What Diet Should I Follow for Multiple Sclerosis?

5 Popular Diets, But No Clear Answer Yet

making a salad
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One of the most stressful aspects of living with multiple sclerosis is the disease's unpredictability. This lack of control over when your old symptoms will creep up or new symptoms will flare can cause anxiety, fear, and emotional exhaustion.

This is why many people with MS engage in healthy lifestyle habits like exercise and eating nutritiously, as well as mind-body therapies like yoga or mindful meditation.

These positive strategies are empowering, giving back some control over a rather unforgiving, "mind of its own" disease.

That being said, one of these strategies, eating nutritiously, is somewhat of a conundrum. What exactly should a person with MS eat? A great question, with no great answer (yet).

Diet in Multiple Sclerosis: A Controversy

It is important to understand that, as of now, there is no specific diet that will cure MS. That being said, there is some research to support that eating certain foods and nutrients and avoiding others may help a person's MS symptoms and maybe even their disease activity.

For example, smaller studies have shown that diets high in saturated fat may be linked to a higher risk of developing MS, whereas diets rich in vegetables and fiber may lower the risk. Likewise, diets low in saturated fat and high in Omega-3 (for example, fatty fish and cod liver oil) and Omega-6 (for example, sunflower seed oil) may benefit those with MS.

This all being said, the scientific evidence to back up any diet at this time is scant, and of the evidence available, the results are mixed and sometimes challenging to interpret. In addition to the lack of scientific data about the role of diet in MS, there is concern that adopting a specific diet may be too restrictive, meaning a person may end up being deficient in important nutrients—causing more harm than good.

Furthermore, there is worry that if a specific diet recommends vitamin intake or intake of a specific substance (for example, cod liver oil in the Swank diet), it's possible that a person may consume toxic amounts of that substance, which can also be harmful.

In the end, it's simply unclear precisely how or what foods can improve a person's MS health. That being said, adhering to a healthy meal plan can give you some control in your life, and may help you feel well (regardless of whether or not it's helping your MS). It may also motivate you to take on other healthy, daily habits like exercise and relaxation or cutting back on caffeine.

5 Popular or Emerging Diets in Multiple Sclerosis

Despite the complex role of diet in MS, it's still a good idea to be knowledgeable about the popular MS diets out there (or ones that are emerging). You may even decide to take one on if you find that it helps your symptoms.

That being said, it is critical you only follow a diet under the guidance of your doctor, as some do require that you take certain vitamins to prevent deficiency, and others may pose a risk if you are taking certain medications or have certain health conditions.

Paleolithic Diet (Paleo diet)

This diet gained popularity with Dr. Terry Wahls, a woman with secondary progressive multiple sclerosis who was wheelchair-dependent.

However, after consuming a modified paleolithic diet (along with physical therapy and neuromuscular electrical stimulation), she was able to walk again.

Her diet mainly consisted of greens, sulfur-containing vegetables (for example, broccoli, and kale) and intensely colored fruits and vegetables. In addition, she had 2 tablespoons of omega-3 oils per day, along with 4 or more ounces of both animal protein and plant protein (for example, legumes and nuts). She also eliminated gluten, dairy, and eggs from her diet.

In terms of scientific evidence, there is not much out there to support this diet's role in MS.

One study showed that the Paleo diet improved MS fatigue in people with secondary progressive MS, but the study was small and other interventions like stretching, massage, and meditation were used along with diet. So, it's hard to tease out what actually helped the participants.

It's also important to note that there are many variations of the Paleo diet—but all are protein heavy (especially animal sources), and, like most other MS-popular diets, you will have to cut out processed foods.

Swank Diet

The Swank diet was discovered by Dr. Roy Swank in the mid-1950s, and he reported his results 20 years later, after following his own patients on the diet. Results revealed that people who adhered to this diet were protected from disability progression and death from MS-related causes.

The Swank diet is low in fat, with no more than 15 grams of saturated fat permitted per day and no more than 20 to 50 grams of unsaturated fat and oils.

In addition, red meat is not allowed the first year on the diet (and then up to 3 ounces weekly) and only dairy products that contain 1 percent or less of butterfat are permitted—so no butter, and no imitation dairy products like margarine. Finally, like the Paleo diet, processed foods are also not allowed.

So what can you eat? Foods that are allowed include:

  • whole grain cereals and pastas
  • fruits and vegetables
  • 1 tsp every day of cod liver oil and a multivitamin
  • white fish and shellfish
  • skinned trimmed poultry

The Swank diet was repeated in a follow-up study, but, still, experts are hesitant, as the study was small and flawed.

Mediterranean Diet

The Mediterranean diet has been found to be beneficial for people with heart disease and type 2 diabetes, and possibly cancer prevention. This diet promotes a low consumption of saturated fats (for example, red meat, butter, and dairy products), a moderate intake of red wine, and a high consumption of whole grains, vegetables, fruits, legumes (for example, beans, peas, lentils, peanuts), olive oil, and fish.

A small 2016 study found that people who adhered to a Mediterranean diet had a lower risk for developing MS. Otherwise, there is no robust evidence linking its benefit to people with MS.

Ketogenic Diet

The ketogenic diet has been used to treat children with epilepsy who do not respond to traditional anti-seizure medications. Now, investigators are examining its potential use for treating other neurological disorders, like MS. The premise behind a ketogenic diet is that the body switches its metabolism from glucose to fat. In a complex way, this is believed to improve mitochondrial function (mitochondria are the powerhouses of cells).

Since an improved mitochondrial function is linked to the survival of nerve fibers (which degenerate and die in progressive MS), scientists believe a ketogenic diet may improve people with primary or secondary progressive MS. That being said, this is all very early—there are no studies yet examining the benefits of this diet in MS yet.

The ketogenic diet is a high-fat, low carbohydrate diet with moderate protein intake. Key foods include avocado, full-fat cheeses, heavy cream, butter, whole eggs, fatty nuts and seeds (like almonds and pumpkin seeds), bacon, beef, fatty fish, and olive oil.

In terms of fruits and vegetables, low carbohydrate vegetables like broccoli, cauliflower, bell peppers, asparagus, and zucchini are permitted. Fruit is high in sugar, but small amounts of berries can be used.

Fasting Mimicking Diet

Somewhat stemming from a ketogenic diet is the fasting mimicking diet (FMD), which promotes intermittent fasting as a means of both suppressing immune system attack on myelin (by killing "bad" immune system cells) and promoting myelin regrowth (by producing "good" healthy cells).

A study in Cell Reports found that periodic 3-day cycles (3 days of fasting every 7 days for 3 cycles) of a fasting mimicking diet were effective in relieving symptoms in an animal model of multiple sclerosis (called the experimental autoimmune encephalomyelitis, or EAE model). In fact, in 20 percent of the animals, there was a complete reversal of symptoms.

Research is underway regarding the role of fasting in humans with MS, and whether this can reverse or slow down symptoms.

What Does the National MS Society Suggest?

There is no special diet recommended by the National MS Society. Instead, the Society encourages a well-balanced nutrition plan that is rich in fiber and low in saturated fat—one that ends up being heart and waistline friendly too. With that, these guidelines are a starting point to keep you on track when it comes to eating for both your MS health and your overall health:

  • Eat a variety of whole grains, vegetables, and fruits.
  • Choose lean sources of protein.
  • Choose healthy fats (for example, avocados, almonds, cashews).
  • Avoid (or limit as much as possible) processed foods.
  • Cut back on sugar and salt.
  • balance overall calorie intake with daily exercise
  • Engage in emotional wellness strategies like stress management and daily relaxation.

A Word From Verywell

The big picture here is that there is no consensus or guidelines to follow when it comes to what you should eat when you have multiple sclerosis. The good news is that research is evolving, and it's exciting, especially since diet is a factor we can control, giving us some power back over this disease.

In the meantime, try not to get too bogged down and restrictive on what you can and cannot eat. If you do try a diet because it makes you feel good, that's great. But, please do it under the guidance of your doctor or nutritionist.

You do not want to risk malnutrition and/or worsening your MS symptoms like fatigue. Be kind to yourself, eat sensibly, and try your best.

Sources:

Bisht B et al. A multimodal intervention for patients with secondary progressive multiple sclerosis: Feasibility and effect on fatigue. J Altern Complement Med. 2014 May 1;20(5):347-55.

Bhargava P. National MS Society: Diet and multiple sclerosis.

Choi IY et al. Diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms. Cell Rep. 2016 Jun 7;15(10):2136-46.

Hadgkiss EJ 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. April,2015;18(3):125-36.

Storoni M, Plant GT. The therapeutic potential of the ketogenic diet in treating progressive multiple sclerosis. Mult Scler Int. 2015;2015:681289.

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