How Best do I eat with Multiple Sclerosis ?

Can diet help slow the progression of my Multiple Sclerosis?

Multiple Sclerosis (MS) is a chronic, progressive disease that affects the central nervous system (the brain and the spinal cord). The body attacks and breaks down the coating around your nerves (the myelin sheath) and replaces it with scar tissue. When this occurs, processes that we generally take for granted such as thinking and moving, begin to stop working as efficiently, as the nerves can no longer conduct signals along these sections both to or from the brain (1). Currently it is unknown what causes the onset or progression of MS. It is believed that diet plays a role in both due to its effect on the metabolic and inflammatory pathways and its influence on the gut microbiota (2).

What are the symptoms of MS?

The symptoms are varied and may not always be visible to other people. The five general categories of symptoms are (1):

·         Motor control- including muscle spasms, tremors and weakness, impaired balance, speech difficulties, breathing difficulties and heart problems.

·         Debilitating fatigue.

·         Other neurological symptoms- such as nerve pain, impaired vision, vertigo and the inability to control body temperature.

·         Bladder and bowel dysfunction.

·         Psychological symptoms- such as impaired memory, personality changes, depression and anxiety, cognitive impairments and difficulty sleeping.

Can diet help slow the progression of my MS?

There are many diets that have become popular over the years to help slow the progression of MS - and not all of these are backed up by research! In reality, the research is still quite inconclusive, evolving with every study published (3). 

In 2019 a review was published comparing different diets and their effect on MS (3). The general consensus from this was that there is currently not enough evidence to recommend a specific diet for MS patients. Overall, however, it was found that a balanced diet of wholegrains, fruit, vegetables and legumes, with limited amounts of saturated fat, salt, animal products and processed foods, helped to reduced fatigue and improve health-related quality of life in MS patients.

We need to be mindful that when foods are taken out of our diet, like many of the diets out there for people with MS, we increase our risk of nutritional deficiencies (3). This can lead to malnutrition which may end up becoming more of a risk to our health than the MS alone (2). Malnutrition contributes to muscle wasting, fatigue, poor immune function, decreased bone strength and increased hospitalisation. One study found that people with MS actually had a more limited diet compared to a healthy comparison group and showed that the levels of antioxidants in the blood (compounds in our food that may decrease demyelination) were lowest in people with severe MS (4).

What can I do to help slow the progression of my MS?

1. Eat a diet that meets your energy needs

Protein, carbohydrate and fat (our macronutrients) are what give our body energy to do the things we love each day. Having regular meals throughout the day will help to reduce fatigue and keep our muscles and immune function strong.

2. Eat foods that reduce inflammation in the body

Inflammation in the body, particularly in our gut, is one of the potential triggers or progressors of MS. The current research indicates that diet patterns that have lots of vegetables, fruit, fish, legumes (such as chickpeas, lentils, red kidney beans and baked beans), probiotics (found in yoghurt, sauerkraut, kefir, kombucha, miso and kimchi) and prebiotics (found in your fibrous foods like spring onion, asparagus, garlic, green peas, savoy cabbage, nectarines, lentils, baked beans and oats), reduce inflammation and are associated with more positive outcomes for MS.

3. Limit foods that increase inflammation in the body

Following a Western-style diet has been shown to increase levels of inflammation in the body. This is one that includes high levels of salt, sugar and saturated (animal) fat.

To reduce these, try:

·         Snacking on nuts, vegie sticks and hummus or popcorn rather than cakes and pastries

·         Swapping fatty meat to lean meat

·         Bulking up your meals with vegetables

·         Seasoning food with herbs and spices rather than salt

·         Swapping sugar sweetened beverages for water or tea (try the tea infusers).

·         Swapping fried fish for grilled fish

·         Adding some lentils or chickpeas to some cooked vegetables for a plant-based option.

4. Choose a variety of foods

Mixing up your diet each day ensures you are getting all the essential micronutrients your body needs. If you do choose to eliminate any foods, it is important that the nutrients in these are consumed in other ways. For example, if dairy is eliminated from the diet, calcium needs must be gained from different sources such as calcium-fortified soy milk to reduce your risk of osteoporosis and bone fractures. Some nutrients, such as vitamin D, may need to be supplemented (5), so have a chat to your GP!

5. Reduce your alcohol consumption

Many symptoms of MS coincide with those of excess alcohol consumption, including loss of balance, slurred speech, slow thinking and problems with vision. To reduce your risk of disability, decreasing your alcohol consumption is a good thing to consider changing.

6. Look after your mind and body in other ways too

Some other things you can do to help control or reduce the progression of your MS symptoms include (1):

·         Keeping your mind active by talking to people, reading books, doing some word puzzles or completing a short course on something that interests you.

·         Doing some physical activity (to the best of your ability) to keep your muscles strong, your brain active and your stress levels down.

·         Keeping your weight under control to reduce any other complications such as cardiovascular disease and diabetes.

·         Reducing your stress by doing things you enjoy and trying out some deep breathing exercises or meditation.

·         Avoiding or stopping smoking to maximise your brain health.

·         Seeking support from you GP, psychologist, or other person that you trust if you need it, especially if you experience any changes in your symptoms.

MOST OF ALL, FIND WHAT WORKS FOR YOU!

The best way to ensure you are getting enough nutrients from your food and are preventing the development of other conditions like malnutrition, would be to book in to see an Accredited Practicing Dietitian. Book here to see a dietitian at Ward Nutrition today for individual dietary advice! or for further information on Ward Nutrition NDIS and Disability Services, click here.

Written by Ward Nutrition Dietitians; Claire Ward - Senior Dietitian at Ward Nutrition

References

1. MS Australia. Understanding Multiple Sclerosis: An Introductory Guide (2019). Accessed 28/10/20 at https://www.msaustralia.org.au/what-ms

2. Esposito S, Bonavita S, Sparaco M, Gallo A, Tedeschi G. The role of diet in multiple sclerosis: A review. Nutr Neurosci. 2018 Jul;21(6):377-390. doi: 10.1080/1028415X.2017.1303016. Epub 2017 Mar 24. PMID: 28338444.

3. Evans E, Levasseur V, Cross AH, Piccio L. An overview of the current state of evidence for the role of specific diets in multiple sclerosis. Mult Scler Relat Disord. 2019 Nov;36:101393. doi: 10.1016/j.msard.2019.101393. Epub 2019 Sep 9. PMID: 31574403.

4. Armon-Omer A, Waldman C, Simaan N, Neuman H, Tamir S, Shahien R. New Insights on the Nutrition Status and Antioxidant Capacity in Multiple Sclerosis Patients. Nutrients. 2019 Feb 18;11(2):427. doi: 10.3390/nu11020427. PMID: 30781687; PMCID: PMC6413226.

5. Dobson R, Cock HR, Brex P, et al Vitamin D supplementation Practical Neurology 2018;18:35-42.