If you have MS, you may find that taking proactive steps to improve your general health is helpful. Several MS symptoms can be made less severe by maintaining a healthy weight or providing the right fuel for your body at the right time of day. Maintaining a healthy diet is, of course sensible for everyone.
The best approach to changing your diet to manage MS is simply to try it and see. Expensive ingredients or supplements are rarely necessary, and you will stick to a diet better if it is easy for you to find and prepare.
Do stay safe with dietary changes, especially if you intend to cut out whole food groups or change your diet radically. Discuss your plans with a dietician, doctor or MS Nurse, and be careful not to leave out essential nutrients.
If you have bladder problems with your MS, you might be tempted to cut back on the amount you drink, so as to reduce the need to visit the toilet. However, drinking too little can lead to concentrated urine that irritates the bladder and encourages infection. You should drink enough to stay hydrated, but avoid spicy foods, alcohol, caffeine and fruit juices. 6-8 glasses of water a day are recommended.
Maintaining a healthy weight can help with bladder problems. Being overweight can increase pressure on the pelvic floor and result in stress incontinence.
Constipation is a common MS symptom that can be eased by eating regularly, and having enough fluid and fibre in the diet. If you plan to increase your fibre intake, do so gradually to avoid further problems. You can switch from white bread, pasta and rice to brown or wholegrain versions, and slowly increase the amount of vegetables and seeds in your diet.
Your body creates energy from the food you eat, and a poor diet will not provide all the fuel you need for the day. Fatigue is a complex MS symptom, and although it isn't just down to the fuel you have in your body, it makes sense to make sure that your diet is not making your fatigue worse.
A healthy, well-balanced diet including plenty of fruit and vegetables, plus complex carbohydrates will give you the best chance of maintaining your energy levels through the day. Complex carbohydrates are starchy foods that release energy slowly into your bloodstream, compared with simple carbohydrates like sugar.
The glycaemic index (GI) is a ranking of carbohydrate-containing foods based on how quickly they affect your blood glucose levels. Slowly absorbed foods have a low GI rating, while foods that are more quickly absorbed have a higher GI rating. Meals and snacks which are rich in complex carbohydrates, such as fresh fruit and multigrain bread, have a low glycaemic index, giving a slower, more sustained energy release. Lactose, the sugar found in milk and milk products such as yoghurt, also has a low glycaemic index. Taking a low-GI food at the same time as a high-GI food can slow down the rate of release of carbohydrate, for instance by drinking a glass of milk with a sweet biscuit.
It’s tempting to reach for sweet and sugary foods if you feel you need an energy boost. However, you will find that your blood glucose levels quickly crash again leaving your energy levels low. High sugar foods and drinks are often low in nutrients, and the extra calories can cause unwanted weight gain.
Being overweight can make it harder to deal with fatigue. The high levels of flavonoids in dark chocolate have been shown to help sufferers of chronic fatigue syndrome. A recent study showed that having a cup of dark chocolate each morning was a safe and pleasant addition to the diet of people with MS. Future research will look at whether it helps with fatigue in MS, but in the meantime you might wish to try it for yourself. Be aware that milk chocolate is high in fat and sugar, and also has lower levels of the flavonoids that are suggested to be beneficial.
It is also very important when you are managing fatigue to drink sufficient fluids, especially water, as even mild dehydration can make you feel tired. Here are some tips to reduce the impact of fatigue when you are preparing and eating meals.
- Organise the kitchen to keep commonly used items close to hand.
- Keep the kitchen as cool as possible.
- Cook at times of day when energy levels are higher.
- Cook in bulk when you feel less fatigued and freeze for use at a later date.
- Get all the ingredients and utensils together before starting to cook.
- Make use of equipment or labour-saving devices where possible, such as electric mixers, can openers and knives.
- Use ready-prepared foods such as grated cheese, diced meat, pre-washed salads to reduce the energy required in preparing these foods.
- Frozen fruit and vegetables are as high in vitamins as fresh.
- Use wire baskets in pans rather than lifting heavy pans.
- Microwave cooking avoids having to lift heavy pans and does not heat up the kitchen.
- Invest in a one-pot cookery book to save on washing up.
- A trolley is useful to avoid extra walking and carrying in the kitchen and when serving.
- Soak dishes rather than washing up straight away.
- Consider a meals delivery service (help may be available from Social Services).
Large meals can leave people feeling bloated and sluggish. If this is the case then try having more frequent, lighter meals or healthy between-meal snacks such as fresh fruit, cereals or sandwiches, and try to eat main meals when energy levels are higher.
Don't miss out on breakfast which is essential to provide enough energy and nutrients for the morning. If the first meal of the day is lunch, then the body may have gone 16 hours or more without food.
When fatigue is a problem it can be easy to rely on ready prepared and snack foods. Convenience foods can help at times, but they are often high in fat and salt. Try keeping the ingredients for easy to prepare healthy snacks or meals in stock, such as beans on wholemeal toast or jacket potato and tuna for the microwave.
Depression is another complex symptom that may be connected to other aspects of your MS. It might not be possible to cure depression with a good diet, but you can make sure you’re giving yourself the best chance to overcome it. Your brain needs good quality fuel to stay healthy.
Try to have some protein and starchy carbohydrates at every meal, plenty of non-caffeinated drinks, and avoid alcohol. High levels of alcohol can reduce B vitamins in your body, which has been shown to affect mood. Make sure that you have plenty of polyunsaturated fats from seeds and oily fish, rather than saturated fats.
People with depression can get into a downward spiral with their diet if they tend to avoid people and social situations such as eating out. Eating with friends and family can reduce feelings of isolation, and also promote eating regularly. Further advice on diet and depression can be found from the British Dietic Association.
Pain is associated with obesity and a poor diet. Studies show that people with MS who are overweight or obese can reduce their pain symptoms by losing weight, although pain can also be a barrier to weight loss if it affects you exercising. A healthy diet can help you manage your weight, but you may wish to take advice from a health professional if you wish to make radical changes.
Advocates of some special MS diets claim that they feel more alert and less 'foggy' since taking up these diets. These are individual opinions, and it is not easy to test them.
It is understood that having heart disease or hypertension is linked to faster cognitive decline and loss of brain volume in people with MS. You can help manage cardiovascular health with diet as well as with medical treatment, but help from a health professional is recommended. If you can improve your cardiovascular health, you may improve your experience of MS as well.
If you experience swallowing problems, then a dietitian can suggest types of food and ways of preparing food that makes it easier to eat. You might also be referred to a speech and language therapist, who will help with exercises to improve your swallowing ability.
You might find that you have gained weight with MS, perhaps as a result of loss of mobility, the side effects of medication or reduced opportunity to exercise.
More than half of people with RRMS are overweight or obese. This can also affect the emotions and can result in a loss of self-esteem and confidence as well as making mobility problems more difficult to manage.
A low fat diet, using small amounts of vegetable oils in preference to animal fats, can reduce the risk of obesity and heart disease, especially if activity levels are also low. Talking to a dietitian could help, and a GP can also refer you to a physiotherapist who can put together an appropriate programme of exercises.
Weight loss can also occur in MS where a decreased appetite may result from depression, cognitive impairment, fatigue or relapse. Difficulty with swallowing can make it a challenge to get enough energy and nutrients from food. Some medications can suppress appetite as a side effect.
Weight loss can put you at increased risk of pressure sores and malnutrition. Malnutrition can diminish your immunity to other conditions, affect mental functioning and reduce muscle strength. Where weight loss is a problem, try to include food with a higher fat content in your diet. You might find guidance from a dietitian helpful.
Weight loss may also be an indication of other conditions and you should inform your doctor about rapid weight loss immediately.