Multiple sclerosis diet: What to eat, lifestyle changes, and more

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MS is an autoimmune disease in which the immune system mistakenly attacks the central nervous system.

The relationship between the diet and MS may involve:

• the role of gut bacteria in immune disorders
• vitamin deficiencies
• nutrients that can support and protect the central nervous system
• the benefits of a healthy, balanced diet for overall well-being

Read an overview of MS.

Anyone following a specific diet needs to consume all the necessary daily nutrients. Before making large dietary changes, a person should speak with a registered dietitian to ensure they can replace any lost nutrients.

Gluten-free diet

A 2020 review assessing the effectiveness of a gluten-free diet in people without celiac disease did not find enough evidence to support a link between gluten sensitivity and MS.

However, people with MS may be more likely to develop celiac disease, which prevents the body from tolerating gluten. As a result, some people with MS may benefit from avoiding gluten.

Gluten is a protein present in wheat, rye, and barley. Therefore, people avoiding gluten should avoid foods containing these grains.

Foods that contain gluten include:

• wheat products such as bread and baked goods
• many premade soups and salad dressings
• barley products such as malt, soups, beer, and brewer’s yeast
• rye, which is often present in bread and cereals

People who follow a gluten-free diet may miss out on important nutrients, including fiber, which is present in whole grains. They can boost their fiber intake by eating plenty of fresh vegetables, fruits, nuts, seeds, and pulses.

Anyone considering a gluten-free diet should consult a doctor first.

Paleo diet

Many people who follow the Paleolithic, or “paleo,” diet believe that the human body has not evolved to eat the highly processed foods people now commonly consume.

The diet involves switching to foods that hunter-gatherers likely ate. The first step is to choose natural foods over processed foods, emphasizing meat and plant-based foods but not grains.

In a small 2017 study, people with relapsing-remitting MS who consumed a modified paleo diet reported improvements in fatigue severity and quality of life scales. However, the authors concluded that larger controlled studies are necessary to fully assess the benefit of a paleo diet for people with MS.

Learn more about the paleo diet.

Wahls diet

The Wahls diet, or Wahls protocol, is a modified version of the paleo diet. Dr. Terry Wahls developed the plan specifically to help people with MS.

Like the paleo diet, the Wahls diet features nutrient-dense, minimally processed foods. A person following the Wahls diet will prioritize green, leafy, and sulfur-rich vegetables; intensely colored fruits; and minimally processed animal proteins.

Small studies have linked the Wahls diet with an improvement in MS symptoms. However, larger, better-controlled randomized studies are necessary to fully examine the effectiveness of the diet.

Swank diet

Doctors developed the Swank diet as an MS treatment in the 1950s.

It reduces saturated fat intake to 15 grams (g) per day and recommends limiting unsaturated fat intake to 20–50 g per day.

People on this diet:

• cannot eat processed foods or dairy fats
• cannot eat red meat during the first year
• can eat as much white fish and shellfish as they like
• should eat at least 2 cups each of fruits and vegetables every day
• should eat whole grain pasta
• should take cod liver oil and multivitamins daily

While some consider the diet to be dated, others report that it helps.

Possible risks include deficiencies in folic acid and vitamins A, C, and E.

Learn how much saturated fat to eat in a day.

Can they help with MS?

In 2015, the National Multiple Sclerosis Society (NMSS) reviewed several diets and their impact on MS.

The authors of the review concluded that there is not enough evidence to recommend one diet over another and acknowledged that most diets restrict or leave out the same types of food.

In general, a person with MS should avoid foods that:

• are highly processed
• are high in saturated fat
• have a high glycemic index

Certain foods may benefit people with MS by affecting the function of the immune system, nerves, and body.

Probiotics and prebiotics

Changes in gut health may contribute to immune disorders. Research indicates that gut health plays a role in many health conditions.

The intestinal flora, or gut flora, is a highly complex system of microorganisms living in the intestines. In humans, these microorganisms are largely bacteria.

These bacteria are responsible for breaking down food and nutrients and play a key role in digestion and immune system health. Healthy gut flora thrives in the intestines when there is ample fiber in the diet.

The authors of a 2021 review suggest that adjusting the gut flora by using probiotics, for example, may be helpful for people with MS.

Probiotics

Probiotic bacteria are present in a range of fermented foods. They are also available in supplement form. The following foods contain healthy levels of Lactobacillus, a type of beneficial bacteria:

• yogurt
• kefir
• kimchi
• sauerkraut
• kombucha, which is fermented tea

Prebiotics

After filling the gut with good bacteria, it is important to feed them. Foods that nourish probiotic bacteria are called prebiotics. Some dietary fibers are prebiotic.

Foods that contain healthy levels of prebiotic fiber include:

• artichokes
• garlic
• leeks
• asparagus
• onions
• chicory

Fiber

High levels of fiber are present in many plant-based foods, including:

• fruits
• vegetables
• nuts and seeds
• legumes, such as lentils
• whole grains
• brown rice

Learn more about high fiber food options.

Consuming these products may have a range of health benefits for people with MS. A high fiber diet can positively affect the body in several ways, including:

• nourishing the gut bacteria
• promoting regular bowel movements
• regulating blood pressure
• keeping the heart healthy by helping manage cholesterol
• reducing the likelihood of weight gain by leaving a person feeling full longer

People with MS may have a higher risk of certain types of heart disease. While dietary measures may not reduce these risks, a balanced diet benefits overall heart health.

Vitamin D

Vitamin D is important for everyone, but it may be especially beneficial for people with MS.

According to the National Institute of Neurological Disorders and Stroke, people with high vitamin D levels appear to have a lower risk of developing MS.

Vitamin D is also important for bone health. People with MS may be more likely to have low bone density and osteoporosis, especially if they cannot move around easily. An adequate intake of vitamin D may help prevent this.

Most of the body’s vitamin D comes from exposure to sunlight, but a person can also get it by consuming:

• oily fish
• fortified dairy products
• some fortified cereals, yogurt, and orange juice
• beef liver
• egg yolks

A 2018 review notes that while evidence of a link between low vitamin D levels and MS is increasing, confirming this will require more research.

Biotin

Biotin is a form of vitamin B. It is present in many foods, but foods particularly high in biotin include:

• eggs
• beef liver
• sunflower seeds
• almonds
• spinach
• broccoli
• whole wheat bread

Small studies indicate that a high dosage of biotin — at least 300 milligrams per day — could help people with progressive MS.

Confirming and specifying the benefits of biotin supplementation will require more research, but following a balanced diet can often ensure that a person consumes enough of this vitamin.

Polyunsaturated fatty acids

There is evidence that polyunsaturated fatty acids (PUFAs) may help support a healthy body and manage inflammation.

For example, the authors of a 2017 study concluded that a low intake of PUFAs may increase the risk of MS.

PUFAs appear to boost bodily functions such as heart health and the ability to think. Foods containing PUFAs include fatty fish, such as salmon and mackerel, and some plant-based oils.

Antioxidants

Many vegetable-based foods contain polyphenols, which have antioxidant and anti-inflammatory effects on the body’s cells.

These effects may help prevent cell damage, making polyphenols potentially useful for people with MS.

Sources of polyphenols include:

• fruits
• vegetables
• spices
• cereals
• legumes
• herbs
• tea

Antioxidants can also help prevent oxidative stress, which researchers have linked to the development of several chronic conditions, including neurological and cardiovascular disease.

Components of some foods may be harmful to people with MS, so people should limit them in their diet.

Saturated fats and highly processed foods

Highly processed foods may affect a person’s health, especially if they contain high levels of:

• saturated fats, trans fats, and hydrogenated oils
• added sodium, or salt
• added sugar

Sodium

A 2017 randomized clinical trial found that a high sodium diet does not directly affect MS disease progression. High sodium consumption can increase blood pressure and the risk of cardiovascular complications in everyone, but it is particularly important for people with MS to moderate their intake.

People with MS have an increased risk of coronary artery disease, heart failure, and heart attacks. As a result, maintaining a moderate sodium intake is essential to promote heart health.

Examples

A person with MS may benefit from limiting their consumption of:

• sugar-sweetened drinks such as sodas and energy drinks
• processed meats, including burgers and sausages
• fried foods such as french fries and potato chips
• highly processed ready-made meals, including frozen pizzas
• trans fats such as margarine and shortening

According to a 2019 research article, obesity during childhood and adolescence may increase the risk of developing MS. The authors also note that obesity could affect the progression of the disease.

Moreover, a person with MS who loses mobility or finds movement more challenging may be more likely to gain weight.

Managing the diet to prevent weight gain may also help prevent MS symptoms from worsening. Dietary changes may boost a person’s well-being and reduce the risk of additional health conditions such as cardiovascular disease.

Certain lifestyle and habit changes may benefit a person’s overall health and help them manage their MS. These include:

• increasing sunlight exposure to boost vitamin D levels
• exercising to help maintain strength and flexibility and support overall health and well-being
• quitting smoking, if applicable, and avoiding secondhand smoke

According to the NMSS, there is insufficient evidence to recommend specific diets for treating MS.

A healthy diet for a person with MS is one that supports the immune system and provides all necessary nutrients. A varied diet that includes all the core food groups and avoids heavily processed foods and saturated fats is key to overall health.

Anyone considering making major changes to their diet or lifestyle should seek guidance from a doctor first.

MS affects the nervous system and can lead to various primary and secondary health issues. It is a lifelong condition that may come and go or progress steadily.

Some people experience only mild tingling, while others lose the ability to move or talk. However, most people with MS remain mobile, and most have the same life expectancy as people without MS.

Healthy dietary choices can benefit people with MS by boosting overall well-being and quality of life. Certain dietary habits may change the condition’s progression or prevent specific symptoms or complications, such as cardiovascular disease.

A range of special diets may help manage MS symptoms and reduce the chance of complications. However, more research is necessary to assess the effectiveness of these diets, and a person should consult a doctor before making any major dietary changes.

People with MS may wish to avoid highly processed foods, saturated fats, and added salt and sugar. Minimally processed whole foods, such as fruits, vegetables, pulses, legumes, and oily fish, are better choices.

A person can find more resources for living with MS by downloading the Bezzy MS app. This free app provides access to expert content on MS and peer support through one-on-one conversations and live group discussions. Download the app for iPhone or Android.

Read this article in Spanish.