Everyone has experienced tiredness or fatigue at some point in their life. But MS fatigue is not your everyday, run of the mill low energy day. In fact many individuals with MS report that fatigue is one of their most challenging symptoms. Many people have tried to describe MS fatigue. Some have used the empty fuel tank as a visual analogy that compares the energy levels of healthy individuals to people with MS. Healthy individuals start out with a full tank of fuel each day and people with MS start out with only a gallon or two…we run out of energy much quicker.
The Spoon theory, which is another good and visual explanation is described very eloquently here.
A Closer Look at MS Fatigue
Some fatigue associated with MS is due to physical changes and immune factors caused by MS, including demyelinization, inflammation, and axonal loss in the central nervous system. In other words, it is directly related to the MS disease process.
Secondary fatigue in MS results from another symptom or cause, rather than being caused by MS directly. Factors that can add to fatigue include lack of sleep, depression, stress, inadequate diet, lack of exercise, infections or medication side effects. Or a combination of these things.
Some Characteristics of MS Fatigue:
There are certain characteristics that set MS fatigue apart from the fatigue typically experienced by healthy individuals. They include fatigue that
- is often intense and debilitating
- is exacerbated by heat and humidity
- tends to come on suddenly
- can interfere with daily activities or duties
- interferes with the ability to concentrate
Is Food a Part of the Problem?
A recent study (Multiple sclerosis patients differ from healthy controls on antioxidant and anti-inflammatory nutrients from self-reported diet history, Sandra D. Cassard, et al) compared the dietary intake of antioxidants and anti-inflammatory nutrients in individuals with MS compared to healthy control population. The results of the study, which used food frequency questionnaires to obtain information about dietary intake, revealed that study participants with MS were consuming diets deficient in Folate, Vitamin E, Magnesium, Lutein-Zeaxanthin and Quercitin. In other words, MS participants were not eating adequate amounts of these beneficial nutrients. The results of the study are to be presented at the American Academy of Neurology’s 67th Annual Meeting in Washington, DC, April 2015.
Food to the Rescue?
I would like to revisit the empty fuel tank analogy described above. This is an informative analogy because of our collective understanding of fuel economy—something we have all come to understand and appreciate when fueling our cars. When purchasing an automobile, fuel economy is one of the important factors considered prior to a purchase. Often we are willing to pay more for a more efficient automobile because we know it will pay off in the long run. With MS, the efficiency of our engine is less than optimal but this is made worse by using poor quality fuel: a diet deficient in important nutrients. By putting a higher quality fuel in the tank we are more likely to get the most energy out of our less than efficient engine.
Higher Quality Fuel = Nutrient Dense Foods!
Vitamins and Minerals
Although vitamins and minerals do not directly provide energy, they function as coenzymes (vitamins which combine with an enzyme to facilitate enzyme function) and are required to obtain energy from macronutrients (carbohydrates, fat & protein). Enzymes are involved in all metabolic processes. If the coenzymes are not present in adequate supply then energy metabolism will suffer.
Opt for healthy fats: Monounsaturated Fatty Acids (MUFA), Polyunsaturated Fatty Acids (PUFA) and Omega 3 Fatty acids.
Consume nutrients with antioxidant properties: plant polyphenols, carotenoids from vegetables, vitamins D and A, lipoic acid, selenium and magnesium.
Where to find vitamins minerals and anti-inflammatory nutrients in the grocery store? This is by no means an exhaustive list, but sometimes knowing which foods to include can be helpful.
Something to keep in mind about nutrient dense foods:
Adding these foods to your diet is the goal; make them a regular part of your nutrition routine! Nutrient dense foods are packed with benefits but they pay dividends over the long haul. I have encountered a number of people that have “dose response” expectations from foods, which are frequently met with disappointment. A sustained dietary pattern that includes nutrient dense foods will pay off far more than a single “dose” of pumpkin seeds, no matter how fabulous they are.
Tip: Try to include 1 or 2 new nutrient dense foods per week!
A word about locally grown fresh versus canned or frozen vegetables:
Eating seasonal and locally grown produce is a wonderful and beneficial goal. It is good for our health, good for your local economy and it supports local farmers which is always a good idea. BUT… what if you don’t have access to these resources?. If you would still like to have farmer’s market fresh local produce but lack the energy to add another stop to your shopping list consider a CSA. They vary in their offerings but some farmers make deliveries to your doorstop.
If frozen or canned vegetables are what you have access to or can reliably obtain, rest easy. They are often just as nutritious as the fresh. Processes like flash freezing ensure that nutrients are preserved. Canned vegetables are going to be higher in sodium due to the canning process and so should be rinsed well before cooking. The important thing is that you are eating more vegetables! Read some more about fresh versus frozen or canned vegetables here.
Are there any other ways that my food and lifestyle choices can help manage fatigue?
- Don’t skip breakfast. Doing so will literally ensure that you start the day with an empty tank and can lead to overeating later in the day. Try to include complex carbohydrates, protein and a healthy fat in your breakfast meal. A slice of whole grain toast with a cup of Greek yogurt topped with toasted walnuts is one (of many) example.
- Eat smaller meals. Large Meals can tax your digestive system and leave you feeling groggy for the afternoon. Food Coma!
- Large meals in the evening, especially those high in fat, can tax your digestive system and disrupt your sleep leaving you fatigued the next day.
- Eat More Frequently. Some people report increased energy with smaller more frequent meals throughout the day. This will provide a steady supply of nutrients to the brain without overloading your digestive process. Just make sure you are actually eating smaller meals, not just more frequent ones.
- Avoid or Limit Calorie Dense Foods With Very Little Nutritive Value. Processed foods with refined carbohydrates, simple sugars can contribute to glucose rollercoaster and leave you with the lethargic crash after the sugar rush. They will also most certainly be higher in sodium.
- Limit Dietary Sodium. Recent research suggest high dietary sodium intake is associated with in increased MS disease activity which in theory could lead to additional Primary Fatigue.
- Stay Hydrated! Dehydration is a leading cause of fatigue. Adequate hydration is always important but especially so with warm weather, exercise, a high fiber diet and some medications. Medications or herbal supplements that have a diuretic effect or that may lead to decreased sensation of thirst are of particular concern.
- Skip the Nightcap. Alcohol can interrupt sleep and excessive consumption can interfere with energy metabolism.
- Limit Caffeine. Caffeine can provide a quick burst of energy but it can backfire and result in a slump a few hours after it wears off. Caffeine can interrupt sleep when consumed in the afternoon and can contribute to dehydration as well.
- Maintain a Healthy Weight. Carrying extra pounds can be very tiring, contribute to joint pain, increase risk factors for comorbid conditions like heart disease, cancer and obstructive sleep apnea … all of which can contribute to a feeling of fatigue.
- Manage Your Stress. Relaxation techniques like meditation, a daily walk or a yoga class can help to reduce stress and fight fatigue.
- Stay Physically Active. Besides being good for general health, exercise has been shown to improve fatigue, depression and bladder & bowel control. Walking can improve mental clarity and help with cognitive fatigue. Go here , here and here for more information about MS and exercise.
- Do Not Smoke. Smoking increases your risk for heart disease, cancer and other diseases. It reduces the amount of oxygen in the blood and leaves you feeling fatigued.
Life Hacks for Eating Well When Fatigue is Present
Invest some time to plan out your week’s meals in advance. Include recipes, grocery list and time involved for each recipe.
Plan meal prep into your day or devote more time one day per week to lessen the time required each day.In other words, chop veggies for salads during the week or bake a chicken to be used in meals throughout the week, etc
When prepping or cooking, conserve energy by gathering all of your tools and ingredients in advance. Sit comfortably during meal prep to minimize fatigue.
Tip: Keep it simple! Search for quick, easy to prepare recipes that have few ingredients or uses a Crock Pot.
If cooking a favorite dish, make double and freeze some for a future meal when you are too tired to cook.
Tip: Use precut produce or frozen vegetables to save time.
Ask for help. With the planning, with the shopping and / or with the preparation as needed. Sometimes a small bit of assistance makes a huge difference. In my house getting my meat eating men to just tell me what they want to eat in the coming week can be a challenge…. and it never goes unappreciated when they are forthcoming with their meal requests.
If doing the shopping is too tiring for you, consider placing your grocery order online with a local grocer and then go pick it up, or have someone pick it up for you. Many local grocers are offering this option now. Depending on where you live, delivery may even be an option.