Dietary Treatment of Trigeminal Neuralgia Pain

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The trigeminal nerve comes off our brainstem and, as its name suggests, splits into three main branches to innervate our face. The top branch goes to the forehead and eyes, the middle branch to the cheeks and upper lip, and the bottom branch to the chin, lower jaw, and most of the tongue. Trigeminal neuralgia typically manifests as brief, recurrent, electric shock–like pains in one of the branches on one side of the face, and is typically triggered by innocuous stimuli, like light touch in that area of the face. Attacks tend to last only a few seconds or minute or two, but people can suffer dozens of attacks per day, which can be so severe they’re highly disabling. Trigeminal neuralgia affects about 1 in 500 people, with a higher prevalence in women, with average age of onset in our fifties.

An MRI of the brain is indicated to make sure nothing is compressing the nerve, like a tumor, but if there isn’t anything actionable, then the standard medical approach is to try to control the symptoms with epilepsy drugs like carbamazepine. Due to unsatisfactory pain relief and/or medication side effects, as many as 50 percent of patients in specialty centers end up going into surgery. Though neurosurgical procedures can be highly effective, they may result in complications in as many as 29 percent, with the pain staying the same or even worsening in 19 percent of patients, and a new and different facial pain felt after the operation in 33 percent. What else can be done?

There are various ways scientists create lab animal models for neuropathic pain, including surgically tying off major nerves or damaging them with toxic chemicals. But another way is just feeding the animals a high-fat diet. Rats fed a diet high in saturated fat and cholesterol developed nerve damage, a significant narrowing of their nerve fibers and surrounding insulation, thought to be due to the diet-induced oxidative stress and inflammation. The researchers noted their study “has some limitations,” for example, the “number of the rats in each group may be augmented.” The limitation I’m thinking of, though, is that they’re rats.

Then, at the 2012 annual meeting of the American Academy of Neurology, a study was presented: “Low Saturated fat Diet Is Effective in Trigeminal Neuralgia,” which was subsequently published the following year. It all started with a civil engineer and his friend. She had been suffering with severe trigeminal neuralgia for twenty-one years and was scheduled to go into surgery. He discovered Dr. Roy Swank’s remarkable work on controlling the nerve disease multiple sclerosis with a diet low in animal fats and suggested she give it a try for her condition. She did and her pain dramatically improved, her surgery was canceled, and, for thirteen years and counting, she continues to feel better after decades of suffering. So, our engineer teamed up with a neurologist to put it to the test.

Fifty-five patients with trigeminal neuralgia for an average of eight years were placed on a diet with a goal of only 10 grams of saturated fat per day, which is about 4 percent of calories). Nearly all of them suffered daily attacks of severe pain averaging 9.6 out of 10 despite medications, and nearly a third had already gone through a total of dozens of failed surgeries. The researchers even included a set of patients with atypical cases of trigeminal neuralgia, with “continuous never ending discomfort.”

Within one month, 96 percent of those with typical trigeminal neuralgia had their pain levels drop down to less than 2 out of 10. And that was after 72% were able to reduce or stop their medications altogether.

They went from an average pain score of more than 9 out of 10 down to an average pain of less than 1 within an average of sixteen days, after suffering for an average of 8 years. Even the atypical continuous pain patients went from about a 9 out of 10 pain level down to 2 out of 10 in a matter of weeks. The post-surgical patients, after a total of dozens of failed surgeries and still suffering severe pain: same thing. They went from living with more than 9 out of 10 excruciating pain down to less than 1 out of 10, like a little paper cut or something. Now the post-surgical group took 20 days to get better, instead of 16 days, but they had been suffering for 11 years straight. Years of extreme suffering, and then 20 days later, gone. They had the power all along, at any time. Every day of that decade they were just 20 days away from being free.

By the time the study was sent for publication, the patients had been on the low saturated fat diet for an average of twenty months, and the only reported side effect was a weight loss of five to seventy-five pounds.

The researchers recognize placebo effects could not be excluded, “although dramatic and sustained improvement even in the post-surgical group with severe and intractable pain makes it unlikely.” They do acknowledge that the results seem too good to be true and call for further trials to be performed. Yet no such studies have been forthcoming.

How is that possible? They reported some of the most striking findings in the entire field of pain medicine, originally presented in the single most widely read and highly cited peer-reviewed neurology journal in the world, but it appears their study has been completely lost down the memory hole. The only reference to it that I could find in the medical literature was a single mention in a dental journal back in 2014.

I am reminded of the medical community’s collective reaction to the multiple sclerosis work that inspired the trigeminal neuralgia study. Before we lost him in 2008 at the age of ninety-nine, Professor Emeritus of Neurology Roy Swank, MD, PhD, published the longest-running study of diet and multiple sclerosis in history in one of the most prestigious medical journals in the world. His work has been considered “the most effective treatment of multiple sclerosis ever reported in the peer review literature.” In patients with early stage MS, 95% were without progression of their disease 34 years after adopting his low saturated fat dietary program. Even patients with initially advanced disease showed significant benefit. To date, no medication or invasive procedure has ever come close to demonstrating such success.” Dr. Swank concluded his “study indicated that, in all probability, MS is caused largely by consumption of saturated animal fat.”

Yet, when the gold standard systematic review “Dietary Interventions for Multiple Sclerosis” was published, it didn’t even consider Swank’s work because it “did not fit the inclusion criteria.” Swank’s study was excluded because it was not a randomized controlled trial ( as if you could effectively randomize people to stick to specific diets for thirty-four consecutive years). Demanding randomized trials makes sense for drugs, which are expensive and risky, killing a hundred thousand Americans every year, but a healthy diet has no downsides, and even good side effects, so we shouldn’t have to wait on randomized controlled trials to start saving people’s lives.

This is a perfect example of how evidence-based medicine biases physicians against nutrition. Doctors are encouraged to ignore any information that doesn’t come from double blind randomized controlled trials. Unfortunately, this approach can easily degenerate into ignoring-most-of-the-truly-important-evidence. Like the dismissal of Dr. Esselstyn’s work on reversing coronary artery disease with a plant-based diet. Or Dr. Kempner’s work at Duke, or Pritikins’s work, or McDougall’s work. Or Dr. Barnard’s work at the Physicians Committee for Responsible Medicine.

Remarkably, a fifty-year follow-up study was published on Swank’s patients, who by then were in their seventies and eighties. The researchers concluded that, with a healthy enough diet, those with multiple sclerosis “can expect to survive and be ambulant and otherwise normal to an advanced age.”

The accompanying editorial was dismissive, suggesting “one should be cautious in drawing conclusions from the report.” Not only was it not a randomized controlled trial, but a “reasonable explanation was not provided to account for the positive results.” The editorial ended with “The big question is: If their results are so stunningly impressive, why haven’t other physicians, neurologists, or centers adopted this method of treatment?” That is a good question. Why indeed?

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• nerve health
• pain
• surgery