Food and Diet
While there are some claims that certain diets can cure or treat multiple sclerosis (MS), there are no large, controlled clinical trials to prove these claims, and the results from research that has been done on diets and MS is mixed with no clear winner. Every person with MS should aim to eat a healthy, balanced diet that provides basic vitamins, nutrients, and calories to support requirements for energy and fitness.1 You should always talk with your doctor before starting any special diets or using any new supplements.
Dietary guidelines stress the importance of maintaining a balance of caloric intake to achieve and stay at a healthy weight and to focus on intake of nutrient-dense foods and beverages. This includes limiting sodium and avoiding foods that contain too much fat, sugar, or refined grains. A healthy diet emphasizes consumption of a variety of vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, eggs, beans, peas, nuts and seeds, and soy products.2
Specific nutritional recommendations
In addition to general recommendations on healthy eating (a balanced low-fat, high-fiber diet), MS specialists and nutritionists emphasize that persons with MS should pay particular attention to caloric intake, calcium intake, getting enough fluids, and adequate fiber intake.
Specific dietary recommendations
Don’t exceed your caloric need:
- Be especially careful to keep calories down to what you require for energy needs (this will depend on how active you are)
- Make sure to get most of your calories from nutritious foods, instead of sweets and junk foods
Calcium is key to bone health:
- Especially important for both men and women with MS, but particularly for women at or near menopause, who are at the highest risk for developing osteoporosis
- Mobility problems, spasticity, weakness, or fatigue can result in lack of exercise, which can lead to bone loss
- Corticosteroid treatments increase risk of bone loss
- Heat sensitivity makes people with MS less likely to get sun, which can result in vitamin D deficiency, and vitamin D is required for calcium absorption
Make sure you get the liquids you need:
- Adequate consumption of liquids is important because decreased intake of fluids can exacerbate fatigue and constipation
- Especially important for people with bladder problems who feel they need to limit liquids
- Recommended consumption of liquids: 8 glasses per day (water is the best; skim milk, seltzer, tea (plain), or coffee next best)
Adequate fiber key to staying regular:
- Fiber intake is important since constipation is a common problem in MS (especially in people who are less active)
- Medications such as baclofen (for spasticity) or amantadine (for fatigue) can contribute to constipation
- Target for daily fiber: 25 to 30 grams (sources: whole grains (breads and cereals) dried beans, vegetables, fruits, nuts, lentils, peas, and whole wheat pastas)
Specific dietary interventions in MS
Dietary interventions are among the most popular complementary and alternative medicine (CAM) approaches used in MS.
High polyunsaturated fatty acid diets
Results from a variety of studies (animal studies, epidemiologic studies, and clinical studies) suggest that diets low in saturated fats and high in polyunsaturated fatty acids (PUFA) had less disability progression and fewer relapses. High PUFA intake is achieved mostly via supplementation with omega-3 or -6 fatty acids, which are inexpensive and generally safe.
There is limited study data available regarding supplementation with another PUFA, omega-3, in MS. While some research shows a benefit, others show no improvement. In general, it’s recommended that people with MS limit their consumption of animal-based fats and opt for sources of omega-3, such as fish oil, flaxseed oil, olive oil, avocado oil, and almond butter.1,3
Both omega-3 and -6 supplements have been found to be generally safe by the U.S. Food and Drug Administration (FDA). However, omega-6 fatty acids have been associated with increases in triglyceride levels. Mild anticoagulant effects, as well as vitamin E deficiency, are associated with both omega fatty acids.
Cranberries, which are grown in bogs in North America and harvested for use as a juice, jelly, and for seasonal decorative purposes, are used (in tablet form or as a juice) in MS to prevent urinary tract infection (UTI). Components of cranberry are thought to inhibit adhesion of bacteria to cells in the urinary tract, thereby preventing infection. Results from several studies suggest that cranberry may be effective in preventing UTIs. However, there is no evidence that the supplement is effective in treating existing infections. Cranberry is well tolerated, although it may increase the anticoagulant effect of warfarin and, with long-term use, may increase risk of kidney stones.4
The use of antioxidants in MS is based on studies that have implicated oxidative damage from free radicals in MS-related nerve damage. There have been a limited number of studies evaluating antioxidants in MS. Results from animal studies have suggested some beneficial effects from antioxidant supplements. However, clinical studies of antioxidants, including inosine, alpha-lipoic acid, and the combination of vitamin C and E and selenium, while they show these agents to be well tolerated, have included too few people to make any determinations about efficacy. Further clinical studies are currently underway.4
Maintaining a healthy microbiome
The microbiome is the diverse population of bacteria that live in our bodies, and the gut microbiome plays a significant role in the immune system. Research suggests that the health of the gut microbiome plays a role in many diseases, including MS. However, additional research is needed to understand what role diet modifications or supplementation play in MS.5,6
Fermented foods naturally contain beneficial bacteria, which can help support a healthy microbiome. Good sources include yogurt, kefir, kim-chi, kombucha, sauerkraut, miso, honey, fish sauce, and sourdough bread. The gut microbiome can also be supported through supplementation, with probiotics and prebiotics. Probiotics are supplements that contain certain strains of beneficial bacteria, and prebiotics are foods that nourish and support the bacteria in the gut, including garlic, onions, asparagus, leeks, and artichokes.5