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2 Diet and nutrition Contents
A word from Yasmin, who has MS 4 Five things to know 5 About this booklet 7
Is there an MS diet? 8 Vitamin D 13 Calcium 16 Essential fatty acids 18 Vitamin B12 20 Antioxidants 22 Special diets 24
Can my diet help with my MS symptoms? 35 If MS symptoms affect your eating and drinking 39 Preparing meals 41 Managing your weight 46 Useful organisations 49 New words explained 51
Further information 54 A word from Yasmin, who has MS
Being diagnosed with an and drinking a lot of fluids helps unpredictable and incurable me feel better. I feel it also helps condition like MS can leave you fight off any infections. feeling powerless. It certainly did with me. The impact that the food you eat makes on your ‘brain health’ When I heard diet could help with is undeniable and not only for MS symptoms I assumed that people with MS but for anyone. this would be a ‘special’, unusual But for people with MS, eating and probably expensive diet. But well is another way to take control the reality was just to eat good of your condition. Chronic illness nutritious food and include lots takes so much away from a of vegetables. With this in mind, person’s life, but being able to eat we get a weekly veg box delivered and share good food with friends to make sure we have a supply and family gives back some of of fresh produce to cook with. what has been lost. I recently completed an Open University degree and believe that eating healthy food helps when trying to study.
This booklet has some helpful information on how to manage your MS symptoms by making changes to your diet. I try to eat smaller meals more often to help me feel less tired and I always make sure I drink enough liquids. I often feel I’m easily dehydrated,
4 Diet and nutrition Five things to know
Aim for a balanced diet so you get enough of the main nutrients: carbohydrates, fats, proteins, vitamins 1 and minerals.
There isn’t an ‘MS diet’ that’s been proven to help treat multiple sclerosis. And some special diets, like The Swank, 2 McDougall, Paleo or Best Bet, cut out certain foods, so if you try them, be careful not to miss out on vital nutrients.
A balanced diet and healthy weight, could help you 3 manage your MS.
Make a plan for your diet that helps your own personal needs - to help with fatigue, the bladder or bowel, 4 swallowing difficulties or keeping a healthy weight.
If you need help with meals - with planning, shopping, preparing or clearing up - ask your GP or MS nurse for 5 an occupational therapist assessment and a referral to a dietitian. They can help make sure you can get a good diet, and help you eat healthily within your budget.
Diet and nutrition 5
About this booklet
Eating is more than just There’s information too on other something we need to organisations that can help with do. It’s something to be issues around food and eating. See ‘Useful organisations’ on enjoyed – it can be a fun page 49. social activity, a cultural experience and something And if you’re keen to stay as fit to make you feel good. And and healthy as possible, our a healthy diet that suits website’s got lots of information how you live can make a about exercise and support for staying active, including videos difference to how you feel. you can use at home: In this booklet we describe the mssociety.org.uk kind of healthy diet that most people should aim for – one that Call the MS Helpline to see how has a balance of different kinds of our Physical Activity support foods. service can encourage your efforts with activity, diet and stopping We’ll also talk about some of the smoking: 0808 800 8000 claims made for special diets for MS. We look at the evidence, to One last thing. Where you see help you make up your own mind a word in bold in this booklet, it about what you choose to eat. means you can turn to the back and find it explained in more Because MS symptoms can detail. sometimes affect what you eat and how you prepare meals, we’ve got tips on planning, preparing, and clearing away.
Diet and nutrition 7 Is there an MS diet?
For most people with MS, the We look at some of the more best diet is a healthy, varied popular diets that are suggested one. And lots of people with for MS in ‘Special diets’ on page 24. MS say that when they eat What should I eat if I’ve well, they feel better. got MS? Aim for a healthy, balanced diet. Some people with MS say that That’s one that gives you the right following a specific diet has made amounts of different kinds of a difference to how they feel. For nutrients: example, they might feel the diet has reduced how many relapses • Proteins for growth and they get, or that it’s improved their tissue repair overall quality of life. But other people don’t feel this way. • Carbohydrates for energy • Fats for energy, to help your Researching diet is very difficult, body absorb certain vitamins, and at the moment there’s not and for essential fatty acids much scientific evidence that any • Fibre for healthy digestion and special diets affect the way MS regular bowel movement develops. But a healthy balanced • Vitamins and minerals diet can help guard against other essential nutrients needed for issues, like heart disease and your body to work properly, strokes. including tissue repair, bone If you feel better eating a certain strength and for absorbing way, it could be a change that works other nutrients for you. The important thing is to make sure you’re not missing out on the healthy nutrition you need.
8 Diet and nutrition • Fluids so the body can work at habits, and keep your bones, its best. Water carries nutrients muscles, teeth and gums healthy. around the body and is used in the chemical processes that The same balanced diet, with happen in our cells exercise, can help cut your risk of getting heart disease, stroke, osteoporosis and certain cancers. The NHS uses the Eatwell Guide to show the different portions they And it can help keep your skin recommend for a balanced diet. in good condition, to protect You can find it atnhs.uk as well as it against getting sore and on national government websites. damaged. This could be important if you spend a long time sitting or Our diet is made up of lots of lying down. different nutrients, not one thing or another on its own. So we have Who can help with diet and to think about diet as a whole. nutrition? But some MS research has GPs, dietitians and occupational looked at particular nutrients and therapists can all help with diet and on pages 13 to 23 we look at nutrition. They can help with what vitamin D, calcium, essential fatty you eat and how you prepare it. For acids (including omega-3), vitamin example: B12, and antioxidants. • Your GP can tell you more about healthy eating, and How can a balanced diet most surgeries will have help? information leaflets you can A balanced diet combined with take home. You can ask them exercise can help you stay in the for a referral to a dietitian. best health possible. For example, • A dietitian can help if you have it can help you keep a healthy any particular nutritional or weight and feel less tired. It can energy needs – for example, if also help you have regular toilet you have a constant tremor, or
Diet and nutrition 9 you’re underweight, or if you Should I take vitamin or have symptoms or another mineral supplements? health condition which might If you’re eating a balanced diet affect your diet. A dietitian can then you should be getting also help you plan your meals enough of most vitamins and so that you’re getting all the minerals through your food. nutrients you need. Research suggests this is the best • An occupational therapist can way to get the nutrients you need, help you find easier ways to rather than through supplements. prepare food, perhaps to save energy or to manage a tremor. But there could be reasons you might need to take supplements. For more information about For example, everyone should getting a healthy diet and how consider regular vitamin D to find a dietitian, visit the NHS supplements (see page 14). website for your nation. Some neurologists test their patients with MS to check their vitamin D levels. If these are low, “All we can do is they can prescribe supplements. eat a healthy, There’s more about vitamin D on balanced diet. If you’re page 13. low on something then pop those If your energy needs are very low supplements. I’m and you don’t eat very much, you sticking to eating might not get enough of certain veggies like my mum vitamins and minerals. ordered.” Mel But speak to a health care professional if you think you might need to take supplements. If you do take them, remember that too much of certain vitamins
10 Diet and nutrition or minerals can sometimes be Of course, alcohol can have all harmful. There’s more about sorts of effects of the body, which vitamins and minerals on the could make MS symptoms worse. NHS Choices website, including For example, some people with recommended safe levels. MS say it makes their balance and coordination worse. It can also Are there foods I should avoid? irritate your bladder and affect There’s very little evidence that your sleep. As with people who removing certain foods from your don’t have MS, the short-term diet is a good way to treat your effects of what you drink vary MS. A healthy, balanced diet would from person to person. mean you’re not getting too much of any particular kind of food. Alcohol can interfere with some medications. Your GP, pharmacist But people with MS can react to or MS team can tell you if you if certain foods, just like anyone that’s the case for anything you’re else. If you think you have an prescribed. allergy or intolerance, speak to your GP who can help you to look The NHS has guidance on alcohol into it further. The charity Allergy for all men and women. It says UK has more about the signs there’s no completely safe level of allergies and intolerances at of drinking, but sticking within allergyuk.org the guidelines lowers your risk of harming your health. Can I drink alcohol if I’ve got MS? They advise people to drink no You don’t have to give up alcohol more than 14 units a week, and to because you’ve got MS. There spread that over 3 or more days, hasn’t been much research into not all in one or two days. As a alcohol and MS, but the evidence guide, a pint of 5.2% alcohol beer doesn’t suggest it makes MS is 3 units. A bottle of 13.5% wine is worse in the long run. 10 units.
Diet and nutrition 11 Coffee and MS healthy for most people. If you’re You don’t need to stop drinking pregnant, the NHS recommends coffee because you’ve got MS. you drink no more than 200mg Some research suggests coffee of caffeine a day. That’s about 2 might even have health benefits, coffees. including reducing the chance of Does salt affect MS? heart disease. Research hasn’t shown a link One study into coffee and between the amount of salt we MS found that people with eat and MS. It doesn’t seem to relapsing forms of MS who drank affect the risk of developing MS, coffee every day had a slower or influence how quickly MS development of symptoms than progresses. those who never drank coffee. But But eating a lot of salt is linked to the evidence isn’t strong enough high blood pressure, heart disease to recommend everyone with and stroke, so it makes sense to relapsing MS drinks coffee. And keep it to less than 6g a day. That’s we also don’t know how much about a teaspoon of salt and it’s coffee might be the best amount the recommended upper limit for to drink if it does have benefits. adults in the UK. We do know drinking too much We need a bit of salt in our diet, coffee can have side effects like but lots of the foods we eat, like nervousness, irritability and bread, cereals and ready meals, stomach upset. And coffee and already contain salt so it’s often other drinks with caffeine in them not necessary to add salt to your can make you need the toilet meals. more often and affect your sleep.
The effects of caffeine vary from person to person, but 4 cups a day would seem to be completely
12 Diet and nutrition Vitamin D
Vitamin D keeps your teeth, further away from the equator muscles and bones healthy where there is less sunshine. So and it plays an important role researchers have looked into possible links between vitamin D in your immune system. and the risk of developing MS. Most people get the majority of Studies show that if you don’t get their vitamin D from sunlight. It’s enough vitamin D when you’re made by our bodies when the a child this could play a role in sunlight shines on our skin. It’s your chances of developing MS. also available in smaller amounts Other research shows that people in food. who naturally have low vitamin D Good food sources of vitamin D levels because of their genes are include oily fish, such as salmon more likely to develop MS. and sardines, fortified breakfast There’s some evidence that cereals, and eggs. Small amounts levels of vitamin D in the body are also found in margarine and might affect how someone’s MS full-fat milk. develops. But it’s almost impossible to But at the moment it’s not clear get all the vitamin D you need that increasing vitamin D (through through diet alone. supplements, for example) can Is there a link between help manage MS. If it could, it’s vitamin D and MS? important to also find out the best There does seem to be a link dose, and if it could help certain between vitamin D and MS. people more than others. We get about 80-90% of our vitamin D from the sun. And there are more people with MS in areas
Diet and nutrition 13 You can keep up with the latest • don’t get outdoors much research on our website • always cover up in the sun mssociety.org.uk/research • are from a minority ethnic Should I take a supplement group with dark skin, such as to get enough vitamin D? of African, African-Caribbean or South Asian origin If you live in the UK, you probably don’t get enough vitamin D through diet and sunshine alone, Some neurologists suggest particularly in the darker months - people with MS should take from October to the end of March. higher doses than other people, all year round. The UK government’s Scientific Advisory Committee on Nutrition If you’re concerned about your recommends that everyone in the vitamin D levels, ask your MS UK considers taking a supplement team about getting a blood test. to make sure they’re getting And speak to your MS team enough vitamin D. before taking high doses. Too much vitamin D could cause For anyone who’s 1-year-old serious health problems. or over, they recommend 10 μg (micrograms) /400 IU The Association of British (international units) a day. Neurologists says women with MS of child-bearing age should These recommendations are for take a vitamin D supplement. the population as a whole, to help Speak to your neurologist about keep bones and muscles healthy. how to take this supplement and All 4 UK governments at which dose. recommend some people take this supplement all year, including if you:
14 Diet and nutrition
Calcium
Calcium is vital for keeping Calcium and vitamin D bones strong. It also helps As well as getting plenty of muscles to work properly. calcium, you should also make sure you’re getting enough How do I get calcium into vitamin D, as it helps your body to my diet? absorb calcium. Low fat products Milk and dairy products – contain less vitamin D than full fat including yoghurt and hard versions. cheeses such as cheddar and edam – are the richest sources of If your MS team recommends you calcium. take a high dose of vitamin D, they might also suggest you should Tinned sardines and pilchards have a low calcium diet. That’s (where the bones are eaten), bread because occasionally, very high (particularly white), tofu, green doses of vitamin D cause calcium leafy vegetables, baked beans to build up in the body and and other pulses, certain nuts and damage the kidney. seeds (tahini, almonds, brazil nuts, hazelnuts) plus dried figs are also How much calcium do I need? good sources. The recommended amount of calcium each day is 700 mg. This Calcium-enriched soya products, is about the same as a pint of milk, such as milk, yoghurts or cheeses, or two to three portions of dairy, are also available. such as a yoghurt or matchbox Skimmed milk contains as much sized piece of cheese. calcium as full-fat, so you can cut down on fat without losing out on calcium.
16 Diet and nutrition Should I take supplements worried you’re not getting enough for bone health? calcium or vitamin D, talk to your If you’re prescribed a course of GP about whether supplements steroids, or if you’re less mobile, are good for you. To find out if a health care professional might you have enough calcium in your suggest calcium supplements to bones, you’d need a scan to check strengthen your bones. If you’re bone mineral density.
Healthy bones
Osteoporosis causes bones to become more fragile and more at risk of breaking. It’s not a symptom of MS, but people with MS might be at a higher risk of developing osteoporosis because of:
• long courses of steroids, used to treat relapses • a lack of weight-bearing exercise (where your feet and legs support your weight) • lack of sunlight, perhaps because of heat sensitivity or inability to get out of the house, leading to lower vitamin D intake
MS symptoms like balance problems can also make people more likely to have falls or break bones. So bone health is important. Keeping up good levels of vitamin D and calcium can help reduce the risk of osteoporosis, as these both help keep your bones strong and healthy.
Diet and nutrition 17 Essential Fatty Acids
Essential fatty acids (EFAs) The research evidence for EFAs are types of fat that the affecting MS is mixed. Overall, human body needs for good it’s not clear that they can reduce relapses or progression in MS. health. You might also hear But there’s no doubt that they’re them called polyunsaturated important for the immune fats or even PUFAs system. (polyunsaturated fatty acids). Many polyunsaturated fats Our bodies need a certain amount in our diet are EFAs. There of fat for a healthy balanced diet, so it makes sense to get that from are two main groups of EFAs: EFAs rather than saturated fats omega 3 and omega 6. which we know can be bad for us. EFAs have important jobs to do in How do I get EFAs in my diet? the central nervous system (the brain and spinal cord). We need Sources of omega 3 EFAs include: them to produce hormone-like oily fish, including sardines, substances, called prostaglandin • mackerel, salmon and fresh E2 and prostaglandin E3. tuna These work together when your • certain nuts, seeds and beans body reacts to inflammation including walnuts, linseed and the immune system goes to and soybeans work. EFAs are needed to make and repair myelin - the protective Sources of omega 6 EFAs include: layer around nerve fibres that gets damaged in MS. • certain seed and vegetable oils such as sunflower, safflower, rapeseed, soy and corn oil
18 Diet and nutrition • food made from the above normally have a typical UK diet, oils including margarine, you could try to aim for more salad dressings and omega 3 EFAs. mayonnaise EFAs still contain the same Should I take an omega 3 amount of calories as other types supplement? of fat so, while they might be Research hasn’t shown clear better for your health, it’s best not benefits for MS from omega 3 to eat too much. More research supplements. is needed to find out the ideal intake. Generally, omega 3 supplements are safe. But they might affect how some medicines work, and very high doses could be harmful. Your doctor or MS team can tell you if any of your medications might be affected by omega 3 supplements, and check the dose is safe for you.
If you’re pregnant, you should avoid supplements which also contain vitamin A, like cod liver oil. How much do I need? A good balance of omega 3 and omega 6 may be more important than the total amounts of each.
The typical UK diet is probably too rich in omega 6 and not rich enough in omega 3. So if you
Diet and nutrition 19 Vitamin B12
The link between vitamin Should I take vitamin B12 B12 and MS is not clear. supplements? But vitamin B12 does have Most people get enough vitamin several important functions, B12 in their diet, but some people including an important role don’t take in enough of it. This is in the nervous system. more likely if you’re vegetarian, vegan or following a special diet The body needs vitamin B12 to without animal products. make myelin – the protective layer around nerve fibres that gets Some people with MS might not damaged in MS. And vitamin B12 be able to take in enough of it even deficiency can lead to symptoms if they include lots of vitamin B12 in similar to MS. So it makes sense to their diet. include foods rich in vitamin B12 in If you’re concerned about your your diet. vitamin B12 levels, speak to your How do I get vitamin B12 into GP who can carry out a blood test. my diet? Research hasn’t shown any benefit Vitamin B12 is found in animal in taking supplements if you have products, including meat, fish enough vitamin B12. and dairy. Look for breakfast cereals that are ‘fortified’ with vitamin B12. Yeast extract such as Marmite can be a good source of vitamin B12 if you are vegan.
20 Diet and nutrition
Antioxidants
Oxidants, or free radicals, One small study funded by the are chemicals that react MS Society suggests antioxidants easily with other substances called ‘flavonoids’ might help with MS fatigue. In the research, in the body. They change they used hot chocolate. Dark or damage their structure. chocolate (over 75% cocoa) is very Some vitamins – including high in flavonoids. You can also vitamin A, C and E – can find flavonoids in other foods, like limit the damage oxidants fruit and vegetables. They’re one cause. So they’re known of the things that give fruit and as antioxidants. vegetables their different colours. Are they linked with MS? This was a small study, and more Some research tells us that research is needed to understand oxidants might be linked to the exactly how flavonoids and other damage that happens in our antioxidants might benefit people central nervous system with MS. with MS. But there have been few studies How do I get antioxidants into the use of antioxidants into my diet? for people with MS and the significance is still unclear. Brightly coloured fruit and vegetables – red, orange, green In theory, antioxidant therapy and yellow – are the best could make the effects of MS source of antioxidants. These worse, as some antioxidants foods also contain other nutrients have a stimulating effect on the our bodies need. immune system – although the levels found in a balanced diet Aim for at least five portions a day, would not cause a problem. choosing a variety of types
22 Diet and nutrition and colours. Dark chocolate (over your food without the need for 75% cocoa) is high in flavonoid supplements. If it’s hard for you to antioxidants. But remember to eat fruit and vegetables or your check how much sugar is also in diet is particularly limited, speak the chocolate. to a dietitian about whether taking supplements would be good for you. Should I take supplements? If you’re eating a balanced diet then you should be getting enough antioxidants through
‘Good’ bacteria In recent years, scientists have shown connections between the bacteria in our gut (our stomach and intestines) and the way the rest of our body works. This could include a link with MS and other conditions. The bacteria, and other tiny organisms, make up what’s called the gut ‘microbiome’.
Together they influence our immune response and central nervous system. This is a very new area of research and at the moment we don’t know exactly how the gut might affect MS, or if our diet could change that. But eating a variety of fruit and vegetables might help encourage a healthy balance of bacteria.
A large study involving people with MS is already underway to find out more. You can read more about this emerging research on our website mssociety.org.uk/research
Diet and nutrition 23 Special diets
Over the years, many It’s difficult to carry out research special diets have been into diet and MS, and at the promoted to help with moment there isn’t enough evidence to recommend any MS. These include low-fat, special diet for people with MS. allergen-free, gluten-free, What we know about diet in pectin-restricted, low-sugar general shows that it’s important diets, and diets that cut out to get a balanced nutritional processed food. Many people intake, instead of avoiding with MS say that following certain foods. a special diet gives them a If you do decide to try a new diet, feeling of control over their it’s important to make sure you MS. Some say that following still get enough energy and all the a special diet makes them nutrients you need. If you cut out feel better and helps with certain food types, make sure you their symptoms, but that’s find ways to get the nutrients you not the case for everyone. need to stay healthy and avoid malnutrition. Malnutrition can Some special diets recommend cause fatigue and make your MS changes which could have symptoms worse. benefits for overall health, such as reducing saturated fats, or eating Before making big changes, ask more vegetables – both generally your GP for a referral to a dietitian. recommended as part of a They can help you check you’ll get healthy, balanced diet. But they the nutrition you need. Like any can also include restrictions which lifestyle change, there are lots of might be unhealthy, or make it things you might want to consider hard for some people to stick to. before choosing to follow one of these diets, including:
24 Diet and nutrition • What’s the evidence? “I’ve eaten • Can you still enjoy your food? porridge for • Is it good for you? breakfast nearly every day for over • How practical is it? 20 years and would love to believe that What’s the evidence? it’s the reason why What’s the evidence behind the my MS is fairly tame. diet? Does it make extravagant But I know that in claims about how it will help your reality, although MS? Are these claims backed up porridge is good, in by science? many ways it’s not magic.” ‘Personal stories’ are just that – everyone’s MS is different. Daff So it’s difficult to know if any improvement is because of the How practical is it? diet or because of the way MS Think about how a diet fits into symptoms sometimes vary. And the way you and your household what helps someone else won’t live. For example, lots of diets ask necessarily help you. you to prepare each meal from fresh ingredients. Do you have Can you still enjoy your food? the time, energy and money Food is about more than just for that? If the diet suggests making sure your body gets the supplements, are they expensive? nutrients it needs. Can you still eat your favourite foods while Don’t feel bad about changing following the diet? If you enjoy things if a very strict diet becomes eating meals in restaurants or more of a chore than a positive with others at home will you still choice. We all know food is more be able to? than the nutrients it contains – it’s a big part of everyday life.
Diet and nutrition 25 Is it good for you? Paleo diets limit dairy, grains, Make sure you can get enough pulses, potatoes and processed energy from the diet. For example, food. if you have ongoing tremor or The Wahl’s diet is based on a you’re underweight, you might Paleo diet, and it’s part of what’s need extra energy. If you limit the called the Wahl’s Protocol. This kind of food you eat you might combines the diet with vitamins, find you lose weight and you meditation, and exercise. There could become malnourished. are also newer versions of the Can you still get a proper balance Wahl’s diet, including a ketogenic of all the nutrients you need? If a (keto) diet. The Wahl’s diet is diet cuts something out, what’s named after Terry Wahls, an the healthy alternative for those American doctor who has MS. nutrients? Do they help with MS? Before you make any major There’s been little research into a changes to your diet, speak with Paleo diet or the Wahl’s Protocol your doctor or nurse, particularly and MS. At the moment, there’s if you have any other health no clear evidence to suggest they conditions as well as MS. have benefits for people with MS. Paleo diets and In 2021, we expect results to the Wahl’s protocol be published from a study that Paleo diets are based on foods compared how a Wahl’s diet and that are thought to have been the Swank diet (see page 29) common in the Paleolithic era, might affect MS fatigue. You can before humans started farming. keep up to date on our website So they include meats, fish, nuts, mssociety.org.uk/research vegetables and fruit. The idea is that our bodies are best adapted to eating these kinds of foods.
26 Diet and nutrition Are they healthy? “I think diet is Following the Paleo diet wouldn’t very important generally be considered bad for us MSers, but for you, although you’d have to the key is to tailor make sure you were getting all it to meet your own the nutrients you need. Current requirements. We’re evidence around good diet all different.” suggests that we should be eating Heather nutritionally balanced diets, so cutting out whole groups of foods Intermittent fasting such as dairy, wholegrains and and keto diets pulses is restrictive. Intermittent fasting puts strict limits on calories some of the Cutting out cereals and dairy time, with the usual calories could mean you miss out on allowed the rest of the time. For some B vitamins, vitamin D example, it could mean cutting and calcium. And if you have what you eat to just 500 calories high energy needs or you’re for 2 days every week. On the underweight, excluded foods other days, you’d eat your might make it harder to get the normal amount. energy you need. Keto diets (also called ketogenic The large amounts of meat diets) are low in carbohydrates. recommended are higher than The idea is to get more of your current health advice on how calories from fats and protein much meat you should eat - and instead. could also make it expensive. Intermittent fasting and keto diets The Wahl’s diet doesn’t stop the body getting energy completely cut out all of the same from its usual carbohydrates, foods as other Paleo diets do, but so the body has to work in a you should still check you get all different way to make use of fats the nutrients you need.
Diet and nutrition 27 and protein. Researchers are in the gut which affect it. But at interested in these kinds of diet the moment, there isn’t enough because of the idea that they evidence to show they have an might reduce inflammation and effect on people’s MS symptoms help protect nerves. or how their MS develops.
Does it help with MS? Is it healthy? Early studies have suggested Keto diets don’t provide all the intermittent fasting and keto diets vitamins and minerals we need, might have a positive effect on the without supplements. And immune system and the bacteria intermittent fasting and keto diets
Religious fasting If you’re thinking of fasting for religious reasons, you might find our Fasting and MS factsheet useful. It could help you discuss things with your religious leader, your doctor or MS nurse, your family and friends.
Lots of people with MS observe these fasts when they feel well enough. But if you’ve got MS, there could be times when fasting is not advised.
Download the factsheet for free at mssociety.org.uk. If you can’t get online, call the MS Helpline on 0808 800 8000.
28 Diet and nutrition can lead to weight loss, so they unsaturated fat. It also limits your might not be advised if you’re intake of red meat and oily fish, underweight or have high although you can eat as much energy needs. white fish as you like.
Serious problems are rare, but the The diet also recommends that way the body gets energy from you take cod liver oil, vitamin C keto diets could lead to problems and E supplements and a multi- with the pancreas and liver. vitamin and mineral supplement.
People fasting or following a keto Does it help with MS? diet can get headaches, fatigue, Some people say that following feel irritable and dizzy for the first this diet has made them feel few days. better, and reduced the number of relapses they’ve had. Other Intermittent fasting can affect people have not had any benefit bone density and make menstrual from following it. periods irregular. From the research that’s been If you cut down on carbohydrates, published, there’s not enough your diet will be lower in fibre too. evidence to show that this diet We need fibre for a healthy gut has benefits for MS. and to avoid constipation. And if your diet is high in fat, this could Although a few studies have been affect your health in the long term. carried out, they’ve not generally been well designed. They also The Swank diet had very high drop-out rates, so The Swank diet is named after without knowing what happened Dr Roy Swank, who developed to the people who dropped out of the diet in the 1940s. It limits the the study it’s hard to draw clear amount of fat you can eat: no conclusions. more than 15g of saturated fat a day, and between 20-50g of
Diet and nutrition 29 In 2021, we expect results to Cod liver oil also contains high be published from a study that levels of vitamin A, so you compared how the Swank diet shouldn’t take it if you also and a Wahl’s diet (see page 26) takesupplements containing might affect MS fatigue. You can vitamin A, or if you eat liver keep up to date on our website mssociety.org.uk/research regularly. If you have diabetes you should speak to your doctor Is it healthy? before taking cod liver oil. Following the Swank diet or a This diet can be low in energy, so similar diet would not generally you might lose weight. If you have be considered bad for you. Not high energy needs or if you are eating too much saturated fat is already underweight then it may widely accepted as good health not be suitable for you. advice. The Overcoming MS diet But cutting down on meat and dairy products to reduce your The Overcoming MS (OMS) diet saturated fat intake might mean was developed by Dr George you’re not getting enough protein Jelinek in 1999 following his own and iron, so you’d need to find diagnosis with MS. It’s part of alternative sources like fish, beans a lifestyle programme which and pulses. includes diet, medication, exercise and meditation. Cod liver oil has a blood-thinning effect, so it should be taken The OMS diet recommendations with caution if you take aspirin are similar to the Swank diet. It or anticoagulant medications advises cutting out dairy and such as warfarin, or if you have a meat, and eating less fat – bleeding disorder. particularly saturated fat. It also recommends flaxseed oil as an omega 3 supplement and
30 Diet and nutrition vitamin D supplements if you If you have high energy needs don’t get out in the sun much. or you’re underweight, excluded foods might make it harder to get Does it help with MS? the energy you need. Research into this diet has not provided conclusive evidence of If you take cod liver oil its benefits. supplements, you should take the same precautions around that as A five-year follow up study for the Swank diet (on page 29). showed that people who had followed this diet reported they A Mediterranean diet felt better physically and mentally, A Mediterranean diet is based on but there was a very high drop- foods traditionally eaten in that out rate. part of the world.
We don’t know what happened It usually includes a lot of to the people who dropped out vegetables, fruits, nuts, beans, of the study. This is one of the cereals, grains, fish, and reasons it’s impossible to draw unsaturated fats like olive firm conclusions about the diet. oil. Regular - but moderate - amounts of red wine are also Is it healthy? sometimes recommended. Red Following the OMS diet isn’t likely meat and dairy are limited, but to be considered bad for you as not cut out completely. long as you’re sure to include the missing nutrients. Does it help with MS? There hasn’t been much research You should make sure you’re into MS and Mediterranean getting enough protein in your diets in particular, and the small diet, through eating plenty of fish, amount of evidence we have beans or pulses. doesn’t prove that they affect the course of MS.
Diet and nutrition 31 But they are usually a balanced immune system because they are diet, which can help you stay in similar to immune cells, leading to the best health possible. the symptoms of MS.
Is it healthy? Does it help with MS? A Mediterranean diet is usually Current research doesn’t support very similar to the Eatwell Guide the theory behind the diet, nor that the NHS uses. We talk about does it suggest there is any the benefits of that kind of a benefit to cutting out any of these healthy, balanced diet on pages 8 food types completely. and 9 of this booklet. This particular diet hasn’t been The Best Bet diet tested in any research trials, so The Best Bet diet was developed there is no evidence that it can by Ashton Embry, a geologist help manage MS symptoms. whose son has MS. Is it healthy? This diet recommends avoiding The Best Bet diet restricts a lot of several different food types, foods and can be low in energy, including all dairy, grains and so it might not be suitable for you legumes (beans and pulses). It if you have high energy needs also recommends taking lots of or if you’re already underweight. supplements, including calcium It also might not be suitable for and vitamin D. vegetarians and vegans, as it cuts out an important source The diet is based on the of protein. assumption that partly digested food protein can pass through You might need very careful from the intestines into the planning to manage the bloodstream. restrictions of the diet, and to get all the recommended The theory is that certain food supplements so you don’t miss proteins are able to activate the out on those nutrients.
32 Diet and nutrition The McDougall diet “Some do well on The McDougall diet is a very low- Swank, or Professor fat vegan diet. It was inspired by Jelinek’s diet, some the Swank diet, but it cuts out on Best Bet diet meat, fish and dairy completely. and there are other It’s high in carbohydrates, with diets, all of which lots of whole grain foods, fruit and will work for vegetables. someone, somewhere. It’s worth a try, Does it help with MS? but only if you feel There’s no research evidence that you really want to, the McDougall diet has an effect or else you’ll hate on MS. your new diet and cheat wherever Is it healthy? possible.” Because it’s a very low-fat vegan Karen diet, make sure you can find sources of protein and get enough calcium, vitamin B12 and zinc.
You might need to take supplements. You could lose weight with this diet, and it might lower cholesterol and blood pressure. If you’re underweight or you’ve got high energy needs, this diet might not be suitable.
Diet and nutrition 33
Can my diet help with MS symptoms?
You might find that making Starchy carbohydrates, such changes to your diet can as potatoes, bread and pasta help you manage specific MS (particularly wholemeal), can give you a slow release of energy that symptoms. can keep you going for longer. Try Diet is only one part of managing to make sure you eat regularly things, so speak to your doctor and include a snack if you have a or MS nurse too. You might long gap between meals. Snacks also want have a look at our can be healthy too, like fruit or information on fatigue or tremor, nuts. or managing bladder and bowel problems. It’s all on our website Dehydration can lead to tiredness, mssociety.org.uk or call the MS so try to keep your fluid intake up. Helpline on 0808 800 8000. It doesn’t just have to be water. Tea, fruit teas, fruit juice (but be Fatigue careful of the high sugar content) If you get tired quickly, you might and coffee can all help you stay find it easier to eat small, frequent hydrated. meals and snacks rather than large, hot meals. Try not to rely If you’re particularly tired, it can be on sugary foods to keep your tempting to drink lots of caffeine. energy levels up – although these But these drinks usually only can have an initial pick-me-up have a temporary effect, and can effect, this is often followed by an leave you more tired. There’s no energy low. evidence, though, that moderate amounts of tea or coffee will make you dehydrated.
Diet and nutrition 35 Some other nutrients might help Bladder problems with fatigue if you include them in If you have bladder problems your usual diet: – particularly problems with urgency or frequency – then you iron – good sources include • might be tempted to drink less so meat, fish, beans and pulses, you don’t need to go to the toilet and fortified cereals. It might as often. help to avoid drinking tea with meals (it could reduce the iron But this can make your urine you absorb) more concentrated, which can • Selenium – found in brazil irritate your bladder. It might nuts, meat, fish, seeds and make you more likely to get a wholemeal bread urinary infection. • Folate – found in liver, green It helps to keep up your fluid vegetables, citrus fruits, beans intake. If you can, aim for about and fortified breakfast cereals 1.5 to 2 litres (or about six to eight • B vitamins – in fortified foods cups) of fluid a day. including wholegrain cereals, meat, fish, eggs and dairy Be careful to limit your alcohol intake, as too much can make you “I love cooking go to the toilet more often. and always loved entertaining, but now I If you need to get used to think: what can I do that drinking more, it’s best to still looks impressive increase your fluid intake but that will take a lot gradually – on days when you less energy? It’s the are at home or when it is easy little things for me like to get to a toilet, for example. how you arrange it, colours, big flavours.” Louisa
36 Diet and nutrition Cranberry juice Cranberry juice or cranberry extract tablets are often thought to help to prevent or treat urinary tract infections. Research studies have been carried out and the evidence suggests they don’t usually help people with MS.
If you do drink cranberry juice, low-sugar versions have fewer calories and can help avoid damage to your teeth.
Tremor to your food adds calories. They If you have constant tremor it might suggest high-energy uses up calories, which might supplements. mean that you lose weight. It can Bowel problems also add to fatigue. Too much Changes to your diet are often alcohol or caffeine might also suggested as the first line of make tremor feel worse. treatment if you have bowel You can speak to your GP or MS problems. nurse for advice. They can refer Constipation - If you’re you to a dietitian if necessary, who experiencing constipation, might give advice on how to get keeping up a good fluid intake can more energy and protein in your help, as can a diet with plenty of diet. For example, adding extra fibre. Fibre can’t be digested and cheese, cream or butter passes straight through the gut.
Diet and nutrition 37 This helps with digesting other Pressure ulcers foods and removing waste. Try Although pressure ulcers are not to gradually increase your fibre a symptom of MS, you may be intake – a sudden increase could at risk of developing one if you make symptoms worse. are severely affected by MS and spend a lot of time in bed or in a A well-balanced diet, with plenty wheelchair. of fruit and vegetables, can provide this fibre. Good sources If you are underweight this can include prunes (or prune juice), add to the risk, because you lose figs, wholemeal bread, fortified the natural padding over your white bread, brown rice, porridge sitting bones and other bony and wholegrain breakfast cereals. points. You can speak to your GP if you, or your carers, are Incontinence - If incontinence concerned about your weight is a problem for you, it’s worth and your risk of pressure ulcers. experimenting with your diet to see if there are any foods that A balanced diet, including foods make it worse, or make your rich in vitamins and protein, is stools firmer. important if you have pressure ulcers or you’re at high risk of High-fibre foods, caffeine, milk getting them. products, chocolate, alcohol, spicy food and artificial sweeteners can There’s more information about all have the effect of producing pressure ulcers on our website loose stools in some people. mssociety.org.uk or call the MS Helpline on 0808 800 8000. If you keep a food diary for a few days it may help you to identify which foods help or make it worse. It may help to do this with the support of a dietitian, for guidance.
38 Diet and nutrition If MS symptoms affect your eating and drinking
MS symptoms can you could ask the person who sometimes affect what or prepares your meals to lay out how we eat. This could be the food as if the plate were a clock face. If the potatoes are when advice from a health placed at ‘12 o’clock’ and meat professional is particularly at ‘6 o’clock’, this might make it helpful. easier for you to find the food on You can find out more about your plate. the symptoms in this part Tremor of the booklet on our website mssociety.org.uk or by If tremor makes it difficult to calling the MS Helpline on hold or reach for things, certain 0808 800 8000. foods might be easier to eat than others. For example, finger foods Visual problems or sandwiches are easier to Double vision or blurring might manage than stews and soups. make it harder and more They can be just as nourishing. If time consuming to prepare your tremor means you need a or eat food. We’ve suggested lot of energy, extra butter, salad some practical things to try in cream or full-fat mayonnaise can ‘Preparing meals’ on page 41. be a useful high calorie filling to add. If you have severe visual problems, you might find it Small changes like eating with your helpful if your food is set out in elbows on the table might help – an agreed way. For example, it’s not bad manners if it works!
Diet and nutrition 39 And you can get specially • If chewing is difficult for you, designed cutlery, crockery and soften your food beforehand kitchen utensils that can make with a fork or blender, or add preparing and eating food more sauces or gravy. Avoid tough manageable. There’s more about or stringy food preparing meals on page 41. • Thickening agents in drinks can help prevent liquids Swallowing difficulties from going down the wrong If you have problems with way. You can get these on swallowing – also known as prescription from your doctor, dysphagia – this can make along with pre-thickened eating more difficult, perhaps fruit juices even stressful.
If you have difficulties chewing If you’re having a lot of problems your food or your food and drink with chewing or swallowing your are going the wrong way, then food, and you are losing weight ask your GP to refer you to a or becoming dehydrated despite speech and language therapist. following the tips above, then They can help you find ways of a direct liquid feeding system managing these difficulties. might be helpful.
After an assessment they might The most common of these is a advise you change what you eat PEG (percutaneous endoscopic or how you eat. For example: gastrostomy) system. With this, the food goes directly into your • Small, frequent meals and stomach through a tube. You can drinking milky drinks may be find out more from the charity easier than large meals, and PINNT at pinnt.com, or call our can help to make sure you’re MS Helpline on 0808 800 8000. still getting enough calories
40 Diet and nutrition Preparing meals
Because of symptoms like Ireland). Your GP can also make a fatigue, you might find you referral for you. have to plan everyday tasks Planning like shopping or preparing • Planning a menu for the food more carefully than week can help cut down on before. The tips in this shopping trips, and avoid section can help make food going to waste things a little easier – from • Cooking double batches planning what to eat to and freezing the spare clearing up afterwards. ones means there’s always something to eat when you’re Most of these tips don’t involve not feeling up to cooking big, obvious changes to what you do – or to your kitchen. It’s all • Even if you don’t get to the about finding the easy, everyday shops or prepare food, get improvements that work for you. involved in planning meals for the week ahead. That way An occupational therapist (OT) you still get to eat the food can suggest energy-saving you want. This is particularly tips and helpful equipment or important if you have a mix adaptations to make preparing of different people – family, food easier. They can also advise friends and paid carers – on grants for adaptations. who might all be involved in preparing meals for you To arrange an OT assessment, • A ‘likes and dislikes’ list can contact social services at your also help make sure you’re local council (at your local Health getting a good mix of meals and Social Care Trust in Northern
Diet and nutrition 41 that are to your taste, even “I set myself up if you’re not the one making a food plan a few them. If your MS affects what months ago, and you can eat, perhaps because with doing a monthly of swallowing difficulties, you shop I can pretty might want to work with a much plan out three dietitian to compile this list so or four weeks’ worth that you’re still getting all the of meals. I’m eating nutrition you need so much better because of it. I think If you live with other people it’s also good because you can start doing If you live with other people, it any prep through the can be tricky if only one person day, rather than all at wants to change their diet. It meal time, so you tire could help if others understand yourself out less.” why you’re making these changes, and why it’s important Louisa to you. It might help to explain that your diet isn’t a criticism of Shopping what someone else eats, or an • All the major supermarkets attempt to change them. offer a delivery service – which can save a trip to the You might be able to find meals shops, or having to carry that share many items, but you heavy bags home. If you do adjust what’s on each plate. your shopping online, you That way, you still feel like you’re can usually save your regular eating the same meal. order so you don’t have to Of course, there can be health remember it each time benefits for everyone if they get a balanced diet.
42 Diet and nutrition • Make a master shopping “I now do my main list of things you regularly food shop online and buy and, if you can, print have it delivered off multiple copies. Before to my home. I find going to the shops, check the list and tick off the items the whole shopping you’ve run out of. It’s a simple experience very tiring. reminder and an energy If the supermarket saver. And if you’re having is very busy, I get a bad day with your MS, quite stressed and someone else can use the sometimes confused. same list I would always need • Delegate tasks – can to plan for a loo someone else in your stop as well!” household, or a friend, do the shopping for you? Lyndsey • If shopping is too difficult, you could ask for an assessment Preparing food of your needs from your • Before starting to cook, local social care services gather everything you’ll need department. You might be together, to avoid moving eligible for help with your around more than you need shopping • Some tasks can be done just as well sitting as standing. COVID-19 support Overhanging worktops can Find out more about shopping often be fitted to kitchens to during COVID-19 restrictions on make this easier. ‘Perching our website mssociety.org.uk or stools’ with sloping seats call the MS Helpline on (and sometimes wheels) can 0808 800 8000. make it easier to get up and down. So can a stool where
Diet and nutrition 43 you can adjust the height. An Gadgets occupational therapist can tell There are gadgets that can help you if you can get one through with almost every daily task in the the NHS kitchen. Hear are some ideas. • Adaptations to your kitchen could make things easier. • If you find it difficult to grip For example, if you have things or handle them: problems with balance, grab jar and ring pull openers; rails can be fitted to many easy grip handles on cutlery, kitchen units and walls. Or peelers and other utensils; maybe you could arrange two-handed cups; non- the space so the table where slip chopping boards; tap you eat is close to where you turners (large handles to fit prepare your food. There’s over existing taps); and knob more about adaptations and turners (for fiddly controls on sources of funding on our cookers and other equipment) website or call the MS Helpline • If you find it hard to lift things: • Using a microwave means cooking baskets, to lift food you don’t have to lift heavy in and out of pans; a wheeled pans. They can also help if trolley to move items around heat makes your symptoms the kitchen; and a kettle tipper, worse, because they don’t for pouring without lifting warm the kitchen while • If you have sight problems: cooking. Induction hotplates large controls and displays also warm the pans without on cookers, microwaves and heating the air around them weighing scales; speaking • Can someone else help you? If scales; coloured tape around you live with others, you could worktops to provide a contrast; share tasks. Or you could take and bright coloured chopping it in turns to cook, so you don’t boards, cutlery and utensils to have to do it every day make them easier to spot
44 Diet and nutrition For more ideas, contact the an assessment of your needs, Disabled Living Foundation, the to see if you are eligible RiDC or the RNIB (page 49). • If you wouldn’t be able to prepare a cooked main meal If preparing food is difficult for yourself even if you had or tiring the ingredients, you might be eligible for Personal • Ready meals can be a practical Independence Payment (PIP). alternative. But they can Find out more on our website be low in protein and high or call the MS Helpline on in salt so they may not be 0808 800 8000 suitable for every day. Choose ones labelled ‘low fat’ or ‘healthy eating’ unless you “I leave plates and are underweight. If you find pans to soak, as yourself relying on them, you often I can’t wash can ask your GP for a referral up straight away. to a dietitian who can help Then they are a lot you to find easy-to-prepare easier to wash alternatives as well.” • If you find it difficult to manage Carole your energy levels, try to eat little and often: try a small Clearing up snack between meals and • Dishwashers can make a dessert after lunch and washing the dishes less tiring. evening meal But they are not great for • You might be able to get everyone, as they still need to ‘meals on wheels’ delivered be filled and emptied directly to your door. Many • If you live with others, share areas offer this service as part the tasks - if you cooked, ask of a care package from social someone else to clear up care services. Contact them for
Diet and nutrition 45 Managing your weight
Living with MS can If you find that you’re losing a sometimes make it harder lot of weight, or you’re already to manage your weight, and underweight, speak to your GP. There are ways to treat the issues both weight loss and weight that might be causing you to gain can be a problem. lose weight. Weight loss If you find it difficult to get Problems with posture, enough energy and nutrients, swallowing, fatigue and tremor your GP might suggest you see a can all make shopping for food, dietitian. They can advise you on preparing it or eating it, more ways to get more nutrients and difficult. And your appetite can energy into your diet. This could also be affected by stress, anxiety be by adding extra calories and and depression, as well as certain protein to your food – known as drug treatments. ‘fortifying’. If you are affected in any of The British Dietetic Association these ways, you might find has more information about how you lose weight. to spot malnutrition and how If left untreated, weight loss can to treat it at bda.uk.com (search lead to malnutrition. You may ‘malnutrition’). not notice this at first, as the early Sometimes high-energy signs of malnutrition – fatigue supplements are recommended. and muscle weakness – can also These are available either over the be symptoms of MS. counter or on prescription and
46 Diet and nutrition should be taken between meals. Weight gain If you do use them, bear in mind Keeping fit and healthy can that they often have a lot of sugar make it easier to cope with the in them so it’s important to visit symptoms of MS. But having MS the dentist regularly. You can find can create extra challenges more about oral health on our with this. website mssociety.org.uk or call the MS Helpline on For example, if you’re less active 0808 800 8000. than you once were, you might find you’re putting on weight when you don’t want to. “I found that telling everyone Some drug treatments, including I was trying to lose steroids to treat relapses, can also lead to weight gain. And if you’re weight was a good increasing your fluid intake, fruit motivator. People kept juice and sugary drinks can be a asking how big source of calories. I was doing, but not in a nagging way. Stress, anxiety and depression can lead some people to comfort And it feels good eat. Doing this occasionally isn’t to be able to say a problem, but if you find you’re I was losing weight, doing it a lot, you’ll put on weight. and this took over If you think your comfort eating is from people asking due to depression, speak to your how my MS was!” GP. Depression is treatable. Anon There’s more information about the signs of depression on our website mssociety.org.uk or call the MS Helpline on 0808 800 8000.
Diet and nutrition 47 If you’re trying to lose weight, healthy eating as well as regular exercise should help.
Try not to crash diet to lose weight quickly. Instead, aim to lose around 1 or 2 pounds a week (that’s half to 1Kg). If you’re not very mobile and you can’t be active, you might find you lose weight more slowly.
If you’ve put on a lot of weight, you may want to speak to your GP about the best way for you to lose the weight and still get all the nutrition you need.
Our website’s got lots of information about exercise and support for staying active, including videos you can use at home.
Call the MS Helpline to see how our Physical Activity support service can encourage your efforts with activity, diet and stopping smoking: 0808 800 8000.
48 Diet and nutrition Useful organisations
Allergy UK NHS websites Provides information for anyone NHS websites have information living with an allergy. on all aspects of healthy living, including diet and nutrition. Helpline 01322 619 898 allergyuk.org • nhs.uk/livewell • Northern Ireland nidirect.gov.uk British Dietetic Association (search ‘healthy eating’)
Their Food Fact page has useful • Scotland guidance on eating for health, nhsinform.scot and some key information on (search ‘nutrition’) malnutrition. • Wales 111.wales.nhs.uk/diet bda.uk.com
PINNT – Patients on Disabled Living Foundation Intravenous and Nasogastric (DLF) Nutrition Therapy Provides information and advice Provides information and support on equipment that might help for anyone using PEG or other with preparing and eating food. feeding systems. Helpline 0300 999 0004 Telephone 020 3004 6193 livingmadeeasy.org.uk pinnt.com
Diet and nutrition 49 RiDC (Research Institute for Vegetarian Society Disabled Consumers) For information on vegetarian Researches and reviews products diet, with ideas for meat-free and services of interest to recipes. disabled people. Reports include kitchen design and appliances. Telephone 0161 925 2000 www.vegsoc.org Telephone 020 7427 2460 ridc.org.uk
RNIB Offers information and support for people with sight problems.
Helpline 0303 123 9999 rnib.org.uk
The Vegan Society Offers information about veganism, including meal planning and nutrition.
Telephone 0121 523 1730 vegansociety.com
50 Diet and nutrition New words explained
Anticoagulant medications – • Sugars – found in fruit, honey, are often called ‘blood thinners’, fruit juices, milk (lactose) and but these medicines don’t really vegetables thin the blood. Instead, these drugs help prevent or break up Fats – are a source of essential clots in your blood vessels or fatty acids such as omega-3. heart. They are essential because your body can’t make them itself. Fat Antioxidants – are man-made helps the body absorb vitamins (supplements) or natural products A, D and E. These vitamins are (fruits and vegetables) that may fat-soluble, meaning they can prevent or delay some types of only be absorbed with the help cell damage in your body. of fats. All fats are high in energy and fat not used by your body is Carbohydrates – are nutrients converted into body fat. that provide our bodies with energy. There are 3 main types: Food allergy – we talk about food allergy when your immune • Fibre – carbohydrates that system reacts to a certain types can’t be digested. Fibre is of foods such as shellfish or nuts found in the plants we eat and you start wheezing, itching for food – fruits, vegetables, and breaking out in a rash. It may grains, and legumes. Fibre possibly cause a severe reaction helps food move through like breathing difficulties. your digestive system Food intolerance – we talk about • Starches – found in bread, food intolerance when you have pasta, rice, couscous, a bad reaction, such as diarrhoea potatoes, breakfast cereals, or cramps, to a particular type oats and other grains like rye of food. When you have a food and barley intolerance your immune system isn’t involved and you can
Diet and nutrition 51 probably still eat small amounts Obesity – we use the term of that food without it causing obesity to describe when a reaction. somebody is very overweight and has a lot of body fat. You’re Fortified –when vitamins and considered obese when your BMI minerals are added to a food to (Body Mass Index) is over 30. make it more nutritious. The BMI helps to calculate how Malnutrition – we use the term much body fat you have based malnutrition when a person’s on your weight and height. To diet doesn’t contain the right find out what your BMI is, you amount of nutrients. You either need to know your weight (in don’t get enough nutrients stone or kilograms) and your (undernutrition) or you get height (in inches or centimetres). more nutrients than you need Ask your GP to calculate your (overnutrition). Either way, being BMI for you or use the NHS BMI malnourished can affect your calculator on the nhs.uk/livewell physical and mental health. And website. if you’re malnourished you’re more likely to get sick. Osteoporosis – we use the term osteoporosis when your Neurological symptoms – we talk bones are weak and can break about neurological symptoms easily. Osteoporosis is usually when we want to describe discovered when you’ve had symptoms you might have as a a fall or impact and your bones, result of the effect your MS has such as your wrist or hip, on your nervous system. Some of fracture easily. these symptoms include blurred vision, difficulty walking, weak Protein – helps the body build, muscles and fatigue. maintain and repair tissue. Foods high in protein include beef, Nutrients – are any substances poultry, seafood, dry beans and that are absorbed and give you peas, eggs, nuts, and seeds. Tofu energy or help your body to and veggie burgers or vegetarian grow, repair or function properly. meat substitutes are also good sources of protein.
52 Diet and nutrition Scientific evidence –we use the a dead animal’s body such as term evidence to describe when gelatine or rennet. tests have been done to prove a (medical) claim does or doesn’t Vitamins – nutrients that your work. Usually, the larger the test, body needs to work properly. the more reliable the proof is, They boost the immune but the way tests are done also system, help in your growth and affects what we can learn from development, and help cells and the results. organs do their jobs.
Steroids – are used to reduce inflammation and make your immune system less active. They’re man-made versions of the hormones you normally produce in your adrenal glands (two small glands that sit on top of your kidneys).
Vegan diet – is a plant-based diet. A vegan does not eat any animal foods such as fish, meat, dairy, eggs and honey. A vegan avoids products made from animals such as wool or leather as well as products that are tested on animals, like cosmetics.
Vegetarian diet – is a diet of grains, pulses, nuts, seeds, vegetables and fruits with, or without, the use of dairy products and eggs. A vegetarian does not eat any meat, poultry, game, fish, shellfish or anything made from
Diet and nutrition 53 Further information
Resources MS Helpline Our award winning information Our free MS Helpline offers resources cover every aspect of confidential emotional support living with MS. and information for anyone affected by MS, including family, You can read them online friends and carers. or download. And you can order printed resources from We can provide information onlineshop.mssociety.org.uk or call 0300 500 8084 • in different languages through and select option 4. an interpreter service • by text relay and British Sign Language interpreters
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About this resource
With thanks to all the people References affected by MS and professionals Email us if you’d like to know the who contributed to this booklet. references for this information. [email protected] We’d love to hear what you think about this information. Photography mssociety.org.uk/yourviews Credit for photography belongs Disclaimer: We have made to Amit Lennon (cover and p34), every effort to ensure that the and Simon Rawles (p6, 15, and 21). information in this publication is correct. We do not accept liability for any errors or omissions. Availability and prescribing criteria for drugs in various parts of the UK may change. Seek advice from the sources listed.
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