Thought: MS and Nutrition
by Denise M. Nowack, RD, with Jane Sarnoff
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Everyone gets tired. However, certain types of fatigue,
such as neuromuscular fatigue, depression-related fatigue, and MS lassitude
can be particular to people with MS. These types of fatigue can be treated
with medications, management strategies, and therapy. People with MS also get
fatigued from everyday life—like everyone else. Fatigue may result in a
decrease in appetite, activity, and less interest in food preparation. If
fatigue is interfering with your activities, discuss the problem with your
Here are some tips to ensure that you get the nutrition
your body needs when fatigue becomes a challenge:
· If the thought of three large meals is too much,
try eating more frequently—five to six smaller meals if your appetite is
small. Resist the urge for low-nutrient convenience foods. Keep your
refrigerator and cupboards stocked with healthful items like string cheese,
low-fat crackers, peanut butter, dried fruit or raisins, small cartons of
fruit juice, individual cartons of low-fat or non-fat yogurt or cottage
cheese, or bagged salads and pre-cut raw vegetables.
· Keep a stack of menus from places that deliver
· Make the most of your freezer. Stock up on
flavorful, low-fat dinners that can be quickly microwaved or heated.
When you do shop and cook … save energy:
· Make a shopping list before you head out to the
· Stock up on basics. Fill your pantry with chopped
tomatoes, prepared sauces, mustards, canned beans, tuna, and other items that
you use regularly.
· If you have difficulty carrying food home, find
delivery services, shopping services or friends and relatives who will shop
from your list.
· When you cook, try to make more than you will eat
in one meal so you can store or freeze the rest for another meal.
· Don’t want to chop? Packaged pre-chopped vegetables
can cut down your preparation time. There are also shredded cheese, jars of
minced garlic, ginger root, sliced olives, and diced peppers.
· Streamline cleanup! Paper plates can be a lifesaver
when energy is low. Enlist family and friends as extra hands—and save your
energy for socializing after the meal.
· How user-friendly is your kitchen? An occupational
therapist can suggest ways to rearrange your kitchen to make meal preparation
easier. There are utensils, storage systems, reaching aids, and adapted
stovetops that increase efficiency. Ask your doctor for a referral to an
occupational therapist who can help you adapt your kitchen to best meet your
· Removing doors underneath cabinet countertops
allows you to sit while fixing food. Just make sure any hot pipes are wrapped
Many people with MS struggle with depression at one time
or another. When depression hits, it can have an adverse effect on
motivation, sleeping patterns, eating habits, and energy. Each of these can,
in turn, affect nutritional well-being.
Some people turn to food for solace when they are
depressed. Certain foods create a sense of comfort. These may be old familiar
favorites from childhood—a scoop of mashed potatoes, macaroni and cheese, a
cup of steaming soup, a bowl of rice pudding. The danger is going overboard
with these favorites. The extra fat, sugar, and calories can add up.
Other people experience a loss of appetite when they are
depressed. It is important to recognize these feelings and understand how
they might be affecting your health. Eating with others can help keep you
connected. But if self-help strategies don’t work, seek professional help.
Serious depression is a treatable medical condition.
Reducing bladder concerns
Bladder problems can be treated. If you have symptoms,
consult your doctor at the first sign of trouble. Keep in mind though that
what you eat and drink can help.
Pour on the water! Quite often fear of urinary frequency
or loss of bladder control causes people with bladder problems to limit their
fluid intake. This can contribute to other problems such as dehydration, dry
mouth, difficulties with swallowing, loss of appetite, constipation, and even
deficiencies in certain nutrients. Be sure to drink 6- to 8-ounce glasses of
water or other fluids every day.
Try these strategies to make sure you get the fluid you
· Take water breaks during the day. If you pass a
water fountain … take a drink!
· Travel with your own personal supply of bottled
· Refresh yourself at meals and snack time with
juice, milk, or sparkling water.
· Limit caffeine-rich beverages like coffee, tea,
cola, and other soft drinks. Caffeine acts as a diuretic and should be
avoided by those with bladder problems.
· Use alcohol prudently. Alcohol provides little
nutrition and many calories. It functions as a central nervous system
depressant, and can increase balance and coordination problems. It may also
irritate the bladder and aggravate problems with urgency.
If you are prone to urinary tract infections, drinking
beverages that help to increase the acid level in urine can help prevent
them. These include cranberry, apple, apricot, and prune juices. Limit foods
and beverages that make urine more alkaline. These include citrus fruits and
juices (orange, grapefruit), tomatoes, potatoes, lima beans, and antacids
that contain sodium bicarbonate.
Whether constipation is a result of your MS or your
habits, don’t despair. The following tips can help keep things moving.
counts … add it up! Dietary fiber is a substance found in foods like
cereal grains, nuts, seeds, vegetables, and fruits, and is not digested
or absorbed by the body. (Animal food products do not contain any
diet that provides 2530 grams of fiber each day is recommended for good
bowel function. There’s an added benefit for the weight conscious—fiber
provides a more lasting sense of fullness, helping you cut back on what
slowly. Fiber should be added into the diet gradually. Adding too much
fiber too fast can cause gas, cramps, diarrhea … and discouragement. The
foods toward the bottom of the Food Guide Pyramid tend to be the highest
These ideas might help you fit fiber onto your
—Start your day with a high-fiber
—Switch to whole-grain breads.
—Eat more beans, peas, and
—Take advantage of ready-to-use
—Experiment with whole grains—like
brown rice, barley, and whole-wheat pasta.
—Make snacks count—eat dried
fruits, raw veggies.
—Eat fruit at every meal.
If you find it difficult to reach the recommended level, fiber
supplements can be used. One tablespoon of these commercial products provides
15 grams of fiber. Remember, these are not laxatives but fiber supplements.
Be sure to consult your physician before using any of these products.
· Don’t forget the fluids. Fiber absorbs water, so as
you increase the fiber in your diet, you need to increase your fluid intake
· Just move! In addition to the many other benefits
of physical activity, exercise can also aid in preventing constipation.
Bowel incontinence can be aggravated by dietary factors.
Surprisingly, in MS, bowel incontinence is often caused by constipation. A
sudden loss of control occurs when the stool breaks through or leaks around a
blockage. Be sure to discuss bowel problems with your doctor or nurse. You
don’t need to accept them as part of your life with MS.
Preventing bone loss
People with MS may be at risk for osteoporosis—a condition where the bones
gradually become brittle due to the loss of calcium and other minerals. Lack
of weight-bearing activity due to immobility or fatigue, a diet low in calcium,
smoking, heavy drinking, and use of steroid drugs may all contribute to loss
of bone mass. Talk to your doctor to determine if you might be at risk.
To prevent bone loss:
· Count on calcium. Calcium-rich foods include
low-fat dairy products, dark green leafy vegetables, fish with edible bones,
and some fortified foods like orange juice and cereals. Keep your intake of
sodium, caffeine, and protein moderate. They all can interfere with calcium
· Be sure to get enough vitamin D. This important nutrient
helps calcium deposit in the bones. The body makes much of the vitamin D it
needs when the skin is exposed to sunlight. But people with MS often avoid
the sun to avoid heat. Food sources are the safest choice. Excess use of
vitamin D supplements can cause serious health problems.
· Be active. Get advice about a regular
weight-bearing activity you’ll enjoy.
Chewing and swallowing
Discuss swallowing problems with your doctor. You may be
referred to a speech pathologist, a specialist who can suggest changes in the
way you prepare foods or in the way you sit and breathe while you eat. You
may need to change the form of your foods in order to eat a nutritionally
· Thicker drinks tend to be easier to swallow. Such
drinks might include milk shakes, juices in gelatin form, fruit sauces,
sherbets, and puddings.
· Foods that crumble easily can cause choking. Avoid
chips, crackers, toast, and cakes.
· Soft foods need less chewing. Eat mashed or baked
potatoes instead of fried, cooked vegetables and stewed fruits instead of
raw. Make use of a blender or food processor to get foods to the texture
easiest for you to handle.
· Eat small, frequent meals so that you don’t become
tired from chewing and swallowing.
· Taking smaller bites can help reduce fatigue and
the risk of choking.
MS ... plus another diagnosis
People with MS can have other health problems. Diabetes,
high blood pressure, or high cholesterol may require special diets or drug
treatments. If you have other health problems and more than one doctor, make
sure each health-care provider understands your special needs. A registered
dietitian can help bring together all the pieces of your dietary puzzle.
Dietitians can provide professional, reliable, objective nutrition
information, and can help you separate facts from fads.
A look at
Never before have there been more nutrition theories or
diets that claim to treat MS. These include diets low in gluten, high in
polyunsaturated fats, or high in certain vitamins, as well as diets which assume
that every individual is allergic to certain types of food.
Some of these diets, such as Dr. Roy Swank’s low-fat diet,
are consistent with accepted dietary guidelines, and pose no nutritional risk
for people with MS. Other diets that claim to be therapeutic may actually
work against the principles of proper nutrition. Before considering any
special diets, seek information from your doctor or a registered dietitian.
Some researchers do believe that nutrition plays some yet
to be determined role in MS treatment, but so far no diet, vitamin, or
dietary supplement has been proven to have therapeutic value. There is no
evidence that a nutrition-related factor plays a part in the origin or cause
The best food for thought is a well-balanced and nutrient-rich
diet, based on the Food Guide Pyramid. Inform yourself about food choices,
make a commitment to healthy eating, and develop menus you enjoy.
Find the diet you can live with ... and then eat well ...
for the health of it!
For additional information
Copyright © National Multiple
Sclerosis Society, 2003
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