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.
2010 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 “vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, eggs, beans, peas, and nuts and seeds.”
Specific nutritional recommendations for persons with MS
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 for Persons with MS
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
- Calcium supplementation: 1,000 mg per day for men and women between 25 and 65 years of age; 1,500 mg per day for postmenopausal women
- Target for daily vitamin D intake: 400 international units or IU (ask your doctor about how best to achieve this target as requirements for daily vitamin D intake in persons with MS or other autoimmune disease can be higher)
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, and low calorie soda 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 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) may provide some disease-modifying benefits. High PUFA intake is achieved mostly via supplementation with omega-3 or -6 fatty acids, which are inexpensive and generally safe.
One popular diet based on consumption of foods low in saturated fats and high in PUFA is the Swank Diet. This diet has been tested in several studies, with the claim of significant effects. However, these studies were not controlled nor randomized, therefore the significance of the results is not known.
Well designed studies have evaluated the effects of supplementation with omega-6, a specific type of PUFA (sources: sunflower seed oil, evening primrose oil, different nuts). Results from these studies have shown reductions in relapse duration and severity and analysis of combined results (across multiple studies) showed benefit in terms of slowed disease progression.
There is limited study data available regarding supplementation with another PUFA, omega-3, in MS. Although one study failed to find a significant treatment effect, another study combining omega-3 supplementation (sources: fish oil, flaxseed oil) with Copaxone (glatiramer acetate) or interferon beta medication found evidence of improved physical and emotional functioning with the combined treatments.
Both omega-3 and -6 supplements have been found to be generally safe by the US FDA. However, omega-6 fatty acids have been associated with increases in triglyceride levels and rare instances of seizures. Mild anticoagulant effects, as well as vitamin E deficiency, are associated with both omega fatty acids.
Cranberry supplement. 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.
Antioxidant supplement. 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.