The role of nutrition in the management of Multiple Sclerosis

Naomi is a Freelance Researcher with Sprout and holds a PhD in Medical Psychology from King’s College London. Naomi is also a qualified nutritionist with 20 years’ experience in the health industry.

What does the research say?

Multiple Sclerosis (MS) is a condition that can affect the brain and spinal cord, affecting around 130,000 people in the UK¹. People with MS can have a range of symptoms including blurred vision, numbness and tingling, and mobility problems. Additionally, MS can have great emotional impacts.

We don’t know why some people get MS. However, research shows that lifestyle factors can play a role. For example, people who smoke are more likely to get MS than those who don’t². This is not surprising, as research has shown that people who smoke are more likely to develop chronic illnesses and autoimmune diseases³. There is also evidence to suggest that some viruses or bacterial infections might trigger MS, and you may be more likely to get MS if you have a relative with it or live in a climate without sufficient sunlight⁴. There is growing evidence pointing to the role of nutrition and that what we eat as a child may be linked to getting MS as an adult.

Childhood diet is linked to MS later in life

A recent Australian study found that children and teenagers aged 11-15 who ate fruit and legumes (e.g., beans and lentils) were less likely to be diagnosed with MS later in life⁵. Other studies have found that people with low levels of vitamin D, especially those who had low levels as a child and teenager, are more likely to get MS⁶. Researchers have also found that getting MS may be linked to obesity, especially if someone was obese as a child or teenager⁷. Evidence suggests that people who are obese are often low in vitamin D, which may be one explanation for this⁸.

What is the role of diet in MS?

There is no official dietary guidance for people with MS. However, as is the case with most chronic illnesses, a healthy, balanced diet is recommended. There is a focus on wholegrains, fruits, and vegetables, as these foods provide a range of nutrients to help support certain symptoms of MS like constipation and bladder problems.

There is some evidence that certain foods may play an important role in the progression of MS and symptom management.

Fish

• Eating oily fish has been found to reduce disability and improve quality of life in people with MS. This may be due to the anti-inflammatory omega 3 fatty acids⁹.

Red meat

• Eating red meat has been linked to an increased risk of chronic illness. However, recent research has found that eating non-processed red meat in moderation as part of a healthy, Mediterranean diet might reduce the risk of getting MS¹⁰. Another study found that restricting red meat did not lead to any changes in disease severity¹¹.

Dairy

• When it comes to dairy, the results are mixed. Dairy is a good source of calcium, vitamin D, and other important nutrients. However, some people with MS report more severe symptoms after eating dairy products¹².

Vitamin D

• As mentioned, low levels of vitamin D may play a role in causing MS⁶. Research also tells us that low levels of vitamin D may worsen disease progression and symptoms for people with MS¹³. We can get vitamin D from the sun, but not all of us live somewhere where this is possible year round. Luckily, certain foods including oily fish and eggs contain vitamin D. Studies show that people with MS need more vitamin D than the general public¹⁴ and that taking a supplement in the early stages of MS may reduce the rate of progression¹⁵.

Take home message:

There is still a long way to go when it comes to fully understanding the links between diet and MS. There are some uncontrollable risk factors for MS (e.g., genes or gender). However, diet is one factor that is controllable and has some evidence to show that it can affect symptoms and progression of MS. Being able to self-manage daily diet may help those living with MS to reduce disease progression and symptoms, improve function and enhance overall quality of life.

References

1. MS Society. What is MS? [Internet]. 2022 [cited 2023 Feb 3]. Available from: https://www.mssociety.org.uk/about-ms/what-is-ms

2. Handel, A. E., Williamson, A. J., Disanto, G., Dobson, R., Giovannoni, G., & Ramagopalan, S. V. (2011). Smoking and multiple sclerosis: an updated meta-analysis. PloS one, 6(1), e16149. https://doi.org/10.1371/journal.pone.0016149.

3. Costenbader, K. H., & Karlson, E. W. (2006). Cigarette smoking and autoimmune disease: what can we learn from epidemiology? Lupus, 15(11), 737–745. https://doi.org/10.1177/0961203306069344 https://www.mssociety.org.uk/about-ms/what-is-ms/causes-of-ms

4. MS Australia. Does childhood diet impact future MS? [Internet]. 2021 [cited 2023 Feb 2]. Available from: https://www.msaustralia.org.au/news/childhood-diet-impact-ms/

5. Pierrot-Deseilligny, C., & Souberbielle, J. C. (2017). Vitamin D and multiple sclerosis: An update. Multiple sclerosis and related disorders, 14, 35–45. https://doi.org/10.1016/j.msard.2017.03.014

6. Pakpoor J, Schmirler K, Cuzick J, Giovannoni G, Dobson R. Estimated and projected burden of multiple sclerosis attributable to smoking and childhood and adolescent high body-mass index: a comparative risk assessment. Int J Epidemiol [Internet]. 2020 Dec 1;49(6):2051–7. Available from: https://doi.org/10.1093/ije/dyaa151

7. Walsh, J. S., Bowles, S., & Evans, A. L. (2017). Vitamin D in obesity. Current opinion in endocrinology, diabetes, and obesity, 24(6), 389–394. https://doi.org/10.1097/MED.0000000000000371

8. Jelinek, G. A., Hadgkiss, E. J., Weiland, T. J., Pereira, N. G., Marck, C. H., & van der Meer, D. M. (2013). Association of fish consumption and Ω 3 supplementation with quality of life, disability and disease activity in an international cohort of people with multiple sclerosis. The International journal of neuroscience, 123(11), 792–800. https://doi.org/10.3109/00207454.2013.803104

9. Pakpoor, J., Schmierer, K., Cuzick, J., Giovannoni, G., & Dobson, R. (2020). Estimated and projected burden of multiple sclerosis attributable to smoking and childhood and adolescent high body-mass index: a comparative risk assessment. International Journal of Epidemiology, 49(6), 2051–2057. https://doi.org/10.1093/ije/dyaa151

10. Black, L. J., Baker, K., Ponsonby, A.-L., van der Mei, I., Lucas, R. M., Pereira, G., & Investigator Group, A. (2019). A Higher Mediterranean Diet Score, Including Unprocessed Red Meat, Is Associated with Reduced Risk of Central Nervous System Demyelination in a Case-Control Study of Australian Adults. The Journal of Nutrition, 149(8), 1385–1392. https://doi.org/10.1093/jn/nxz089

11. Sattarnezhad, N., Caron, K., Chua, A., Healy, B., Cook, S., Tankou, S., Kaplan, T., Diaz-Cruz, C., Glanz, B., Weiner, H., & Chitnis, T. (2016). Effects of Red Meat Diet Restriction on Multiple Sclerosis Severity (P1.404). Neurology, 86(16 Supplement), P1.404. http://n.neurology.org/content/86/16_Supplement/P1.404.abstract

12. University of Bonn. (2022, March 1). Milk may exacerbate MS symptoms: Cow’s milk protein triggers autoimmune response in mice that damages neurons. ScienceDaily. Retrieved February 13, 2023 from sciencedaily.com/releases/2022/03/220301131110.htm

13. Ascherio, A., Munger, K. L., White, R., Köchert, K., Simon, K. C., Polman, C. H., Freedman, M. S., Hartung, H. P., Miller, D. H., Montalbán, X., Edan, G., Barkhof, F., Pleimes, D., Radü, E. W., Sandbrink, R., Kappos, L., & Pohl, C. (2014). Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA neurology, 71(3), 306–314. https://doi.org/10.1001/jamaneurol.2013.5993

14. MS Society. Vitamin D [Internet]. 2018 [cited 2023 Feb 3]. Available from: https://mstrust.org.uk/a-z/vitamin-d

15. Simpson, S., Jr, van der Mei, I., Lucas, R. M., Ponsonby, A. L., Broadley, S., Blizzard, L., Ausimmune/AusLong Investigators Group, & Taylor, B. (2018). Sun Exposure across the Life Course Significantly Modulates Early Multiple Sclerosis Clinical Course. Frontiers in neurology, 9, https://doi.org/10.3389/fneur.2018.00016