A to Z of MS Linoleic acid

Linoleic acid is a naturally occurring omega-6 essential fatty acid, present in a variety of foods, including the oils of seeds and nuts, such as sunflower, safflower, soya, corn seeds or walnuts.

In the early 1980s, three separate trials were conducted, looking at the importance of dietary linoleic acid for people with multiple sclerosis. 181 people with MS took part, 90 people receiving linoleic acid and 91 receiving oleic acid, a non-essential fatty acid that is naturally present in olive oil, as a control substance.

Two of the trials gave participants 17 grams daily of linoleic acid in the form of sunflower oil with 8g daily of olive oil as the control substance. The third trial gave participants 23g daily of linoleic acid in the form of a sunflower spread, with the control group receiving 16g of olive oil spread daily. Everyone included in the trials was able to walk, and whilst two of the trials looked only at relapsing remitting MS, one trial also included people with progressive MS.

Results from these trials showed that people receiving linoleic acid had less accumulation of disability over time. This was most noticeable in people who had little or no disability when they started on the trial, suggesting that linoleic acid was of most benefit to people who are newly diagnosed. Linoleic acid did not appear to affect the number of relapses that people had, but those people who received linoleic acid experienced shorter relapses, whatever their level of disability when the trials started. There is no evidence that increasing linoleic acid benefits people with progressive MS as an insufficient number of people with this type of MS were included in the trials.

Based on this research, the NICE Guideline for the Clinical Management of MS recommends linoleic acid for people with relapsing remitting MS as a treatment that may help to slow the disabling effects of MS. However, since the NICE Guidelines were published, a subsequent review has cast doubt on the quality of the original research trials and called for further research in this area.

What is the best dose of linoleic acid?

The trials gave people with multiple sclerosis 17-23g daily of either sunflower spread or sunflower oil, thus forming the basis of NICE's recommendation. However, it was noted by the researchers that it was unclear whether this was the optimum amount of linoleic acid. For people who have a poor appetite, or who are trying to lose weight, these levels may well not be desirable. Other downsides of linoleic acid can be that the oily taste may be unpleasant and it can cause diarrhoea in some people.

Linoleic acid should be considered in the context of a balanced diet, which is low in total fat and includes five portions of fruit and vegetables a day.

It is not advisable to increase your linoleic acid intake without making other changes to your diet. If in any doubt, ask your GP to refer you to a dietitian.

Sources of linoleic acid

Sources include full fat sunflower margarine or sunflower, safflower or sesame seed oils. It can be used in salad dressings, neat from the bottle, or as a spread on toast, bread or crackers. To get the benefit of the linoleic acid, oil or spreads should not be heated, and should be stored in cool, dark conditions. Alternatively, or additionally, supplements can be taken, although it may be difficult to consume enough linoleic acid in this way.

If you have a good appetite it is likely that you will take 17-23g of linoleic acid a day through food. The following each provide 3.5-4.5g of linoleic acid.

Five portions are needed each day to achieve the target:

• 3 level teaspoons (12g) of full fat polyunsaturated margarine, for example, sunflower, corn, safflower or soya;
• 2 teaspoons (8g) of corn oil, cotton seed oil, soya oil, walnut oil or wheatgerm oil;
• 1 teaspoon of safflower oil or sunflower oil;
• 10-15g of walnuts, brazil nuts, sesame, sunflower, pumpkin or poppy seeds;
• 20-30g of peanuts, peanut butter or almonds;
• 2 teaspoons (10g) of full fat mayonnaise;
• 30g of full fat soya flour;
• 35g of taramasalata or soya dessert topping;
• 5.8g (5800mg) blackcurrant seed oil supplement*;
• 4.5g (4500mg) evening primrose oil supplement*;
• 5.3g (5300mg) grape seed oil supplement.

*including gamma linolenic acid (GLA) content.

NB. Supplements are more expensive than dietary sources of linoleic acid. If you are in any doubt ask your GP or consultant for a referral to a dietician.

Gamma linolenic acid (GLA)

There is some theoretical evidence that another omega-6 essential fatty acid, GLA, may also be beneficial in multiple sclerosis. Animal studies show that GLA suppresses immune system activity and decreases the severity of an MS-like disease. However, these benefits have not been replicated in human studies. The main source of GLA is evening primrose oil, which contains around 8-10% GLA and approximately 70% linoleic acid. Obtaining enough GLA or linoleic acid through evening primrose oil capsules alone is very difficult. There are no evidence-based recommendations for dosages of GLA.

References

Dworkin RH, et al.
Linoleic acid and multiple sclerosis: a reanalysis of three double-blind trials.
Neurology 1984;34:1441-1445.
abstract

National Institute for Health and Clinical Excellence (NICE).
Multiple sclerosis - understanding NICE guidance - information for people with multiple sclerosis, their families and carers, and the public.
London: NICE; 2003.
read online

Farinotti M, et al.
Dietary interventions for multiple sclerosis.
Cochrane Database Systematic Review 2007; (1): CD 004192.
abstract

Fatty acids.
In: Food Standards Agency.
McCance and Widdowson's the Composition of Foods. 6th ed.
Cambridge: The Royal Society of Chemistry; 2002.

Bowling AC.
Complementary and alternative medicine and multiple sclerosis. 2nd ed.
New York: Demos; 2007.

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