The role of nutrition and diet in MS - MS Nurse PRO
The role of nutrition and diet in MS

The role of nutrition and diet in MS


The role of nutrition and diet in MS

Diet has a wide range of effects on an individual’s health — it impacts a person’s weight, and can alter the risk of heart disease, bone problems, and other health issues. There are a number of different special diets that are said to be beneficial for people with MS including the Paleo diet, Keto diet, the Swank diet, the Overcoming MS diet, the Best Bet diet, and the McDougall diet. Despite this, it is still unclear if any one dietary strategy is best for people with MS. The Mediterranean diet may exert a protective influence regarding the risk of subsequently developing MS compared with Western-style diet.[i] It has also been linked to less objective disability in MS.A recent systematic review reported possible beneficial effects of Mediterranean-like diets for people with MS but highlighted that large-scale multiple-centre interventional studies are needed.

Generally, it is recommended that individuals with MS eat a varied and well-balanced diet along the lines of what is typically recommended in the general population — lots of plant-derived foods like fruits, vegetables, and whole grains, and fewer foods that are processed or high in refined sugars and fats.[iv] Eating a balanced diet that provides for all nutritional needs may help people with MS better manage and control their MS. Specifically, a good diet can help in:

  •  reducing the likelihood of relapses
  • lessening the chances of disability progression
  • improving both physical and mental health-related quality of life.

Being less active and eating an unhealthy diet can lead to weight gain and obesity. Being obese or overweight is linked with worse severity of some MS symptoms, such as fatigue and pain. Changes to diet that help patients lose weight may ease these types of symptoms.

Some specific nutrients of particular relevance to MS include:

  • Vitamin B12: This vitamin is used to make myelin; while a deficiency in this vitamin may result in MS-like symptoms, there is no evidence that B12 supplements benefit people with MS with normal levels of the vitamin.
  • Vitamin D: Affecting a number of biological functions, this vitamin is known to impact immune activity. Low vitamin D levels have been linked with an increased risk of MS and more severe disease activity.
  • Calcium: Supplements may be given to people with MS at risk of bone problems — for example, individuals who have limited mobility or are taking steroid medications.
  • Essential fatty acids (EFAs): EFAs are a class of polyunsaturated fats that cannot be synthesized in the body and must be acquired through diet. They are needed to repair damaged nerve cells and to produce certain signalling molecules that control inflammation. There are two main types of EFAs — omega 3 and omega 6 fatty acids. A Swedish case-control study found a decreased incidence of MS among those who reported high fatty fish intake. Similarly, an Australian study found significantly decreased risk of a first clinical demyelinating event among those who reported high intake of omega-3 fatty acids.
  • Antioxidants: Oxidative stress is a type of cell damage that contributes to inflammation in MS. Antioxidants are molecules that can lessen oxidative stress, thereby helping to reduce inflammation and neuronal damage. Common antioxidants include vitamins A, C, and E, as well as compounds such as flavonoids and beta-carotenes.

It remains unclear whether consuming dairy products affects the course of MS. Some studies have found people with MS who consume more dairy tend to have more severe disease, but other studies have reported the exact opposite trend, with more dairy consumption linked to less severe MS.5, Full-fat dairy products are often high in saturated fats, but dairy also can be a good source of protein, calcium, and vitamin D. 

Some research has suggested a link between higher salt (sodium) intake and more severe MS, but other studies have shown no connection between salt consumption and MS severity. A high-salt diet can increase the risk of other health problems (e.g., high blood pressure), so it is generally recommended that salt in the diet be moderated.

Several studies have explored whether gluten intake may influence MS, but there is not enough evidence to make any conclusions one way or another. Available evidence suggests the rate of gluten intolerance, known as celiac disease, is no higher among people with MS than in the general population.

In summary, epidemiologic research, a small number of prospective studies, and limited clinical trials suggest the importance of various dietary factors in MS. Clinical and experimental studies provide indirect evidence that a balanced diet in combination with an overall healthy lifestyle is linked with an improvement in several clinical parameters as well as measurements of quality of life for patients with MS.

Sources | Further reading

  • Alfredsson L, Olsson T, Hedstrom AK. Inverse association between Mediterranean diet and risk of multiple sclerosis. Mult Scler. 2023;29:1118–1125.
  • Sand IK, Levy S, Fitzgerald K, et al. Mediterranean diet is linked to less objective disability in multiple sclerosis. Mult Scler. 2023;29:248–260.
  • Abbasi H, Shakouri F, Mosadegghi-Heris R, et al. Mediterranean-like diets in multiple sclerosis: A systematic review. J Neurol. 2023;e-pub ahead of print.
  • Fitzgerald KC, Tyry T, Salter A, Cofield SS, Cutter G, Fox R, Marrie RA. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2018;90:e1–e11.
  • Stoiloudis P, Kesidou E, Bakirtzis C, et al. The role of diet and interventions in multiple sclerosis: a review. Nutrients. 2022;14:1150.
  • Sand IK. The role of diet in multiple sclerosis: mechanistic connections and current evidence. Curr Nutr Rep. 2018;7:150–160.
  • Baarnhielm M, Olsson T, Alfredsson L. Fatty fish intake is associated with decreased occurrence of multiple sclerosis. Mult Scler. 2014;20:726–732.
  • Hoare S, Lithander F, van der Mei I, Ponsonby AL, Lucas R, Ausimmune Investigator G. Higher intake of omega-3 polyunsaturated fatty acids is associated with a decreased risk of a first clinical diagnosis of central nervous system demyelination: results from the Ausimmune Study. Mult Scler. 2016;22:884–892.
  • Hadgkiss E, Jelinek E, Weilan T, et al. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci. 2015;18:125–36.
  • Farez M, Fiol M, Gaitan M, et al. Sodium intake is associated with increased disease activity in multiple sclerosis. J Neurol Neurosurg Psychiatry.  2015;86:26–31.
  • Nourbakhsh B, Graves J, Caspar C, et al. Dietary salt intake and time to relapse in paediatric multiple sclerosis. J Neurol Neurosurg Psychiatry. 2016;87:1350–1353.
  • Thomsen H, Jessen E, Passali M, et al. The role of gluten in multiple sclerosis: a systematic review. Mult Scler Relat Disord. 2019;27:156–163
  • Passali M, Josefsen K, Frederiksen J. Current evidence on the efficacy of gluten-Free diets in multiple sclerosis, psoriasis, type 1 diabetes and autoimmune thyroid diseases. Nutrients 2020;12:2316.
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