Diet & Nutrition in MS

Well balanced diets

Like everyone else, people with MS can benefit from a healthy diet. These pages explain what is meant by a 'well-balanced diet', why we should all be aiming for one and how to get one.

You might find that symptoms of MS affect what you can eat or how you prepare meals. Learning new ways of cooking, or using energy-saving tips can help you carry on eating what you enjoy. Adjusting to MS will not always mean changing your diet, but sometimes it can help.

Eating nutritionally balanced meals helps the body work to its full potential, which is particularly important for people living with long-term, unpredictable conditions like MS.

The effects of MS vary from person to person and can change from one day to the next. Many people find they can improve their quality of life and sense of well-being by focusing on aspects of health that can be controlled and changed – such as diet. This, combined with appropriate exercise, can help:

The effects of MS vary greatly and you may never experience some of the symptoms or problems mentioned here. But changes to your circumstances might affect the foods you choose and your nutritional needs.

Because everyone has different experiences, culture and lifestyle, how each person adapts will vary.

Food is more than just a necessity. It can also be a social activity, so any changes to your diet need to be realistic and suited to your lifestyle as well as your dietary needs. Be ready to try new things – if you choose healthy food that you like, it might be easier to stick to any changes you make.

It is now widely recognised that a healthy diet contains a balance of the major food groups:

These food groups contain nutrients with specific roles and a lack of any of these may cause health problems directly, or affect how other nutrients are absorbed by the body. For example, a lack of calcium can cause bone weakness, but even if there is enough calcium in the diet, a lack of vitamin D can slow the absorption of calcium and also lead to bone weakness. This is why it is important that there is a balance of all these food groups in your diet.

Special diets and MS

        Can special diets be a treatment for MS?

Many special diets have been proposed as treatments for MS, but none have been proven to prevent MS or affect the way it may develop. Special diets are best approached with caution as some may be expensive or even harmful.

Most people do not need to use expensive supplements either. You can usually get the nutrients you need through your daily meals.

Research does not support the use of gluten-free or other diets excluding specific foods to treat MS.

With careful planning, perhaps with the help of a dietitians, you can make sure you meet your dietary needs – even if they change over time. Many people with MS report that they feel better when they eat well. 

Are vegetarian and vegan diets compatible with MS?

Vegetarian and vegan diets may need more careful planning to ensure they cover all essential nutrients, but a dietitians can help you find alternatives. The Vegetarian Society and Vegan Society can also provide information. 

        Can food allergies and food intolerance cause or affect MS?

There is no evidence to suggest that food allergies or intolerance can cause MS, or that MS can cause allergies or intolerance. However, just like anyone else, people with MS can react to particular foods. If you think you may have an intolerance or allergy, your doctor or dietitians can help you look into it further. Reliable testing for food allergy or intolerance involves following a properly supervised exclusion diet. As this process can be time-consuming, inconvenient and costly, it is worth considering the pros and cons: will following the diet be worse than the symptoms it could alleviate; will you still be able to have a balanced diet and maintain a healthy weight; how would such a diet impact on finances, shopping, cooking, family meals and meals out? 

Practical solutions for preparing food

Living with MS can mean that regular tasks like shopping and preparing food take longer or need more careful planning. For example, fatigue can make shopping trips over-tiring, or tremor could make chopping vegetables difficult. An occupational therapist can suggest energy saving tips and helpful equipment or adaptations. They can also advise on grants that may be available for adaptations.

Shopping

There are many grocery delivery services available, including online shopping, which can save a trip round the supermarket or high street, and avoids carrying heavy shopping home. 

        Tips for preparing food

• To avoid moving around the kitchen unnecessarily, why not gather all the ingredients together before you start to cook? Some people prefer to use a table in the kitchen to eat at, rather than carry meals to another room. If balance is a problem, grab rails can be fitted to many kitchen units and walls.
• Cooking with a microwave means there are no heavy pans to lift.
• Some tasks can be done just as well sitting as standing. Overhanging worktops can often be fitted to kitchens to make this easier. Height-adjustable stools and stools with sloping 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 as they don’t warm the kitchen while cooking. Induction hotplates also warm the pans without heating the air around them.
• If you live with others, sharing tasks can make preparing meals easier and quicker, and cooking together can be fun. 

        Are there any services or help available to make it easier to shop and prepare food?

• If preparing food is difficult or tiring, ready meals can be a good solution. However, they are sometimes high in fat and salt so may not be suitable for every day. Dietitians can advise on easy-to-prepare alternatives or ways to supplement your diet if you rely greatly on ready meals.
• Meals on wheels deliver ready-prepared meals to your door. Many areas offer this service as part of a care package from social services. Caterers can usually meet special requirements on health or religious grounds.
• If you have trouble preparing a cooked meal, you may be eligible for Disability Living Allowance. For more information, see the MS Society publication Claiming Disability Living Allowance.

        What kind of adaptations or practical equipment are available?

There are gadgets and tools to help with almost every daily task in the kitchen. The following list gives an idea of what is available and organisations like the Disabled Living Foundation, Ricability and the RNIB can provide further information.

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 different shapes 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 prepared food more easily
• kettle tipper – lets you pour a kettle without lifting it

If you have visual problems:

• large controls and displays on cookers, microwaves, timers and weighing scales
• speaking weighing scales
• coloured tape around worktops can help provide a contrasting edge
• brightly coloured chopping boards, cutlery and utensils also contrast better with surfaces and make items easier to spot in drawers

Weight gain and weight loss

        Can managing your weight be a problem with MS?

Both weight loss and weight gain can be a problem for people with MS, but this can be managed and controlled by tailoring a 'personal diet plan'. A dietitians can help you develop a plan that adjusts as your needs change, ensuring you always get a healthy balance of nutrients. It is not always easy to stick to a rigid plan, so keep it flexible and remember that occasional treats are not forbidden. Remember also that weight problems may not be directly linked to your MS. Your doctor or other healthcare professional can investigate the problem to find the cause. 

        Managing weight loss

If someone is underweight they may become malnourished and weak, which can make MS symptoms like fatigue, muscle weakness or spasms worse.

There are many reasons people with MS might not eat as much as they need. Problems with posture, swallowing, fatigue and tremor can 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 your doctor if you have concerns about any of these issues.

Because early signs of malnutrition, like fatigue and muscle weakness, can also be symptoms of MS, the problem may initially go unnoticed. But your doctor or dietitians can help investigate and treat the underlying causes of your weight loss.

If getting enough energy and nutrients is difficult, over-the counter or 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.
 

        Managing weight gain

Keeping generally fit and healthy can make it easier to cope with the symptoms of MS. But having MS may mean you are less active than you once were, so you might find you put on weight. Appropriate exercise and a healthy, balanced diet can help you return to your natural weight, but there may be additional things you can do to help with weight loss.

For example, to keep up a good intake of liquids, some people rely on fruit juices or sugary drinks. Switching to water or low-sugar versions could cut down the calories without risking dehydration. Sugary and fatty snacks are sometimes ‘comfort food’ at times of stress and worry. Occasional snacking like this should be no great cause for concern, but if you are comfort eating a lot and think you may be depressed, discuss this with your doctor as depression is easy to treat.

Some drug treatments, including steroids used for acute relapses, can also cause weight gain. Certain changes to what, and how, you eat may help with managing particular MS symptoms.
 

Diet and MS symptoms

        Can diet be adapted to help manage swallowing problems – dysphagia?

Difficulties with swallowing – or dysphagia – can be a distressing symptom, especially if not managed properly, but there are a number 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 milky 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 minimise chewing and make swallowing easier.
• If swallowing is weak, thin fluids like water or tea can go down the wrong way, causing discomfort and a potential choking hazard. Using thickening agents in drinks can help and are available on prescription.
• Some people find it harder to drink enough fluid through the day when drinks have been thickened. To avoid dehydration, sip little and often. Pre-thickened fruit juices, also available on prescription, may be more appetizing and they are always the right consistency.
• If swallowing difficulties are causing weight loss, nutritional supplements might be helpful.

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

        Can diet be adapted to help manage fatigue?

Fatigue can sometimes be helped by adjusting the diet. For those who get tired quickly, eating large, hot meals can be difficult, so smaller, more frequent snacks may be better. It can also be a good idea to include starchy carbohydrates, like potatoes and bread, in meals throughout the day, as this can help keep energy levels up. Relying too much on sugary foods for energy can make fatigue worse, as they cause energy peaks followed by lows.

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

        Can diet be adapted to help manage tremor?

Tremor can affect your nutritional needs or your approach to eating. Constant tremor uses up calories, so high-energy foods and drinks between meals might be necessary to avoid weight loss or worsening fatigue.

If tremor affects holding or reaching for things, certain foods may be easier to eat than others. A sandwich, for example, is easier to manage than spaghetti or soup. Specially designed cutlery, crockery and kitchen utensils, can make the preparation and eating of food more manageable. 

        Visual problems

Double-vision or blurring may make preparing or eating food more time consuming and may seem to limit choice. However, there are practical solutions that can help.

Diet, bladder and bowel

        Can diet affect bladder problems?

Some people with bladder problems drink less to reduce their need to go to the toilet. However, this can mean you have more concentrated urine, which can irritate the bladder and increase the chances of getting urinary tract infections.

Drinking six to eight cups (about 1.5 litres) of water per day is generally recommended. It is best to avoid large quantities of caffeine and alcohol as these irritate the bladder.

There is no conclusive evidence that cranberry juice in particular helps to prevent or treat urinary tract infections. 

        Can diet affect bowel problems?

Dietary changes are often suggested as the first line of treatment for people with MS who experience constipation. Good fluid intake can help regular bowel function, as can a diet with plenty of insoluble fibre. This fibre cannot be digested and passes straight through the gut, helping digestion of other foods and removal of waste. A well-balanced diet, with plenty of fruit and vegetables can provide this fibre. Prunes (or prune juice), figs, wholemeal bread, fibre-fortified white bread, brown rice and wholegrain breakfast cereals are particularly good sources of insoluble fibre. 

Other health problems, diet and MS

        Dental hygiene

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 brushing your teeth more difficult. Certain drugs used to treat MS symptoms can cause a dry mouth, which might also affect the health of your teeth and gums. Your dentist may recommend a mouthwash or fluoride gel to help avoid problems and can give advice on the easiest ways to brush effectively.  

        How is osteoporosis affected by diet and MS?

Osteoporosis causes bones to become fragile and more at risk of breaking. Several factors might increase the risk of osteoporosis for people with MS:

• Extensive use of steroids to treat relapses.
• A lack of weight-bearing exercise, for example, for those who 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 levels of both vitamin D and calcium in the diet, as these both help keep bones strong and healthy.

Good sources of vitamin D include oily fish, liver and eggs. Care should be taken not to take excessive doses of vitamin D supplements as this can be harmful.

Milk and dairy products are the richest sources of calcium, but tinned sardines and pilchards (where the bones are eaten), sultanas, bread, spinach and red kidney beans are also good sources. Skimmed milk contains as much calcium as full-fat milk, so cutting down on fat need not mean losing out on calcium. Calcium-enriched soya products offer a non-dairy alternative.

If you do not get much exposure to sunlight, or you are prescribed a course of steroids, a doctor or dietitian may suggest supplements to prevent a deficiency, but most people, most of the time, get sufficient calcium and vitamin D through their diet and sunlight. 

        How are pressure sores related to diet and MS?

If someone lies or sits in one position for long periods, there is a risk of pressure sores developing. Losing too much weight can add to this risk, if you lose the natural padding over bony points. A dietitian can help you monitor and maintain a healthy weight to avoid this. 

Caring for the dietary needs of people more severely affected by MS

Some people more severely affected by MS can find food and fluid intake difficult. They may be unable to prepare meals, buy food or plan a balanced diet. Carers – sometimes family or friends – may become more involved and might want to consult specialist healthcare professionals to ensure they are meeting the dietary needs of the person they care for. Professional advice can benefit everyone – getting a healthy balanced diet is valuable for carers too.

Taking into account likes and dislikes

Whatever someone's needs or restrictions when eating and drinking, they will have favourite foods and foods they would rather avoid. Religious, cultural and personal tastes should all be 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 help make meals enjoyable as well as nourishing. A dietitians can help with this, ensuring the list of 'likes' is broad enough to keep things interesting as well as healthy, accommodating tastes and preferences as much as possible. A perfectly balanced diet is no use if it is left uneaten! 

        Planning for the week

It is not uncommon for someone to have a number of carers, possibly a mix of professionals, friends or family. If several people assist with food, it can help to monitor meals prepared, to be sure there is a good overall balance. Agreeing a weekly plan is one way to do this. Shopping lists can be tailored to the weekly plan, avoiding food going to waste and unnecessary trips to the shops. Also, getting together to plan the week's food lets everyone have an input, even if they do not visit the shops themselves. Internet shopping is another way to choose groceries from home.

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

Making food and drink accessible

It can be handy to have a selection of food and drinks available and easily accessible night and day. A secure, clean place to store food and drink near the bedside, for example, can save unnecessary trips to the kitchen – and is especially helpful if eating regular small meals or sipping drinks.

Some people with severe visual problems find it helpful if food is set out in an agreed way. For example, laying out the different parts of a meal as if the plate were a clock face makes it easier to choose which foods to eat – potatoes might be placed at '12 o'clock' and meat at '6 o'clock'. 

        What is PEG feeding?

If swallowing and chewing is so difficult that softening food, thickening drinks and eating small meals fail to stop weight loss or dehydration, the use of a direct liquid feed may be appropriate.

A PEG (percutaneous endoscopic gastrostomy) system is the most common. This allows nourishing liquid food to go directly through a tube into the stomach and can be a relief to those who have severe chewing or swallowing difficulties. People can often continue to eat a little by mouth, so they don’t lose the chance to enjoy their favourite foods.

The PEG tube is usually fitted under local anaesthetic and the process is fully reversible if no longer needed. Even so, it can still be a daunting step for a person with MS and their carers. Some changes to a person's lifestyle are inevitable and carers will need to learn to care for the PEG tube. District nurses and community dietitians can help when considering PEG feeding, or if issues arise once a PEG system is fitted. Most manufacturers of PEG systems also have 24-hour helplines and employ specialist nurses to help PEG users and their carers. 

Vitamins and minerals

Vitamins and minerals have a number of vital functions and have complex relationships with each other. Some are needed so that the body can use other nutrients effectively – for example zinc and vitamin B6 are both needed in the diet if you are to benefit from omega 3 and omega 6 essential fatty acids. Seven others, like vitamins A, C and E, can work as 'antioxidants'.

        Can supplements help, or be used instead of fruit and vegetables?

Vitamins and minerals have a number of vital functions in the body. Certain drug treatments can lower levels of vitamins and minerals in the body and a doctor or dietitians may suggest supplements to replenish these. But a balanced diet usually provides a sufficient supply for most people and there is no evidence that high doses benefit people with MS. Excess vitamins and minerals can be harmful.

Some studies have suggested that eating fruit and vegetables has greater health benefits than taking vitamin and mineral supplements. This is because supplements 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 it appears they may have health benefits. On top of this, fruit and vegetables are healthy sources of fibre and carbohydrates. 

        Can antioxidants relieve the symptoms of MS?

Oxidants, or free radicals, are chemicals that react easily with other substances in the body, changing or damaging their structure. For example, essential fatty acids are vulnerable to attack from oxidants. Certain vitamins can limit the damage oxidants cause and protect the essential fatty acids. These vitamins are known as antioxidants.

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

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

        Can vitamin B12 be related to MS and MS treatments?

The exact relationship between MS, MS treatments and vitamin B12 is complex and not yet fully understood. Vitamin B12 is needed for the body to make myelin – the protective 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 those found in MS, some people have suggested it can help treat or prevent MS. However, research does not support these theories.

Most people with MS have normal vitamin B12 levels but deficiencies can arise. Your doctor can check if this is a problem and provide appropriate treatment if necessary. 

        Can vitamin D levels be related to MS?

We get vitamin D through our diet and by exposure to sunlight.

Some people have suggested that low levels of exposure to the sun could increase the chances of developing MS. This is because MS is more common in areas further from the equator – areas where there is less intense sunshine and people may therefore get less vitamin D. However, there may be other explanations for these geographical differences. Further research is needed to understand the relationship between exposure to sunlight and MS.

Research with dietary supplements of vitamin D has also been inconclusive, partly because it is difficult to rule out the effects of other vitamins in the diet and vitamin D through sunlight. Currently, research evidence does not support vitamin D as a therapy for MS.

However, because vitamin D can help reduce the risk of osteoporosis, sufficient intake is important. This is particularly true for those who are less mobile or have taken long courses of steroids. 

Research into diet and MS

        What research has there been into diet and MS?

There has not been a great deal of research into diet and MS, which can be frustrating. This is partly because, so far, no direct link has been made between any specific part of the diet and MS. This leaves the research community with a conundrum: where should their studies begin when there are so many areas that could potentially be investigated?

Effective studies into diet can also be more difficult to design and control than laboratory trials into drug treatments. To be confident in a trial, researchers have to account for anything that may affect the results. For example, if a new drug is given to a group of people on a trial, researchers need to know if any of them are already taking other drug treatments. If they are, this could explain unusual results. However, because diet is part of people’s everyday lives, and people eat many different types of food, it is almost impossible to ensure everyone involved in the trial eats exactly the same things over a long period of time. This makes it very difficult to closely monitor particular foods and draw definite conclusions from the research.

Currently, research does not show that diet causes MS. Neither have any special diets been proven to prevent MS or affect the way it may develop. Research has not found high-doses of any vitamins or minerals to be of benefit either.

A healthy, balanced diet will usually provide you with appropriate levels of nutrients. High doses of certain vitamins and minerals should be avoided as they may do more harm than good.