Category: Managing your Multiple Sclerosis

There are two broad ways in which diet and nutrition can be considered in relation to MS. The first and less contentious relates to your general health: ideas about what is a good diet for general health do, of course, change from time to time. The second deals with the possible beneficial or harmful effects that some diets themselves might have on either symptoms or, more fundamentally, on the underlying cause of the Multiple Sclerosis.
Diet is the most obvious and easy to implement factor that could be changed by people with MS, and many people have focused on this issue. Also, health care professionals are often very interested in diet and its effects on all aspects of general health. Although there has been research on diet and MS, it has not been a core interest of most researchers because Western populations are largely well-nourished – obesity and overeating, on the contrary, are major health concerns.
There have been many diets that have been suggested to affect either specific symptoms or the cause of MS. There is little evidence that any of these diets has the effects that their supporters suggest – however, we here discuss a number of the more plausible diets.

Essential fatty acids

One of the areas of nutrition that has been researched in relation to MS has been that of ‘essential fatty acids’, which form part of the building blocks of the brain and nervous system tissue, and are essential to the development and maintenance of the CNS. Actually essential fatty acid is rather an odd phrase in lay terms, for we are used to thinking of anything ‘fatty’ as very bad for you. However, there are many kinds of
‘fats’, ranging from the saturated fats, often found in meat and dairy produce, too much of which is not good for you, to the unsaturated and polyunsaturated fats, many of which are found in vegetable sources, and from some of which key essential fatty acids are derived – these are broadly very good for you. About 60% of normal nervous system tissue is made up of these ‘essential fatty acids’.
Some research has suggested that several of these essential fatty acids are present in lower quantities in the CNS of people with MS than in that of people without the disease; one theory has been that MS arose because, in their early years such people were deprived of (or unable to assimilate) these essential fatty acids in the development or maintenance of the structure and function of the CNS. However, the reasons for this lower level of fatty acids remain a matter of speculation. Is it a cause or effect of the disease? Does it occur very early in life? Some scientists have thought that the obvious remedy would be to increase the intake of these fatty acids. However, things did not prove to be as simple as that, for many of the essential fatty acids are produced indirectly by the breakdown in the body of particular constituents from the food that we eat.
The use of oil from the evening primrose plant, and some other oils, has become quite common amongst people with MS, for they do provide some of these constituents in a relatively ‘purer’ form but its effectiveness has not been proven scientifically. It is not clear, however, even if the level of the essential fatty acids is returned to ‘normal’, whether this will affect the course of Multiple Sclerosis, if the CNS damage has already been under way for some time. Research on this point has not proved conclusive, although many people with MS still feel that, on a precautionary basis, they wish to continue taking these essential oils.
It would not be wise to assume that, if you eat more of the food containing essential fatty acids, it will have a definite and positive effect on your MS or its symptoms. There are several reasons for this:

• The deficiency in essential fatty acids in the brain may be a result of some other process that causes MS; remedying this deficiency may not of itself produce major benefits in relation to the disease.
• The particular fatty acids, often in relatively short supply in the brain tissue of people with MS, are not ones that you can just eat
in increased quantity; they are actually produced by the body itself through a conversion process from other less complex fatty acids, and these you can eat. It is this conversion process in the body, which changes simpler forms of fatty acids into more complex
ones needed by the brain, that appears to be defective in people with Multiple Sclerosis. So, even if you have eaten good quantities of the simpler fatty acids, they may not be converted into the vital and more complex ones.
• The process of eating and digestion itself may reduce the amount of the simpler fatty acids being absorbed into the body.
• The relationship between increasing the intake of brain-building fatty acids and the subsequent symptoms of MS is not clear. In principle, whilst more of the fatty acids should assist nervous system function, the relationship between one and the other, and particularly in reducing any symptoms that you might have, appears to be very complex.
• It is likely that any damage to the nervous system from lower levels of essential fatty acids is longstanding, and has occurred, at least
in part, very early in life, so it would be very optimistic to expect major changes as a result of a change of diet perhaps several decades later.

Nevertheless, there are a number of studies, not many of them scientifically well designed, which suggest that there may be specific benefits to MS from increasing your intake of those foods that help form complex essential fatty acids, and from decreasing your intake of saturated fats. Although many people believe that this broad strategy can help fight the disease, most scientists and doctors do not.

Which foods are involved?
To get technical for a moment, there are two important families of essential fatty acids for brain function. The first of these is called the ‘omega-6 group’, with linoleic acid as its ‘parent’ – the parent meaning the basic fatty acid from which all the others in the family are derived. The second is the ‘omega-3 group’, with alpha-linoleic acid as its
‘parent’. In each case more complex fatty acids are formed in the body from simpler ones. Foods rich in the omega-6 family are those such as:

• sunflower and safflower seed oil
• evening primrose oil
• offal such as liver; kidney, brains, sweetbread
• lean meat
• legumes (peas and beans).

Food rich in the omega-3 family are:

• green vegetables
• fish and seafood
• fish liver oils
• linseeds
• certain legumes.

The difficulty is that most of these foods contain only small quantities of the relevant fatty acids, and then only in their simplest form. However, one or two foods have been found to have not only larger quantities of essential fatty acids, but to have them in a form that is closer to that needed by the brain. For example, the oil of the evening primrose plant has become a very popular dietary supplement for people with MS, because it is unique and contains large quantities of a substance called gamma-linoleic acid, a more complex form of linoleic acid, which is converted into further important fatty acids by the body. Some other rarer oils may also contain good quantities of gamma-linoleic acid.
In principle, the effects of taking these fatty acids could be profound on some key characteristics of the underlying pathology of MS, but in formal clinical trials the results have not been as good as hoped for, although there is some evidence from one or two good trials that attacks of MS may be fewer over time in those taking additional fatty acids. However, these results do not approach the more dramatic findings from studies on the latest immune-based drugs.
Many people with MS continue to take evening primrose oil even if, for example, they do not follow religiously all the other dietary recommendations, either as a kind of ‘insurance policy’, in that they are doing something that they hope will help the MS, or – and there are reasonable grounds for this – knowing that is not actually harmful, and may be helpful to your general health. It is likely to be a more costly alternative than modifying your diet to include some of the other foods containing essential fatty acids, but may be easier to manage. We must state again that the effectiveness of evening primrose oil has not been proven scientifically.

Saturated fats

People argue about whether changes in your saturated fat intake will make any difference to your MS. If, in general, essential fatty acids are
‘good’, then you could increase your intake of these as we have noted, and/or reduce your intake of the ‘bad’ saturated fats. Of course, there are general health grounds for suggesting that you should lower your intake of saturated fats, but some people who have devised low saturated fat diets for their MS claim that such diets may be far more beneficial for their MS. Again, there is little formal evidence that reducing your intake of saturated fats will specifically stabilize or improve your MS.

Exclusion diets

Cutting out saturated fats is an exclusion diet, but there are other diets that cut out many more specific substances. MS symptoms are considered by some people to be an allergic reaction to certain foods or drinks, and this view has led to other exclusion diets. One such diet is the
‘gluten-free diet’, in which it is argued that gluten has produced damage in the digestive and elimination system and has made the Multiple Sclerosis worse. Thus by eliminating gluten it is hoped that damage to the intestine can be prevented. Such diets were developed from those for people with coeliac disease who cannot absorb fats when gluten is present from cereal grains. At one stage these diets gained considerable popularity, but the burden placed on people with MS to stick to a very rigid gluten-free diet, together with disappointing results for many people and a lack of scientific support, has led to their decline.
The relative success claimed for very different diets in particular individuals suggests not so much that these diets are improving MS, but that concomitant problems are possibly being helped in some way by the diets. Of course, if your general health is better, you will feel better, and certain (but not all) symptoms of your MS might be a little improved. The key issue is balancing whatever benefits that you may be gaining against the costs, time and resources that you have to devote to maintaining what can be a formidable dietary regimen.

A healthy diet

There are certain general dietary principles now widely accepted for general health which, on those grounds alone, should be considered by people with MS. These include:

• very little intake of saturated fat (with very limited dairy produce, and generally only certain specific cuts of meat, liver for example);
• plenty of fish;
• a plentiful intake of vegetables and salads – either raw or as lightly cooked as possible;
• pulses;
• plenty of fresh fruit;
• a good intake of most nuts, seeds and seed oils (but excluding those containing saturated oils and certain nuts containing saturated fats, such as brazil nuts);
• as little as possible refined carbohydrates, sugar, processed or packaged foods;
• cutting down on alcohol consumption, and
• cutting out smoking.

In addition, if you want to supplement this diet with liver and/or evening primrose oil, for example, it will not do you any harm, as long as you don’t feel these supplements are adding greatly to your budget.
Most of these recommendations are broadly in line with more general nutritional advice for a healthy lifestyle, although they may be rather more draconian in relation to eating meat, for example than those general diets. So, even if you do not believe the various claims – some verging on the miraculous – that have been made by individuals for the diets devised for themselves or for their partners with Multiple Sclerosis, there are good grounds for following the broad guidelines. You may feel healthier on this kind of diet just because your general health might have improved. If symptoms of your MS have been helped, that would be a bonus.

Vitamin and mineral supplements

Most of the diets used by people with MS appear to be also supplemented by various vitamins and minerals. The value of these for MS itself is unclear, although there is a mountain of popular information suggesting that most vitamins and minerals in our bodies need supplementing. However, there is little scientific evidence that the average healthy adult with a reasonably balanced diet needs any significant vitamin or mineral supplements. The key questions for people with MS are:

• How much has your general health been compromised and do you need supplementation for this?
• Will additional vitamins and minerals help your MS?

As far as general health is concerned, it is clearly important that people with MS receive a balanced intake of vitamins and minerals appropriate to their age, gender and situation. This can best be undertaken through a balanced diet, of the general kind we have mentioned above. Supplementation should only be necessary where, for various reasons, it is not possible to follow such a diet. There is little scientific evidence that supplementing beyond this general level will produce significant health benefits, although many popular books appear to suggest so.

Vitamin supplements
There is no scientific evidence that serious deficiencies in vitamin intake could produce the kind of damage in the nervous system evident in Multiple Sclerosis. So, conversely, the key question is whether major supplementation could produce beneficial effects. Since the 1920s there have been claims that supplementation with various vitamins (A, B1, B6, B12, C, D, E, K) singly and in combination, administered by mouth, injection or intraspinally, have had some beneficial effect on MS. Most of these studies have not been controlled against a group of people with MS who did not take the vitamins and, for various other reasons, the studies have been scientifically dubious.
Although some of the studies suggest the benefits of vitamin supple- mentation, it is likely that most of these benefits were the result of the often spontaneous and unpredictable changes in the course of MS, and not the vitamins themselves. High dose ‘megavitamin’ therapy has also become relatively popular. Although there are many anecdotal reports of changes in MS, there is still no reliable scientific evidence that ‘megadoses’ of any vitamin or vitamin combinations have any effect on the course of the disease. The administration of vitamins A and D, in particular, has to be undertaken carefully as they are toxic in high doses. Vitamin B6 may also produce symptoms in the peripheral nervous system at high doses, and vitamin C can produce stomach problems and kidney stones.
Overall, the formal evidence on vitamins and MS suggests that, apart from taking care that you have a normal balanced intake of vitamins, there is little to be gained from major supplementation of vitamins in your diet.

Mineral supplements
A broadly similar position seems to apply here. Many minerals have been tried in Multiple Sclerosis over the years. These have ranged from gold, silver, mercury, arsenic, thorium, metallic salts and potassium bromide to, more recently, manganese, zinc and potassium gluconate. There is a paradox that some of the metals tested earlier, for example mercury, can produce neurological symptoms themselves. The more recent candidates are generally based on a sounder principles, but they have not, for the most part, been subjected to careful evaluation through formal scientific studies.
There is a problem in devising effective vitamin or mineral therapies, even if it is accepted that there is a key role for minerals and vitamins in MS, in that how the body uses them is poorly understood. Often it is not the presence of a major dose of some mineral or vitamin that is the key, but the fact that they all work in a complex way together. Also, many mineral and vitamin supplements are not taken in a form that the body can easily use, and are in any case changed, as in the case of essential fatty acids, into the different substances needed by the body. This is why it is far better, if possible, to eat a balanced diet rather than go to the expense of supplements.
In general, there is little evidence that major doses of any minerals or vitamins will help MS, and a number – indeed perhaps most – are toxic when used in large doses, and produce neurological symptoms themselves.

Nutrition and weight reduction

This can be a problem for all or us! As we grow older, everyone tends to put on more body weight, unless we become increasingly careful about what we eat and how we exercise. When you are in a wheelchair, or are sitting down most of the day, clearly you are likely to get less exercise than you used to do. Lack of exercise together with a fondness for processed carbohydrates and getting a little older, produces the weight gain. It can be tackled in a number of ways, but for anyone who has evolved a lifestyle – whether by force or design – that has led to weight increase, it is not an easy task to take it off again.
In seeking to reduce weight it is important to tackle the problem sensibly. Just eating very little is not necessarily the right solution, for your diet must be a balanced one. It is also important to bear in mind that almost all weight loss achieved very quickly is put back on again within a short period of time.
Even more concerning, in the case of multiple sclerosis, is that in rapid weight loss, a proportion, and sometimes a substantial proportion can involve loss of muscle tissue, even when people are considerably overweight – this is the last thing that people with Multiple Sclerosis should be risking.
Thus it is important to have a long-term plan of weight loss in which you should not aim to lose much more than a pound a week. This steady loss of weight is less likely to be put on again quickly, and it will not risk muscle loss in the same way as very rapid weight loss. You ought to try and get back to a diet with less processed carbohydrates and more fresh fruit and vegetables. By and large vegetables are bulky but have far less carbohydrates, including saturated fats, than processed foods. It may mean a bit of painful adaptation as you change from sweet, sugary and fat-based foods to others, but it is worth the effort. Perhaps one of the most important things is to try and make this a family affair for you and your partner, friend or children. Food eating is a social activity and being a successful dieter often involves not just getting the moral support of others, but their joining in with you. It will be good for them as well!
As far as exercise is concerned, there are more things than you usually think that you can do if you are in a wheelchair. You should ask your physiotherapist in particular what exercises you can do. Find out about any classes you could join at local sports and leisure centres: they are increasing in popularity, again on the principle that group support is important in maintaining exercise.  In general, losing weight is easier if you have other things to do, and are not thinking about food as the main highlight of your day. Good luck!