We know that our health and happiness are intricately bound up in our choice of food and drink. We also know we gain a sense of well-being from taking control of our diets. It’s not surprising that people with MS so frequently ask: “What type of food should I eat to stay healthy?”
The simple answer – ”a low animal-fat diet” – is true of relapsing-remitting MS and is good advice. However, the real answer is actually quite complex as individual needs in MS are as varied and unpredictable as the symptoms of MS themselves.
In the beginning
When MS is first diagnosed, most people are able to eat a varied diet. This is a good time to encourage the principles of a healthy-eating regimen, outlined in Table 1, as most people with MS are motivated to make positive changes. Those who have had MS for some time will be familiar with the concept of a healthy diet, low in animal fats such as butter and fatty meat, but rich in vegetable fats and oily fish. This type of diet has been advised by MS societies world-wide for many years.
The evidence in support of this type of diet suggests that omega-3 oils found in oily fish such as mackerel, sardines, herring and tuna may have an anti-inflammatory role in many conditions, including MS. Linoleic acid, a type of omega-6 polyunsaturated fat found in some vegetable oils, has been described as a treatment which may help slow down the disabling effects of MS. Health professionals are not unanimous about this, but there is no doubt that linoleic acid is a valuable part of a healthy diet. However, the daily recommended amount can be obtained through a balanced diet and there is no need for capsules if the diet is adequate. More than the recommended dose does not increase the potential benefits.
As many people with MS are minimally active, with low energy needs, the lower amounts of linoleic acid they need are best taken from concentrated omega-6 oils, such as sunflower oil, safflower oil or soya oil. These oils are also a rich source of vitamin E. This is thought to protect myelin and other tissues from oxidative damage. Vitamin E is found in abundance in wholegrain cereals as well.
Using omega-6 oils
Food oils can be easily consumed as a salad dressing, with added herbs for flavour, as a dip for bread, or sprinkled into sauces and soups. Heating them to a high temperature reduces their nutritional benefit, so they should not be used in frying, other than for a rapid stir-fry. In practice, people with MS should be encouraged to use a variety of omega-6 oils and spreads in moderation, to provide about 10 per cent of total energy intake.
As symptoms progress
Diet is of particular benefit in the clinical management of MS when symptoms of disability develop. Constipation, weight gain, urinary tract infections (UTIs), swallowing difficulty, malnutrition, pressure sores and fatigue may all benefit from appropriate food, fluid and nutritional care.
Early warning
Change in body weight and nutritional well-being in MS usually occurs slowly and so the onset of debilitating weight gain or malnutrition is often ill-defined and a pattern of poor eating habits has become well-established by the time any action is taken. This can be prevented by ensuring that weight and height are recorded at diagnosis and that weight is recorded at each clinic visit thereafter to enable a nurse, nutritionist or dietician to monitor “body mass index” (BMI), a measure of weight for height.
Poor mobility
Constipation, weight gain and UTIs often occur simultaneously in those with MS who use a wheelchair, due to limited mobility. Their diet should include a fair amount of bulky, low fat, high fibre foods, including soft fruits such as bananas, prunes and peaches, a good selection of vegetables, wholegrain cereals, and a daily intake of two litres or more of sugar-free fluids. Cranberry juice is popular in the prevention of UTI. However, cranberry drinks contain a lot of sugar so they should be used with caution. Cranberry capsules are an alternative to juice.
Modify with care
At no time is choice of diet of greater importance in MS than when the ability to swallow food or fluid is affected. Dysphagia, as this is known, causes coughing and choking during meals and commonly results in poor intake. This can lead to severe weight loss, possible dehydration, and to pneumonia if food particles are aspirated during coughing or choking. The diet should be modified with care.
To prepare soft but nourishing food, it may be necessary to finely mash chopped fish or meat into thick sauce or gravy with a fork. If a purée diet is advised by a health professional trained to assess swallowing ability, then a food blender may be needed. Sometimes drinks are taken more easily when thickened a little with a special food starch. Thickening can help prevent a trickle of fluid from entering the lungs.
When malnutrition is a problem
Other symptoms of MS can also contribute to malnutrition and should be identified early. Severe tremor and postural difficulties may make eating physically difficult to accomplish. Tremor may also increase energy and nutrient needs. Many adaptive aids are available that can assist people who experience physical difficulties while eating or drinking. These include plates with rims and non-slip surfaces, special grip cutlery, weighted utensils, drinking cups with handles, special grip surfaces or weights and many others.
Poor vision affects the ability to shop, prepare meals and to eat. Online shopping using an adapted computer screen can be helpful for some people with visual difficulties. An occupational therapist can provide suggestions for adapting meal preparations and eating.
Fatigue and poor appetite cause weight loss as small, less frequent meals are taken. Fatigue can be especially problematic for people with MS who have the responsibility for meal preparation in the home. Table 2 lists some energy-conservation strategies that can be helpful during food preparation.
Poor memory or depression can reduce the motivation to eat. People with these types of problems should be encouraged to discuss these issues with their healthcare professionals.
Finally, some drugs for MS symptoms may cause poor appetite or a dry mouth, which makes it difficult to chew and swallow.
When malnutrition is a risk, the greatest nutritional need is for energy to help prevent loss of body weight and muscle strength. Food may need to be quite high in fat to provide concentrated nourishment. Full-fat dairy foods, such as milk, cream, cheese and butter should not be avoided as they can be stirred into sweet and savoury food to increase their energy content. Milk, cheese and yoghurt are also rich sources of calcium. This is essential for bone health, especially when mobility is poor or when taking steroids.
Choose wisely
A multi-vitamin supplement can be reassuring, but if a good variety of high-energy food is available, expensive supplements (in pill form or drinks) should not be needed. Be wary of self-help books that suggest avoiding specific foods or taking expensive supplements. To date, there is no medical evidence to support any of these ‘MS diet’ or supplement claims, and while they may give people a temporary feeling of control and well-being, they may contribute to the onset of malnutrition and be expensive or even dangerous. So before following any special diet, people with MS should consult a qualified healthcare professional.
Table 1: Tips for Healthy Eating
Choose low-fat dairy products, such as low-fat yoghurt and semi-skimmed milk.
Eat oily fish, such as salmon and mackerel,
two to three times weekly.
Choose chicken, turkey and leaner cuts
of red meat.
Grill, bake, steam or poach foods in
preference to frying.
Use omega-6 vegetable oil or spreads in moderate amounts. These include sunflower, safflower, and soya products.
Avoid the animal fats contained in pastry, pies, cakes, chocolate and cream.
Eat wholegrain bread and wholemeal cereals.
Eat five portions of fruit and vegetables daily.
Drink two litres or more of sugar-free
fluids daily.
Avoid “megadose” preparations of
single vitamins.
Table 2: Energy conservation strategies during meal preparation
Use pre-washed, pre-cut foods.
Use electrical appliances whenever possible (for example, dishwasher, blender,
microwave, etc.).
Prepare larger portions to be stored in the freezer for future meals.
Use a home-delivery service for groceries.
Keep a fan in the kitchen to avoid overheating.
Sit while preparing meals (a chair with wheels can be very useful).
Prepare meals during the time of the day when energy is highest.
Keep commonly-used items on the easiest-to-reach shelves.
Involve others in the work!
Tai chi promotes balance through movement and body awareness.
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