100918 Nutrition Webinar

“What foods should I be avoiding because of MS? “

“What foods should I be eating because of MS?”

As a registered dietitian living with MS and helping people with MS navigate their unique nutrition challenges, these are the two most frequently asked questions that I encounter, by far.

I would like to take this opportunity to answer these questions here and now. A healthy eating pattern is no different for someone living with MS than someone who does not have MS. Really!

  • There is no food or nutrient that you should be eating simply because of your MS diagnosis.
  • There is also no food or nutrient that you should be avoiding because of your MS diagnosis.

If you are eating a variety of:

  • colorful plant foods
  • lean proteins
  • beans and legumes
  • nuts and seeds
  • whole grains
  • Low fat calcium foods

While limiting:

  • Saturated fats
  • Sodium
  • Added sugars
  • Highly refined foods

And avoiding trans fats entirely….

…then you are following a healthy and balanced eating pattern encouraged by the American Heart Association, American Diabetes Association, The Institute for Cancer Research and the Arthritis Foundation as well as other well known health organizations. Which means that your nutrition needs are likely being met. There is no “diet” or nutrient that has been shown to impact the MS disease process.

There is however, considerable research to suggest that having one or more comorbid (coexistent) chronic health conditions along with MS is linked to an increase in disability and a decrease in quality of life. This suggests that adopting food and lifestyle habits that keep these conditions well managed (or prevented if you don’t have one) is an important part of a healthy eating pattern while living with MS.

MS can make it harder to practice a healthy eating pattern

Having MS does not require a special eating pattern, but it does pose some unique challenges that can make it more difficult to practice health promoting food and lifestyle behaviors on a daily basis.

Physical symptoms like:

  • Pain, which makes everything more difficult
  • Fatigue, which can contribute to a lack of motivation to cook, or leave you feeling too tired to cook
  • Mobility limitations which may make shopping for and preparing meals and in some cases even eating meals difficult. A decrease in activity may also lead to a decrease in calorie expenditure.
  • Swallowing difficulties, which may require a modification to food and beverage textures to prevent weight loss and nutrient deficiencies.

Medication side effects such as:

  • Appetite alterations
  • Sleep interruptions or drowsiness as a side effect
  • Taste alterations
  • GI upset

Emotional symptoms such as:

Anxiety and or Depression, which are both common, underreported and under treated in people with MS and each of which can impact how you relate with or behave around food.

Are you able to recognize your hunger and fullness cues?

A cue is simply a trigger that encourages you to act in a certain way. Very often, people are not aware of these cues, and how they impact our behavior / choices. 

Appetite is the desire to eat food. There are numerous hormones that play a role in our appetite. These hormones send signals or internal cues telling you to eat when you are hungry and stop when you are full. This system allows your body to regulate how much food is eaten, in an attempt to maintain your body's weight and energy balance.

However, there are many external cues that can disrupt this system and make it more difficult to recognize and respond to our internal cues of hunger and fullness.

External cues include (but are not limited to):

  • Social situation (are you alone or with a group?)
  • Time of day
  • Sensory properties of food (smells good!)
  • Pain
  • Stress
  • Fear
  • Depression
  • Anxiety
  • Boredom

External cues often come into play without our realizing it and impact how much we eat (or don’t eat). Whether we enjoy our food. Whether there is fear, shame, guilt or stress around our food choices or the amount of food eaten. “Diets” and food rules are also examples of external cues that disrupt our ability to eat in response to our internal cues.

Sometimes food becomes a coping tool

Resilience is an important part of living well with any chronic illness, but particularly with a disease that is as unpredictable as MS. Adjustment and flexibility become daily requirements.

Sometimes people turn to dieting as a coping tool. For some people who are bored, food becomes something to do. People who are anxious sometimes use food to calm themselves. Some who feel lonely or unloved use food as a friend. And some who are upset use food to sooth or console themselves. Still others find comfort in the structure of restrictive food rules.

Is this a bad thing?

Obviously using food as your only coping skill isn’t going to lead to optimal health. But creating stress and anxiety around food because you are so nervous about eating it for reasons other than physical hunger isn’t good for your health either. The goal is not to NEVER EAT EMOTIONALLY. Rather it is to connect your feelings to the behaviors that follow. You can then reframe your thoughts, disrupt the negative feelings and change your behaviors.

Instead of trying to get rid of emotional eating as a coping tool, try to fill your toolbox with several coping tools so that you have many ways to sooth yourself when you’re feeling anxious, lonely, depressed, annoyed, frustrated, etc. You might consider calling a friend to vent frustration, or keep a journal, meditate, go for a walk, take a nap, watch a funny movie, listen to your favorite music, or engage in a hobby.  Allow food to be one of several tools and whenever you choose eating as a way of coping, try to remain mindful during the eating experience. Notice how the food is making you feel. And then move on.

Three tools that are NOT diets but might be a useful addition to your toolbox

1) Mindful Eating

Mindful eating is a useful tool for combating the disruption of external cues. It keeps us focused on the act of eating, allowing us to tune in to how hungry or full our body is allowing us to respond accordingly. Mindfulness is about getting good at feeling what’s present and knowing yourself better.

2) Intuitive Eating

Intuitive eating encourages trusting your body to make choices around food that feel good in your body, without judgment and without influence from external cues.

Both mindful eating and intuitive eating are tools to help you reconnect with your body. Neither can be done “perfectly”. Perfection, after all is another external cue, right? 

3) 80/20 Rule, well more of a guideline than a rule…

This might appeal to people who find comfort in structure. The 80/20 rule is about balance, not perfection.

It goes like this: if you are choosing nourishing foods and engaging in other health promoting habits 80% of the time, then it is not going to significantly impact your health if you make different choices during the other 20% of the time. This could simply mean savoring the amazing foods on your once in a lifetime vacation. It could also include occasionally indulging in your favorite comfort food after a long difficult week.

However, if that balance gets flipped and you are making health promoting choices closer to 20% of the time… you will likely begin to see a negative impact on your health. And you may want to reach out to your health care team for assistance getting back into balance.

Is your relationship with food a healthy one?

Are you able to recognize when you are making food choices based on fear? The specific food components of a healthy eating pattern are listed above. Some seek to take back some of the control that MS has stolen from them by following restrictive food rules and practices. But consider this… who becomes more in control through restrictive dieting practices? Isn’t it the food that is in control?

Food is an important part of a healthy eating pattern, but so is:

  • being flexible in our food choices
  • eating a variety of foods
  • enjoying our foods
  • Enjoying food with family and friends

And our food related habits are also important and can impact our relationship with food:

  • Eliminating a bunch of foods from your diet is not a part of a healthy eating pattern
  • Arbitrary restrictions or eliminating whole food groups just means that you have fewer options to eat, depriving your body of the variety it craves
  • Being overly focused on food is not part of a healthy eating pattern
  • Moral judgements about food are not a part of a healthy eating pattern

Be patient with yourself

When emotions and food are combined, the conversation becomes complex pretty quickly. Then when you add the impact of an unpredictable disease like MS the complexity ratchets up a few notches. But it is not impossible to reconnect with your internal cues. It takes a great deal of time and effort to counter old habits and build new ones. Begin with small steps and stay focused as you learn to recognize food triggers and change your responses to them. Learning to manage cues appropriately is just part of your journey toward a healthier eating pattern.