Multiple Sclerosis Diet
A diet designed for patients with multiple sclerosis (MS) may help control and possibly eliminate many of the symptoms that come along with the disease. It is also believed that these diet guidelines may slow the progression of the disease. There are some basic guidelines for dietary changes for the MS patient, but always the patient should make these diet changes under the supervision of the health care professional.
A key factor in a healthy multiple sclerosis diet is to eliminate all gluten. In general, you should avoid eating anything with flour, but you can check package ingredients if you are unsure of their content. Many diets besides the MS diet do not allow gluten, so this is now easily found on many packages. Avoiding wheat, barley, oats, or rye is recommended to minimize the use of gluten containing products. A successful diet should also limit or avoid animal fats, including dairy products and margarine. Olive oil, sunflower oil, and safflower oil are suitable alternatives for cooking or salads. Fried foods and foods high in saturated fats are also to be avoided. White meat skinless chicken, seafood, and fish are the best meat choices. Make sure to always completely remove any fat. Anyone, but especially those on a MS diet, should try to completely eliminate refined sugar. There are many healthier alternatives. Honey, fructose, or natural unsweetened fruit or vegetable juices would be ideal for a person on this diet.
Obviously, any foods you are allergic to should be cut from your diet. If you are unsure of allergies, try consulting a doctor or allergy specialist. You may also try eliminating all of the most common problem foods from your diet, and after two weeks bring them back one at a time. If you have a bad reaction to any food, then you should probably eliminate it from your multiple sclerosis diet.
You should increase the amount of fresh vegetables and fruits in your MS diet. Try to always eat freshly cooked food. This will increase the amount of vitamins and minerals that your body absorbs. Vitamin supplements may also be beneficial or even necessary for your Multiple Sclerosis, but you should consult a doctor to make sure you take the right vitamins.
Always drink lots of water. It is very easy for a person with Multiple Sclerosis to become dehydrated, so make sure to drink at least 8 large glasses of water every day. These tips for improving your MS diet are intended to help you control many common problems such as fatigue, incontinence, and constipation. Adjusting your diet may also help to avoid making other problems worse. Many of these tips are included in other diets, and even people without special dietary needs may benefit from following these suggestions.
Symptoms
What are the Symptoms of MS?
Symptoms of MS may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of MS patients.
The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbaror optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some time or other and it will be the first symptom of MS in approximately 15 percent. This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities in the patient's spinal fluid.
Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Spasticity-the involuntary increased tone of muscles leading to stiffness and spasms-is common, as is fatigue. Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.
Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss.
Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared.
Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ depending on the individual's disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction. .
Depression, which is unrelated to cognitive problems, is another common feature of MS. In addition, about 10 percent of patients suffer from more severe psychotic disorders such as manic-depression and paranoia. Five percent may experience episodes of inappropriate euphoria and despair-unrelated to the patient's actual emotional state-known as "laughing/weeping syndrome." This syndrome is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases.
As the disease progresses, sexual dysfunction may become a problem. Bowel and bladder control may also be lost.
In about 60 percent of MS patients, heat-whether generated by temperatures outside the body or by exercise-may cause temporary worsening of many MS symptoms. In these cases, eradicating the heat eliminates the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For the same reason, swimming is often a good exercise choice for people with MS.
The erratic symptoms of MS can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Support groups (listed on a card in the pocket at the back of this pamphlet) and counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause.
Possible Symptoms of Multiple Sclerosis
How is MS Diagnosed?
There is no single test that unequivocally detects MS. When faced with a patient whose symptoms, neurological exam results, and medical history suggest MS, physicians use a variety of tools to rule out other possible disorders and perform a series of laboratory tests which, if positive, confirm the diagnosis.
Imaging technologies such as MRI can help locate central nervous system lesions resulting from myelin loss. MRI is painless, noninvasive, and does not expose the body to radiation. It is often used in conjunction with the contrast agent gadolinium, which helps distinguish new plaques from old. However, since these lesions can also occur in several other neurological disorders, they are not absolute evidence of MS.
Several new MRI techniques may help quantify and characterize MS lesions that are too subtle to be detected using conventional MRI scans. While standard MRI provides an anatomical picture of lesions, magnetic resonance spectroscopy (MRS) yields information about the brain's biochemistry; specifically, it can measure the brain chemical N-acetyl aspartate. Decreased levels of this chemical can indicate nerve damage.
Magnetization transfer imaging (MTI) is able to detect white matter abnormalities before lesions can be seen on standard MRI scans by calculating the amount of "free" water in tissues. Demyelinated tissues and damaged nerves show increased levels of free" (versus "bound") water particles.
Diffusion-tensor magnetic resonance imaging (DT-MRI or DTI) measures the random motion of water molecules. Individual water molecules are constantly in motion, colliding with each other at extremely high speeds. This causes them to spread out, or diffuse. DT-MRI maps this diffusion to produce intricate, three-dimensional images indicating the size and location of demyelinated areas of the brain. Changes in this process can then be measured and correlated with disease progression.
Functional MRI (fMRI) uses radio waves and a strong magnetic field to measures the correlation between physical changes in the brain (such as blood flow) and mental functioning during the performance of cognitive tasks.
In addition to helping scientists and physicians better understand how MS develops-an important first step in devising new treatments-these approaches offer earlier diagnosis and enhance efforts to monitor disease progression and the effects of treatment.
Other tests that may be used to diagnosis MS include visual evoked potential (VEP) tests and studies of cerebrospinal fluid (the colorless liquid that circulates through the brain and spinal cord). VEP tests measure the speed of the brain's response to visual stimuli. VEP can sometimes detect lesions that the scanners miss and is particularly useful when abnormalities seen on MRI do not meet the specific criteria for MS. Auditory and sensory evoked potentials have also been used in the past, but are no longer believed to contribute significantly to the diagnosis of MS. Like imaging technologies, VEP is helpful but not conclusive because it cannot identify the cause of lesions.
Examination of cerebrospinal fluid can show cellular and chemical abnormalities often associated with MS. These abnormalities include increased numbers of white blood cells and higher-than-average amounts of protein, especially myelin basic protein and an antibody called immunoglobulin G. Physicians can use several different laboratory techniques to separate and graph the various proteins in MS patients' cerebrospinal fluid. This process often identifies the presence of a characteristic pattern called oligoclonal bands.
While it can still be difficult for the physician to differentiate between an MS attack and symptoms that can follow a viral infection or even an immunization, our growing understanding of disease mechanisms and the expanded use of MRI is enabling physicians to diagnose MS with far more confidence than ever before. Today, most patients who undergo a diagnostic evaluation for MS will be classified as either having MS or not having MS, although there are still cases where a person may have the clinical symptoms of MS but not meet all the criteria to confirm a diagnosis of MS. In these cases, a diagnosis of "possible MS" is used.
A number of other diseases may produce symptoms similar to those seen in MS. Other conditions with an intermittent course and MS-like lesions of the brain's white matter include polyarteritis, lupus erythematosus, syringomyelia, tropical spastic paraparesis, some cancers, and certain tumors that compress the brainstem or spinal cord. Progressive multifocal leukoencephalopathy can mimic the acute stage of an MS attack. Physicians will also need to rule out stroke, neurosyphilis, spinocerebellar ataxias, pernicious anemia, diabetes, Sjogren's disease, and vitamin B12 deficiency. Acute transverse myelitis may signal the first attack of MS, or it may indicate other problems such as infection with the Epstein-Barr or herpes simplex B viruses. Recent reports suggest that the neurological problems associated with Lyme disease may present a clinical picture much like MS.
Investigators are continuing their search for a definitive test for MS. Until one is developed, however, evidence of both multiple attacks and central nervous system lesions must be found before a diagnosis of MS is given.
Prevention
There are several recognized risk factors in Multiple Sclerosis, although there is no definite known cause.
Heredity is the first of the known risk factors for Multiple Sclerosis. If no one has Multiple Sclerosis in your family, then your chances of having MS are only 1 in 750. Having a parent or sibling with MS increases the odds to 1 in 100. If you have an
identical twin with MS, your chances are 1 in 4, although both twins do not always have MS. For this reason, many researchers believe that Multiple Sclerosis is not just a genetic disease, although heredity does affect the chances you will have it.
Environmental factors are the second risk factor for Multiple Sclerosis. Research shows that bacteria and viruses, especially at certain ages, can increase your chances of having MS. Alone these infections should not cause MS, but when combined with other risk factors for Multiple Sclerosis, especially heredity, they can greatly increase the odds of having it. The infections that could be related to MS are measles, herpes, chickenpox, rubella, mononucleosis, chlamydia, and some types of flu. These may have the most risk when they are contracted as a teenager.
For some unknown reason, MS is more common in temperate climates such as Europe, southern Canada, northern United States, and southeastern Australia. This geographical factor seems to be most important during puberty.
Women are 2 to 3 times more likely than men to have MS. This is believed to be due to hormonal differences. Men who smoke are twice as likely as men who do not smoke to be diagnosed with MS.
Age is the fifth risk factor for Multiple Sclerosis. Usually MS is diagnosed in people between 20 and 50. It is possible to be diagnosed during childhood or after the age of 50, but this age range seems to be the most critical.
The sixth risk factor in Multiple Sclerosis the use of cow's milk to infants under one year of age. This is a newly discovered risk, and the reasons are not yet known. Pediatrician's advise against cow milk for infants under one year of age, anyway, so it would be best to be careful. Breast milk is believed to be the best food for infants because it helps the brain develop faster and more fully.
Heredity is probably the strongest risk factor for Multiple Sclerosis, but combining several of these factors together may further increase the risk. Public awareness of these risks of developing MS are important and certainly anyone with persistent neurologic symptoms should seek appropriate medical evaluation.
A diet designed for patients with multiple sclerosis (MS) may help control and possibly eliminate many of the symptoms that come along with the disease. It is also believed that these diet guidelines may slow the progression of the disease. There are some basic guidelines for dietary changes for the MS patient, but always the patient should make these diet changes under the supervision of the health care professional.
A key factor in a healthy multiple sclerosis diet is to eliminate all gluten. In general, you should avoid eating anything with flour, but you can check package ingredients if you are unsure of their content. Many diets besides the MS diet do not allow gluten, so this is now easily found on many packages. Avoiding wheat, barley, oats, or rye is recommended to minimize the use of gluten containing products. A successful diet should also limit or avoid animal fats, including dairy products and margarine. Olive oil, sunflower oil, and safflower oil are suitable alternatives for cooking or salads. Fried foods and foods high in saturated fats are also to be avoided. White meat skinless chicken, seafood, and fish are the best meat choices. Make sure to always completely remove any fat. Anyone, but especially those on a MS diet, should try to completely eliminate refined sugar. There are many healthier alternatives. Honey, fructose, or natural unsweetened fruit or vegetable juices would be ideal for a person on this diet.
Obviously, any foods you are allergic to should be cut from your diet. If you are unsure of allergies, try consulting a doctor or allergy specialist. You may also try eliminating all of the most common problem foods from your diet, and after two weeks bring them back one at a time. If you have a bad reaction to any food, then you should probably eliminate it from your multiple sclerosis diet.
You should increase the amount of fresh vegetables and fruits in your MS diet. Try to always eat freshly cooked food. This will increase the amount of vitamins and minerals that your body absorbs. Vitamin supplements may also be beneficial or even necessary for your Multiple Sclerosis, but you should consult a doctor to make sure you take the right vitamins.
Always drink lots of water. It is very easy for a person with Multiple Sclerosis to become dehydrated, so make sure to drink at least 8 large glasses of water every day. These tips for improving your MS diet are intended to help you control many common problems such as fatigue, incontinence, and constipation. Adjusting your diet may also help to avoid making other problems worse. Many of these tips are included in other diets, and even people without special dietary needs may benefit from following these suggestions.
Symptoms
What are the Symptoms of MS?
Symptoms of MS may be mild or severe, of long duration or short, and may appear in various combinations, depending on the area of the nervous system affected. Complete or partial remission of symptoms, especially in the early stages of the disease, occurs in approximately 70 percent of MS patients.
The initial symptom of MS is often blurred or double vision, red-green color distortion, or even blindness in one eye. Inexplicably, visual problems tend to clear up in the later stages of MS. Inflammatory problems of the optic nerve may be diagnosed as retrobulbaror optic neuritis. Fifty-five percent of MS patients will have an attack of optic neuritis at some time or other and it will be the first symptom of MS in approximately 15 percent. This has led to general recognition of optic neuritis as an early sign of MS, especially if tests also reveal abnormalities in the patient's spinal fluid.
Most MS patients experience muscle weakness in their extremities and difficulty with coordination and balance at some time during the course of the disease. These symptoms may be severe enough to impair walking or even standing. In the worst cases, MS can produce partial or complete paralysis. Spasticity-the involuntary increased tone of muscles leading to stiffness and spasms-is common, as is fatigue. Fatigue may be triggered by physical exertion and improve with rest, or it may take the form of a constant and persistent tiredness.
Most people with MS also exhibit paresthesias, transitory abnormal sensory feelings such as numbness, prickling, or "pins and needles" sensations; uncommonly, some may also experience pain. Loss of sensation sometimes occurs. Speech impediments, tremors, and dizziness are other frequent complaints. Occasionally, people with MS have hearing loss.
Approximately half of all people with MS experience cognitive impairments such as difficulties with concentration, attention, memory, and poor judgment, but such symptoms are usually mild and are frequently overlooked. In fact, they are often detectable only through comprehensive testing. Patients themselves may be unaware of their cognitive loss; it is often a family member or friend who first notices a deficit. Such impairments are usually mild, rarely disabling, and intellectual and language abilities are generally spared.
Cognitive symptoms occur when lesions develop in brain areas responsible for information processing. These deficits tend to become more apparent as the information to be processed becomes more complex. Fatigue may also add to processing difficulties. Scientists do not yet know whether altered cognition in MS reflects problems with information acquisition, retrieval, or a combination of both. Types of memory problems may differ depending on the individual's disease course (relapsing-remitting, primary-progressive, etc.), but there does not appear to be any direct correlation between duration of illness and severity of cognitive dysfunction. .
Depression, which is unrelated to cognitive problems, is another common feature of MS. In addition, about 10 percent of patients suffer from more severe psychotic disorders such as manic-depression and paranoia. Five percent may experience episodes of inappropriate euphoria and despair-unrelated to the patient's actual emotional state-known as "laughing/weeping syndrome." This syndrome is thought to be due to demyelination in the brainstem, the area of the brain that controls facial expression and emotions, and is usually seen only in severe cases.
As the disease progresses, sexual dysfunction may become a problem. Bowel and bladder control may also be lost.
In about 60 percent of MS patients, heat-whether generated by temperatures outside the body or by exercise-may cause temporary worsening of many MS symptoms. In these cases, eradicating the heat eliminates the problem. Some temperature-sensitive patients find that a cold bath may temporarily relieve their symptoms. For the same reason, swimming is often a good exercise choice for people with MS.
The erratic symptoms of MS can affect the entire family as patients may become unable to work at the same time they are facing high medical bills and additional expenses for housekeeping assistance and modifications to homes and vehicles. The emotional drain on both patient and family is immeasurable. Support groups (listed on a card in the pocket at the back of this pamphlet) and counseling may help MS patients, their families, and friends find ways to cope with the many problems the disease can cause.
Possible Symptoms of Multiple Sclerosis
- Muscle weakness
- Spasticity
- Impairment of pain, temperature, touch senses
- Pain (moderate to severe)
- Ataxia
- Tremor
- Speech disturbances
- Vision disturbances
- Vertigo
- Bladder dysfunction
- Bowel dysfunction
- Sexual dysfunction
- Depression
- Euphoria
- Cognitive abnormalities
- Fatigue
How is MS Diagnosed?
There is no single test that unequivocally detects MS. When faced with a patient whose symptoms, neurological exam results, and medical history suggest MS, physicians use a variety of tools to rule out other possible disorders and perform a series of laboratory tests which, if positive, confirm the diagnosis.
Imaging technologies such as MRI can help locate central nervous system lesions resulting from myelin loss. MRI is painless, noninvasive, and does not expose the body to radiation. It is often used in conjunction with the contrast agent gadolinium, which helps distinguish new plaques from old. However, since these lesions can also occur in several other neurological disorders, they are not absolute evidence of MS.
Several new MRI techniques may help quantify and characterize MS lesions that are too subtle to be detected using conventional MRI scans. While standard MRI provides an anatomical picture of lesions, magnetic resonance spectroscopy (MRS) yields information about the brain's biochemistry; specifically, it can measure the brain chemical N-acetyl aspartate. Decreased levels of this chemical can indicate nerve damage.
Magnetization transfer imaging (MTI) is able to detect white matter abnormalities before lesions can be seen on standard MRI scans by calculating the amount of "free" water in tissues. Demyelinated tissues and damaged nerves show increased levels of free" (versus "bound") water particles.
Diffusion-tensor magnetic resonance imaging (DT-MRI or DTI) measures the random motion of water molecules. Individual water molecules are constantly in motion, colliding with each other at extremely high speeds. This causes them to spread out, or diffuse. DT-MRI maps this diffusion to produce intricate, three-dimensional images indicating the size and location of demyelinated areas of the brain. Changes in this process can then be measured and correlated with disease progression.
Functional MRI (fMRI) uses radio waves and a strong magnetic field to measures the correlation between physical changes in the brain (such as blood flow) and mental functioning during the performance of cognitive tasks.
In addition to helping scientists and physicians better understand how MS develops-an important first step in devising new treatments-these approaches offer earlier diagnosis and enhance efforts to monitor disease progression and the effects of treatment.
Other tests that may be used to diagnosis MS include visual evoked potential (VEP) tests and studies of cerebrospinal fluid (the colorless liquid that circulates through the brain and spinal cord). VEP tests measure the speed of the brain's response to visual stimuli. VEP can sometimes detect lesions that the scanners miss and is particularly useful when abnormalities seen on MRI do not meet the specific criteria for MS. Auditory and sensory evoked potentials have also been used in the past, but are no longer believed to contribute significantly to the diagnosis of MS. Like imaging technologies, VEP is helpful but not conclusive because it cannot identify the cause of lesions.
Examination of cerebrospinal fluid can show cellular and chemical abnormalities often associated with MS. These abnormalities include increased numbers of white blood cells and higher-than-average amounts of protein, especially myelin basic protein and an antibody called immunoglobulin G. Physicians can use several different laboratory techniques to separate and graph the various proteins in MS patients' cerebrospinal fluid. This process often identifies the presence of a characteristic pattern called oligoclonal bands.
While it can still be difficult for the physician to differentiate between an MS attack and symptoms that can follow a viral infection or even an immunization, our growing understanding of disease mechanisms and the expanded use of MRI is enabling physicians to diagnose MS with far more confidence than ever before. Today, most patients who undergo a diagnostic evaluation for MS will be classified as either having MS or not having MS, although there are still cases where a person may have the clinical symptoms of MS but not meet all the criteria to confirm a diagnosis of MS. In these cases, a diagnosis of "possible MS" is used.
A number of other diseases may produce symptoms similar to those seen in MS. Other conditions with an intermittent course and MS-like lesions of the brain's white matter include polyarteritis, lupus erythematosus, syringomyelia, tropical spastic paraparesis, some cancers, and certain tumors that compress the brainstem or spinal cord. Progressive multifocal leukoencephalopathy can mimic the acute stage of an MS attack. Physicians will also need to rule out stroke, neurosyphilis, spinocerebellar ataxias, pernicious anemia, diabetes, Sjogren's disease, and vitamin B12 deficiency. Acute transverse myelitis may signal the first attack of MS, or it may indicate other problems such as infection with the Epstein-Barr or herpes simplex B viruses. Recent reports suggest that the neurological problems associated with Lyme disease may present a clinical picture much like MS.
Investigators are continuing their search for a definitive test for MS. Until one is developed, however, evidence of both multiple attacks and central nervous system lesions must be found before a diagnosis of MS is given.
Prevention
There are several recognized risk factors in Multiple Sclerosis, although there is no definite known cause.
Heredity is the first of the known risk factors for Multiple Sclerosis. If no one has Multiple Sclerosis in your family, then your chances of having MS are only 1 in 750. Having a parent or sibling with MS increases the odds to 1 in 100. If you have an
identical twin with MS, your chances are 1 in 4, although both twins do not always have MS. For this reason, many researchers believe that Multiple Sclerosis is not just a genetic disease, although heredity does affect the chances you will have it.
Environmental factors are the second risk factor for Multiple Sclerosis. Research shows that bacteria and viruses, especially at certain ages, can increase your chances of having MS. Alone these infections should not cause MS, but when combined with other risk factors for Multiple Sclerosis, especially heredity, they can greatly increase the odds of having it. The infections that could be related to MS are measles, herpes, chickenpox, rubella, mononucleosis, chlamydia, and some types of flu. These may have the most risk when they are contracted as a teenager.
For some unknown reason, MS is more common in temperate climates such as Europe, southern Canada, northern United States, and southeastern Australia. This geographical factor seems to be most important during puberty.
Women are 2 to 3 times more likely than men to have MS. This is believed to be due to hormonal differences. Men who smoke are twice as likely as men who do not smoke to be diagnosed with MS.
Age is the fifth risk factor for Multiple Sclerosis. Usually MS is diagnosed in people between 20 and 50. It is possible to be diagnosed during childhood or after the age of 50, but this age range seems to be the most critical.
The sixth risk factor in Multiple Sclerosis the use of cow's milk to infants under one year of age. This is a newly discovered risk, and the reasons are not yet known. Pediatrician's advise against cow milk for infants under one year of age, anyway, so it would be best to be careful. Breast milk is believed to be the best food for infants because it helps the brain develop faster and more fully.
Heredity is probably the strongest risk factor for Multiple Sclerosis, but combining several of these factors together may further increase the risk. Public awareness of these risks of developing MS are important and certainly anyone with persistent neurologic symptoms should seek appropriate medical evaluation.
