Medicine & Research

A 5 Step Recipe for Eating Healthy with MS

By Mona Bostick

People with multiple sclerosis are increasingly interested in alternative treatment options. These treatments may involve diets, supplements, herbal remedies, acupuncture, massage therapy, exercises, meditation, and many others. This interest has led to numerous questions about how nutrition broadly supports health and if food choices may affect MS or help to manage symptoms of MS.

So, why do we eat food anyway? 

The primary purpose of eating is to sustain life; it is a basic human need for survival and health. The human body prefers to obtain nutrients from food. The nutrients from the food we eat have three primary roles:

1. Provide energy in the form of calories
2. Contribute to body structure (cells, muscles, organs, bones, everything)
3. Regulate chemical processes in the body (metabolism, nerve transmission, fluid balance, muscle contraction, and so much more)

In other words, our bodies require food to function. So, eating to support this requirement is an integral part of being a healthy human. Do any of our nutrient requirements change after a MS diagnosis? Or do nutrients have different roles because of MS? Based on currently available evidence, the answer to both questions is no. 

One of the more confusing aspects of eating healthy after receiving a MS diagnosis is whether it is necessary to modify your eating pattern or adopt a specific diet. Unlike kidney disease (for example), in which the kidneys do not work as well to remove waste products from your body, MS does not require a specific diet or eating pattern. There are no particular foods that, if avoided, can prevent or halt MS from progressing. Eating for health is essential, but with all the conflicting nutrition information available everywhere, it can be tough to know what that means. Here is a five-step recipe for eating healthy even with MS.

Step 1: Start by eating for health.

The Dietary Guidelines for Americans advises us on what to eat and drink to meet nutrient needs, promote health, and prevent disease. Broadly speaking the guidelines make the following recommendations:

1. Follow a healthy eating pattern at every stage of life.
2. Customize and enjoy nutrient-dense food and beverage choices to reflect personal preferences, cultural traditions, and budgetary considerations.
3. Focus on meeting nutritional needs with nutrient-dense foods and beverages.
4. Limit foods and beverages that are higher in saturated fat, added sugars, and sodium.
5. Limit alcoholic beverages.

How does your current intake stack up against the Dietary Guidelines for Americans? The DGA also offers more specific guidance on how to meet nutrient needs with foods. These recommendations are a great place to begin eating healthy with MS (or any chronic health condition). Are you currently eating these foods in the recommended amounts?

• Vegetables: at least 21⁄2 cup equivalents per day
• Dark green: 11⁄2 cup equivalents per week
• Red and Orange: 51⁄2 cup equivalents per week
• Starchy: 5 cup equivalents per week
• Fruits: 11⁄2 -2 cup equivalents of fruit per day
• Whole Grains: 3-6 oz equivalents per day
• Meat, Poultry, Eggs: 26 oz equivalents per week
• Seafood: 8 oz equivalents per week
• Beans, Legumes: 11⁄2 cups per week
• Nuts, Seeds, Soy: 5 oz equivalents per week
• Low-fat Calcium foods: 3 cups low-fat dairy or fortified alternative This example is based on the recommended daily or weekly intake of specific foods and subgroups for a 2,000 calorie/day eating pattern. If you do not measure up, so to speak, you can begin by using these recommendations as your goal. And don't beat yourself up; you are not alone. Would you be surprised to learn that the eating patterns of more than 50 percent of Americans are also not meeting daily intake recommendations?

According to the DGA, roughly
• 90 percent of Americans are not eating the recommended amount of vegetables
• 80 percent of Americans are not eating the recommended amount of fruits
• 94 percent of Americans are not eating the recommended amount of whole grains
• 88 percent of Americans are not consuming the recommended amount of dairy foods
• 87 percent of Americans are not eating the recommended amount of seafood and
• 55 percent of Americans are not eating the recommended amount of nuts, seeds, or soy foods

Let's remember that food has three primary roles: provide energy/calories, contribute to body structure, and regulate chemical processes. Our health may suffer if we are not consuming the nutrients needed to fill these crucial roles. Of course, there are foods that, as Americans, we either meet the intake recommendations or overconsume.

According to the DGA, roughly

• 70 percent of Americans meet or exceed the recommended amount of meats, poultry, and eggs
• 94 percent of Americans meet or exceed the recommended amount of refined grains.

Time to rethink food math?

Even though most Americans fail to eat enough nutrient-dense foods to meet our nutrient needs, most wellness messaging focuses on what to limit instead what to add. Since the purpose of eating food is survival and the foods that we eat provide us with a range of nutrients, including:

*macronutrients (carbohydrates, protein, fat)
*micronutrients (vitamins, minerals) and
*phytonutrients (fiber, antioxidants, etc.)

A message of addition may serve us better. A focus on adding nutrient-dense foods that help your body function optimally may be a more effective means of ensuring adequate intake of nutrients.

Step 2: Be sure to include balance, variety, and flexibility. 

When selecting your foods and building meals, be sure to remember:

• Balance means not consuming one nutrient at the expense of another.
• Variety may be the actual "superfood" because each food source provides a different nutrient profile. Variety helps to ensure you consume a diversity of nutrients.
• Flexibility has allowed humans to survive over the millennia despite constantly changing food sources. Throughout history, including periods of famine and food scarcity, humans have found ways to adapt. Nutrient-dense foods, balance, variety, and flexibility are likely to result in nutritional adequacy, which is the foundation of nutrition health. Inadequacy may lead to malnutrition, which is not beneficial for anyone.

Step 3: Eat to manage/prevent comorbid conditions.

Once you are consistently implementing steps one and two, it is time to consider comorbidities (chronic health conditions you live with in addition to MS). Comorbid health conditions are linked to several poor health outcomes, including increased disability and poor quality of life in people with MS. While there is no therapeutic diet for MS, therapeutic diets (or nutrition interventions) are clinically beneficial for each of the comorbid conditions listed below. Each of them uses the DGA as the jumping-off point because nutrition adequacy remains the goal.

• Dyslipidemia
• Hypertension
• Kidney disease
• Heart disease
• Glucose control
• Bone health
• Gastrointestinal disease
• Chronic lung disease

For example, the specific objective in eating with kidney disease is to consume the most balanced, varied, and adequate nutrition while modifying the intake of electrolytes and protein that might tax the kidneys. MS does not require any such dietary modification. In fact, based on current evidence, no nutrition intervention affects the MS disease course. There is some limited evidence that interventions may affect symptoms, such as fatigue.

Step 4: Experiment with eating for MS symptom management. 

A few studies suggest food choice may affect some common MS symptoms. Whether this is because of an intentional focus on eating healthy and selecting foods that meet nutrient needs which allow our body to function better, or because of a specific intervention is not clear. What is clear is that any nutrition intervention you experiment with should align with steps one through three. In other words, meet your nutrient needs with food; include balance, variety, and flexibility; and do not interfere with therapeutic interventions for comorbid conditions.

Step 5: Eating healthy should be physically, emotionally be physically, emotionally nourishing.

The first four steps in this recipe describe how food provides the nutrients required for our bodies to function. But to suggest that fuel is the only role food plays in our lives is akin to saying that sex is only for reproduction. This final step is a reminder that eating for physical health should not come at the expense of emotional health. Food features predominantly in many of the genuinely human moments in our lives. Joy is an essential ingredient in a healthy eating pattern.