Diets for MS
How different food plans could affect your disease
by Aviva Patz
Eat a Mediterranean diet to lose weight and move better! Eat keto to ease fatigue! Try intermittent fasting for emotional well-being!
People have long touted a variety of diets as a treatment or cure for multiple sclerosis, but the evidence behind them has been limited.
Now, the National Multiple Sclerosis Society’s Nutrition Wellness Subgroup, a team of experts who study lifestyle factors in MS, have taken a hard look at the impact of diet on MS to get some answers. In their analysis, presented at the 2021 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, they reviewed existing studies on dietary interventions in MS through 2020 and provided guidance meant to inform and empower.
“It’s easy to get the wrong impression when you read one small study,” says Kathleen Zackowski, PhD, associate vice president of research with the Society.
“So, we wanted to review the literature and provide a practical, take-home message: What does this mean for you?”
Read on to learn highlights of the findings and how your daily menu could be affecting your MS.
Results of the studies
After analyzing 16 studies, the researchers found no one-size-fits-all diet for MS. “We know diet and MS are linked,” Zackowski says. “We just don’t know which dietary factors are critical to affecting the disease.”
Instead, particular features of diets may be important.
For example, a study on salt intake found that people with a high-salt diet had more relapses than those on a low-salt diet, and people with MS following a low-salt diet saw improvements in symptoms.
“It’s too soon to say sodium is bad for MS, but it’s a clue,” Zackowski says.
Similarly, obesity increases the odds of getting MS and speeds disease progression, according to Zackowski, and “that suggests that something about a high-fat diet
is important.”
Beyond the impact of the diet on your body is your ability to follow it consistently. “Maybe the best diet is one you can stick to long-term,” Zackowski adds. It should also be affordable; you should be able to shop at any grocery store or grow the foods yourself.
Why it’s important
There’s a lot of empirical evidence that people say they feel better when they’re on a healthy diet, according to Zackowski. The inverse is also true.
“We know that MS disability can accrue over time,” Zackowski explains. “If people gain weight, it’s harder to move. So having a healthy diet can often help people stay a healthy weight.”
“We also know that MS affects emotional health,” she adds. “Having a healthy diet low in fat is one thing you can do to optimize your physical and emotional health.”
Besides potentially minimizing your MS symptoms, eating a healthy diet can put you in the best possible position to receive new treatments. “Companies are looking for people who are otherwise healthy to be in their study,” Zackowski says.
Conclusions of the studies
Diet is clearly a factor that could address MS — researchers just don’t know exactly how. It’s also unclear whether the diets that have been studied will benefit everyone with MS equally.
“We probably all have some foods that affect us differently than someone else,” Zackowski explains. “It’s going to come down to a personalized medicine approach. We have to know enough about each person’s biology and their environment to determine which foods will provide the greatest benefit.”
Until we know more, Zackowski recommends a diet low in processed foods and rich in a variety of fruits and vegetables, like the one recommended by the American Heart Association.
“A good, healthy diet is something you can do right now for optimum wellness with MS,” she says, “even before we have all the answers.”
Diets at a glance
Modified Mediterranean
Details of the study: 18 people were randomly assigned to follow this diet — rich in olive oil, fish, nuts, fruits and vegetables, with zero meat and dairy, and limited processed foods and salt, for six months — while 18 people ate their regular diet. (Published in Multiple Sclerosis and Related Disorders, November 2019)
Conclusions of the study: The modified Mediterranean diet may reduce weight, fatigue and disability, and improve quality of life.
Simple, practical tips for following this diet: The more colorful your plate can be, the better, says Kathleen Zackowski, associate vice president of research with the National Multiple Sclerosis Society. “Make sure your plate has fruits and vegetables at every meal.”
Ketogenic
In a second six-month study, 20 people with relapsing-remitting MS followed a ketogenic diet (defined as fewer than 50 grams of carbohydrates, more than 160 grams of fat and less than 100 grams of protein daily); another 20 followed a fasting-type diet (200–350 calories per day) for one week followed by a plant-based Mediterranean diet; and a third group of 20 people followed their regular diet. (Published in Cell Reports, June 2016)
Conclusions of the study: The ketogenic diet may reduce weight, fatigue, depression and disability, and improve quality of life. (The fasting– Mediterranean diet has similar results.)<
Simple, practical tips for following this diet: Focus on whole, fresh foods, mainly proteins and healthy fats; source minimal carbs from produce, nuts, or dairy. “It’s important to stay within the allotted food groups,” Zackowski adds.
Caloric restriction/intermittent fasting
In a second study, 15 people with relapsing-remitting MS either reduced their daily caloric intake to below 500 calories every other day for 15 days or ate normally. (Published in Cell Metabolism, June 2018)
Conclusions of the study: Following a program of caloric restriction or intermittent fasting may help with weight loss and improve emotional well-being in people with MS.
Simple, practical tips for following this diet: This diet emphasizes fresh, whole foods and eliminates all processed foods, so if something looks factory-made, don’t eat it. “You have to be very careful about the details — it’s not just a diet,” Zackowski adds. “They provide supplements that are specific and encourage exercise and stress reduction.”
Paleolithic
In a second study, 20 people with progressive MS followed the modified paleolithic diet for 12 months. The program also included supplements, exercise, electrical muscle stimulation and stress reduction techniques. (Published in Degenerative Neurological and Neuromuscular Disease, February 2015)
In another study, 10 people with progressive MS followed the modified paleolithic diet for 12 months and added supplements, exercise, electrical muscle stimulation and stress reduction techniques. (Published in Journal of Alternative and Complementary Medicine, May 2014)
Conclusions of the study: The paleolithic diet can help reduce fatigue and boost MS-related quality of life.
Simple, practical tips for following this diet: This diet emphasizes fresh, whole foods and eliminates all processed foods, so if something looks factory-made, don’t eat it. “You have to be very careful about the details — it’s not just a diet,” Zackowski adds. “They provide supplements that are specific and encourage exercise and stress reduction.”
McDougal
Conclusions of the study: The McDougal diet can help you lose weight, reduce fatigue, and improve cholesterol and insulin resistance.
Simple, practical tips for following this diet: Since you’re avoiding oils, make your fresh produce and whole grains tastier by steaming them with herbs and spices and adding garlic and onion powder and salt-free spice blends.
Swank
Conclusions of the study: A low-fat diet, especially one that’s low in saturated fat, can decrease disability and increase longevity.
Simple, practical tips for following this diet: Replace red meat with fish and limit oils, eggs, nuts and high-fat dairy. After that, the diet is fairly simple — you can enjoy all vegetables, most fruits (limit avocado and olives), white-meat chicken, fat-free dairy, whole-grain pasta and brown rice, coffee and even alcohol.
Aviva Patz is a writer in Montclair, New Jersey.
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