Contents
Living with MS usually doesn’t require a change in diet, although sometimes such a change can help, especially for people who have previously preferred unhealthy foods such as fast food.
Diet is often proposed as a treatment for MS. However, according to the researchers, none has proven to be effective. A similar problem is the use of multivitamin kits. Most people with MS don’t need supplements. Usually, the nutrients contained in daily meals are sufficient, as long as these meals are prepared in accordance with the principles of healthy eating.
A healthy diet should contain the following elements in the right proportions:
• protein – necessary for the growth and reconstruction of tissues;
• carbohydrates – a source of energy;
• fats – help you absorb certain vitamins and contain essential fatty acids;
• fiber – aids digestion;
• vitamins and minerals – necessary for many processes in the body, including tissue regeneration;
• fluids – optimizing the body’s work
Each of these dietary components is essential for the proper functioning of the body. The lack of one of them can affect the absorption of the other. For example, a lack of calcium causes bone weakness, but even enough calcium in the diet in a vitamin D deficiency causes a reduction in calcium absorption and also results in weakening of the bones. That is why it is important to maintain the right proportions, i.e. to properly balance the diet.
RESEARCH
Researchers were interested in the role that fats, also known as lipids, play in MS. There are three main forms of lipids: saturated, monounsaturated, and polyunsaturated. Lipids are a source of energy and can store some vitamins. They also play an important role in the functioning of the central nervous system (brain and spinal cord). How unsaturated omega 3 and omega 6 fatty acids affect the nervous system is not well understood. Perhaps the beneficial effect is due to their anti-inflammatory and immunosuppressive effects. The recommended dose is usually included with meals, so there is no need to take supplements.
Antioxidants
Vitamins and minerals have a lot of important life functions, they also have a mutual influence. Some of them are necessary for the use of certain nutrients by the body, for example zinc and vitamin B6 are necessary for the proper use of omega 3 and omega 6 fatty acids. Others, such as vitamins A, C and E, act as antioxidants. Some studies indicate a close relationship between the appearance of demyelination in the central nervous system and the action of oxidants. So far, however, little research has been done on the use of antioxidants in MS, hence their role is still unclear. Antioxidant therapy is also risky for people with MS, as some antioxidants stimulate the immune system, which can exacerbate the symptoms of the disease.
Vitamin B12
The relationship between MS, MS medications, and vitamin B is yet to be understood. Vitamin B12 is known to be essential in building myelin, the protective sheath surrounding nerves that is destroyed in MS. Since vitamin B12 deficiency can cause symptoms similar to MS, some believe that taking this vitamin may protect against the disease. Unfortunately, there are no studies to prove this. Most people with MS have normal levels of vitamin B12 in their bodies, but of course you should take vitamin supplements prescribed by your doctor if you need to.
Vitamin D
The body receives vitamin D from both the diet and exposure to sunlight. There are ideas that MS is associated with less exposure to sunlight. The evidence is to be the more frequent occurrence of MS in regions further from the equator, i.e. where there is less sunlight and where the inhabitants receive less vitamin D. The previous studies related to the influence of vitamin D on MS have also not provided an answer, because it is difficult to determine where the role of the vitamin begins as a result of sunlight and that contained in the diet. However, it is worth remembering about vitamin D because it plays an important role in the prevention of osteoporosis, so it is especially useful for people with reduced mobility.
Diet and weight
Losing weight and gaining weight is both a problem for people with MS, so it is important to control your weight and follow your diet. A person who is too thin or malnourished may become weaker, which will aggravate the symptoms of MS: fatigue, muscle weakness or spasticity. Meanwhile, people with MS often don’t eat as much as they should. Fatigue, trouble speaking, and tremors make it difficult both to shop and cook. As a result of stress, anxiety, depression, and even the effects of certain medications, the appetite may be lower. The first symptoms of malnutrition, fatigue or muscle weakness, are sometimes interpreted as symptoms of MS, so initially the problem goes unnoticed. However, if it starts to increase, it is necessary to contact a doctor who will prescribe appropriate vitamin and mineral supplements. Eating high-calorie foods can also be helpful, but remember that they have a lot of sugar, which means you need to take more care of your teeth.
Living with MS also means less physical activity, which makes you overweight. Adequate exercise and a healthy, balanced diet should help. A few dietary changes will also be useful, for example, you can drink water or low-sugar juices instead of juice, which is usually high in sugar. Sweets and fatty snacks sometimes become ‘mood-boosting foods’. Of course, a small snack is not a problem, but eating a huge amount of sweets to improve your mood can also be a symptom of depression. It is worth talking to your doctor then, as depression is treatable. Medications, such as steroids used to treat relapses, can also affect weight gain.
Diet and symptoms of MS
Changing what the person with MS eats and how can help them manage their MS symptoms. Some people with bladder problems drink less to reduce the need to go to the toilet frequently. However, then the urine becomes more concentrated, irritating the bladder and increasing the likelihood of urinary tract infections. It is recommended to drink 6 to 8 cups of fluid a day. It’s better to avoid large amounts of caffeine and alcohol, which irritate the bladder.
Trouble with bowel movements
People with MS who have problems with bowel movements are advised to change their diet, i.e. drink enough fluids and eat foods that contain fiber. Fiber causes better movement of food in the intestines and thus better digestion and excretion of undigested food remains. Dietary fiber includes plums (or plum juice), whole grain bread, brown rice, and whole grain breakfast cereals.
Swallowing problems – dysphagia
Difficulty swallowing or dysphagia is a very disturbing symptom, especially if not properly treated. Here are some ways to deal with this problem:
• If chewing becomes difficult, hard or stringy foods should be avoided
• if eating a meal is too strenuous, eat less, but more often; milk drinks will help to replenish the calorie deficit
• changing your eating position may make swallowing easier
• grinding food with a fork or blender will reduce chewing effort
• if your esophagus is working poorly, ‘thin’ fluids such as water or tea can enter the windpipe, causing you to choke; it is better to drink “thick” liquids or to use thickeners
• some say it is more difficult to drink an adequate daily fluid intake when drinks are thickened; to avoid dehydration, drink often in small sips
• if swallowing problems make you lose weight, take vitamin and mineral supplements.
Eating this way can also help people with facial (trigeminal) pain, which makes it difficult to open their mouths and chew.
Tiredness
Fatigue can be reduced with a proper diet. If you find eating a large, hot meal particularly strenuous, you should eat more often but less. It may also be a good idea to eat carbohydrate-containing foods, such as potatoes or bread. This will keep your energy at the right level. However, you cannot rely too much on energy from carbohydrates, because immediately after consumption they raise the level of energy, but then it drops off sharply. Dehydration can also cause fatigue, so remember to drink 8 glasses of fluid a day (about 1,5 liters). Caffeinated beverages such as tea, coffee, and Coca-Cola are initially stimulating, but too much caffeine causes dehydration.
Trembling
Tremor affects both nutritional needs and the physical ability to eat. Constant tremor consumes a large amount of calories, so it is imperative to use high-energy snacks and drinks in between meals. This will avoid both weight loss and fatigue. Some foods may be “easier to eat” if tremors are interfering with holding capacity. A sandwich will be easier to eat than spaghetti or soup. Special cutlery and dishes can also facilitate eating and preparing a meal. A regular drinking straw can be a great solution – a tool for consuming not too thick soup, e.g. borscht.
Osteoporosis
Osteoporosis makes bones more fragile and increases the risk of fractures. People with MS are more likely to develop osteoporosis because of:
• the use of high doses of steroids to treat relapses
• lack of adequate bone-bearing exercises
• avoiding the sun as a source of high temperature that increases the feeling of fatigue. This leads to a reduction in the absorption of vitamin D.
Good sources of vitamin D are oily fish, liver and eggs. Rich sources of calcium are milk and dairy products, as well as canned sardines and anchovies (if eaten with the bones), bread, raisins, spinach, and red beans. If someone does not like milk and its products, they can reach for soy rich in calcium.
Bedsores
The risk of pressure ulcers occurs in people who lie or sit in one position. Losing weight exacerbates the problem, as the natural fat protection is lost in places particularly prone to the formation of pressure ulcers (e.g. near the coccyx). Therefore, it is important to maintain a healthy body weight in avoiding pressure ulcers.
PEG — przezskórna endoskopowa gastrostomy
If chewing and swallowing becomes too difficult despite eating small meals and drinking concentrated drinks, weight loss and dehydration continue, enteral nutrition should be considered. PEG – percutaneous endoscopic gastrostomy – is the most commonly used. This allows liquid food to be introduced directly into the stomach bypassing the esophagus. Of course, sick people can still enjoy the taste of the food, but the meals they eat themselves must be small. The procedure for introducing the probe is performed under local anesthesia. The probe can of course be removed as soon as it becomes unnecessary to use it.
More information in the brochure: “MS and … diet” available at the Polish Multiple Sclerosis Society.
Text: Iza Czarnecka