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Multiple Sclerosis and Nutrition
A diagnosis of MS can be overwhelming, particularly with all of the new information to process. Beyond medications, physical therapy treatments, and other healthcare-related appointments, patients often wonder if there is anything they can be doing in their day-to-day lives to control the symptoms of their MS. Nutrition is not often discussed in-depth but can be beneficial in controlling MS symptoms and benefiting overall health and wellbeing. While there is not a cure for MS, and no one particular diet will reverse the progression of the disease, proper nutrition can have a positive impact on MS symptoms.
WHAT IS MS?
According to the National MS Society website (https://www.nationalmssociety.org/What-is-MS/Definition-of-MS), multiple sclerosis is characterized as a progressive disease of the brain and spinal cord. It is known as an “immune-regulated” disorder as opposed to an autoimmune disorder. In MS, the immune system attacks the myelin sheath surrounding axons in the brain and spinal cord. Myelin acts as a conductor for the signals sent by the brain, through the spinal cord, and to the muscles and organs. A breakdown in myelin will cause communication issues between your brain and your body. The exact cause of MS is currently unknown, although it is thought to be related to both environmental and genetic factors.
WHAT ARE THE SYMPTOMS?
Because the locations of lesions in MS can be widespread and variable person-to-person, symptoms can vary, as well. According to the Mayo Clinic, early symptoms that you may notice can include: fatigue, dizziness/vertigo, weakness, walking (gait) problems, spasticity, vision changes, bowel/bladder changes, pain, emotional changes/depression, and cognitive changes. The symptoms listed above are known as primary symptoms, or symptoms that arise as a direct result of the changes happening due to MS progressing. For more information on primary symptoms, as well as secondary and tertiary symptoms, you can visit the Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269.
HOW IS IT DIAGNOSED?
If you suspect you or someone you know may have MS, it is important to go see your Primary Care Physician (PCP) or, if you do not have a PCP, you can make an appointment with an MD at a general practitioner’s office. If your doctor suspects MS or a neurological condition, they may refer you to a neurologist or a neurophysiologist. They will run tests that will help them determine a diagnosis of MS, if indicated. These tests include:
Magnetic Resonance Imaging (MRI): will look for plaques or damage in the brain and/or spinal cord
Cerebral Spinal Fluid (CSF) Test: will look for elevated levels of IgB antibodies and will detect the presence of ogligoclonal bands (this test is not MS specific, but can help in making a diagnosis)
Evoked potentials: this test will detect impaired transmission along optic pathways – this test is typically run for MS diagnoses, as vision changes are a common early symptom in MS
HOW DOES IT AFFECT MY DIGESTIVE SYSTEM?
As stated earlier, MS breaks down the myelin sheath, leading to communication errors between the brain, spinal cord, and other organs. The MSAA (Multiple Sclerosis Association of America) website contains excellent information, particularly regarding common bowel problems (and other associated symptoms) as a result of MS. There are essentially three outward symptoms of MS effects on gut motility:
1) Constipation: MS can decrease the motility of your gut and can affect the pelvic floor muscles by making it difficult for them to relax (this helps with voiding). The decrease in motility and relaxation of muscles makes constipation a common problem for those with MS.
2) Diarrhea: Diarrhea or even bowel incontinence (a loss of bowel control) can result from MS, although it is less common than constipation. These can be caused by MS which takes the opposite effect of what is stated above – food moves too quickly through the digestive system. Both constipation and diarrhea can cause a lack of nutrient absorption, so it is important to consult with your physician regarding your nutrient intake if you are experiencing these symptoms.
3) Gastroparesis: The NIH (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0027317/) defines gastroparesis as delayed stomach emptying. It is a disorder that slows or stops the movement of food from the stomach to the small intestine. The stomach muscles are controlled by the vagus nerve, which can be affected by MS. The gastrointestinal (GI) tract takes the food from the stomach and aides in the digestion and release of food. With injury to the vagus nerve, those stomach muscles stop working normally, which can lead to slower movement of food through the GI system and can stop moving altogether. This can cause weight loss or weight gain, and people with gastroparesis may experience constant hunger or food craving due to the lack of absorption of nutrients. The cause and effect of MS and gastroparesis is currently unknown, but it is known that these can be associated with one another.
It is important to note that the MSAA website contains information regarding symptoms #1 & 2 (https://mymsaa.org/ms-information/symptoms/bowel-problems/), as gastroparesis is only more recently entering the discussion on a scientific basis in association with MS. This site (https://aboutgastroparesis.org/what-is-gastroparesis/causes-of-gastroparesis.html) contains more information regarding gastroparesis itself, not necessarily as a result of MS. Again, it is imperative to speak with your healthcare team if you are experiencing these symptoms, as they will be best equipped to discuss treatment paths designed for you.
WHAT ARE CATEGORIES OF FOODS TO STAY AWAY FROM?
MS is a complex disorder that can be managed by a number of different treatment methods. Again, there is no diet or panacea that will cure MS, however, there are certainly foods to increase your intake of and decrease your intake of if you are looking to improve your overall nutrition, and, possibly, decrease some of your MS-related symptoms. Below is a summary of types of foods to avoid:
1) Saturated Fats: This applies to both saturated and trans-fatty foods. Doctors currently suggest maintaining a low-fat diet that avoids increased intake of animal-based foods (ex: oils, full-fat dairy), as these contain higher amounts of saturated and trans fats.
2) Alcohol: Alcohol affects the central nervous system (CNS), which is the system that MS attacks, as well. You may be worsening your symptoms and progression of MS due to increased intake of alcohol, as this acts a CNS depressant, meaning it slows down and inhibits the work of your CNS. You may see an exacerbation of your symptoms after just one to two drinks, so this is certainly something to avoid.
3) Sugar and Refined Grains: Almost all foods contain sugar in some form, however, there are different types of sugars available, so there are some to be more careful of when choosing your food. Simple sugars and refined grains can lead to a blood sugar imbalance, which can contribute to the common symptom of fatigue in MS patients, as well as contribute to the onset of diabetes. It is important to note that this also applies to diet soda drinks (discussed further below).
4) Aspartame: This is an artificial sweetener found in many diet drinks and can be attributed to an increase in the damage around your myelin sheaths. Those myelin sheaths are your conductors that help to send signals from the brain/spinal cord to the body, so it is important to avoid progression of damage to them. Be sure to read the label of what you are consuming to ensure you are not intaking aspartame.
5) MSG: Monosodium glutamate (MSG) is an additive that does not have a taste, however, it causes you to eat more of the food than you otherwise would if it did not contain this additive. Additionally, it is known commonly as an excitotoxin, and this can also lead to increased damage of the myelin sheath.
6) Salt: The Journal of Neurology, Neurosurgery & Psychiatry, states that increased salt intake can lead to an exacerbation of symptoms. Avoid canned foods, as these are high in sodium, and opt for fresh/frozen vegetables and fruits. Additionally, you can try using salt’s best friend, pepper, in place of salt for additional seasoning of your food.
7) Caffeine: Caffeine is known as a stimulant, but it is lesser known as a bladder irritant. If you have ever had a cup of coffee and quickly found yourself in the bathroom what seems like moments later, you can most likely attribute that to the irritability factor of caffeine. As it is common to have bowel and bladder issues with MS, this is a good one to avoid.
8) Gluten: Foods containing gluten can be much more difficult to digest, and as it is common for those with MS to experience digestive system issues, those foods should be avoided when possible. Additionally, it has been found that MS patients tend to have a higher instance of gluten intolerance.
WHAT SHOULD I EAT?
Now you know what foods might not be your best first choice – now, what foods should you be eating? Below is a list of foods to consider increasing in your daily diet:
1) Vitamin D: According the the NIH, “Among people with early-stage MS, those with higher blood levels of vitamin D had better outcomes during 5 years of follow-up.” (https://www.nih.gov/news-events/nih-research-matters/vitamin-d-levels-predict-multiple-sclerosis-progression). It is unclear the cause/effect of vitamin D on MS or vice versa, however, it is known to be an important factor in maintaining good outcomes for as long as possible. Vitamin D can be found in some foods, such as orange juice, but typically juices contain high amounts of sugars and might need to be avoided. Speak with your physician about a vitamin D supplement and sunlight exposure, as sunlight contains vitamin D, as well.
2) Lean Meats: You will want to select leaner meats, as these contain lower amounts of fat.
3) Whole Grains: Whole grains contain more fiber and help with blood sugar regulation. Due to increased fiber, these foods can also help with healthy bowel habits. Foods that can be classified as whole grains include quinoa, oats, and brown rice.
4) Fresh Fruit/Vegetables: Fresh fruit is a great way to substitute your sugar cravings while maintaining a healthy diet. The sugars in fruits can actually help to stabilize your blood sugar levels and fight your fatigue – which will not be the case when eating those refined sugars mentioned above. Fruits and vegetables contain higher amounts of fiber, which can help to contribute to a healthy digestive system.
5) Fatty Fish: Fish is high in Omega-3’s, which is thought to help slow the progression of MS. According to one study that followed 312 patients, those taking a supplement regularly experienced better outcomes over a 2-year period. However, this study was not “statistically significant”, but that does not mean that there is no value to increasing your intake of Omega-3’s. You can find more information regarding MS and Omega-3’s on the National MS Society website: https://www.nationalmssociety.org/Living-Well-With-MS/Diet-Exercise-Healthy-Behaviors/Diet-Nutrition/Omega-3.
6) Plant-based Oils: As discussed above, it is important to avoid foods high in saturated and trans fats. Instead, replace your butter/shortening with olive, hemp, or flaxseed oil.
7) Ginger and Turmeric: MS is known to have inflammatory responses, so ginger and turmeric are great spices to utilize because they have been shown to decrease inflammation, which can help to ease MS symptoms.
8) Avocado: Avocado also contributes to decreased inflammation and contains healthy unsaturated fats.
SUPPLEMENTS I SHOULD KNOW ABOUT?
Supplements are a widely discussed and controversial topic at this time – many can be beneficial but there are a number of fakers out there due to the fact that these supplements are not regulated by the FDA. What exactly should you know about adding supplements to your daily routine? There are two main points to know before adding or changing your supplement routine:
1) Dosage matters
2) Discuss with your Doctor first: Because MS varies widely person-to-person, it is important that you consult with you physician before making any changes to your diet.
Prior to speaking with your physician, there is an excellent PDF from the National MS Society that discusses the types of supplements you may want to consider adding to your diet/lifestyle: https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-Vitamins,-Minerals,-and-Herbs-in-MS_-An-Introduction.pdf
EFFECTIVE MS TREATMENT BEYOND NUTRITION CHANGES?
Proper nutrition is imperative in maintaining a healthy lifestyle, as is exercising regularly. With a diagnosis of MS, a physical therapist will be one of the key members of your healthcare team. They will discuss with you the benefits of exercise with chronic, progressive diseases, and they can help you to maintain your function for longer, improve/maintain your independence, and overall increase your quality of life. Below are two links that discuss the benefits that physical therapy can have on your life with MS:
HOW SHOULD I GO ABOUT GETTING STARTED?
When researching for yourself, look for articles or websites that use high-quality evidence as references. Common sites that use only evidence-based research include the NIH, Pubmed, and the National MS Society. Look for articles that were written by those accredited in their fields with proper credentials, i.e. if someone is writing about the benefits of physical therapy, it would be beneficial to know that that person is a licensed physical therapist. Finally, discuss your research with your physician and healthcare team – they are there to help you and should be listening effectively to your specific needs. Do not be afraid to ask questions or consult with your healthcare team!