Multiple sclerosis (MS) is mostly diagnosed between the ages of 15 and 40 years. It is three times more prevalent in women than in men. The cause is unknown but it is classified as an autoimmune disease. It involves the body attacking its own protective covering (the myelin sheath) on nerves in the brain and spinal cord. This causes multiple scars or sclerosis. The consequence is damage or loss of nerve function. The inflammation and scarring interrupts the communication between the brain and nerves. Loss of balance, numbness, tingling or weakness in a limb, blurred or double vision are common symptoms.

Being diagnosed with a disease that is unpredictable is difficult. Not only can MS have effects on physical health, it can also have a profound effect on mental resilience. The physical and mental weariness and stress associated with the ongoing challenges of disease management results in fatigue.

Depression and anxiety can occur just after diagnoses or in advancing MS. Support is critical and a good relationship with your neurologist and MS nurse is crucial.

Feeling in charge and in control of a personal care plan helps. Eating well assists in feeling well and managing symptoms. Trawling the internet when you have just been diagnosed with MS can leave you feeling confused and conflicted as to which particular dietary approach to adopt. Be assured there is no need to follow a restrictive and rigid diet of any kind.

Ask your neurologist for a referral to a hospital or community-based dietitian working with MS patients.

Discussing how a specific dietary approach might affect your medical treatment is important. Many MS treatments down-regulate the immune system. Therefore supplements and complementary alternative approaches should also be considered for their potential effect on the immune system.

Excessive intakes of nutrients and supplements that promise to boost your immune function may be unnecessary and even dangerous. Your consultant is pivotal in managing your treatment. Have a discussion about the additional therapies and supplements you might like to take.

A 2011 article in Autoimmune Disease reported that as many as 70 per cent of MS patients try out some additional complementary and alternative treatments. Quite worryingly, they do so without notifying their neurologist.

The role of diet in the progression of MS and in the reduction of flare-ups is continually under review. But because of the individual nature and course of MS, it is particularly difficult to explore the effects of dietary interventions. Symptoms come and go and the progression of the condition varies from person to person.

Fatigue is a significant factor affecting many. It can interfere with shopping and cooking food. Meal skipping and excessive alcohol consumption intensifies fatigue, just the way it can for anyone. A good diet and exercise regime helps to reduce fatigue, maintains strong bones, muscle strength, range of motion and flexibility. It also improves heart health and circulation.

The primary cause of death in individuals with MS is cardiovascular disease and cancer, similar to the rest of the population.

Nutrient concerns

Several associations between diet and the management of symptoms and flare-ups have been proposed but none have been proven to date. Some fashionable MS diets are very difficult to sustain and they may or may not affect the course and progress of the condition. There is no denying that a healthy diet is fundamental but a gluten- and milk-free diet or high doses of supplements may not benefit everyone.

Some, but not all, observational studies, have found that serum levels of antioxidant vitamins (beta carotene, vitamin C and E) are low in individuals with MS. Controlled intervention studies have not been carried out to study the role of supplementation. General advice is to include at least five servings of fruits and vegetables a day, ensuring plenty of green vegetables throughout the week.

There seems to be a higher prevalence of vitamin B12 deficiency in individuals with MS compared with age and gender-matched controls. This does not mean that everyone with MS would benefit from routine vitamin B12 supplementation, but that serum B12 levels should be monitored and supplements recommended if low.

Similarly, serum vitamin D levels should also be monitored. Observational data suggests that individuals with MS may have lower levels than the general population. Supplementation is necessary to correct vitamin D insufficiency or deficiency.

High doses of up to 10,000IU/day may help regulate the immune system and appear to be safe according to PEN – Practice-based Evidence in Nutrition – but your consultant will discuss a suitable dosage with you. It is uncertain if routine vitamin D3 supplementation can reduce flare-ups and shorten relapses in MS patients. Numerous studies have suggested that it may help but better quality randomised controlled trails are required.

Vitamin D also helps absorb calcium and reduces the risk of osteoporosis. It is important to ensure an adequate intake, especially if you are taking steroids or if you are unable to get any weight-bearing exercise. Low bone mineral density and increased fracture rates are possible if dairy foods are excluded and alternative sources of bone minerals, such as calcium, are not included. As well as having serum vitamin D levels checked regularly, include at least two dinner portions of oily fish per week (salmon, mackerel, fresh tuna or herring) and get adequate sunlight safely.

Oily fish is also rich in omega-3 fatty acids. These essential fats are anti-inflammatory and are important for the reconstruction of the damaged myelin sheath and cognitive function. Omega-3 fatty acids are also found in flaxseed or linseed oil, camelina oil, walnuts and chia seeds. Including omega-3 fatty acids and other unsaturated fats found in olives, olive oil, rapeseed oil, nuts and avocado instead of saturated fats is a good strategy for everyone, not just MS patients. In 1948 Dr Roy Swank reported that his MS patients fared better on a diet containing 15g/day of vegetable oil, 5g/day of cod liver oil and less than 15g/day of saturated fat. At that time there was no magnetic resonance imaging (MRI) to measure the progression of the disease and his studies lacked a control group.

Dr Swank’s findings may be dubious and the evidence insufficient, yet many MS patients follow this and similar diets in a bid to manage their symptoms.

Treatment

The Overcoming Multiple Sclerosis programme was developed by Prof George Jelinek, who was diagnosed with MS in 1999. He has not had a relapse in those 15 years. A five-year follow-up study showed self-reported improvements in both physical and mental wellbeing, according to the

MS Society

UK.

However, there was a very high and unexplained drop-out rate too. Although MS treatment is not associated with any one specific evidenced-based MS diet, ensure whatever approach you take provides all essential nutrients and allows you to stay a healthy weight for your height.

Paula Mee is a dietitian and a member of the Irish Nutrition and Dietetic Institute. Email:paula@paulamee.com Twitter: @paula_mee