HealthyLiving

Diet That includes two liters of water and 30 grams of Is there an MS diet? fiber every day, a palate with bright, colorful foods, and foods that have high nutritional value. Decrease by Judi Hasson and refined sugar,” Dr. Crayton added. Some doctors who look to a more aggressive eat- here are low-cal diets and low-carb diets, liquid ing plan to deal with MS support the Swank Diet, a Tdiets, vegan diets, diets that claim to fight stringent low- diet developed by Dr. Roy Swank aging, arthritis, autism, and anxiety—and that’s more than 30 years ago. It bans all dairy products, only the “A”s. glutens (found in ), legumes For people with MS, many (meaning beans and peas) and doctors recommend a traditional What do experts say about virtually all from low-cal, low-fat diet; others pro- the thicket of claims? animal sources. It stresses fish and mote strict limits on certain food Can a diet moderate MS? fish oils. groups. Or they emphasize certain Dr. Swank reported that 95% foods such as fatty fish, apples, of patients who adopted this very blueberries, broccoli or almonds. low-fat diet following an early diagnosis of MS had The varied recommendations and the lack of a a remarkably good chance of remaining free from distinct game plan can leave people with MS just further disability. plain confused. “They have to follow the diet strictly because “While it is unlikely that a simple diet will be even small amounts of fat make a big difference,” therapeutic in MS, recent data regarding the roles Dr. Swank said. He asserted that patients who had a of vitamins such as vitamin D and niacin daily intake of eight grams of saturated fat in maintaining a healthy immune and (one hamburger or two ounces of cheddar nervous system suggest that we should cheese) significantly increased their risks. pay more attention to nutrition,” said Dr. Dr. Swank published his study in the British Peter Calabresi, who heads the Multiple medical periodical The Lancet in 1990. Sclerosis Center at Johns Hopkins “Most people in this country expect Hospital in Baltimore. to be cured by a pill, and to have a cure “No one is completely sure what that is almost instantaneous. With the works and what doesn’t,” said Dr. low-fat diet, people actually have to Heidi Crayton, director of the MS work to get better,” Dr. Swank Center of Greater Washington, told Dr. John A. McDougall, DC. “There are guidelines for founder and medical director smart eating, but there is of the McDougall Program, no fail-safe plan. I tell my which promotes this very patients with MS that low-fat approach. it’s really important to The problem is have a healthy diet. other researchers

36 Momentum • Fall.2008 have not duplicated Dr. Swank’s results, and there either for or against specific foods or supplements. is no generally accepted proof that the Swank diet He agrees with Dr. Yadav that research on MS and really controls MS. There is anecdotal evidence diet is very limited. from people with MS who say this diet makes them All these doctors agree that while there is no con- feel better. crete evidence that a specific diet controls MS, there Dr. Vijayshree Yadav, a neurologist at the Ore- is every good reason to eat a healthy diet and avoid gon Health & Science University MS Center in things that are known to be bad for everybody. So Portland, Oregon, said there is little current research while there is no true consensus, an MS plan might on the Swank diet. In fact, “diet has not been paid look like this: that much attention,” she said. “But diet can make • Cut back on saturated fat. That means avoid- a difference.” ing highly marbled red meat, butter, cheese and She advises her MS patients to go low-fat: “It’s other full-fat dairy products. healthy. And it’s such a low-risk intervention that I • Use oils from vegetables, seeds, and fish. Try don’t see any reason not to recommend it.” She also butter substitutes, such as soft or tub margarine, said a new study is expected to get underway next but use sparingly and look for “0 trans fats” on the year at the Oregon facility to take a hard clinical label. look at the impact of diet on MS. • Eat fish regularly, especially salmon, herring, “Diets have been used for MS from time mackerel, tuna, sardines and lake trout. immemorial. If they worked, we wouldn’t be still • Eat skinless chicken or turkey, lean meats talking about them,” said Dr. Randall T. Schapiro, trimmed of visible fat, or go meatless with vegetable the director of the Schapiro Center for Multiple proteins from beans, lentils, soy or nuts. Sclerosis in Minneapolis. Like many other • Consume five servings of fruits and MS specialists, Dr. Schapiro recommends vegetables a day, choosing the brightly a healthy diet that is low in saturated fat. colored fiber-rich varieties. Other than that, he said no specific diet has • Eat three to four servings of whole-grain shown any long-term benefit. products daily. There is no concrete evi- According to Dr. Allen Bowling, dence that gluten has any impact on MS. director of the Complementary and • Exercise to stretch muscles affected Program at the by MS, stay in shape, manage mood, Rocky Mountain MS Center in fight fatigue, promote bone health, Englewood, Colo., it may be rea- and maintain a healthy weight. sonable for some people with • Be cautious with caffeine MS to take a fish oil supple- and alcohol. ment that includes one to two grams of EPA plus Judi Hasson is a Washing- DHA. He also notes ton, DC-based journalist that it’s wise to beware who was diagnosed of overstated claims with MS in 2007.

nationalmssociety.org/magazine Momentum • Fall.2008 37 HealthyLiving

Diet important components of myelin and other central Is there a diet that helps nervous system tissues. They include both monoun- saturated fats—found in olive, canola and peanut people with MS? oils, avocados, and nuts including by Denise Nowack, RD almonds, hazelnuts, and peanuts, Yes, says our columnist. and polyunsaturated fats— hen I’m asked, “Is there an Good nutrition promotes found in other vegetable oils such WMS diet?” I say “Yes,” even optimal health—and helps as safflower, sunflower seed, corn though I know no diet has yet manage some troublesome and soybean oils, seeds, and nuts been proved to be an effective MS symptoms. including walnuts and Brazil nuts. treatment. I say that because it’s When these fats replace saturated the best answer to the hidden fats in the diet they can help to question, “Can diet make my MS better?” lower cholesterol and the risk of heart disease. Yes! Good nutrition has a positive impact on There is some limited research showing that some MS symptoms and also lowers the risk of certain types of polyunsaturated fats—specifically other diseases and disorders. The goal is optimal omega-3 fatty health throughout a lifetime. A diet that can make acids and omega-6 MS easier to live with begins with a look at fats. fatty acids—could actually have a About those unhealthy fats beneficial effect on Saturated fats have long been associated MS. In the context of a with high blood pressure, heart disease, low-fat diet, they showed a stroke and some cancers. These fats are usu- tendency to decrease the severity ally solid at room temperature and can be and duration of MS attacks. Additionally, found in highly marbled meats, the skin on poultry, the omega-3s may improve mood and memory. rich, creamy cheeses, butter and whole milk dairy Omega-3s can be found in fatty fish like mackerel, products. There are saturated fats in coconut, herring, sardines, albacore tuna and salmon. These palm and palm kernel oils (often called fish contain two omega-3s—EPA (eicosapentaenoic tropical oils), and cocoa butter, too. acid) and DHA (docosahexaenoic acid). For spe- cific amounts in fish go to fn.cfs.purdue.edu/fish Trans fats act just like satu- 4health/NutritionalContentofFish/omega3.pdf. rated fats in the body and Plant sources such as soybeans, canola oil, are typically found in walnuts or flaxseeds contain ALA (alpha-linolenic shortening, margarine, acid), a less potent form of omega-3. cookies, crackers, snack Omega-6 fats are in safflower, sunflower, and foods and fried foods. Most sesame seed oils, in other seeds and nuts, and in trans fats are manmade through a leafy vegetables and grains. process called hydrogenation— where a liquid fat like corn oil is made into a more Fitting in the fat solid form, like margarine or shortening. While fat is an important part of a healthy diet, moderation is key. Leading health agencies recom- About those healthy fats mend that less that 30% of total daily calories come Unsaturated fats play a very important role in from fats and that unhealthy saturated and trans diet, supporting many essential functions. They are fats be limited to no more than 7% of the total.

38 Momentum • Fall.2008 to provide greater benefit than Nutrition Facts Nutrition Facts any do alone. This is one more Serving Size 1 Tbsp (14g) Serving Size 1 Tbsp (14g) reason to choose foods over Servings Per Container 32 Servings Per Container 32 supplements.

Amount Per Serving Amount Per Serving Finding antioxidant-rich Calories 100 Calories from Fat 100 Calories 100 Calories from Fat 100 foods is easy. Look for brightly % Daily Value % Daily Value colored fruits and vegetables— Total Fat 11 g 17% Total Fat 11 g 17% red, orange, yellow, green and Saturated Fat 7g 35% Saturated Fat 2g 10% Trans Fat 0 g Trans Fat 3 g blue—and include four to six Cholesterol 30 mg 10% Cholesterol 30 mg 10% servings every day.

Nutrition Label, Butter Nutrition Label, Stick Margarine Those evil carbs? Saturated Fat: 7 g Saturated Fat: 2 g Carbohydrates provide the + Trans Fat: 0 g + Trans Fat: 3 g most desirable form of fuel for Combined Amount: 7 g Combined Amount: 5 g the human body and brain. However, popular low-carb diets have led the public to Let the label be your guide believe that carbs are an unnecessary evil. The big new food labels provide all the informa- True, not all carbohydrates are created equal. tion you need to choose healthy fats. Here’s how Much like fats, some promote good it works. When comparing food products add health while others increase the the grams (g) of saturated fat and trans fat on risk of diseases like diabe- a food label and choose the one with the lowest tes and heart disease. The combined amount. carbs in highly processed foods such as white bread, About antioxidants—a catch for people with MS white rice, baked goods, or Antioxidants protect cells from damage caused by sweetened beverages are best free radicals, or oxidants. This damage may con- avoided. But those in fruits, tribute to aging, cancer and heart disease. There is vegetables, beans, and whole grains provide essen- preliminary evidence suggesting that oxidants may tial fuel along with vitamins, minerals, fiber, and be a factor in the damage to myelin and nerve fibers other important nutrients. in MS. Sounds good for antioxidants. But there’s a catch. Antioxidants, like vitamins C What diet can do for MS symptoms: constipation and E, may stimulate the immune system. In MS, Whether constipation is a result of MS or lifestyle where an overactive immune system appears to be habits, a healthy diet that includes 25–30 grams of part of the disease process, stimulation may not be fiber a day promotes good bowel function. Fiber- desirable. The safety of taking antioxidant supple- rich foods often provide a more lasting sense of ments for people with MS has not been established; fullness, too, which helps people cut back on por- the potential for harm is unknown. tion sizes. There is fiber in cereal grains, nuts, seeds, Food sources appear to be the safest and best vegetables and fruits. To fit more into your diet: approach. In addition to vitamins, there are many • Start your day with a high-fiber breakfast cereal other natural compounds in plant foods that func- • Switch to whole-grain breads and pastas tion as antioxidants. Carotenoids and flavonoids are • Eat beans, peas, lentils, brown rice, barley, and among them. These nutrients work synergistically other whole grains nationalmssociety.org/magazine Momentum • Fall.2008 39 HealthyLiving

• Snack on dried fruits and • Refresh yourself at snack time with ready-to-eat raw vegetables diluted fruit juice, low-fat milk or yogurt • Have fruit at every meal drinks, sparkling water, cool herb teas • Travel with a supply of water Start slow. Fiber should • Limit drinks like cola, coffee, and caf- be added gradually. Too feinated teas; they can be bladder irritants. much fiber too fast can cause gas, cramps, diarrhea Diet and exercise are perfect partners … and discouragement! There are many reasons why a person with Don’t forget fluids. Fiber MS may gain or lose weight—but controlling absorbs water, so as you increase weight is the same story for everyone: calories fiber increase fluids, too. we don’t use for fuel are stored as fat. Together, For a longer list of fiber-rich foods, go here: physical activity and good nutrition are the perfect nationalmssociety.org/diet. combination for weight control. Not only does activity burn calories, it can: What diet can do for MS symptoms: fatigue • Decrease feelings of fatigue (Really. Even Fatigue can make it easy to miss meals and with MS.) then rely on getting a boost from high-calorie • Decrease symptoms of depression fast foods. That further contributes to fatigue • Maintain regular bowel and bladder by depriving you of the quality food your functions body needs to function effectively. • Minimize the risk of skin breakdown Fight fatigue these ways: and irritation • When eating or cooking feel over- • Make the most of muscle strength, whelming, try smaller meals and regular or even build strength, depending on snacks. Don’t go more than four hours your program without eating something. • Increase endurance • Stock up on ready-to-eat healthy • Maximize range of motion and joint snack items to help you resist low-nutrient flexibility convenience foods. • Protect bone mass • When you do cook, conserve energy: • Improve cognition. Gather the ingredients you need before you start. Use a tall stool to minimize standing. The impact of special needs Use precut, prewashed vegetables. A final note: people with MS may have special • When you do cook, double up on recipes and needs. Always talk with your health-care profes- freeze meals for the next time your energy is low. sional about your special circumstances. There is much more information in the Society What diet can do for MS symptoms: bladder booklet, Food for Thought, which I’ve just revised. It might be tempting to avoid beverages as a strat- Read or download it at nationalmssociety.org/ egy to manage bladder problems. This can lead to diet—or call 1-800-344-4867 and ask for a dry mouth, loss of appetite, swallowing difficulties, free copy. deficiencies in certain nutrients, and increased risk for urinary tract infections. Keep the fluids flowing: Denise Nowack, RD, is a registered dietitian and execu- • Take regular water breaks during the day tive vice president of Chapter Programs for the Southern • “Water down” your meals California Chapter.

40 Momentum • Fall.2008 Books for easier cooking • Sandra Lee’s “semi-homemade” philosophy has driven her to write Semi-Homemade Slow Cooker by Greta Herron Recipes and its sequel Semi-Homemade Slow Cooker Recipes 2, blending big- reparing nutritious meals is fl avor ingredients and multispice These books focus on quick important for good health, packets into one-pot meals P and easy recipes—without but cooking can seem a Hercu- (semihomemade.com/books). lean task when MS symptoms compromising taste or • Beth Hensperger and Julie fl are. Before you reach for the healthy eating. Kaufmann’s Not Your Mother’s take-out menus, consider Slow Cooker Cookbook includes some cookbooks by authors tips on choosing a slow cooker along who have found simpler ways with hundreds of recipes (amazon. to cook. com). Using a smaller cooker, or • Cooking Light’s 5 Ingre- just tired of having too much food? dient 15 Minute Cookbook is Hensperger also offers Not Your a survival guide for a busy cook; Mother’s Slow Cooker Recipes includes a grocery list (amazon for Two: For the Small Slow .com). Cooker (amazon.com). • Rozanne Gold’s Healthy • Cooking Light magazine 1-2-3: The Ultimate Three- has two slow cooker books: Slow Ingredient Cookbook, Fat-Free, Cooker by Terri Laschober and Healthy Slow Low Fat, Low Calorie focuses on a sensible and Cooker by Judith Finlayson (amazon.com). nutritious approach to meals, with just a few ingre- And fi nally, from one who knows MS dients (bn.com). personally: • Rachael Ray has a number of books out, • Nutritionist Elizabeth Yarnell, who was diag- including Express Lane Meals: What To Keep On nosed in 1999, patented her method of cooking in Hand, What To Buy Fresh For The Easiest-Ever multiple layers. Try her book Glorious One-Pot 30-Minute Meals (amazon.com). According to Meals: A New Quick & Healthy Approach to customer reviews on Amazon, Rachael Ray’s recipes Dutch Oven Cooking (gloriouspotmeal.com). are fast, but they are more comfort food than nutri- Her Web site offers product information, blogs, tious meals. videos and a subscription to her newsletter. For set-it and leave-it cooking, a slow cooker may be the way to go. Greta Herron is on the staff of Momentum .

nationalmssociety.org/magazine Momentum • Fall.2008 41