A LOW SATURATED FAT DIET STOPS TN PAIN                           
                                                                 Presented at the Trigeminal Neuralgia Association's 5th National Conference
                                                                    The Hilton Hotel in the Walt Disney World Resort, November 11, 2004     




                                                                 


I would like to thank the TN Association for giving me the opportunity to bring this information to the attention of patients and doctors.  This is primarily a case study of one patient’s success in stopping TN pain by restricting the saturated fat in their diet to10 grams a day.  Twenty-five years ago the patient knew something had happened while a tooth was being drilled for a root canal.  The pain that followed was diagnosed as typical TN.  It was controlled for seven years with various medications--mostly Tegretol.  When the medications became ineffective they had a glycerol injection that was successful for 9 years.
            *  Then a radiofrequency rhizotomy (RF) successful for 5 years.
            *  Another RF for 3 years.
            *  Another RF for six months.
            *  And finely a glycerol injection that failed.

They did not consider MVD surgery because they were 76 and their heart stopped during a gall bladder operation.  At this time the approximate pattern of their pain, was about one severe shock an hour and at least five shocks a day that were a ten.  Also interspersed were less painful flurry attacks.  Anything could trigger an attack like eating, talking, touching the face, or even a light breeze.  They would occasionally bury their head in a pillow and scream.  When night attacks were very severe, one of her daughters would stay the night and just hold her.  The patient was taking Tegretol, Neurontin, Codeine, Darvocet, Aspirin and applying Capsaicin cream.  This made her drowsy and fatigued, but did little to reduce the pain. 

                                                                                 TN Alert Newsletter
At a support group meeting I found the following letter reprinted in an old issue of the TN Alert newsletter: 
          Dear TNA, I was diagnosed with TN when I was 38, and for twelve years endured all kinds of treatments with no long-term relief.  A year after
          a failed radiofrequency rhizotomy I was considering MVD surgery and decided to get in the best possible physical shape, so I started the
         American Heart Association diet limiting my fat intake to 20  percent.  In two weeks, I noticed my TN was not as severe and two weeks later my
         TN disappeared.  Later I splurged on a lasagna dinner and the next morning the TN was back.  I returned to my diet, and the pain went away.  I
         shared this with another TN sufferer and he also became pain-free.


                                                                               
American Heart Association Diet
The 76 year old patient that was in constant pain, had an attack of colitis and while hospitalized was given no food only liquid.  After leaving the hospital she was put on a diet of liquid, bullion cube soup, and Jell-O.  In a week her pain stopped.  When she returned to her usual diet the pain returned.  I encouraged the patient to try the American Heart Association diet, and once again her pain was gone.  The patient was still taking 1200 mg of Tegretol daily.  However, when she reduced the saturated fat to10 grams a day, she was able to stop taking the Tegretol.  It is now six years later and the patient is still pain-free.  The diet is described in the handouts which also include a list of the saturated fat in140 foods.  The following observations were made over the last six years as the patient has struggled to stay on a rigid diet:
       
1. If the fat that could be tolerated was slightly exceeded, there was movement in the face signaling an attack,  Disregarding this warning and
            continuing to increase the fat in the diet, always resulted in a  full-blown attack.
       
2. A single exceptionally high fat meal would consistently result in an attack two to three hours after the meal.
       
3. If substantially less than 10 grams of fat was eaten for a day or two, then approximately the amount of saturated fat not consumed, could be added to the
            10 grams allowed for the next day.
        4. By taking Tegretol, the saturated fat could be increased from 10 to about 20 grams a day.  By adding Baclofen to the Tegretol, even more fat could be
            tolerated.  However, if the fat continued to be increased while on both medications and an occasional attack ignored, a full-blown series of attacks would
            follow that would take weeks to bring under control.  
These observations have been made by the patient and her three daughters who live nearby and frequently visit her to monitor the food she eats and buys.  Also, I have frequently observed the eating habits of the patient during the past six years.

 

                                                                                       Patient Survey
Approximately forty patients have requested information on this diet.  A questionnaire was sent to them asking for their experience with the diet.  Twenty-two responded with 50% saying they had substantial improvement.  The remainder reported no change.  Here are some examples of why I believe some patients did not have better success:
        * A gentleman in our support group whose medication was not working well decided to try the diet.  He was starting to have success but was having 
           difficulty because he was used to eating heavy meals of meat and rich food, so he tried changing his medication.  When he had success with the 
           new drug Trileptal, he stopped the diet.
        * Another example is a woman in a neighboring community who tried the diet and her daily attacks stopped, but occasionally she still had bouts of severe
           pain.  In questioning her I found she was still eating butter.  Just a level tablespoon of butter is 7 grams of saturated fat, that's the allowance for two 
           meals.  Some patients feel they intuitively know how much saturated fat is in the food they're eating.
        *A patient, from the other side of the state went on the diet and in a short time cut her Tegretol dosage in half, but she was afraid to further reduce it.
        * Bill Hare has a support group in Texas and told me about one of his members who goes on a fishing trip to Arkansas every year.  On these trips he
           only eats vegetables and fish cooked in tomato juice and has no TN pain.  When he returns home, his pain returns.  He loves pastries, sweets,
          desserts, and wondered if that had anything to do with his pain.  When I called John and asked if he would consider going on a low fat diet, he said 
          it wasn't necessary because he was now taking Tegretol and it was controlling the pain.

Checking the internet to find if there was any information relating saturated fat to TN, I found this testimonial:  “I heard about this Health Expo at our convention center.  At one of the lectures the speaker said by following her plan of healthy living you could get well from many diseases.  I was all ears!  My husband and I came home and threw out everything in the pantry and refrigerator that was not good for our new lifestyle.  Within a very short time, my TN pain stopped and I have been completely well for over 4 years!  Praise God!”  

 

                                                                              Multiple Sclerosis 
Is the success of these patients an anomaly?  Or is the excessive fat in our diet so damaging to our health that it not only causes TN pain, but also is a factor in many of the diseases killing Americans?  In a recent article in Scientific American it said:  "The consumption of fat in America is not only responsible for the high incidence of heart disease, type-2 diabetes,  colon cancer, breast cancer, prostate cancer, and ovarian cancer, but also increases the likelihood of Alzheimer's."

Multiple sclerosis is another disease of the nervous system.  Dr. Swank, head of Neurology at the University of Oregon, became aware of a connection between a high fat diet and MS in 1945 when he came across studies in Europe dating back to 1918 that confirmed a higher incidence of MS in the beer-butter culture of northern Europe as compared to the wine-oil culture of the southern Mediterranean region.  Also a thirteen-year study in Norway found four times as many cases of MS in the inland farming areas that have a traditional high fat diet, as compared the coastal fishing areas.  During World War II the incidence of multiple sclerosis dropped significantly where meat and fat consumption had decreased.  It would be interesting to know if there is a similar correlation between dietary fat and TN throughout the world.  Examining thirty-five hundred MS patients and maintaining contact with two thousand for a period of ten to thirty-six years, Dr. Swank concluded that a diet of no more that 5 to 7 grams of saturated fat reduced the number and severity of MS attacks and in a few cases even reversed the disease.  The medical community did not accept his conclusions.  However, it was recently observed that MS patients on cholesterol-lowering drugs like Zocor were doing  better than patients not on statins.  Since a low fat diet also reduces cholesterol, clinical trials were undertaken to see if a direct connection could be made between saturated fat and MS.  At a recent annual meeting of the American Academy of Neurology, the reported results of these trials not only confirmed Dr. Swank fifty years of research, but also agreed with him that saturated fat had to be kept to 5 grams a day to significantly decreased the number of brain lesions  They reported that those on10 grams showed no significant improvement.

 

                                                                                                 A Favorite Story
Six hundred years ago the Pima Indians split into two tribes living distant from each other, but in the same harsh desert environment of the southwestern United States.  These two tribes are of interest to scientists because they come from the same genetic stock yet now live completely different lifestyles.  One tribe owns a very successful casino that has contributed to their becoming the largest identifiable group of obese people in the United States.  They are 60 percent diabetic.  The other tribe lives in Mexico in a remote area of the Sierra Madre Mountains.  They have a very low incidence of diabetes.  Because both tribes come from the same genetic stock one can only conclude that the high incidence of diabetes is not due to a genetic weakness, but is a result of their life-style.


                                                                                      National Institute of Health
 This is a follow-up story from an unrelated article on the National Institute of Health's Web site:  The desert surrounds the home of a Pima Indian who has lived with diabetes for many years.  Both his parents had diabetes.  Three brothers died from it.  Another brother is on dialysis.  This man was diagnosed with diabetes while still in his twenties, and now has developed diabetic neuropathy.  His left leg had to be amputated because of it.  Soon afterwards he developed kidney problems.  Told he would have to go on dialysis, he and his wife met with the dietician.  He did just what the dietician told him to do.  He says, "I had to give up just about everything I ate."  He eats meat, but in small amounts.  "Like they told me 'Put two fingers together.' and just that much" he gestured.  "Two bites" he adds, with a laugh.  He learned to fill up with rice and lots of vegetables.  "When I last saw the doctor, he looked at my chart and said, 'what did you do? You don't need to go on that dialysis machine.' "  He went from weighing 250 pounds to a nice trim weight.  His blood sugar went from 250 to 90.  He said "Oh I feel great whenever I just sit back and think about it."  Then he adds with a wide smile, "it just feels great--just great."

 

                                                                                                        Conclusion  
With typical, atypical, and atypical facial TN, trigeminal neuralgia is a complex disease and a diet low in saturated fat can't be expected to stop pain for every patient, but it is another option in the arsenal of pain control and it has the important advantage of increasing the probability of the patient living a longer and healthier life. Thank you.