Multiple Sclerosis and Diet: All You Need to Know

There are no official dietary guidelines for people with multiple sclerosis (MS). However, eating an overall nutrient-rich, well-balanced diet can help reduce inflammation and improve overall health. Read on to learn more about foods to eat and foods to limit or avoid.

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What is MS?

Multiple sclerosis (MS) is an autoimmune disorder that gradually destroys the protective coverings that wrap around your nerve fibers. These coverings are called myelin sheaths.

Over time, this disease can permanently damage your nerves, affecting nerve communication in the brain and spinal cord.

Symptoms of MS include:

• fatigue
• tingling
• bladder dysfunction
• movement difficulties and spasticity
• impaired vision
• brain fog

MS is highly complex, and the way the disease progresses varies from person to person. Recent research has linked infection with the Epstein-Barr virus as a contributing trigger of MS, but a cure remains to be found.

Although diet cannot cure MS, some research suggests that making dietary changes can help improve health and reduce inflammation. A balanced diet can make you stronger and healthier, reducing the effects of MS.

Summary

Multiple sclerosis (MS) is a neurological condition that gradually destroys the protective coverings called myelin sheaths that wrap around your nerve fibers. A cure hasn’t been discovered yet, but diet can help improve health and reduce inflammation.

How does diet affect MS?

Currently, there are no official dietary guidelines, or evidence of any specific diet or dietary pattern, for people with MS.

That’s why any dietary guidelines and recommendations for people with MS should aim to improve overall health.

Diet may help with MS in several ways, including:

• preventing or controlling its progression
• reducing flare-ups

Ideally, an MS-friendly diet is:

• high in antioxidants to curb inflammation
• high in fiber to aid bowel movements
• adequate in calcium and vitamin D to address osteoporosis
• high in vitamins and minerals to relieve fatigue and promote wellness

An MS-friendly diet limits foods that have been linked to chronic inflammation and other negative health effects, or those that simply make day-to-day activities more difficult for someone with MS. For example, avoiding ultra-processed foods is recommended, as they are known to cause disease in general.

A 2019 study involving 20 adults with MS found that certain nutrients, including fish oil, B vitamins, N-acetylcysteine, and CoQ10, may benefit people with mild to moderate MS, potentially leading to better general functioning as well as an improved quality of life and mobility.

The nutrients associated with these positive changes included increased:

• fat
• cholesterol
• folate
• iron
• magnesium

Decreased carb intake appeared to be beneficial.

There’s also preliminary evidence that people with MS are more likely to have deficiencies in some nutrients, including vitamins A, B12, and D3. Researchers suggest that taking certain vitamins, minerals, fatty acids, antioxidants, plant compounds, and melatonin may help improve some symptoms.

Scientists need to do more research before making official recommendations about many of the dietary patterns discussed here.

Summary

There are no official dietary guidelines for MS. While diet cannot cure MS, making certain dietary changes may improve overall health.

Foods to eat

Here is a list of foods to include in an MS-friendly diet:

• Fruits and vegetables: all fresh fruits and vegetables
• Grains: all grains, such as oats, rice, and quinoa
• Nuts and seeds: all nuts and seeds
• Fish: all fish, especially fresh fish and fatty oily fish, such as salmon and mackerel, as they’re high in omega-3 fatty acids and vitamin D
• Meats: all fresh meats, such as beef, chicken, lamb, and more, especially beef liver, which is particularly high in vitamin D and biotin
• Eggs: good source of biotin, vitamin D, and other important nutrients
• Dairy products: such as milk, cheese, yogurt, and butter
• Fats: healthy fats, such as olive, flax seed, coconut, and avocado oils
• Probiotic-rich foods: such as yogurt, kefir, sauerkraut, and kimchi
• Beverages: water, herbal teas
• Herbs and spices: all fresh herbs and spices

In short, the guidelines for an MS-friendly diet are similar to an overall nutrient-rich, well-balanced diet.

That’s because plant-based foods and grains are higher in fiber, vitamins, minerals, and fluid, which can help with MS symptoms, such as constipation.

They’re also higher in compounds that function as antioxidants, which are molecules that help defend your cells against free radical damage and inflammation. These compounds may help fight inflammation and potentially slow MS progression.

Fatty fish such as salmon and mackerel may be beneficial for MS. They are high in omega-3 fatty acids, which reduce the relapsing rate and inflammatory markers in MS.

They’re also high in vitamin D, which can help keep your bones strong when combined with calcium. People with MS also have a higher likelihood of vitamin D deficiency.

Research on the effects of red meat and saturated fat intakes on MS symptoms shows mixed results.

Dairy products also show mixed results. In some studies, dairy products were linked to disease activity. However, they’re a good source of calcium, vitamin D, vitamin A, and potassium, so you can try including them in moderation in an MS-friendly diet.

Talk with your doctor if you believe dairy products are worsening your MS symptoms.

Summary

Eating plenty of fruits, vegetables, grains, and fish may help improve health for people with MS. A person with MS can eat red meat and dairy in moderation, as current research on their effects is mixed.

Foods to limit or avoid

While an MS-friendly diet allows plenty of options, there are still some food groups you can limit or avoid to help manage MS symptoms.

Most of these foods are linked to chronic inflammation. They include processed meats, refined carbs, trans fats, and sugar-sweetened beverages, just to name a few.

Here’s a list of foods to consider limiting or avoiding if you have MS:

• Processed meats: sausages, bacon, canned meats, and meats that are salted, smoked, or cured
• Refined carbs: white bread, pasta, biscuits, and flour tortillas
• Fried foods: french fries, fried chicken, mozzarella sticks, and doughnuts
• Highly processed foods: fast food, potato chips, and convenience and frozen meals
• Trans fats: margarine, shortening, and partially hydrogenated vegetable oils
• Sugar-sweetened beverages: energy and sports drinks, soda, and sweet tea
• Alcohol: limit consumption of all alcoholic beverages as much as possible

Summary

An MS-friendly diet is similar to a diet focused on promoting overall health and well-being. It limits or avoids some foods, such as processed meats, refined carbs, and trans fats. These foods do not help manage MS symptoms and may worsen inflammation.

Specialty diets

Several diets specifically aim to help slow progression and prevent flare-ups of MS. They include the Swank diet and variations of the Wahls diet. These diets are popular within the MS community.

Before starting any diet, especially ones that restrict food groups, talk with your doctor. Your doctor can help you decide whether starting a diet is right for you and can make sure that you are getting the nutrients you need.

Swank diet

The Swank diet for MS is a low fat, low saturated fat eating pattern that neurologist Dr. Roy Swank, MD, PhD, developed in 1948. Its recommendations include:

• avoid processed foods that contain saturated fat or hydrogenated oils
• limit saturated fat to 15 grams per day; consume no more than 20 to 50 grams per day of unsaturated fats
• avoid red meat for 1 year, then limit red meat to 3 ounces per week
• avoid dark meat poultry and limit fatty fish to 50 grams per day
• choose only dairy with 1% fat or less
• avoid egg yolks
• consume as many fruits and vegetables as you want
• enjoy whole grain breads, rice, and pastas
• snack on nuts and seeds daily
• consume 1 teaspoon of cod liver oil and a multivitamin and mineral supplement daily

However, a 2019 review on the effectiveness of the Swank diet is limited to a series of reports Dr. Swank published.

The reports follow a group of individuals with relapsing-remitting MS who adhered to the Swank low fat diet for 50 years. Swank assessed individuals for compliance with the diet, frequency and severity of MS attacks, and performance status (e.g., wheelchair use, ability to walk, and ability to work).

Those who adhered to the diet (consumed 20 grams of fat or less) had fewer and less severe MS-related exacerbations than those who consumed greater than 20 grams of fat.

Individuals with lower performance status at the start of the observation period or who were in the progressive phase of MS were likely to experience continued decline, even if they complied with the Swank diet.

While Swank’s studies had a long follow-up duration and large cohort size, they were not randomized controlled trials and were subject to several forms of bias.

Larger, better-designed studies are needed to determine whether the Swank diet can help improve symptoms or delay the progression of MS.

Wahls diet

Dr. Terry Wahls developed the modified paleolithic Wahls diet for managing MS in 2008.

Some evidence suggests that a modified paleolithic diet and taking supplements may help improve perceived fatigue in people with MS.

The Wahls diet is a version of the paleolithic (paleo) diet. The paleo diet promotes eating:

• meat
• fish
• eggs
• vegetables
• fruits
• nuts
• seeds
• herbs
• spices
• healthy fats
• oils

On the other hand, the paleo diet avoids:

• processed foods
• sugar
• grains
• most dairy products
• legumes
• artificial sweeteners
• vegetable oils
• margarine
• trans fats

The modified paleo Wahls diet makes the following recommendations beyond the general paleo diet:

• eat 9 or more cups of fruits and vegetables daily (3 cups each of green leafy vegetables, sulfur-rich vegetables, and intensely colored fruits or vegetables)
• emphasize consumption of seaweed, algae, and nutritional yeast
• consume limited servings of gluten-free grains and legumes
• avoid eggs
• consume lower meat and fish intake than the paleo diet

According to a 2021 analysis, the diet is effective in reducing symptoms of fatigue and improving quality of life in MS.

Dr. Wahls developed the Wahls elimination diet in 2015. It recommends avoiding all grains (including gluten-free ones), legumes, and nightshades (including tomatoes, white potatoes, eggplant, peppers, and seed spices) to reduce lectin in the diet.

It also recommends avoiding all dairy and allows for unlimited consumption of saturated fat.

Like the modified paleo Wahls diet, the Wahls elimination diet recommends at least 9 cups of fruits and vegetables daily as well as seaweed, nutritional yeast, and fermented foods.

A 2021 study with 77 people with relapsing-remitting MS found that the Wahls elimination diet was associated with an increased quality of life and decreased fatigue. Another analysis of that study found that the diet improved anxiety and depression scores in participants.

However, much of the existing research, including the studies linked here, on the effectiveness of the Wahls diet involves Dr. Wahls. More research without the potential for bias is needed to explore this diet for MS.

It’s also important to note that diets that exclude whole food groups (like grains and dairy in the Wahls elimination diet) increase the chance of nutritional insufficiency. Taking supplements under a doctor’s supervision when on these diets can help reduce the risk of nutritional deficiency.

Summary

Both the Swank diet and Wahls elimination diet were developed to slow progression and prevent flare-ups of MS.

Research on the effectiveness of these diets for MS is promising, but more well-designed research is needed.

Keep in mind that any diet that eliminates whole food groups (like the Wahls elimination diet) increases the risk of nutritional insufficiency. Talk with your doctor before starting any diet, especially ones that restrict whole food groups.

Other diets

Ketogenic diet

A 2022 study examining whether ketogenic diets may help improve symptoms in people with MS did not have promising results. However, this research is ongoing, and scientists need to further investigate the role of diet in MS.

The ketogenic diet is considered in MS research because it’s high in fat and low in carbohydrates. Since myelin is a lipid-based (fat) substance, some research has focused on whether a high fat diet could help restore myelin. However, current results are not reflecting this prediction.

And since it is restrictive, a ketogenic diet can be difficult to follow. Moreover, it restricts food groups that are recommended in an overall balanced diet.

Clinical trials investigating the effects of ketogenic diets and intermittent fasting on MS are currently underway.

Fast-mimicking diets

A 2022 meta-analysis found that fast-mimicking diets, or a dietary pattern that involves periodic cycles of low calorie intake, and ketogenic diets have not shown effects on relapsing-remitting MS.

Still, researchers suggest that more large, prospective clinical studies are needed.

In a 2019 study, researchers gave people with MS a ketogenic diet that restricted carbohydrate intake to fewer than 20 grams per day for 6 months. They found that the diet helped improve fatigue and depression, promoted fat loss, and reduced inflammatory markers.

However, this study included 19 people, and only 15 remained in the study for the full 6 months. Thus, more large studies are needed.

Diet tips to help with MS

In addition to the diet guidelines in this article, people with MS may want to consider the following food tips to help manage their symptoms.

• Make sure you eat enough food: Eating too few calories can cause fatigue.
• Prep your meals in advance: If you have time, batch-making meals can help you save energy later. If you’re often fatigued, this can be especially helpful.
• Rearrange your kitchen: Place food, utensils, and other equipment in areas that are close by and easy for you to clean up. This will help you save energy.
• Try “ready-to-use” items: Buying precut fruits and veggies can help you shave minutes off cooking time and make cooking simpler.
• Make thicker drinks: If you have difficulty swallowing, preparing thicker beverages like a nutrient-rich smoothie may be easier to manage.
• Soft foods may help: If chewing too much is making you fatigued, try choosing softer foods like baked fish, bananas, avocado, and cooked veggies.
• Limit crumbly foods: If you have difficulty swallowing or find yourself choking on food often, consider limiting foods that crumble, such as toast and crackers.
• Reach out for help: Even if you do not like asking for help, having members of your support network help with small tasks, like preparing meals, cleaning, or setting the table, can help ease your fatigue.
• Stay active: Although exercise can make a person with MS feel fatigued, it’s especially important for helping achieve and manage optimal health and a moderate weight. It’s also important for preventing osteoporosis, which is more common among people with MS.

If you have other MS-related concerns not addressed above, it’s important to notify your healthcare team. They can offer personalized tips to help you manage your symptoms better.

Summary

The tips listed in this section can help improve your quality of life with MS by helping you maintain a moderate weight and manage symptoms like fatigue and swallowing issues. If you have other concerns, contact your healthcare team.

Resources for MS diet help

If you’re considering changing your diet to help manage your MS symptoms and would like more information, here are some good resources:

• National Multiple Sclerosis Society: Diet and Nutrition
• Swank MS Foundation: The Swank Low-Fat Diet for the Treatment of MS
• MS Society: Special Diets and MS

A registered dietitian nutritionist (RDN) who specializes in MS can make personalized dietary recommendations to help you manage your symptoms and reduce flare-ups of MS.

To find one near you, use the Find a Nutrition Expert search function at the Academy of Nutrition and Dietetics website.

The takeaway

Multiple sclerosis (MS) is an autoimmune condition that affects the nervous system.

There are no official dietary guidelines for MS. However, making certain dietary changes may help relieve common MS symptoms, such as constipation and fatigue, as well as improve overall quality of life.

Dietary changes that may help include eating more grains, fish, and plant-based foods.

In addition, avoiding low nutrient foods may help manage MS symptoms and potentially slow disease progression.

It’s recommended that people with MS avoid certain foods, including processed meats, refined carbs, trans fats, and sugar-sweetened beverages.

Other tips to manage MS symptoms include:

• making meals in bulk
• using “ready-to-use” grocery items
• rearranging your kitchen for convenience
• choosing foods with appropriate textures
• reaching out for help to manage daily activities

As with any new diet, it’s important to notify your healthcare team before making major changes to your diet to manage MS.

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