Vol.3, No.6, 402-406 (2013) Open Journal of Preventiv e Me dic ine
http://dx.doi.org/10.4236/ojpm.2013.36054
Low saturated fat diet is effective in trigeminal
neuralgia*
Narayan Verma1, Frank Sherwood2
1OUWB School of Medicine, Warren, USA;
2BG Tricounty Neurology and Sleep Clinic, Warren, USA
Received 13 June 2013; revised 15 July 2013; accepted 1 August 2013
Copyright © 2013 Narayan Verma, Frank Sherwood. This is an open access article distributed under the Creative Commons Attribu-
tion License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Objective: To determine the effectiveness of low
saturated fat diet (LSFD) in patients with trigemi-
nal neuralgia (TN). Design: 1) Internet forum
where patients could request a 10 page LSFD
plan, and 2) Follow-up assessment done by a
retrospective 20-item questionnaire. Duration of
treatmen t—2 months to 13 yea rs. Pain rated on a
Visual Analogue Scale and reported as typical,
atypical, or both, defining typical TN as inter-
mittent quick jolts/stabbing pain and atypical TN
as continuous never ending discomfort. Setting:
General community. Patients: 55 unselected pa-
tients, most with unilateral, severe and daily
symptoms in V2 and V3 distribution for a mean
duration of 8 years and on medications. 84% had
pain level 9 - 10 before treatment, 89% had daily
attacks and 31% had undergone surgical pro-
cedures. Intervention: LSFD for 2 months-13
years (mean 20 months). Main outc ome measure:
VAS score and medication use before and after
LSFD treatment. Results: Reported SF content
was 3 - 25 gm. With treatment 96% typical TN (p
< 0.0001) and 71% atypical TN (p < 0.002) im-
proved to level 0% - 2. 9% improved in less than
a week, 47% in 1 - 2 weeks and 44% in 3 - 4
weeks. 66% rated their compliance with diet as
excellent and 27% as good. There were no side
effects except weight loss. 72% of those on me-
dications reduced or discontinued them. All pa-
tients with post-surgical residual severe typical
TN also improved (p < 0.0001). Conclusions:
LSFD is effective in TN with high compliance,
few adverse effects and may result in reduction/
elimination of medications even in most severe
cases.
Keywords: Trigeminal Neuralgia; Low Saturated
Fat Diet; Cranial Neuropathy; Neuralgia
1. INTRODUCTION
Dietary treatment in neurological illnesses is not a
novelty. The ketogenic diet for intractable childhood
seizures is well known [1]. Efficacy of a dietary regimen
in stabilizing the neuronal/axonal membranes in epilep-
tics, presumed instability of membranes in the patho-
genesis of trigeminal neuralgia (TN) and consequent ef-
ficacy of anticonvulsants in TN provides a therapeutic ra-
tionale for pursuing a dietary interv ention in TN as well.
Late Roy L. Swank (1909-2008) introduced his low
saturated fat diet (LSFD) in multiple sclerosis (MS) in
1948 and published data on 144 patients over a 34 year
period in Lancet (1990) [2] regarding its effectiveness,
and published again as a review in 2003 [3]. Although,
not universally accepted, his results do provide a ration-
ale to try LSFD in TN, as two percent patients with TN
have MS [4].
TN is multi-factorial in etiology. Although vast major-
ity are idiopathic, possible symptomatic etiologies in-
clude aneurysms, tumors, chronic meningeal inflamma-
tion, or other lesions such as abnormal vascular course of
the superior cerebellar artery, primitive trigeminal artery,
venous compression, an area of demyelination from mul-
tiple sclerosis or lesions in the pons at the root entry zon e
(REZ) of the trigeminal fibers, symptomatic intracranial
hypotension, among others [5-8].
According to Weigel [9], no studies have ever tested
the efficacy of diet in TN. This study aims to fulfill that
vacuum.
2. SUBJECTS AND METHODS
One of us (FS) established an internet forum where
patients with known TN could request a 10 page multi-
colored LSFD plan. He was motivated by improvement
*Presented as a poster at AAN conference, New Orleans, April 24,
2012.

N. Verma, F. Sherwood / Open Journal of Preventive Medicine 3 (2013) 402-406 403
in his own serious health issues by this diet and a seren-
dipitous improvement in the symptoms of a friend of his
with severe TN for 21 years who was scheduled to un-
dergo micro-vascular decompression, but was able to
avoid that as she dramatically improved on this diet and
remains so after 13 years.
The TN was diagnosed and treated by a board-certi-
fied neurologist or neurosurgeon in each case and their
clinical characteristics are listed in results below. There
were no exclusion criteria.
Patients rated their pain using the zero to 10 Visual
Analogue Scale (VAS). They were instructed to report
pain as typical, atypical, or both. Typical TN was defined
as intermittent attacks of quick jolts of electrical-like
stabbing excruciating pain and atypical TN as continuous
never ending discomfort.
The plan had the diet instructions, the saturated fat ( SF)
content in 140 foods, recipes, how to read nutrition labels,
suggestions for restaurant eating and related health in-
formation. Highlights of the diet are summarized in Ta-
ble 1. The goal was to keep the daily saturated fat intak e
to as close to 10 gram as possible. The diet did not need
to be plant based and animal products were not prohib-
ited. Supplements, yoga, sunshine, lifestyle changes,
exercise and smoking cessation were not required. Al-
cohol, salt, sugar, simple sugar products and caffeine
were not restricted.
The follow-up assessment was done using a 20-item
questionnaire administered retrospectively by e-mail.
The questionnaire requested the demographic infor-
mation. Clinical status pre- and post-diet was ascertained
as well.
Patient self-rated their compliance as excellent, good
or poor.
Statistical analyses were done using the 2 tailed paired
student’s t test comparing the VAS scores before and
after the dietary treatment.
Post-surgical subgroup was analyzed both as a part of
the entire group as well as separately.
The questionnaires, the diet plans and mailings were
all self funded.
A control group was not neither felt to be necessary or
practical as patient’s pre-diet status served as control.
Collateral benefits were qualitatively asked to be com-
mented upon in an open ended question.
3. RESULTS
Table 2 illustrates the de mographics and clinical char-
acteristics of 55 unselected patients who returned the
questionnaire. Vast majority had unilateral, severe and
daily symptoms in V2 and V3 distribution for a mean
duration of 8 years and were on medications. Eight pa-
tients (15%) were not on any medication. The pain level
was 9 - 10 in 75 percent of patients not on medications
Table 1. LSFD highlights.
Foods that must be avoided
Lard Butter
Cream Bacon
Full fat Ice cream Cheese
All pastry Nuts
Coconut Avocado
Full fat yogurt Margari n e
Soft candy Pizza
Gravies Sauces
Foods in moderation
3 1/2 ounces (The size of a deck of playing cards)
Liver
Round
Lamb leg
Pork tenderloin
Cured ham
Ham steak
Eggs
Zero to very little saturated fat
Poultry (no skin) Fish
Canadian bacon Veal
Fat free luncheon meat Soy cheese
Spaghetti Beans
Low fat salad dressing Rice
Fat free dairy products Canola oil
Corn flakes Oatmeal
Pancakes Bagels
Cream of wheat Bread
Chestnuts Olives
Angle food cake Pretzels
Fat free ice cream Hard candy
Fat free puddings Gelatin deserts
Trigger foods
Tomatoes Pickles
Citrus fruits Tea
Coffee Sugar
Artificial sweeteners Spices
Hot sauce Salt
Pepper Cocoa
and 85 percent of those on medications. Forty seven pa-
tients (85%) were on medications: 19 on carbamazepine,
15 on gabapentin, 11 patients on oxcarbazepine, 6 pa-
tients on pregabalin, 4 patients on baclofen, 3 patients on
topiramate, 3 patients on hydrocodone-acetaminophen, 2
patients on duloxetine, 2 patients on lamotrigine, 1 pa-
tient on phenytoin, 1 patient on amitriptyline, 1 on nor-
triptyline and one on acetaminophen-codeine.
Seventeen patients (31%) had 35 surgical procedures
with residual severe pain for a mean dura tion of 11 years:
5 microvascular decompressions, 7 glycerol injections, 7

N. Verma, F. Sherwood / Open Journal of Preventive Medicine 3 (2013) 402-406
404
Table 2. Clinical characteristics of TN before treatment.
N = 55
Gender: F 42, M 13
Age: 28 - 89 (mean 58)
Type: typical 48, atypical 4, both 3
Laterality: unilateral 46, bilateral 9
Branches affected: V2 and/or V3 in all except 2, V1 also
affected in addition to V2 a n d V3 in 15
Duration: 4 months-34 years (Mean 8 years)
Co-existing MS: yes 3, no 52
Medications: On meds 47, not on meds 8
Intensity on VAS: 9 - 10 (46), 7 - 8 (7), 5 - 6 (2)
Mean intensity on VAS for typical TN (N = 51) = 9.55 ± 0. 94 *
Mean intensity on VAS for atypical TN (N = 7) = 8 .57 ± 1.13**
Frequency: daily 49, weekly 6, monthly 0
Surgery: yes 17 (total 35 pro c ed u res), no 38
Occupation: Various (see text)
*, **These 2 lines add to 5 8 as 3 patients had both typical and atypical TN.
gamma knife surgeries, 12 radiofrequency ablation, 2
cyber knife surgeries, 1 balloon compression, and 1 sur-
gery for neural gi a in duced cavitati onal ost eo-necrosis.
The following occupations were reported: college
graduates, teachers, nurses, business owners, PhD can-
didate, senior vice president of finance, certified nutri-
tionist, director of health services, physical therapist,
hospital director of qu ality and risk management, creden-
tialing, deputy prothontary, acupuncturist, defense con-
tractor technician, geologist, NASA employee, university
administrator, print shop coordinator, business consultant,
para-optometrist, office manager, CPA, IT consultant,
realtor, lifestyle counselor, computer operator, computer
programmer, pastor, cosmetologist, secretary, salesmen,
seamstress, domestic, homemaker and farmer.
Post-Diet
Table 3 shows results after LSFD treatment. Ninety
six percent typical TN and 71 percent atypical TN im-
proved to a pain level of 0 - 2 after 4 weeks of treatment.
Thirty four (72%) of those on medications (47/55) re-
duced or discontinued them. Those who continued
medications did so because either they were frightened
or wanted to increase the percentage of LSFD to a toler-
able level. Compliance was excellent or good in 93 per-
cent.
Table 4 outlines the results in post surgical patients as
a subgroup. All patients with post-surgical residual typi-
cal TN responded to LSFD except one patient whose
typical TN improved but not the atypical TN. The speed
of improvement was slightly longer (mean 20 days) than
that for the entire group (mean 16 days). However, the
mean duration of pain in the po st surgical gro up was also
longer (11 years vs. 8 years).
Table 3. Results wit h LSFD.
Reported daily
saturated fat intake: 3 - 25 gm (mean 10 gm)
Duration: 2 months-13 years (mean 20 months)
Excellent: 36
good: 15
Compliance:
poor: 4
Noticeable pain relief: 1 week 26, 2 weeks 25, 3 - 4 we ek s 4
Maximum pain relief: 1 week 5, 2 weeks 27, 3 - 4 weeks 23
(mean 16 days)
0.14 ± 1.45 typical TN* (0 - 2 49/51)
Intensity on VAS: 2.28 ± 2.92 atypical TN** (0 - 2 5/7)
Discontinued meds: 16/47#
Reduced meds: 18/47##
*, **3 patients had both typical and atypical pain; *paired 2 tailed student’s t
test t 65.685, SED 0.143, df 50 (p < 0.0001)*; **paired 2 tailed student’s t
test t 5.197, SED 1.209, df 6 (p < 0.002)**; #, ##8 patients were not on
medications.
Table 4. Post surgical patients.
N = 17
Procedures: 35 (see text)
Type: typical TN 16, both 1
Laterality: unilateral 14, bilateral 3
Duration: 2 - 34 years (mean 11 years)
Frequency: daily 16, weekly 1 , monthly 0
Reported daily
saturated fat intake: 3 - 16 gm (mean 11 gm)
Excellent: 10
good: 5
Compliance:
poor: 2
Noticeable pain relief: 1 week 10, 2 weeks 6, 3 - 4 weeks 1
Maximum pain relief: 1 week 1, 2 weeks 8, 3 - 4 weeks 8
(mean 20 days)
Pre-diet: 6 - 10 (mean 9.53 ± 1.07)
Intensity of typical
TN on VAS: Post-diet: 0 - 2
(mean 0.29 ± 0.59) 17/17*, **
Pre-diet: On meds 15, not on meds 2
Medications: Post-diet: Discontinued meds 4,
reduced 9, continued 2
*paired 2 tailed student’s t test t = 31.7 SED = 0.291, df = 16 p < 0.0001;
**One patient had atypical TN as well, with intensity of 8, which did not
change at all post-diet .
The data storm diagrams (Figures 1(a)-(c)) show that
the VAS scores in typical TN, atypical TN and post-sur-
gical patients respectively have virtually no overlap in
the data before and after diet accounting for the statisti-
cally significant results.
Only side effect reported was weight loss. The amount
of weight loss varied from 5 lbs to 75 lbs.
Collateral benefits qualitatively rep orted were lowered
cholesterol levels and trig lyceride lev els, improved blood
pressure, improvement of long standing itching, im-

N. Verma, F. Sherwood / Open Journal of Preventive Medicine 3 (2013) 402-406 405
(a) (b) (c)
Figure 1. Data storm diagram compar ing the VAS score before
and after LSFD diet in each of the 3 groups: Typical TN,
atypical TN and post-surgical TN showing hardly any overlap.
(a) Typical TN (N = 51); (b) Atypical TN (N = 7); (c) Post-
surgical subgroup (N = 17).
proved GERD, reduction in wart size on hands, more
energy level, more endurance and improved fibromylagic
symptoms, constipation, hemorrhoids, migraines, sleep
and Irritable bowel symptoms. One patient reported im-
proved symptoms of glossopharyngeal neuralgia and
another showed improvement in post-herpetic neuralgia
which co-existed with TN.
4. DISCUSSION
LSFD for TN differs from other low saturated fat diets
such as Ornish’s [10] and Esselstyn’s [11]. The Ornish
diet is restrictive for patients because it limits alcohol,
salt, oils, sugar, simple sugar derivatives, and does not
allow caffeine. Ornish diet allows fish supplements and
occasional consumption of animal products. Also for
maximum results, the Ornish diet is to be used in con-
junction with a holistic health program including, exer-
cise, yoga, meditation, lifestyle changes, stress reduction ,
nutritional supplementation and smoking cessation.
LSFD diet does not impose any such restrictions. Essel-
styn diet is mostly plant-based vegan diet, which is hard
to follow. LSFD does not require TN patients to be vegan.
It simply strives to limit saturated fats to abo ut 10 grams
a day. Perhaps that is why the compliance was good to
excellent in 93 percent. It cannot be compared to Medi-
terranean diet [12] as the latter has much higher saturated
fat content-up to 8 percent and relies on the beneficial
effects of wine, healthy lifestyle and sunlight as well.
Our results demonstrate that LSFD is a quick, safe and
reliable method to treat both typical and atypical TN.
Ninety six percent typical TN and 71 percent atypical TN
improved from a severe pain level to minimal (0 - 2) in 1
- 4 weeks (average 2 weeks). Seventy two percent of
patients on medications reduced or discontinued them.
Typical TN in all surgical failures improved as well.
Weight loss was the only side effect.
Women were overrepresented in our population, per-
haps as they are more likely to surf the net for diets. Bi-
laterality was slightly more (16%) than in the literature
(12%) and MS was more frequent (5.5%) than in the
literature (2%) likely related to overrepresentation of
women in the sample. Women are more likely to have
MS and MS is the most common (18%) known cause of
bilateral trigeminal neuralgia [13,14]. Aside from this,
the demographics and clinical features of our patients are
in line with the literatu re indicating that even though they
were not consecutive patients-impossible to obtain the
low cost and novel method employed-they truly repre-
sent most TN patients. Given their background, it is
likely that they answered the questionnaire honestly and
accurately.
Some of the proposed mechanisms of TN [15-17] are
as follows:
1) Neuropathic p ain may be due to the small unmyeli-
nated and thinly myelinated primary afferent fibers that
sub serve nociception. 2) The pain mechanisms them-
selves may be altered. 3) Microanatomic small and large
fiber damage in the nerve, essentially demyelination,
commonly observed at the REZ, leads to ephaptic trans-
mission, in which action potentials jump from one fiber
to another. 4) A lack of inhibitory inpu ts from large mye-
linated nerve fibers may play a role. 5) A reentry mecha-
nism may cause an amplification of sensory inputs such
as from vibration, to trigger an attack. 6) Features also
suggest an additional central mechanism (e.g., delay be-
tween stimulation and pain, refractory period).
LSFD is known to improve endothelial dysfunction
and reduce inflammation by increasing the number of
LDL receptors on mononuclear cells, influencing type 1
plasminogen inhibitor and V W factor, decreasing P-
selectin plasma levels and improving vasomotor function
[18-20]. An improvement of the endothelial dysfunction
and reduction of inflammation may well improve one or
more underlying mechanisms detailed above. Reduced
blood viscosity and decreased aggregation of blood cells
[3] noted almost immediately after starting LSFD may
improve circulation and blood-nerve barrier.
Whether long-term reduction of cholesterol levels and
weight loss is operative in the improvement of TN is
debatable as improvement occurred too soon for reduced
cholesterol and weight loss to be a decisive factor. Rela-
tively slow improvement in post-surgical group (mean of
20 days vs. 16 days) may well be related to longer dura-
tion of pain in that group (11 vs. 8 years) prior to treat-
ment.

N. Verma, F. Sherwood / Open Journal of Preventive Medicine 3 (2013) 402-406
406
The shortcomings of our study are that the data are
self-reported from patients who are not directly under
our care and the retrospective nature of the questionnaire.
However, the technique employed by us is novel, low
cost and deserves a second look for collecting data in
difficult situations such as this. The placebo effect is not
excluded although dramatic and sustained improvement
even in post-surgical group with severe and intractable
pain makes it unlikely. Dramatic and quick results may
raise the question of biological improbability of the re-
sults but they are presented here as many novel therapies
are initially serendipitous, and appear dramatic and im-
probable. A well designed prospective study with inclu-
sion of a control group is necessary to further buttress the
results. We also do not suggest that this improvement is
specific for TN and overall contributions of unintentional
life style modifications, which may occur while using
this diet regardless, is not excluded, although the rapidity
of improvement makes this possibility unlikely.
OPEN A CCESS
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