Healthy Eating: A guide for people with MS · PDF fileHEALTHY EATING: A GUIDE FOR PEOPLE WITH MS Like everyone else, people with MS can benefit from a healthy diet. This booklet explains

Healthy Eating:

A guide for people

with MS

Written by James Bailey

This publication has been reviewed by Carrie Shea, Registered Dieticianof Canada.

© 2008 Multiple Sclerosis Society (Great Britain and Northern Ireland).

Reprinted by the Multiple Sclerosis Society of Canada with permission ofthe Multiple Sclerosis Society of Great Britain and Northern Ireland.

Canadian adaptation and editing: Nadia Pestrak

Further acknowledgements: Thanks to Jennifer Carstens, Jennifer Eades,Atul Gadhia, Colleen Harris, Wendy Morrison, Jackie Munroe, Dr. Paul O'Connor and Nadia Pestrak.

Design and Publishing: Greenwood Tamad Inc.

ISBN 0-921323-97-2

HEALTHY EATING: A GUIDE FOR PEOPLE WITH MS

Multiple Sclerosis Society of Canada, 2008Legal Deposit –National Library of Canada

COVER ARTWORK Diane EstrabrookPear Power, Watercolour on paper

"Pear Power is an analogy for me; I can either stand out or sit out in life."

Diane Estabrook has had MS as long as she has painted.With over 30 years of joy and struggle behind her, she hasnever given up. Diane bought a business at age 43, achieveda BFA degree at 49 and received a certificate in ArtsManagement a year later.

This is the second time one of Diane’s paintings has appearedon the cover of an MS Society of Canada publication. GoneForever appears as cover art on the publication CognitiveChange and Multiple Sclerosis.

HEALTHY EATING: A GUIDE FOR PEOPLEWITH MSLike everyone else, people with MS can benefit from a healthydiet. This booklet explains what is meant by a ‘well-balanceddiet’, why we should all be aiming for one and how to getone. You might find that symptoms of MS affect what you caneat or how you prepare meals. Learning new ways of cooking,or using energy-saving tips can help you carry on eating whatyou enjoy. Adjusting to MS will not always mean changingyour diet, but sometimes it can help. Many special diets havebeen proposed as treatments, but none have been proven toprevent MS or affect the way it may develop. Special diets arebest approached with caution as some may be expensive oreven harmful. Most people do not need to use expensivesupplements either. You can usually obtain the nutrients youneed through your daily meals. With careful planning, perhapswith the help of a dietitian, you can make sure you meet yourdietary needs – even if they change over time. Many peoplewith MS report that they feel better when they eat well.

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Table of Contents

A well-balanced diet .............................................................6Practical suggestions for a balanced diet ...........................10Practical solutions for preparing food .................................13Managing your weight........................................................17Diet and your MS ................................................................19Caring for the dietary needs of people more severely affected by MS ......................................................23Research into diet and MS ..................................................26Essential fatty acids and MS ...............................................27Vitamins, minerals and MS..................................................29Further information .............................................................31

The benefits of a well-balanced dietEating nutritionally balanced meals helps the body work to itsfull potential, which is particularly important for people livingwith long-term, unpredictable conditions like MS. The effects ofMS vary from person-to-person and can change from one dayto the next. Many people find they can improve their quality oflife and sense of well-being by focusing on aspects of healththat can be controlled and changed – such as diet. This,combined with appropriate exercise, can help:

‹ weight control‹ decrease fatigue‹ maintain regular bowel and bladder function‹ minimize the risk of skin problems‹ keep bones healthy and strong‹ maintain healthy teeth and gums‹ strengthen the heart‹ improve muscle strength and range of motion‹ increase flexibility

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What makes up a healthy, balanced diet?It is now widely recognized that a healthy diet contains abalance of the major food groups:

‹ proteins – for growth and tissue repair;‹ carbohydrates – for energy;‹ fats – to absorb certain vitamins and for essential

fatty acids;‹ fibre – for healthy digestion;‹ vitamins and minerals – for numerous processes in the

body, including tissue repair, bone strength and theabsorption of other nutrients; and

‹ fluids – for optimum working of the body. Water carriesnutrients around the body and is used in the variouschemical processes carried out in our cells.


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A WELL BALANCED DIET‘A healthy, well-balanced diet, combined with exercise has awide range of health benefits.’

The chart below from the Canada Food Guide shows howmany food guide servings you need from each of the four foodgroups every day. Having the amount and type of foodrecommended will help:‹ meet your needs for vitamins, minerals, and other nutrients;‹ reduce your risk of obesity, type 2 diabetes, heart disease

and certain types of cancer and osteoporosis;‹ contribute to your overall health and vitality.

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Children Teens Adults

4 5 6

3 4 6

2 2 3-4

1 1 1-2

Age in Years 2-3 4-8 9-13 14-18 19-50 51+

Sex Girls and Boys Females Males Females Males Females Males

Vegetables andFruit

Grain Products

Milk andAlternatives

Meat andAlternatives

7 8

6 7

3-4 3-4

3-4 3-4

7-8 8-10

6-7 8

2 2

2 3

7 7

6 7

3 3

2 3

What is one food guide serving? Look at the examples below:


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Vegetablesand Fruit

Fresh, frozen, orcanned vegetables125 mL (1/2 cup)

Leafy vegetablesCooked: 125 mL(1/2 cup)Raw: 250 mL (I cup)

Fresh, frozen orcanned fruits1 fruit or 125mL(1/2 cup)

100% juice125 mL (1/2 cup)

Grain Products Bread 1 slice (35 g) Cooked rice, bulguror quinoa 125 mL(1/2 cup)

CerealCold: 30gHot 175 mL (3/4 cup)

Cooked pasta orcouscous 125 mL(1/2 cup)

Milk andAlternatives

Milk or powderedmilk (reconstituted)250 mL (1 cup)

Fortified soybeverage 250 mL (1cup)

Yogurt175 g (3/4 cup)

Cheese 50 g (1 ½ oz)

Meat andAlternatives

Cooked fish,shellfish, poultry,lean meat 75 g (2 ½ oz.)/125 mL(1/2 cup)

Cooked legumes175 mL (3/4 cup)

Eggs2 eggs

Peanut or nutbutters 30 mL (2 Tbsp)

You can find out more information about Canada’s Food Guiderecommendations by going to the website: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php or bycalling Health Canada at: 1-800-622-6232.

These food groups contain nutrients with specific roles and alack of any of these may cause health problems directly, oraffect how other nutrients are absorbed by the body. Forexample, a lack of calcium can cause bone weakness, but evenif there is enough calcium in the diet, a lack of vitamin D canslow the absorption of calcium and also lead to boneweakness. This is why it is important that there is a balance ofall these food groups in your diet.

Remember that there is no harm in the occasional treat that ishigh in saturated fat, sugars or salt. You needn’t feel guilty forenjoying a chocolate bar or bag of chips every now and then.Some treats can be healthy! Strawberries, for instance, are fullof vitamins and zinc, even if they do have a little cream pouredover them. Dining out can also be a good way to try newthings – and can give you new ideas to try out at home.

Can supplements help, or be used insteadof fruit and vegetables? Vitamins and minerals have a number of vital functions in thebody. Certain drug treatments can lower levels of vitamins andminerals in the body and a doctor or dietitian may suggestsupplements to replenish these. But a balanced diet usuallyprovides a sufficient supply for most people and there is noevidence that high doses benefit people with MS. Excess vitaminsand minerals can be harmful. Some studies have suggestedthat eating fruit and vegetables has greater health benefitsthan taking vitamin and mineral supplements. This is becausesupplements do not contain many of the nutrients known as‘phytochemicals’, which are found in fruit and vegetables.These nutrients have only recently been looked into, but itappears they may have health benefits. In addition to this, fruitand vegetables are healthy sources of fibre and carbohydrates.

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Vegetarian and vegan dietsVegetarian and vegan diets may need more careful planning toensure they cover all essential nutrients, but a dietitian canhelp you find alternatives.

Food allergy and intoleranceResearch does not support the use of gluten-free or other dietsexcluding specific foods to treat MS. However, just like anyoneelse, people with MS can react to particular foods. If you thinkyou may have an intolerance or allergy, your doctor or dietitiancan help you look into it further. Reliable testing for foodallergies or intolerance involves following a properly supervisedexclusion diet. As this process can be time-consuming,inconvenient and costly, it is worth considering the pros andcons: will following the diet be worse than the symptoms itcould alleviate; will you still be able to have a balanced dietand maintain a healthy weight and, how would such a dietimpact on finances, shopping, cooking, family meals and mealsout?

Adapting to a new diet and newtechniquesThe effects of MS vary greatly and you may never experiencesome of the symptoms or problems mentioned in this booklet.Changes to your circumstances might affect the foods youchoose and your nutritional needs.


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Because everyone has different experiences, culture andlifestyle, how each person adapts will vary. Food is more thanjust a necessity. It can also be a social activity, so any changesto your diet need to be realistic and suited to your lifestyle aswell as your dietary needs. Be ready to try new things – if youchoose healthy food that you like, it might be easier to stick toany changes you make.

Some MS symptoms can have an impact on dental hygiene, so it is important to have regular check ups with your dentist.Tremor and fatigue, for example, might both make brushingyour teeth more difficult. Certain drugs used to treat MSsymptoms can cause a dry mouth, which might also affect thehealth of your teeth and gums. Your dentist may recommend amouthwash or fluoride gel to help avoid problems and cangive advice on the easiest ways to brush effectively.

PRACTICAL SUGGESTIONS FOR A BALANCED DIETOf course, our eating habits don’t neatly fit into diagrams orlists of food groups, and judging whether a diet matches theseproportions can be difficult. Planning a flexible menu for theweek can be helpful, and by following some simple principlesof healthy eating, you can be confident you are getting abalanced diet.

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Five

por

tion

s of

fru

it o

r ve

geta

bles

ever

y da

y in

clud

ing

one

port

ion

ofda

rk g

reen

, lea

fy v

eget

able

s

Use

pol

yuns

atur

ated

mar

gari

nes

and

oils

suc

h as

sun

flow

er o

il or

cor

n oi

l,in

stea

d of

sat

urat

ed f

at s

uch

as la

rdan

d bu

tter

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Gri

ll, b

ake,

ste

am o

r po

ach

food

inst

ead

of f

ryin

g.

Choo

se le

an c

uts

of m

eat.

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dog

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and

ham

burg

ers

are

ofte

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ghin

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at.

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d to

o m

uch

satu

rate

d fa

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and

shor

teni

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ds li

ke p

astr

y,

cake

s an

d ch

ocol

ate.

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a

non-

hydr

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mar

gari

ne.

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uit a

nd v

eget

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s are

goo

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urce

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vita

min

s, m

iner

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and

fibre

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en, l

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veg

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les

also

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ain

a sm

all a

mou

nt o

f an

omeg

a 3

esse

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l fat

ty a

cid (E

FA).

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nflo

wer

oil

and

corn

oil

are

polyu

nsat

urat

ed fa

ts w

hich

are

also

good

sou

rces

of t

he o

meg

a 6

EFAs

.

•Fr

ying

food

s of

ten

mea

ns u

sing

mor

e fa

t. It

is be

tter t

o us

e th

ese

low

er fa

t coo

king

opt

ions

.

•M

eat i

s ric

h in

iron

, zin

c, B

vita

min

san

d pr

otei

n.

•W

hen

liqui

d ve

geta

ble

oil i

s tu

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into

sol

id fa

t – th

roug

h a

proc

ess

calle

d hy

drog

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ion

– ha

rmfu

l‘tr

ans

fats

’ can

be

form

ed. L

ike

satu

rate

d fa

t, tra

ns fa

ts c

an ra

isebl

ood

chol

este

rol l

evel

s.

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tam

ins

and

min

eral

s ha

ve m

any

bene

fits,

inclu

ding

wor

king

as

antio

xida

nts

and

help

ing

the

body

use

oth

er n

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nts

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bre

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ep th

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gest

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y.•

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ega

3 EF

As a

re im

porta

nt fo

r a h

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y ne

rvou

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rt an

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meg

a 6

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are

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lthy

nerv

ous

syst

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lyuns

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ates

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lood

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lest

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ls an

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ore

help

redu

ce th

e ris

k of

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rt di

seas

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n sa

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ted

fats

can

redu

ce th

e ris

k of

hea

rt di

seas

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n he

lps

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bloo

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car

ry o

xyge

n ar

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the

body

.•

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is im

porta

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r hea

ling

and

repa

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d al

low

s th

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carb

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rate

s, fa

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pro

tein

s ef

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ivel

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amin

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var

iety

of u

ses:

to m

anta

in a

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lthy

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ore

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ergy

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our

food

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the

body

.•

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ody

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Sugg

esti

onN

utri

tion

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lth

bene

fits

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Eat

at le

ast

two

port

ions

of

fish

aw

eek,

one

of

whi

ch s

houl

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oily

fish

like

mac

kere

l, pi

lcha

rds,

salm

onor

sar

dine

s.

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low

-fat

dai

ry p

rodu

cts

such

as

skim

med

milk

, low

-fat

yog

urt

or

low

fat

che

eses

.

Eat

who

lew

heat

bre

ad a

ndw

hole

grai

n ce

real

s.

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nk s

ix t

o ei

ght

cups

of

fluid

dai

ly(a

bout

1.5

litr

es).

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’t r

ely

on h

igh-

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dri

nks,

such

as

coff

ee, t

eaan

d co

la.

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h is

a go

od so

urce

of p

rote

in,

vitam

ins a

nd m

iner

als,

such

as

sele

nium

and

iodi

ne.

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ly fis

h is

rich

in o

meg

a 3

EFA

and

vitam

ins A

and

D.

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iry p

rodu

cts a

re a

goo

d so

urce

of

prot

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cal

cium

and

vita

min

s A, B

12,

and

D.•

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er fa

t alte

rnat

ives,

like

skim

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and

1% m

ilk, r

educ

e th

e fa

t but

kee

pth

e ot

her n

utrie

nts.

• A

low

-fat s

ourc

e of

car

bohy

drat

es.

• Hi

gh in

B v

itam

ins a

nd v

itam

in E

.•

High

in fi

bre.

• W

ater

is n

eede

d fo

r the

bod

y to

func

tion.

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meg

a 3

EFAs

are

impo

rtant

for a

hea

lthy

nerv

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syst

em, h

eart

and

circu

latio

n.•

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min

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goo

d fo

r the

ski

n an

d ey

es.

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tam

in D

hel

ps k

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bone

s an

d te

eth

heal

thy.

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leni

um p

lays

a ro

le in

a h

ealth

y im

mun

e sy

stem

and

act

s as

an

ant

ioxi

dant

.•

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ne h

elps

pro

duce

impo

rtant

hor

mon

es fo

r a h

ealth

y m

etab

olism

.•

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te fi

sh is

par

ticul

arly

low

in fa

t.

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otei

n is

need

ed fo

r the

bod

y to

repa

ir an

d he

al it

self.

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lcium

and

vita

min

D a

re n

eede

d fo

r stro

ng b

ones

and

teet

h.•

Vita

min

A is

goo

d fo

r the

ski

n an

d ey

es.

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tam

in B

12 is

impo

rtant

for a

hea

lthy

nerv

ous

syst

em.

•Ca

rboh

ydra

tes

are

a vi

tal s

ourc

e of

ene

rgy.

•Vi

tam

in E

has

man

y fu

nctio

ns, i

nclu

ding

as

an a

ntio

xida

nt.

•B

vitam

ins

have

a v

arie

ty o

f use

s: fo

r a h

ealth

y ne

rvou

s sy

stem

, to

rele

ase

ener

gy fr

om o

ur fo

od a

nd to

hel

p bl

ood

carry

oxy

gen

arou

nd th

e bo

dy.

•Fi

bre

help

s ke

ep th

e di

gest

ive

syst

em h

ealth

y. A

high

fibr

e di

et

cont

ains

25-

30g

of fi

bre

daily

.

•De

hydr

atio

n ca

n af

fect

mem

ory,

conc

entra

tion

and

ener

gy le

vels.

• A

good

flui

d in

take

can

hel

p ke

ep th

e bl

adde

r and

bow

els

heal

thy.

•Ca

ffein

e an

d al

coho

l can

mak

e th

e bo

dy m

ore

dehy

drat

ed.

Sugg

esti

onN

utri

tion

Hea

lth

bene

fits

PRACTICAL SOLUTIONS FOR PREPARING FOOD

‘Some tasks can be done just as well sitting as standing.’

‘If you live with others, sharing tasks can make preparingmeals easier and quicker.’

‘There are gadgets and tools to help with almost every dailytask in the kitchen.’

Living with MS can mean that regular tasks like shopping andpreparing food take longer or need more careful planning. Forexample, fatigue can make shopping trips over-tiring, or tremorcould make chopping vegetables difficult. An occupationaltherapist can suggest energy saving tips and helpful equipmentor adaptations. They can also advise on grants that may beavailable for adaptations.

ShoppingThere are many grocery delivery services available, includingonline shopping, which can save a trip round the supermarket,and avoids carrying heavy shopping home.


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Techniques for preparing foods‹ To avoid moving around the kitchen unnecessarily, why not

gather all the ingredients together before you start tocook? Some people prefer to use a table in the kitchen toeat at, rather than carry meals to another room. If balanceis a problem, grab rails can be fitted to many kitchen unitsand walls.

‹ Cooking with a microwave means there are no heavy pansto lift.

‹ Some tasks can be done just as well sitting as standing.Overhanging worktops can often be fitted to kitchens tomake this easier. Height-adjustable stools and stools withsloping seats can make getting up and down less tiring.

‹ Dishwashers can make cleaning less tiring, but may not be the best option for all as they still need to be filled and emptied.

‹ If heat makes symptoms worse, microwaves can help asthey don’t warm the kitchen while cooking. Inductionhotplates also warm the pans without heating the airaround them.

‹ If you live with others, sharing tasks can make preparingmeals easier and quicker, and cooking together can be fun.


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Pre-prepared foods‹ If preparing food is difficult or tiring, ready-made meals can

be a good solution. However, they are sometimes high infat and salt so may not be suitable for every day. Dietitianscan advise on easy-to-prepare alternatives or ways tosupplement your diet if you rely greatly on ready meals.

‹ Many communities throughout the country offer a meals onwheels service – where ready-prepared meals are deliveredto your door. Check your your local MS Society to see whatis available in your area. Caterers can usually meet specialrequirements on health or religious grounds.

Practical equipmentThere are gadgets and tools to help with almost every dailytask in the kitchen. The list below gives an idea of what isavailable. An occupational therapist can help you identify whatwould be helpful in your particular situation. You can also findinformation via organizations like:

The Abilities Foundation www.enablelink.org

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Call your local MS Society of Canada if you have any questionsabout what resources or services might exist in your community.

If grip is difficult or dexterity affected:

‹ jar and ring-pull openers

‹ easy-grip handles on cutlery, peelers and other utensils

‹ tap turners – large handles to fit over existing taps

‹ knob turner – adaptable gadget that fits many differentshapes and sizes to help with fiddly controls

‹ two-handed cups

‹ non-slip chopping boards

If lifting heavy items is difficult:

‹ cooking baskets – let you lift food in and out of pans,rather than lifting a heavy pan of boiling water

‹ a wheeled trolley – to move ingredients, pans and preparedfood more easily

‹ kettle tipper – lets you pour a kettle without lifting it

If you have visual problems:

‹ large controls and displays on ovens, microwaves, timersand weighing scales

‹ speaking weighing scales


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‹ coloured tape around worktops can help provide acontrasting edge

‹ brightly coloured chopping boards, cutlery and utensils alsocontrast better with surfaces and make items easier to spotin drawers

MANAGING YOUR WEIGHTBoth weight loss and weight gain can be a problem for peoplewith MS, but this can be managed and controlled by tailoring a‘personal diet plan’. A dietitian can help you develop a planthat adjusts as your needs change, ensuring you always get ahealthy balance of nutrients. It is not always easy to stick to arigid plan, so keep it flexible and remember that occasional treatsare not forbidden. Remember also that weight problems maynot be directly linked to your MS. Your doctor or other healthcareprofessional can investigate the problem to find the cause.

Weight lossIf someone is underweight they may become malnourishedand weak, which can make MS symptoms like fatigue, muscleweakness or spasms worse.

There are many reasons people with MS might not eat as much asthey need. Problems with posture, swallowing, fatigue and tremorcan all make shopping for, preparing or eating food more difficult.Appetite can also be affected by stress, anxiety and depression,as well as certain drug treatments. You should approach yourdoctor if you have concerns about any of these issues.

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Because early signs of malnutrition, like fatigue and muscleweakness, can also be symptoms of MS, the problem mayinitially go unnoticed. Your doctor or dietitian can helpinvestigate and treat the underlying causes of your weight loss.

If getting enough energy and nutrients is difficult, over-the-counteror prescription supplements may be useful. If you use high-energy foods and drinks, remember that they often have high-sugar content, so early, preventative dental care is important.

Weight gainKeeping generally fit and healthy can make it easier to copewith the symptoms of MS. But having MS may mean you areless active than you once were, so you might find you put onweight. Appropriate exercise and a healthy, balanced diet canhelp you return to your healthy weight, but there may beadditional things you can do to help with weight loss.

For example, to keep up an adequate intake of liquids, somepeople rely on fruit juices or sugary drinks. Switching to wateror low-sugar versions could cut down the calories withoutrisking dehydration.

Sugary and fatty snacks are sometimes ‘comfort food’ at timesof stress and worry. Occasional snacking like this should be nogreat cause for concern, but if you are “comfort” eating a lotand think you may be depressed, discuss this with your doctoras depression is treatable. Some drug treatments, includingsteroids used for acute relapses, can also cause weight gain.


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DIET AND YOUR MSCertain changes to what and how you eat may help withmanaging the effects of MS.

Bladder problemsSome people with bladder problems drink less to reduce theirneed to use the toilet. However, this can mean you have moreconcentrated urine, which can irritate the bladder and increasethe chances of getting urinary tract infections. Drinking six toeight cups (about 1.5 litres) of water per day is generallyrecommended. It is best to avoid large quantities of caffeineand alcohol as these irritate the bladder.

Bowel problemsDietary changes are often suggested as the first line oftreatment for people with MS who experience constipation.Good fluid intake can help regular bowel function, as can adiet with plenty of insoluble fibre. This fibre cannot be digestedand passes straight through the gut, helping digestion of otherfoods and removal of waste. A well-balanced diet, with plentyof fruit and vegetables can provide this fibre. Prunes (or prunejuice), figs, wholewheat bread, fibre-fortified white bread,brown rice and high fibre breakfast cereals are particularlygood sources of insoluble fibre.

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Swallowing problems – DysphagiaDifficulties with swallowing – or dysphagia – can be a distressingsymptom, especially if not managed properly, but there are anumber of ways to modify your eating habits or diet that can help.

‹ If chewing is difficult, try to avoid tough or stringy food.

‹ If big meals are a problem, small, frequent meals and highcalorie drinks can help to ensure you get enough calories.

‹ A change in your seating position may make swallowing easier.

‹ Soften food with a fork or blender to minimize chewingand make swallowing easier.

‹ If swallowing is difficult, thin fluids like water or tea can godown the wrong way, causing discomfort and a potentialchoking hazard. Using thickening agents in drinks can helpand are available over the counter and/or by prescription.

‹ Some people find it harder to drink enough fluid through theday when drinks have been thickened. To avoid dehydration,sip little and often. Pre-thickened fruit juices, also availableover the counter and/or on prescription, may be moreappetizing and they are always the right consistency.

‹ If swallowing difficulties are causing weight loss, nutritionalsupplements might be helpful.

These ways of eating and drinking might also help if youexperience facial pain (trigeminal neuralgia), which can makeopening the mouth and chewing difficult.


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FatigueFatigue can sometimes be helped by adjusting the diet. Forthose who get tired quickly, eating large, hot meals can bedifficult, so smaller, more frequent snacks may be better.Proteins with all meals or snacks, or complex carbohydratessuch as a wholegrain bread can help keep energy levels up.Relying too much on sugary foods for energy can make fatigueworse, as they cause energy peaks followed by lows.

Dehydration can lead to tiredness, so aim to drink six to eightcups (about 1.5 litres) of fluids per day. Drinks that contain alot of caffeine, such as tea, coffee and cola can have a pick-me-up effect initially, but too much caffeine can dehydrate you.

TremorTremor can affect your nutritional needs or your approach toeating. Constant tremor uses up calories, so high-energy foodsand drinks between meals might be necessary to avoid weightloss or worsening fatigue.

If tremor affects holding or reaching for things, certain foodsmay be easier to eat than others. A sandwich, for example, iseasier to manage than spaghetti or soup. Specially designedcutlery, crockery and kitchen utensils can make the preparationand eating of food more manageable.

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Visual problemsDouble-vision or blurring may make preparing or eating foodmore time consuming and may seem to limit choice. However,there are practical solutions that can help. These are outlinedon page 16.

OsteoporosisOsteoporosis causes bones to become fragile and increases therisk of breaking. Several factors may increase the risk ofosteoporosis for people with MS:

‹ extensive use of steroids to treat relapses;

‹ a lack of weight-bearing exercise, for example, for thosewho are less mobile;

‹ avoiding sunlight because of heat sensitivity or fatigue,leading to lower vitamin D intake.

To help reduce this risk, it is important to keep up good levelsof both vitamin D and calcium in the diet, as these both helpkeep bones strong and healthy. In addition, researchers arealso now looking carefully at vitamin D as a way to possiblyreduce the risk of MS developing in the first place.

Good sources of vitamin D include oily fish, liver and eggs.Many physicians now suggest that people with MS mightbenefit from taking a daily intake of 1,000-2,000 IU of vitaminD because they may be vitamin D deficient.


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Milk and dairy products are the richest sources of calcium, buttinned sardines, sultanas, bread, spinach and red kidney beansare also good sources. Skimmed milk contains as much calciumas full-fat milk, so cutting down on fat need not mean losingout on calcium. Calcium-enriched soya products offer a non-dairy alternative.

Pressure soresIf someone lies or sits in one position for long periods, there isa risk of pressure sores developing. Losing too much weightcan add to this risk if you lose the natural padding over bonypoints. A dietitian can help you monitor and maintain a healthyweight to avoid this.

CARING FOR THE DIETARY NEEDS OFPEOPLE MORE SEVERELY AFFECTED BY MSSome people more severely affected by MS can find food andfluid intake difficult. They may be unable to prepare meals, buyfood or plan a balanced diet. Caregivers – sometimes family orfriends – may become more involved and might want toconsult specialist healthcare professionals to ensure they aremeeting the dietary needs of the person they care for.Professional advice can benefit everyone – getting a healthybalanced diet is valuable for caregivers too.

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Likes and dislikesWhatever someone’s needs or restrictions when eating anddrinking, they will have favourite foods and foods they wouldrather avoid. Religious, cultural and personal tastes should allbe taken into account with any changes that need to be made.

Making changes to a diet can mean having to cook new foods,or prepare them in new ways. A ‘likes and dislikes’ list can helpmake meals enjoyable as well as nourishing. A dietitian canhelp with this, ensuring the list of ‘likes’ is broad enough tokeep things interesting as well as healthy, accommodatingtastes and preferences as much as possible. A perfectlybalanced diet is of no use if it is left uneaten!

Planning for the weekIt is not uncommon for someone to have a number ofcaregivers, possibly a mix of professionals, friends or family. Ifseveral people assist with food, it can help to monitor mealsprepared, to be sure there is a good overall balance. Agreeingon a weekly plan is one way to do this. Shopping lists can betailored to the weekly plan, avoiding food going to waste andunnecessary trips to the grocery store. Also, getting together toplan the week’s food lets everyone have input, even if they donot visit the grocery store themselves. Internet shopping isanother way to choose groceries from home.

Keeping the plan flexible allows for the changes and surprisesthat can happen in daily life. The idea is to plan for a healthy,balanced diet, rather than regiment an everyday activity.

Make food and drink accessibleIt can be handy to have a selection of food and drinksavailable and easily accessible night and day. A secure, cleanplace to store food and drink near the bedside, for example,can save unnecessary trips to the kitchen – and is especiallyhelpful if eating regular small meals or sipping drinks.

Some people with severe visual problems find it helpful if foodis set out in an agreed way. For example, laying out thedifferent parts of a meal as if the plate were a clock facemakes it easier to choose which foods to eat – potatoes mightbe placed at ‘12 o’clock’ and meat at ‘6 o’clock’.

Chewing and swallowing – Feeding TubeIf chewing and swallowing are so difficult that softening food,thickening drinks and eating small meals fail to stop weightloss or dehydration, the use of a feeding tube may beappropriate. A Speech and Language Pathologist can assess aperson’s need for a feeding tube.

A feeding tube allows nutritionally complete liquid food to godirectly through a tube into the stomach and can be a relief tothose who have severe chewing or swallowing difficulties.People can often continue to eat a little by mouth, so they canstill enjoy their favourite foods.

The feeding tube is usually fitted under local anaesthetic andthe process is fully reversible if no longer needed. Even so, itcan still be a daunting step for a person with MS and their


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caregivers. Some changes to a person’s lifestyle are inevitableand caregivers will need to learn to care for the feeding tube.Public Health Nurses and dietitians can help when consideringtube feeding, or if issues arise once a feeding tube system isfitted.

RESEARCH INTO DIET AND MSNo diet has been proven to impact the course of MS. That said,it makes sense to choose healthy, nutritious foods. A diet lowin saturated fats (meat, eggs, dairy products) and high inmonounsaturated fats (canola oil, olives and olive oil, nuts,seeds, avocados) and polyunsaturated fats (flaxseed oil, fishand fish oil) may be helpful. Some individuals with MS believethat avoiding wheat and dairy products helps alleviate theirsymptoms. Eating plenty of fruits, grains and vegetables helpsto keep your heart healthy, avoid constipation, and maintain ahealthy weight.

In addition, people with MS sometimes wonder whether theyshould take extra vitamins or food supplements. There is noscientific evidence that they will make a difference with oneexception. Researchers are now looking carefully at vitamin Das a way to possibly reduce the risk of MS developing in thefirst place. In terms of food supplements, people with MSshould avoid those that claim to boost the immune system.That could be a problem in MS, which results because of amisdirected immune attack on myelin within the centralnervous system.

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Effective studies into diet can be more difficult to design andcontrol than laboratory trials into drug treatments. To beconfident in a trial, researchers have to account for anythingthat may affect the results. For example, if a new drug is givento a group of people in a trial, researchers need to know if anyof them are already taking other drug treatments. If they are,this could explain unusual results. However, because diet ispart of a person's everyday life and within that diet they willeat many different types of food, it is almost impossible toensure everyone involved in the trial eats exactly the samethings, over a long period of time. This makes it very difficult toclosely monitor particular foods and draw definite conclusionsfrom the research.

Currently, research does not show that diet causes MS. Neitherhave any special diets been proven to prevent MS or affect theway it may develop. Research has not found that high-doses ofany vitamins or minerals are of any benefit either.

A healthy, balanced diet will usually provide you withappropriate levels of nutrients. High doses of certain vitaminsand minerals should be avoided as they may do more harmthan good.

ESSENTIAL FATTY ACIDS AND MSOne aspect of MS research that has received a lot of interest inrecent years is the role of fats and oils, also known as ‘lipids’.There are three main forms of lipids in our diet: saturated,monounsaturated and polyunsaturated. Lipids are a source ofenergy that store certain vitamins. They have received


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particular attention in MS research because they also have arole in the central nervous system (the brain and spinal cord).This is where damage occurs in MS.

In particular, some think that omega 6 linoleic acid – an‘essential fatty acid’ – may benefit some people with MS. Healthprofessionals do not all agree that this is the case, but there isno doubt that linoleic acid is a valuable part of a healthy diet.The recommended amount can usually be obtained through abalanced diet, without the need for supplements.

The ways in which essential fatty acids affect the centralnervous system are complex and not yet fully understood. Butpart of the story may be their immunosuppressive and anti-inflammatory effects.

A good balance of Essential Fatty Acid(EFA)s It is unclear exactly how omega 3 and omega 6 interact andthe relative advantages of each. Both play an important part ina healthy nervous system, but to be broken down and usedeffectively they have to compete for the same chemicals in thebody. Too much of either might limit the effects of the other,and the best levels needed for each EFA are not yet clear. Agood balance of both omega 6 and omega 3 may be moreimportant for people with MS than the total amounts of each.Further research is needed to identify the ideal intake. Abalanced diet as recommended on pages 11 and 12 shouldprovide healthy amounts of both.

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VITAMINS, MINERALS AND MSVitamins and minerals have a number of vital functions andhave complex relationships with each other. Some are neededso that the body can use other nutrients effectively – forexample zinc and vitamin B6 are both needed in the diet if youare to benefit from omega 3 and omega 6 essential fatty acids.Others, such as vitamins A, C and E, can work as‘antioxidants’.

AntioxidantsOxidants, or free radicals, are chemicals that react easily withother substances in the body, changing or damaging theirstructure. For example, essential fatty acids are vulnerable toattacks from oxidants. Certain vitamins can limit the damageoxidants cause and protect the essential fatty acids. Thesevitamins are known as antioxidants.

Some research has suggested that oxidant activity in thecentral nervous system may be linked to the damage thatoccurs in MS. However, there have been few studies into theuse of antioxidants for people with MS and the significance ofoxidants is still unclear.

Antioxidant therapy might also carry a risk for people with MS,as some antioxidants have a stimulating effect on the immunesystem, which in theory could worsen the effects of MS.Further research is needed to determine the safety andpotential benefits of antioxidant therapy for MS.


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Vitamin B12The exact relationship between MS, MS treatments and vitaminB12 is complex and not yet fully understood.

Vitamin B12 is needed for the body to make myelin – theprotective layer around nerve fibres that gets damaged in MS.Because of the importance of vitamin B12 in the nervous system,and because a deficiency can lead to symptoms similar to thosefound in MS, some people have suggested it can help treat orprevent MS. However, research does not support these theories.

Most people with MS have normal vitamin B12 levels butdeficiencies can arise. Your doctor can check if this is aproblem and provide appropriate treatment if necessary.

Vitamin DWe obtain vitamin D through our diet and exposure to sunlight.

Some people have suggested that low levels of exposure tothe sun could increase the chances of developing MS. This isbecause MS is more common in areas further from the equator– areas where there is less intense sunshine and people maytherefore receive less vitamin D. However, there may be otherexplanations for these geographical differences. Furtherresearch is needed to understand the relationship betweenexposure to sunlight and MS.

As mentioned earlier in the publication, vitamin D – whetherdelivered through sunlight, fish such as salmon or tuna, milk,or in pill form – may play a role in preventing MS. Many

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physicians now suggest that people with MS themselves mightbenefit from taking a daily intake of 1,000-2,000 IU of vitaminD because some people may be vitamin D deficient. If you dochange your diet radically or increase your intake of vitamins, itis a good idea to consult your doctor or a nutrition specialist.

In addition, because vitamin D and sufficient calcium can helpreduce the risk of osteoporosis, sufficient intake is important.This is particularly true for those who are less mobile or havetaken long courses of steroids.

FURTHER INFORMATION MS Society publications, website and magazineThe MS Society of Canada has publications on a wide varietyof topics. For more information, please call 1-800-268-7582,or visit the website at www.mssociety.ca

Further reading

Dietary Supplements and Multiple Sclerosis: A Health Professional'sGuide, by Allen C. Bowling and Thomas M. Stewart. Publishedby Demos Medical Publishing (2004), ISBN: 1888799900.Aimed at health professionals, this book summarizes theresearch behind a range of dietary supplements.

I-Can’t-Chew-Cookbook. Delicious soft-food recipes for peoplewith chewing, swallowing and dry-mouth disorders, by J RandyWilson. Published by Hunter House Publishers(2003), ISBN:0897934008. This American book contains recipes for a widevariety of meals and includes nutritional information for each one.


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Useful resources

Dietitians of Canadawww.dietitians.ca

Abilities Foundationwww.enablelink.orgLinks to Canadian disability resources and services

Health Canadawww.hc-sc.gc.ca/index-eng.php

Canada’s Food Guidehttp://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

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How to reach the MS Society of CanadaCurrent as of December, 2008

British Columbia Ontario DivisionDivision 175 Bloor Street East1501-4330 Kingsway Suite 700, North TowerBurnaby, British Columbia Toronto, OntarioV5H 4G7 M4W 3R8(604) 689-3144 (416) [email protected] [email protected]

Alberta Division Quebec Division#150, 9405 - 50 Street 550 Sherbrooke Street WestEdmonton, Alberta Suite 1010, East Tower T6B 2T4 Montréal, Québec(780) 463-1190 H3A [email protected] (514) 849-7591

[email protected]

Saskatchewan Division Atlantic Division150 Albert Street 71 Ilsley Avenue, Unit 12Regina, Saskatchewan Dartmouth, Nova ScotiaS4R 2N2 B3B 1L5(306) 522-5600 (902) [email protected] [email protected]

Manitoba Division National Office100-1465 Buffalo Place 175 Bloor Street EastWinnipeg, Manitoba Suite 700, North TowerR3T 1L8 Toronto, Ontario(204) 943-9595 M4W [email protected] (416) 922-6065

[email protected]

Call toll-free in Canada: 1-800-268-7582www.mssociety.ca


Our Mission

To be a leader in finding a cure formultiple sclerosis and enabling people

affected by MS to enhance their quality of life.

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Contact the Multiple Sclerosis Society of Canada:

Toll-free in Canada: 1-800-268-7582

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Website: www.mssociety.ca

Healthy Eating: A guide for people with MS · PDF fileHEALTHY EATING: A GUIDE FOR PEOPLE WITH MS Like everyone else, people with MS can benefit from a healthy diet. This booklet explains

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