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We have received many questions on special diets for people living with MS over the years, and we’ve compiled several of them in this issue’s Q&A. Overall, any concerns regarding diet and MS begin with a basic principle: People with MS should eat foods that support overall good health, relying on the same dietary guidelines set forth for the general population. That being said, diet is clearly of special interest to people with MS who want to enhance their sense of control over an unpredictable disease. A good way to start is by understanding what diet can and can’t do for MS.

Q. Are there any special diets that will improve my MS?

A. No known diet has been proven to cure, cause, prevent, or change the course of MS. We say known diet because research evidence on diet and MS is meager. For one reason, diets contain many different foods and nutrients, and sorting out which component accounts for an observed effect in a research trial is very difficult. Further, MS by its nature can improve or worsen for reasons that may have nothing to do with a diet under study. What research does show is that a low-fat, high-fiber diet—such as the type recommended by the American Heart Association (www.americanheart.org)—can benefit people with MS like everyone else. The Food Guide Pyramid of the U.S. Department of Agriculture (www.mypyramid.gov) is a good place to begin building this kind of diet.

Q. What about the Swank Diet or the MS Recovery Diet?

A. There is some evidence that a diet low in saturated fats (found mainly in red meat and butter) and high in omega-3 fatty acids (found in fish) is especially helpful for people with MS. In 1949, a neurology professor named Roy Swank began placing MS patients on this diet plan and kept track of them over time. He reported that among 144 patients, two thirds of those who adhered closely to the diet were still alive after 34 years, compared with one fifth of the “poor dieters.” The study was not well designed—for example, it did not randomize the patients to the Swank diet versus standard fare. But the diet itself is in keeping with today’s general guidelines and poses no health risk for people with MS.

The MS Recovery Diet, described in a book of the same name, identifies dairy products, grains containing gluten, legumes (beans and peas), eggs, and yeast as triggers of the immune response believed to underlie MS. The authors say these foods, along with saturated fats and sugar, should be avoided to control MS symptoms. Like the Swank diet, the MS Recovery regimen has not been well researched, and it does eliminate foods that are considered to be a part of a healthy and varied diet. No special diet has been shown to replace disease-modifying therapies (DMTs), all of which have been proven to slow the progression of MS.

Q. I’ve read about the benefits of omega-3 fatty acids and vitamin D. Should I start eating lots of fish and dairy? Should I take supplements?

A. Whether or not they benefit MS, omega-3 fatty acids are good for the heart and blood vessels—so good that the American Heart Association urges people with or without heart disease to consume them regularly. The best way is to eat salmon, mackerel, herring, sardines, and other fatty fish. It is important to note that some species of fatty fish, such as king mackerel, may also contain high levels of mercury and thus should be eaten only in limited amounts by children and women who are pregnant or planning to become pregnant. Visit www.cfsan.fda.gov/seafood1.html for specifics. Omega-3’s are also made in the body from alpha-linoleic acid (ALA), found in soybeans, flaxseed, sunflower seeds,walnuts, and their oils. People without heart disease should eat fatty fish at least twice weekly and include ALA-rich foods and oils in their diet.

Vitamin D promotes calcium absorption for strong bones and may play a beneficial role in immunity. It’s provided in milk, cereals, eggs, sardines, and spinach, but the body can make its own vitamin D with the aid of sunshine. Because MS is more common in less sunny regions of the world, researchers have theorized that low vitamin D levels increase the risk of MS. However, therapy with vitamin D supplements has not clearly prevented or improved MS. Supplements to support bone health may be appropriate for people with low levels of vitamin D, but a doctor’s advice is essential, as the appropriate amount of supplemented vitamin D has yet to be determined, and too much vitamin D can be harmful.

Q. Can diet affect MS symptoms like fatigue or bladder and bowel problems?

A. Yes, it can, if the right foods are combined with exercise and plenty of water.

• To combat fatigue, eat smaller, more frequent meals—never go more than 4 hours without eating. Choose high-protein snacks, like cheese sticks, cottage cheese, yogurt, or peanut butter. Avoid sugary desserts, and limit caffeine,which can cause sleeplessness, dehydration, and anxiety. 
• To support bowel function, consume insoluble fiber—the kind that passes undigested through the intestines, taking other waste with it. The best sources are prunes, figs, brown rice, and wholegrain cereals and breads. 
• To compensate for tremor, which uses up calories, consume high-energy foods or drinks between meals. Have sandwiches rather than soup and other hard-tohandle foods. 
• To adapt to swallowing problems, avoid stringy foods, soften chewy foods with a blender, and consume milk shakes or prethickened drinks (available with a doctor’s prescription).

Q. I have MS, but I am also overweight. How can I improve my diet and lose weight without affecting my MS?

A. If having MS curtails exercise,* weight gain is likely to follow unless calories are adjusted downward. Corticosteroids can also increase weight. Safe weight loss calls for a reduction in:

• High-fat foods, which contain more calories per portion than carbohydrates and highprotein foods. Choose lean meats (“loin” cuts of meats are generally the most lean), poultry, fish, and vegetable oils. Enjoy low- or no-fat yogurt and cottage cheese. Think fruits, vegetables, and whole-grain products that help you feel full.
• Portion sizes, which may be supplying too many calories even if your food choices are healthy. Use measuring utensils and portionsize guides, or try smaller plates and bowls to make it seem as though you are eating a larger amount of food. An important note about low-carbohydrate diets: Most allow large amounts of high-fat foods while limiting whole grains, fruits, and vegetables. The result may be greater fatigue, loss of calcium and vitamins, and constipation.

* Having MS does not automatically prevent a person from engaging in a regular exercise program. In fact, exercise can help relieve some MS symptoms. To learn more about exercising with MS, see "Exercising With MS."

Q. I have lost weight due to problems with my MS.How can I change my diet to gain weight?

A. MS-related fatigue, tremor, depression, weakness, swallowing problems, and some drug treatments can lead to weight loss or even malnourishment. Step 1 is to manage the MS symptoms with the help of a doctor or nurse. Calories and portion sizes may then need to be adjusted upward. High-energy food and drinks might also be considered. A dietitian can suggest new foods and new ways to prepare them, or social services like Meals on Wheels can deliver prepared foods. The goal is to ensure that mealtime is practical and enjoyable as well as nourishing.