Nutrition Library

Multiple sclerosis (MS) is a chronic disease which affects the function of the brain, spinal cord and/or the nerves to the eyes. Many patients who suffer from MS look for ways to improve and increase their quality of lives. Good nutrition is among the cornerstones of health-promotion activities. Maintaining a balanced diet and exercising regularly are essential for promoting wellness and well-being and enhancing quality of life. Diet recommendations for the treatment of MS have shown mixed results, and specific dietary guidelines for people with MS have not been established. The same recommendations concerning a well-balanced diet apply equally as they do for the general population. Although there is no direct evidence that nutrition is involved in the etiology of MS, healthy eating can decrease the risk of developing other chronic diseases and secondary conditions. For example, diets high in calcium and vitamin D may reduce the risk of osteoporosis and the risk of MS, diets low in saturated and trans fat may reduce the risk of cardiovascular disease, and maintaining an appropriate intake of calories reduces the risk of obesity.

Clinicians and nutritionists recommend a well-balanced diet that is low in saturated and trans fats, cholesterol, salt (sodium), added sugars, and high in poly- and monounsaturated fats, fiber, calcium and vitamin D. For people with MS, healthy eating may improve symptoms specific to MS, such as fatigue and constipation. This article will review some common nutritional alterations in MS and current dietary recommendations.

Vitamins and minerals are taken by many people with MS. Research is lacking regarding the possible benefits and risks of vitamin and antioxidant supplementation in MS. Supplements should be considered in light of their potential effects on the immune system. In MS, immune stimulation may be dangerous; therefore, supplements that claim to boost or improve immune function may not be good choices. Additionally, the immune effects of many supplements are not well understood, and there is limited evidence to support their use. Vitamins do not function in isolation of one another; therefore, a high concentration of one vitamin might cause a deficiency of another. Dietary sources, such as fruits and vegetables, of vitamins appear to be preferable to supplements. Fruits and vegetables contain vitamins and minerals in useful proportion, along with fiber, and other chemicals found in plants that play a role in disease prevention.

There is particular interest among MS patients regarding the use of antioxidant vitamins and minerals: vitamins A, C, and E, and selenium. There are no well-documented studies that show a clinical benefit to MS patients taking antioxidant supplements. There is a theoretical risk with taking these vitamins. Antioxidants stimulate the immune system, and in MS, an overactive immune system is responsible for the disease; therefore, such stimulation may be unfavorable. We recommend obtaining antioxidants from consuming 5-9 servings of fruits and vegetables per day. If antioxidant supplements are used, it may be best to use them only in moderation. In some cases, a daily multivitamin may be supplemented.

Dietary Fats, Polyunsaturated Fatty Acids and Omega-3 Fatty Acids:

The relationship between nutrition and MS has focused largely on the influence of dietary fats - saturated and unsaturated - on disease activity.Polyunsaturated fatty acids (PUFAs), such as omega-3 fatty acids found in vegetable and fish oils, may have an anti-inflammatory effect in the central nervous system. However, omega-3 fatty acids seem to have no major effect on the risk of clinical relapses and disease progression, and the data available are insufficient to assess any potential benefit or harm from supplementation of omega-3 fatty acids. There is still not enough definite proof available to recommend omega-3 fatty acid supplements for MS, yet there are findings to suggest beneficial effects from consuming foods rich in omega-3 fatty acids, and a diet low in saturated and trans fat. Furthermore, there is evidence that omega-3 fatty acids reduce the risk of cardiovascular events; therefore, foods rich in omega-3 fatty acids are encouraged (see table “Dietary recommendations for MS”).

There may be a possible relationship between low B12 levels and neurological symptoms. Severe vitamin B12 deficiencies cause neurological symptoms similar to those seen in people with MS. Vitamin B12 is required for the production of red blood cells and proper function of the nervous system. Vitamin B12 is found in eggs, meat, poultry, shellfish, and dairy. There is no scientific basis to supplement the diet with B12 apart from treating a diagnosed deficiency. B12 deficiency can be screened with a blood test. Only those diagnosed with B12 deficiency should supplement with B12.

In patients that have urinary issues, especially a history of urinary tract infections, it is recommended to consume 100% pure cranberry juice and/or cranberry pills. More research is required to assess the effectiveness of vitamin supplementations in MS. Constipation is a common MS symptom that can be managed by diet. The reasons for constipation in MS may include reduced rectal sensation, reduced functioning of pelvic floor muscles, decreased physical activity, and inadequate consumption of fiber and fluids. Constipation may cause physical and social discomfort and may lead to long-term consequences such as anal fissures and hemorrhoids. Dietary recommendations to prevent and manage constipation include increasing fluids to at least 8-10 cups per day and increasing fiber intake to 30 grams per day. High fiber foods include: whole-grain breads and cereals, oatmeal, whole wheat pastas and brown rice, fresh fruits (including the skin and pulp), dried fruit, green-leafy vegetables, root vegetables, beans, peas, nuts and seeds, such as almonds and whole flaxseed.

Osteoporosis is a disease that is common in women with MS. Inadequate calcium intake, decreased physical activity, decreased exposure to sunlight, and frequent treatment with steroids among patients with MS increase the risk for osteoporosis. Supplemental calcium and vitamin D intake, in addition to weight-bearing exercise, is an important strategy for the prevention of osteoporosis. Studies indicate that vitamin D alters immune function in a way that may be desirable in MS.

Weight Gain and Obesity:

Weight gain and obesity have been reported in patients with MS. Weight gain may have remarkable effects on health and wellness. These may include increased risk for heart diseases and diabetes. Weight gain is related to reduced mobility, low energy expenditure, fatigue, deconditioning of muscles, depression, fatty convenience foods, boredom and cognitive difficulties, corticosteroid and anti-depressant medications, high alcohol intake, and increased intake of high calorie, sugary drinks. Symptoms such as fatigue, muscle weakness, decreased mobility, and balance problems make physical activity difficult for patients with MS. A decrease in physical activity reduces the amount of calories expended; therefore, caloric intake must be adjusted or weight gain will occur (see table “Diet recommendations for MS”).

Although dietary recommendations and supplements have shown mixed results and specific dietary guidelines for people with MS have not been established, diets low in saturated and trans fats, cholesterol, salt (sodium), and added sugars and high in poly- and monounsaturated fats, fiber, calcium and vitamin D are recommended based on nutritional benefits for the general population. Good nutritional practices among patients with MS may provide the benefits of reducing disease activity and enhancing quality of life.

Dietary Recommendations for MS:

  • Eat calcium-rich foods.
  • Eat foods containing or fortified with vitamin D (milk, salmon, mackerel, sardines, liver, cod liver oil (1 tsp.), whole egg, ready-to-eat cereals).
  • Use low-fat dairy products, such as low-fat yogurt and skim milk instead of full-fat variations.
  • Choose lean cuts of meat, chicken, poultry, and fish; beans and nuts.
  • Increase your omega-3 fatty acids in the diet by:
    - Eating a variety of fish (preferably fatty) at least 2 times weekly, 3-4 ounces per serving, e.g., wild salmon, herring, mackerel, anchovies, sardines, trout, tuna, halibut, shrimp, cod, snapper.
    - Including oils and foods rich in omega-3 fatty acids, such as flaxseed (ground and oil), canola and soybean oils, walnuts, soybeans, tofu, and green leafy vegetables into your diet.
  • Eat 5-9 servings of fruits and vegetables a day, including dark, green leafy vegetables, and fresh fruit (with skin and pulp)
  • Avoid saturated fats (found in animal fats).
  • Avoid trans fats (hydrogenated oils), cholesterol, salt (sodium), and added sugars (commonly found in pastry, pies, cakes, and cookies).
  • Eat whole-grain breads and fiber-rich foods.
  • Drink at least 8-10 cups of fluid a day.
  • Grill, bake, steam, or poach foods.
  • Use poly- and monounsaturated margarines and oils, e.g., canola and olive oil.
  • Avoid mega-doses of vitamin supplements.
  • Avoid sugar-containing and caffeinated beverages.
  • Eat no fewer than 3 meals and preferably 5-6 small meals a day, including breakfast.
  • Monitor portion sizes.

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