Your Diet and MS
This section offers some guidelines for maintaining a healthy diet and provides some advice on the foods you should consume and those you should avoid.
Eating for health
There has been a lot of research to discover any link between diet and the progression of MS. To date, there is no indisputable evidence that any particular diet that can affect the relapse rate in the relapsing-remitting form or alter the rate of progression in the secondary progressive form. Having said that, there have been studies 1-3 that have shown some benefit from two classes of nutrient:4
Essential fatty acids
Essential fatty acids are those fats that body needs for health but is unable to make for itself and so has to obtain it from the diet. They are all unsaturated fats which means that not all its chemical bonds have been filled up. They form an important part of the structure of brain tissue and the myelin sheath.
Linoleic acid is the most widely used of these essential fatty acid and is present in large amounts in evening primrose oil and starflower oil. This is called an omega-6 series fatty acid, the 6 referring to the place in the molecule where the unsaturated bond is found. Another type of essential fatty acid is the omega-3 series, which are found in fish oils and flaxseed oil. There is evidence that these essential fatty acids may be able to alter the inflammatory response in auto-immune diseases such as MS.
Antioxidants
The chemical processes that release the energy we use for life rely on the oxygen we breathe in. As a by-product, these processes create large amounts of very reactive oxygen compounds called free radicals. They are also produced by exposure to sunlight and urban pollution. Free radicals react with various body tissues, including myelin, where they can produce damage. Our diet normally contains certain vitamins and minerals, called antioxidants, that eliminate these free radicals: Vitamin E - fat soluble, found in margarine, butter and fresh fruit
Vitamin C - water soluble, found in fresh fruit and vegetables
Vitamin A (as beta-carotene) - fat soluble, found in liver, fresh fruit and vegetables
Selenium - essential mineral found in grain products, fish, eggs, cheese and meat
Restrictive diets
Many different diets that exclude various types of food, such as gluten, have been claimed to help people with MS, but none has been scientifically proven to be beneficial. Many people with MS actually suffer from a deficiency of nutrients and a restrictive diet can be harmful.
Diet in relapsing-relapse MS
The diet suggested in relapsing-relapse MS is the same as the healthy-eating diet recommended for the normal adult population. Its aim is to increase levels of essential fatty acids, antioxidants, folic acid and vitamin B12 whilst maintaining a healthy gut function.
Use polyunsaturated margarines and oils (e.g. sunflower)
Eat oily fish regularly, ideally 2-3 times a week
Use low fat dairy products, e.g. skimmed or semi-skimmed milk
Choose chicken and leaner cuts of meat
Eat five portions of fruit and vegetables daily, including a helping of dark green leafy vegetables
Avoid sausages, bacon, burgers and other processed foods with a high content of saturated animal fat
Avoid cakes, chocolate and cream that are high in fat and sugar
Shallow fry in oil or grill, bake, steam or poach food rather than deep fry it
Choose wholegrain bread and wholemeal cereals
Drink 8-10 cups of fluid daily (1.5-2l)
Avoid megadoses of vitamins supplements
Diet in secondary-progressive MS
People with secondary-progressive MS need to tailor their diet to meet their individual requirements. Weight gain can be a problem for some people because of lower activity as a result of reduced mobility, fatigue and, perhaps, depression. Being greatly overweight can compound problems with mobility and increase the risk of other diseases such as diabetes and heart disease. A carefully controlled diet is usually not appropriate in people with secondary-progressive MS but simple measures that can help are using low fat dairy products and calorie-reduced drinks and convenience foods, as well as reducing alcohol intake if appropriate.
At the other end of the spectrum, many people with secondary-progressive MS lose weight and become malnourished. This can, itself, produce muscle wasting, spasm, fatigue, reduced mental function, impaired immune response to infection and anaemia.
There are many reasons why weight loss and malnutrition can develop:
Reduced mobility, poor sight and fatigue create problems with shopping and cooking
Inappropriate care regimens
Physical problems with feeding, such as tremor
Early fatique when eating so only small meals are taken
Poor appetite; person may actually claim to eat more than they actually do. Can be the result of inadequate fluid intake
Mental difficulties - may not recognise weight loss as a problem
Difficulty with swallowing
Professional help may be needed with some or all of these problems. A dietician, physiotherapist and occupational therapist can all help. The dietician may suggest:
Small frequent meals and snacks
Liberal use of sunflower margarine on bread and potatoes
Snacks high in vegetable oils such as crisps, nuts and peanut butter
Use of full fat dairy produce
Using skimmed milk powder to fortify food
Using supplement drinks and multivitamin preparations
Dysphagia
Dysphagia, or difficulty with swallowing, often accompanies speech problems. It can be recognised by coughing and choking during meals and frequent chest infections. The condition should be assessed by a speech therapist and treated with a special diet of minced, mashed and pureed food, or thickened liquids, depending on the severity of the condition. Because these can be bland and uninteresting, weight loss can occur and milk drinks and supplements may be necessary. In extreme case feeding via a nasogastric tube can be required.
References
1 Bates D, Cartlidge NEF et al. A double-blind controlled trial of long chain n-3 polyunsaturated fatty acids in the treatment of multiple sclerosis. Journal of Neurology, Neurosurgery, and Psychiatry 1989;52:18-22.
2 Dworkin RH, Bates D et al. Linoleic acid and multiple sclerosis: a reanalysis of three double-blind trials. Neurology 1984;34:1441-1445.
3 Warren G, McKendrick M, Peet M. The role of essential fatty acids in chronic fatigue syndrome. A case-controlled study of red-cell membrane essential fatty acids (EFA) and a placebo-controlled treatment study with high dose of EFA. Acta Neurologica Scandinavica 1999;99(2):112-116.
4 Payne A. Nutrition and diet in the clinical management of multiple sclerosis. Journal of Human Nutrition and Dietetics 2001; 14: 349-357.
