Food for Thought: Multiple Sclerosis and Nutrition

Two-hundred people are diagnosed with multiple sclerosis (MS) each week. For most, the initial diagnosis is associated with a myriad of emotions, including fear and sometimes anger. As in any chronic medical condition, one with MS must learn to manage ongoing symptoms and adapt to changes in functional ability and self-identity.

Multiple sclerosis is a chronic autoimmune inflammatory disease of the central nervous system that affects more than 450,000 people in the United States and over 2.5 million worldwide. The disease is driven by a dysfunctional immune system that incites recurrent attacks on nerves in the brain, spinal cord and optic nerves. These attacks lead to acute neurological symptoms called exacerbations or flare-ups and can lead to long-term disability.

The most common symptoms of MS include fatigue, visual symptoms, memory dysfunction, numbness, weakness and bladder dysfunction. One of the most challenging aspects of this disease is managing symptoms. I have many patients who are more interested in lifestyle changes or natural remedies, rather than prescription medications, to manage their symptoms. One of the more common questions posed to me regards diet.

I have read a lot about MS diets online. Is there one diet I should follow?

There’s a quotation that I love by a nutrition writer, Michael Pollan. He sums up vast information of nutrition into these seven words:

“Eat food. Not Too Much. Mostly Plants.”

I inform my patients that there is no one diet that has been proven beneficial for MS. Diets that promote cutting back on saturated fats and enhancing polyunsaturated fats, especially omega-3 fatty acids, make the most sense. There is scientific rationale to support this diet’s anti-inflammatory effect, which is optimal in MS. Those that follow strict vegetarian diets may want to consider supplementing with fish oil or other omega-3 supplements.

Food for energy

Fatigue is not only the most common MS symptom but also the most frustrating. There is not much scientific evidence for diet and fatigue. I recommend trying small, frequent meals. After a meal, our blood sugar increases and then begins to drop. This drop in sugar can be fatiguing for anyone. By eating smaller, more frequent meals, there will be fewer fluctuations in blood sugar.

Another dietary option to manage fatigue is a gluten-free diet. Although there is no scientific evidence for this, many patients will say they feel better avoiding gluten. Even if a person does not have Celiac disease (immune condition caused by gluten), they can still have sensitivity to gluten. Despite being more expensive, a gluten-free diet is less onerous to initiate and adhere to nowadays due to increased availability of options.

Is there anything I should avoid?

Besides the obvious stuff like fast food and high sugary treats, diets high in salt may be deleterious. Recent studies in animals have shown that high-salt diets seem to activate parts of the immune system that may cause inflammation. These animal studies will need to be replicated in human trials, but for now I think it’s reasonable to encourage people to adhere to low-salt diets.

What vitamins should I be taking?

Every week I see someone who comes to me on a “novel” of vitamins and supplements. I generally feel that this only produces expensive urine. I generally recommend taking a good multivitamin as well as aggressive supplementation of vitamin D. Of all supplements and vitamins, vitamin D has the most compelling evidence in MS. There is a very strong association of developing MS if one is deficient in vitamin D. In addition, multiple studies have shown that higher levels of vitamin D seem to reduce the risk of attacks and new inflammation in the brain. I get bi-annual vitamin D levels in my patients and supplement to levels greater than 50 in the blood.

It is important to combine healthy living with proven effective medications for MS. Neither should be employed alone. In addition, all dietary changes or additions of supplements should be discussed with your physician as some supplements can be immune boosting, which is not ideal for those living with MS.