People with multiple sclerosis (MS) are increasingly interested in alternative treatment options. These treatments may involve diets, supplements, herbal remedies, acupuncture, massage therapy, exercises, meditation, etc. This interest has led to numerous questions about how nutrition broadly supports health and if food choices may impact MS or help manage symptoms of MS. It has also led to many “diets” promoted to benefit folks with MS.

But before we get into the specifics of eating specifically for multiple sclerosis, let’s answer an even more fundamental question:

Why do we eat food anyway?

The primary purpose of eating is to sustain life; it is a basic human need for survival and health. The human body prefers to obtain nutrients from food. The nutrients from the food we eat have three primary roles: 

1. Provide energy in the form of calories.
2. Contribute to body structure (cells, muscles, organs, bones, everything!)
3. Regulate chemical processes in the body (metabolism, nerve transmission, fluid balance, muscle contraction, and so much more).

In other words, our bodies require food to function. So, eating to support this requirement is integral to being healthy. The body needs six classes of nutrients for overall health: 

1. Carbohydrates
2. Lipids
3. Proteins
4. Water
5. Vitamins
6. Minerals

One of the more confusing aspects of eating healthy after receiving a MS diagnosis is determining whether it is necessary to make dietary changes or adopt a specific diet. 

• Do any of our nutrient requirements change after a MS diagnosis?
• Do nutrients have different roles in our body because of MS?

What does the research say?

Not as much as you may think. Compared to the amount of research investigating the role of nutrition in human health, the study of nutrition in the MS disease process is still relatively new.

The existing body of research investigating the role of nutrition in human health Informs food-based dietary guidelines, including the Dietary Guidelines for Americans (DGA), which provide advice on what to eat and drink:

• to meet nutrient needs (with food)
• to promote health
• to prevent disease

No research indicates that the recommendations laid out in the Dietary Guidelines for Americans do not apply to people with MS. However, as you will see in a minute if you are like your fellow “Standard Americans,” you may not be meeting your nutrient needs with food. 

Based on currently available evidence, the answer to the questions raised above in red is no.

So, what ingredients can help ensure I am eating well with MS? Let’s dive into each one at a time.

Eating well with MS includes five essential ingredients.

#1: Eat for Health

Remember that based on abundant research, the Dietary Guidelines for Americans (DGA) advises us on what to eat and drink to meet nutrient needs, promote health, and prevent disease. Although it is not specifically highlighted, these guidelines do support the immune system as well. Broadly the guidelines make the following recommendations:

1. Follow a healthy eating pattern at every stage of life.
2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.
3. Focus on meeting nutrition needs with nutrient-dense foods and beverages.
4. Limit foods and beverages that are higher in saturated fat, added sugars, and sodium.
5. Limit alcoholic beverages.

How does your current intake stack up against the Dietary Guidelines for America (DGA)? 

The DGA also offers more specific guidance on how to meet nutrient needs with foods. These recommendations are a great place to begin eating healthy with MS (or any chronic health condition). 

Are you currently eating these foods in the recommended amounts?

• Vegetables at least 2 ½ Cup Equivalents per day
• Dark Green 1½ Cup Equivalents per week
• Red and Orange 5½ Cup Equivalents per week
• Starchy 5 Cup Equivalents per week
• Fruits 1 ½ -2 Cup Equivalents of fruit per day
• Whole Grains3-6 oz equivalents per day
• Meat, Poultry, Eggs 26 oz equivalents per week
• Seafood 8 oz equivalents per week
• Beans, Legumes 1 ½ cups per week
• Nuts, Seeds, Soy 5 oz equivalents per week
• Lowfat Calcium foods 3 cups low-fat dairy or fortified alternative

*This example is based on the recommended daily or weekly intake of specific foods and subgroups for a 2,000-calorie/day eating pattern. *

If you would like to optimize your eating pattern but are not sure where to start, using these recommendations to inform your goals would be a great place to begin. And don’t beat yourself up if you are not meeting the intake recommendations; you are not alone.

Would you be surprised to learn that the eating patterns of more than 50% of Americans need to meet intake recommendations?

According to the DGA, roughly

• 90%of Americans are not eating the recommended amount of Vegetables
• 80%of Americans are not eating the recommended amount of Fruits
• 94%of Americans are not eating the recommended amount of Whole Grains
• 88%of Americans are not consuming the recommended amount of Dairy Foods
• 87%of Americans are not eating the recommended amount of Seafood
• 55%of Americans are not eating the recommended amount of Nuts, Seeds, or Soy Foods

Let’s remember that food has three primary roles: provide energy/calories, contribute to body structure, and regulate chemical processes. Our health may suffer if we are not consuming the nutrients needed to fill these crucial roles. 

Of course, there are foods that, as Americans, we either meet the intake recommendations or overconsume. According to the DGA, roughly

• 70%of Americans meet or exceed the recommended amount of Meats, Poultry, and Eggs
• 94%of Americans meet or exceed the recommended amount of Refined Grains.

Is it time to rethink food math? 

Even though most Americans fail to eat enough nutrient-dense foods to meet our nutrient needs, most wellness messaging focuses on what to restrict, limit or avoid instead what to add. Since the purpose of eating food is survival, the foods we eat provide us with a range of nutrients, including:

• macronutrients (carbohydrates, protein, fat) 
• micronutrients (vitamins, minerals) 
• phytonutrients (fiber, antioxidants, etc.) 

A message of addition may serve us better. Adding nutrient-dense foods that help your body – including your nervous system- function optimally is a more effective means of ensuring an adequate intake of nutrients. 

#2: The Trio of Balance, Variety, and Flexibility

When selecting your foods and building meals, be sure to include the following:

• Balance means not consuming one nutrient at the expense of another.
• Variety may be the actual “superfood” because each food source provides a different nutrient profile. Variety helps to ensure that you consume a diversity of nutrients.
• Flexibility has allowed humans to survive over the millennia despite constantly changing food sources. Humans have found ways to adapt throughout history, including periods of famine and food scarcity. Flexibility leads to resilience!

(Nutrient-dense) foods + balance + variety + flexibility are likely to result in nutritional adequacy, which is the foundation of nutrition health. Inadequacy may lead to malnutrition, which is not beneficial for anyone, especially someone with a chronic condition like MS. Nutritional inadequacy can also exacerbate MS symptoms like fatigue and cognitive challenges.

 

“Food is an important part of a balanced diet.” – Fran Lebowitz 

#3: Manage/Prevent Comorbid Conditions

Once you are consistently implementing ingredients one and two, it is time to consider any chronic health conditions you live with in addition to MS (known as comorbidities).

Why does this matter? I have MS, which is more impactful in my day-to-day life than my other conditions. I get this question a lot. 

Did you know that comorbid health conditions are associated with several poor health outcomes, including increased disability and poor quality of life in people with MS?

The weight of comorbidity in folks with MS is pretty significant. Comorbidity is associated with the following:

• Increased healthcare resource usage and cost of illness
• Increased mortality
• Higher sickness absences from work and increased odds of lower income
• Increased relapse rate
• Increased cardiovascular dysfunction with metabolic comorbidities
• Having MS may contribute to the accumulation of comorbidities
• People with MS and multimorbidity (multiple comorbidities) report numerous barriers to self-care

While there is no therapeutic diet for MS, therapeutic diets (or nutrition interventions) are clinically beneficial for each of the comorbid conditions listed below (among others). Each therapeutic nutrition intervention uses the DGA as the jumping-off point- because nutrition adequacy remains the goal.

• Dyslipidemia
• Hypertension
• Kidney Disease
• Heart Disease
• Glucose Control
• Bone Health
• Gastrointestinal Disease
• Chronic Lung Disease
• Disordered Eating

For example, the specific objective in eating with kidney disease is to consume the most balanced, varied, and adequate nutrition while modifying the intake of electrolytes and protein that damaged kidneys may not tolerate. The goal of these modifications is to limit the buildup of waste products in the body, which is one of the functions of healthy kidneys.

MS does not require any such dietary change. Based on current evidence, no nutrition intervention impacts the MS disease course. There is some limited evidence that interventions may impact symptoms like fatigue. We will go into this in more detail in just a minute.

#4: Keep it Physically and Emotionally Nourishing

The first three steps in this recipe describe how food provides the nutrients required for our bodies to function optimally. But to suggest that fuel is the only role food plays in our lives is akin to saying that sex is only for reproduction.

Wellness culture (aka diet culture) promotes a seemingly endless variety of decidedly untherapeutic diets that can begin to interfere with your relationship with food and your emotional well-being. This critical step is a reminder that eating for physical health should not come at the expense of emotional health. Food features prominently in many of the genuinely human moments in our lives.

Joy is an essential ingredient in a healthy human eating pattern.

#5: Experiment With Foods to Manage Symptoms

A few small studies suggest food choice may impact some common MS symptoms. Whether this is due to an intentional focus on eating healthy and selecting foods that meet nutrient needs and allow our body to function better or something more specific is unclear.

What is clear is that any nutrition intervention you experiment with should align with steps one through four. In other words, aim for optimal health by meeting your nutrient needs with food, including balance, variety, and flexibility, aligning with therapeutic interventions for comorbid conditions, and honoring your physical and emotional health equally.

Don’t forget the “snowflake factor”…everyone experiences MS symptoms and responds to symptom management differently. Context, nuance, and consideration of individual experience are required. 

*This is an updated version of the article I originally wrote for the Fall 2022 edition of the MS Focus Magazine.*