M, Humpal-Winter J, DeLuca H (2000) In vivo upregulation of interleukin-4 is one mechanism underlying the immunoregulatory effects of 1,25-dihydroxyvitamin D3. Arch Biochem Biophys 377:135–138CrossRefPubMedGoogle Scholar
  17. 17.
    Cantorna MT, Hayes CE, DeLuca HF (1996) 1,25-Dihydroxyvitamin D3 reversibly blocks the progression of relapsing encephalomyelitis, a model of multiple sclerosis. Proc Natl Acad Sci USA 93:7861–7864CrossRefPubMedGoogle Scholar
  18. 18.
    Cendrowski W, Wender M, Dominik W et al. (1969) Epidemiological study of multiple sclerosis in western Poland. Eur Neurol 2:90–108PubMedGoogle Scholar
  19. 19.
    Clausen J, Jensen GE, Nielsen SA (1988) Selenium in chronic neurologic diseases. Multiple sclerosis and Batten’s disease. Biol Trace Elem Res 15:179–203PubMedGoogle Scholar
  20. 20.
    Clausen J, Moller J (1967) Allergic encephalomyelitis induced by brain antigen after deficiency in polyunsaturated fatty acids during myelination. Is multiple sclerosis a nutritive disorder? Acta Neurol Scand 43:375–388PubMedGoogle Scholar
  21. 21.
    Clausen J, Moller J (1967) Experimental allergic encephalomyelitis provoked in rats after developmental lack of polyunsaturated tally acids. Acta Neurol Scand 43 [Suppl 31]:74PubMedGoogle Scholar
  22. 22.
    Coo H, Aronson KJ (2004) A systematic review of several potential non-genetic risk factors for multiple sclerosis. Neuroepidemiology 23:1–12Google Scholar
  23. 23.
    Cook AW, Gupta JK, Pertschuk LP et al. (1978) Multiple sclerosis and malabsorption. Lancet i:1366CrossRefGoogle Scholar
  24. 24.
    Cosman F, Nieves J, Komar L et al. (1998) Fracture history and bone loss in patients with MS. Neurology 51:1161–1165PubMedGoogle Scholar
  25. 25.
    Cumings JN, Shortman RC, Skrbic T (1965) Lipid studies in the blood and brain in multiple sclerosis and motor neurone disease. J Clin Pathol 18:641–644PubMedGoogle Scholar
  26. 26.
    Cunnane SC, Ho SY, Dore-Duffy P et al. (1989) Essential fatty acid and lipid profiles in plasma and erythrocytes in patients with multiple sclerosis. Am J Clin Nutr 50:801–806PubMedGoogle Scholar
  27. 27.
    Deutsche Gesellschaft für Ernährung (DGE) (1999) Tips der Deutschen Gesellschaft für Ernährung e.V. zur Ernährung bei Multipler Sklerose. http://www.dge.de/Pages/navigation/presse/akt1099.htm, accessed 03.05.2004.
  28. 28.
    Dworkin RH, Bates D, Millar JH et al. (1984) Linoleic acid and multiple sclerosis: a reanalysis of three double-blind trials. Neurology 34:1441–1445PubMedGoogle Scholar
  29. 29.
    Embry AF, Snowdon LR, Vieth R (2000) Vitamin D and seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol 48:271–272Google Scholar
  30. 30.
    Esparza ML, Sasaki S, Kesteloot H (1995) Nutrition, latitude, and multiple sclerosis mortality: an ecologic study. Am J Epidemiol 142:733–737PubMedGoogle Scholar
  31. 31.
    Evers J (1969) Die diätetische Therapie der Multiplen Sklerose. Kasuistik und Epikrise meiner ersten durch Diät geheilten Multiple-Sklerose-Patienten nach einer Verlaufsbeobachtungszeit von 20 Jahren und Bericht über meine anderen 9000 diätetisch behandelten Multiple-Sklerose-Patienten. Med Welt 31:1700–1707PubMedGoogle Scholar
  32. 32.
    Evers J (2002) Die Evers-Diät, 13. Aufl. Haug, StuttgartGoogle Scholar
  33. 33.
    Fawcett J, Sidney JS, Hanson MJ et al. (1994) Use of alternative health therapies by people with multiple sclerosis: an exploratory study. Holist Nurs Pract 8:36–42PubMedGoogle Scholar
  34. 34.
    Fisher M, Johnson MH, Natale AM et al. (1987) Linoleic acid levels in white blood cells, platelets, and serum of multiple sclerosis patients. Acta Neurol Scand 76:241–245PubMedGoogle Scholar
  35. 35.
    Fleming JO, Hummel AL, Beinlich BR et al. (2000) Vitamin D treatment of relapsing-remitting multiple sclerosis (RRMS): a MRI-based pilot study. Neurology 54:A338Google Scholar
  36. 36.
    Fratzer U (1992) Multiple Sklerose: Eine neue Therapie vor der Blut-Hirn-Schranke. VitaMinSpur 3:142–147Google Scholar
  37. 37.
    Freedman DM, Dosemeci M, Alavanja MC (2000) Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates. Occup Environ Med 57:418–421CrossRefPubMedGoogle Scholar
  38. 38.
    Frequin ST, Wevers RA, Braam M et al. (1993) Decreased vitamin B12 and folate levels in cerebrospinal fluid and serum of multiple sclerosis patients after high-dose intravenous methylprednisolone. J Neurol 240:305–308PubMedGoogle Scholar
  39. 39.
    Gallai V, Sarchielli P, Trequattrini A et al. (1995) Cytokine secretion and eicosanoid production in the peripheral blood mononuclear cells of MS patients undergoing dietary supplementation with n-3 polyunsaturated fatty acids. J Neuroimmunol 56:143–153CrossRefPubMedGoogle Scholar
  40. 40.
    Ghadirian P, Jain M, Ducic S et al. (1998) Nutritional factors in the aetiology of multiple sclerosis: a case-control study in Montreal, Canada. Int J Epidemiol 27:845–852CrossRefPubMedGoogle Scholar
  41. 41.
    Ghezzi A, Zaffaroni M (2001) Neurological manifestations of gastrointestinal disorders, with particular reference to the differential diagnosis of multiple sclerosis. Neurol Sci 22(Suppl 2):S117–122Google Scholar
  42. 42.
    Gibson RA, Lines DR, Neumann MA (1992) Gamma linolenic acid (GLA) content of encapsulated evening primrose oil products. Lipids 27:82–84PubMedGoogle Scholar
  43. 43.
    Gilgun-Sherki Y, Melamed E, Offen D (2001) Oxidative stress-induced neurodegenerative diseases: the need for antioxidants that penetrate the blood brain barrier. Neuropharmacology 40:959–975CrossRefPubMedGoogle Scholar
  44. 44.
    Gilgun-Sherki Y, Melamed E, Offen D (2004) The role of oxidative stress in the pathogenesis of multiple sclerosis: the need for effective antioxidant therapy. J Neurol 251:261–268CrossRefPubMedGoogle Scholar
  45. 45.
    Goldberg P, Fleming MC, Picard EH (1986) Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses 21:193–200CrossRefPubMedGoogle Scholar
  46. 46.
    Goodkin DE, Jacobsen DW, Galvez N et al. (1994) Serum cobalamin deficiency is uncommon in multiple sclerosis. Arch Neurol 51:1110–1114PubMedGoogle Scholar
  47. 47.
    Grann V, Glass GB (1961) Blood serum levels and intestinal absorption of vitamin B12 in multiple sclerosis. J Lab Clin Med 57:562–567PubMedGoogle Scholar
  48. 48.
    Gul S, Smith AD, Thompson RH et al. (1970) Fatty acid composition of phospholipids from platelets and erythrocytes in multiple sclerosis. J Neurol Neurosurg Psychiatry 33:506–510PubMedGoogle Scholar
  49. 49.
    Gupta JK, Ingegno AP, Cook AW et al. (1977) Multiple sclerosis and malabsorption. Am J Gastroenterol 68:560–565PubMedGoogle Scholar
  50. 50.
    Gusev E, Boiko A, Lauer K et al. (1996) Environmental risk factors in MS: a case-control study in Moscow. Acta Neurol Scand 94:386–394PubMedGoogle Scholar
  51. 51.
    Harbige LS (1998) Dietary n-6 and n-3 fatty acids in immunity and autoimmune disease. Proc Nutr Soc 57:555–562PubMedGoogle Scholar
  52. 52.
    Harbige LS (2003) Fatty acids, the immune response, and autoimmunity: a question of n-6 essentiality and the balance between n-6 and n-3. Lipids 38:323–341PubMedGoogle Scholar
  53. 53.
    Harbige LS, Layward L, Morris-Downes MM et al. (2000) The protective effects of omega-6 fatty acids in experimental autoimmune encephalomyelitis (EAE) in relation to transforming growth factor-beta 1 (TGF-beta1) up-regulation and increased prostaglandin E2 (PGE2) production. Clin Exp Immunol 122:445–452CrossRefPubMedGoogle Scholar
  54. 54.
    Harbige LS, Yeatman N, Amor S et al. (1995) Prevention of experimental autoimmune encephalomyelitis in Lewis rats by a novel fungal source of gamma-linolenic acid. Br J Nutr 74:701–715PubMedGoogle Scholar
  55. 55.
    Hayes CE (2000) Vitamin D: a natural inhibitor of multiple sclerosis. Proc Nutr Soc 59:531–535PubMedGoogle Scholar
  56. 56.
    Hayes CE, Cantorna MT, DeLuca HF (1997) Vitamin D and multiple sclerosis. Proc Soc Exp Biol Med 216:21–27PubMedGoogle Scholar
  57. 57.
    Hayes CE, Nashold FE, Spach KM et al. (2003) The immunological functions of the vitamin D endocrine system. Cell Mol Biol 49:277–300Google Scholar
  58. 58.
    Hebener O (1998) Fundamente der Hoffnung: Theorie und Therapie der Multiplen Sklerose. Verlag Medizin und Gesundheit, HeidelbergGoogle Scholar
  59. 59.
    Hebener O, Ackermann H, Kappel U et al. (2002) Empirische Untersuchungen zur Progressionsminderung der Multiplen Sklerose durch eine ergänzende bilanzierte Diät. Erfahrungsheilkunde 51:675–681CrossRefGoogle Scholar
  60. 60.
    Herndon R, Mohandas N (2000) Osteoporosis in multiple sclerosis: a frequent, serious, and under-recognized problem. Int J MS Care 2:5Google Scholar
  61. 61.
    Hewson DC, Phillips MA, Simpson KE et al. (1984) Food intake in multiple sclerosis. Hum Nutr Appl Nutr 38:355–367PubMedGoogle Scholar
  62. 62.
    Holman RT, Johnson SB, Kokmen E (1989) Deficiencies of polyunsaturated fatty acids and replacement by nonessential fatty acids in plasma lipids in multiple sclerosis. Proc Natl Acad Sci USA 86:4720–4724PubMedGoogle Scholar
  63. 63.
    Horrobin DF (1979) Multiple sclerosis: the rational basis for treatment with colchicine and evening primrose oil. Med Hypotheses 5:365–378CrossRefPubMedGoogle Scholar
  64. 64.
    Jellin J, Gregory P, Batz F (2002) Natural medicines comprehensive database: Pharmacist’s letter/Prescriber’s letter natural medicine comprehensive database. Therapeutic Research Faculty, StocktonGoogle Scholar
  65. 65.
    Jensen C, Clausen J (1986) Glutathione peroxidase activity, associated enzymes and substrates in blood cells from patients with multiple sclerosis—effects of antioxidant supplementation. Acta Pharmacol Toxicol (Copenh) 59:S450-S453Google Scholar
  66. 66.
    Jensen GE, Gissel-Nielsen G, Clausen J (1980) Leucocyte glutathione peroxidase activity and selenium level in multiple sclerosis. J Neurol Sci 48:61–67CrossRefPubMedGoogle Scholar
  67. 67.
    Jimenez-Jimenez FJ, de Bustos F, Molina JA et al. (1998) Cerebrospinal fluid levels of alpha-tocopherol in patients with multiple sclerosis. Neurosci Lett 249:65–67CrossRefPubMedGoogle Scholar
  68. 68.
    Kira J, Tobimatsu S, Goto I (1994) Vitamin B12 metabolism and massive-dose methyl vitamin B12 therapy in Japanese patients with multiple sclerosis. Intern Med 33:82–86PubMedGoogle Scholar
  69. 69.
    Knox EG (1977) Foods and diseases. Br J Prev Soc Med 31:71–80PubMedGoogle Scholar
  70. 70.
    Kris-Etherton PM, Harris WS, Appel LJ (2002) Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation 106:2747–2757CrossRefPubMedGoogle Scholar
  71. 71.
    Lauer K (1989) Multiple sclerosis in relation to meat preservation in France and Switzerland. Neuroepidemiology 8:308–315PubMedGoogle Scholar
  72. 72.
    Lauer K (1994) The risk of multiple sclerosis in the U.S.A. in relation to sociogeographic features: a factor-analytic study. J Clin Epidemiol 47:43–48CrossRefPubMedGoogle Scholar
  73. 73.
    Lauer K (1995) Environmental associations with the risk of multiple sclerosis: the contribution of ecological studies. Acta Neurol Scand Suppl 161:77–88PubMedGoogle Scholar
  74. 74.
    Lauer K (1997) Diet and multiple sclerosis. Neurology 49:S55–S61PubMedGoogle Scholar
  75. 75.
    Lauer K, Firnhaber W (1986) An evaluation of laboratory investigations in patients with multiple sclerosis. J Chronic Dis 39:767–774CrossRefPubMedGoogle Scholar
  76. 76.
    Marchioli R, Barzi F, Bomba E et al. (2002) Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico (GISSI)-Prevenzione. Circulation 105:1897–1903CrossRefPubMedGoogle Scholar
  77. 77.
    Mazzella GL, Sinforiani E, Savoldi F et al. (1983) Blood cells glutathione peroxidase activity and selenium in multiple sclerosis. Eur Neurol 22:442–446PubMedGoogle Scholar
  78. 78.
    Meade CJ, Mertin J, Sheena J et al. (1978) Reduction by linoleic acid of the severity of experimental allergic encephalomyelitis in the guinea pig. J Neurol Sci 35:291–308CrossRefPubMedGoogle Scholar
  79. 79.
    Millar JH, Zilkha KJ, Langman MJ et al. (1973) Double-blind trial of linoleate supplementation of the diet in multiple sclerosis. Br Med J 1:765–768PubMedGoogle Scholar
  80. 80.
    Munger KL, Zhang SM, O’Reilly E et al. (2004) Vitamin D intake and incidence of multiple sclerosis. Neurology 62:60–65PubMedGoogle Scholar
  81. 81.
    Murrell TG, Matthews BJ (1990) Multiple sclerosis—one manifestation of neurobrucellosis? Med Hypotheses 33:43–48CrossRefPubMedGoogle Scholar
  82. 82.
    Nashold FE, Miller DJ, Hayes CE (2000) 1,25 dihydroxyvitamin D3 treatment decreases macrophage accumulation in the CNS of mice with experimental autoimmune encephalomyelitis. J Neuroimmunol 103:171–179CrossRefPubMedGoogle Scholar
  83. 83.
    Navarro X, Segura R (1988) Plasma lipids and their fatty acid composition in multiple sclerosis. Acta Neurol Scand 78:152–157PubMedGoogle Scholar
  84. 84.
    Neu IS (1983) Essential fatty acids in the serum and cerebrospinal fluid of multiple sclerosis patients. Acta Neurol Scand 67:151–163PubMedGoogle Scholar
  85. 85.
    Nieves J, Cosman F, Herbert J et al. (1994) High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology 44:1687–1692PubMedGoogle Scholar
  86. 86.
    Nightingale S, Woo E, Smith AD et al. (1990) Red blood cell and adipose tissue fatty acids in mild inactive multiple sclerosis. Acta Neurol Scand 82:43–50PubMedGoogle Scholar
  87. 87.
    Nijst TQ, Wevers RA, Schoonderwaldt HC et al. (1990) Vitamin B12 and folate concentrations in serum and cerebrospinal fluid of neurological patients with special reference to multiple sclerosis and dementia. J Neurol Neurosurg Psychiatry 53:951–954PubMedGoogle Scholar
  88. 88.
    Nordvik I, Myhr KM, Nyland H et al. (2000) Effect of dietary advice and n-3 supplementation in newly diagnosed MS patients. Acta Neurol Scand 102:143–149CrossRefPubMedGoogle Scholar
  89. 89.
    O’Connor JS, Davis RL, Langworthy OR et al. (1960) B12 metabolism and multiple sclerosis. Proc Soc Exp Biol Med 103:180–183PubMedGoogle Scholar
  90. 90.
    Paty DW, Cousin HK, Read S et al. (1978) Linoleic acid in multiple sclerosis: failure to show any therapeutic benefit. Acta Neurol Scand 58:53–58PubMedGoogle Scholar
  91. 91.
    Payne A (2001) Nutrition and diet in the clinical management of multiple sclerosis. J Hum Nutr Diet 14:349–357CrossRefPubMedGoogle Scholar
  92. 92.
    Pisacane A, Impagliazzo N, Russo M et al. (1994) Breast feeding and multiple sclerosis. BMJ 308:1411–1412PubMedGoogle Scholar
  93. 93.
    Poskanzer DC, Sheridan JL, Prenney LB et al. (1980) Multiple sclerosis in the Orkney and Shetland islands. II: The search for an exogenous aetiology. J Epidemiol Community Health 34:240–252PubMedGoogle Scholar
  94. 94.
    Reynolds EH (1992) Multiple sclerosis and vitamin B12 metabolism. J Neuroimmunol 40:225–230CrossRefPubMedGoogle Scholar
  95. 95.
    Reynolds EH, Linnell JC (1987) Vitamin B12 deficiency, demyelination, and multiple sclerosis. Lancet 2:920CrossRefGoogle Scholar
  96. 96.
    Reynolds EH, Linnell JC, Faludy JE (1991) Multiple sclerosis associated with vitamin B12 deficiency. Arch Neurol 48:808–811PubMedGoogle Scholar
  97. 97.
    Sandyk R, Awerbuch GI (1993) Vitamin B12 and its relationship to age of onset of multiple sclerosis. Int J Neurosci 71:93–99PubMedGoogle Scholar
  98. 98.
    Schwartz CE, Laitin E, Brotman S et al. (1999) Utilization of unconventional treatments by persons with MS: is it alternative or complementary? Neurology 52:626–629PubMedGoogle Scholar
  99. 99.
    Sepcic J, Mesaros E, Materljan E et al. (1993) Nutritional factors and multiple sclerosis in Gorski Kotar, Croatia. Neuroepidemiology 12:234–240PubMedGoogle Scholar
  100. 100.
    Seviton Online Shop (2004) http://www.seviton.de/shop.html, accessed 03.05.2004
  101. 101.
    Shabas D, Weinreb H (2000) Preventive healthcare in women with multiple sclerosis. J Womens Health Gend Based Med 9:389–395CrossRefPubMedGoogle Scholar
  102. 102.
    Sharts-Hopko NC, Sullivan MP (2002) Beliefs, perceptions, and practices related to osteoporosis risk reduction among women with multiple sclerosis. Rehabil Nurs 27:232–236PubMedGoogle Scholar
  103. 103.
    Shatin R (1964) Multiple sclerosis and geography. New interpretation of epidemiological observations. Neurology 14:338–344PubMedGoogle Scholar
  104. 104.
    Shukla VK, Jensen GE, Clausen J (1977) Erythrocyte glutathione perioxidase deficiency in multiple sclerosis. Acta Neurol Scand 56:542–550PubMedGoogle Scholar
  105. 105.
    Simopoulos AP (2002) Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr 21:495–505PubMedGoogle Scholar
  106. 106.
    Simpson CA (1964) Vitamin B12 Levels in the serum and cerebrospinal fluid in multiple sclerosis. J Neurol Neurosurg Psychiatry 27:174–177Google Scholar
  107. 107.
    Simson G, Herfort A, Krim M et al. (1950) Effects of vitamin B12 in multiple sclerosis. Proc Soc Exp Biol Med 75:721PubMedGoogle Scholar
  108. 108.
    Slawta JN, Wilcox AR, McCubbin JA et al. (2003) Health behaviors, body composition, and coronary heart disease risk in women with multiple sclerosis. Arch Phys Med Rehabil 84:1823–1830CrossRefPubMedGoogle Scholar
  109. 109.
    Smelzer S, Zimmerman V, Capriotti T (2000) Osteoporosis risk factors and bone mineral densitiy in women with MS. Int J MS Care 4:17–29Google Scholar
  110. 110.
    Smith DK, Feldman EB, Feldman DS (1989) Trace element status in multiple sclerosis. Am J Clin Nutr 50:136–140PubMedGoogle Scholar
  111. 111.
    Somerset M, Campbell R, Sharp DJ et al. (2001) What do people with MS want and expect from health-care services? Health Expect 4:29–37CrossRefPubMedGoogle Scholar
  112. 112.
    Spencely M, Dick G (1982) Breast feeding and multiple sclerosis. Neuroepidemiology 1:216–222Google Scholar
  113. 113.
    Swank RL (1950) Multiple Sclerosis: a correlation of its incidence with dietary fat. Am J Med Sci 220:421–430PubMedGoogle Scholar
  114. 114.
    Swank RL (1960) Treatment of multiple sclerosis with a low-fat diet. J Am Diet Assoc 36:322–325PubMedGoogle Scholar
  115. 115.
    Swank RL (1970) Multiple sclerosis: twenty years on low fat diet. Arch Neurol 23:460–474PubMedGoogle Scholar
  116. 116.
    Swank RL, Bourdillon RB (1960) Multiple sclerosis: assessment of treatment with a modified low-fat diet. J Neurochem 131:468–488PubMedGoogle Scholar
  117. 117.
    Swank RL, Dugan BB (1990) Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet 336:37–39CrossRefPubMedGoogle Scholar
  118. 118.
    Swank RL, Lerstad O, Strom P et al. (1952) Multiple sclerosis in rural Norway; its geographic and occupational incidence in relation to nutrition. N Engl J Med 246:721–728Google Scholar
  119. 119.
    Szeinberg A, Golan R, Ben Ezzer J et al. (1979) Decreased erythrocyte glutathione peroxidase activity in multiple sclerosis. Acta Neurol Scand 60:265–271PubMedGoogle Scholar
  120. 120.
    Szeinberg A, Golan R, Ben-Ezzer J et al. (1981) Glutathione peroxidase activity in various types of blood cells in multiple sclerosis. Acta Neurol Scand 63:67–75PubMedGoogle Scholar
  121. 121.
    Thomas FJ, Wiles CM (1999) Dysphagia and nutritional status in multiple sclerosis. J Neurol 246:677–682CrossRefPubMedGoogle Scholar
  122. 122.
    Thompson RH (1972) Fatty acid metabolism in multiple sclerosis. Biochem J 128:4PGoogle Scholar
  123. 123.
    Timmerman GM, Stuifbergin AK (1999) Eating patterns in women with multiple sclerosis. J Neurosci Nurs 31:152–158PubMedGoogle Scholar
  124. 124.
    Tola MR, Granieri E, Malagu S et al. (1994) Dietary habits and multiple sclerosis. A retrospective study in Ferrara, Italy. Acta Neurol (Napoli) 16:189–197Google Scholar
  125. 125.
    Tsang WM, Belin J, Monro JA et al. (1976) Relationship between plasma and lymphocyte linoleate in multiple sclerosis. J Neurol Neurosurg Psychiatry 39:767–771PubMedGoogle Scholar
  126. 126.
    Uhlemann HJ (1951) Erfahrungen bei der Behandlung der Multiplen Sklerose mit Evers-Diät. Dtsch Med Wochenschr 76:1212–1214PubMedGoogle Scholar
  127. 127.
    United States Department of Agriculture (2004) Nutrient data laboratory. National Nutrient Database for Standard Reference. http://www.nal.usda.gov/fnic/foodcomp/Data/SR16-1/reports/sr16-1pg.htm, accessed 03.05.2004
  128. 128.
    van Etten E, Branisteanu DD, Verstuyf A et al. (2000) Analogs of 1,25-dihydroxyvitamin D3 as dose-reducing agents for classical immunosuppressants. Transplantation 69:1932–1942CrossRefPubMedGoogle Scholar
  129. 129.
    Vieth R (1999) Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr 69:842–856PubMedGoogle Scholar
  130. 130.
    Wade DT, Young CA, Chaudhuri KR et al. (2002) A randomised placebo controlled exploratory study of vitamin B-12, lofepramine, and L-phenylalanine (the “Cari Loder regime”) in the treatment of multiple sclerosis. J Neurol Neurosurg Psychiatry 73:246–249CrossRefPubMedGoogle Scholar
  131. 131.
    Webb AR, Kline L, Holick MF (1988) Influence of season and latitude on the cutaneous synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab 67:373–378PubMedGoogle Scholar
  132. 132.
    Weinstock-Guttmann B, Baier M, LeeKwen P et al. (2002) A randomized study of low-fat diet with omega-3 fatty acid supplementation in patients with relapsing-remitting multiple sclerosis (RRMS). Neurology 58:A461-A462Google Scholar
  133. 133.
    Westlund KB, Kurland LT (1953) Studies on multiple sclerosis in Winnipeg, Manitoba, and New Orleans, Lousiana. Am J Hyg 57:397–407PubMedGoogle Scholar
  134. 134.
    White R, Ashworth A (2000) How drug therapy can affect, threaten and compromise nutritional status. J Hum Nutr Diet 13:119–129CrossRefGoogle Scholar
  135. 135.
    Wikstrom J, Westermarck T, Palo J (1976) Selenium, vitamin E and copper in multiple sclerosis. Acta Neurol Scand 54:287–290PubMedGoogle Scholar
  136. 136.
    Williams CM, Lines CM, McKay EC (1988) Iron and zinc status in multiple sclerosis patients with pressure sores. Eur J Clin Nutr 42:321–328PubMedGoogle Scholar
  137. 137.
    Winterholler M, Erbguth F, Neundörfer B (1997) Verwendung paramedizinischer Verfahren durch MS-Patienten—Patientencharakterisierung und Anwendungsgewohnheiten. Fortschr Neurol Psychiatr 65:555–561PubMedGoogle Scholar
  138. 138.
    Wozniak-Wowk CS (1993) Nutrition intervention in the management of multiple sclerosis. Nutr Today 28:12–20Google Scholar
  139. 139.
    Yoshida M, Takase S, Itahara K et al. (1983) Linoleate and fatty acid compositions in the serum lipids of Japanese patients with multiple sclerosis. Acta Neurol Scand 68:362–364PubMedGoogle Scholar
  140. 140.
    Zhang SM, Hernan MA, Olek MJ et al. (2001) Intakes of carotenoids, vitamin C, and vitamin E and MS risk among two large cohorts of women. Neurology 57:75–80PubMedGoogle Scholar
  141. 141.
    Zhang SM, Willett WC, Hernan MA et al. (2000) Dietary fat in relation to risk of multiple sclerosis among two large cohorts of women. Am J Epidemiol 152:1056–1064CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Neurologische KlinikKlinikum Mannheim der Universität Heidelberg
  2. 2.Medizinische KlinikKlinikum Mannheim der Universität Heidelberg
  3. 3.Neurologische UniversitätsklinikKlinikum MannheimMannheimDeutschland

Personalised recommendations