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Food for Thought: MS and Nutrition

by Denise M. Nowack, RD, with Jane Sarnoff

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Managing fatigue

Everyone gets tired. However, certain types of fatigue, such as neuromuscular fatigue, depression-related fatigue, and MS lassitude can be particular to people with MS. These types of fatigue can be treated with medications, management strategies, and therapy. People with MS also get fatigued from everyday life—like everyone else. Fatigue may result in a decrease in appetite, activity, and less interest in food preparation. If fatigue is interfering with your activities, discuss the problem with your doctor.

Here are some tips to ensure that you get the nutrition your body needs when fatigue becomes a challenge:

        If the thought of three large meals is too much, try eating more frequently—five to six smaller meals if your appetite is small. Resist the urge for low-nutrient convenience foods. Keep your refrigerator and cupboards stocked with healthful items like string cheese, low-fat crackers, peanut butter, dried fruit or raisins, small cartons of fruit juice, individual cartons of low-fat or non-fat yogurt or cottage cheese, or bagged salads and pre-cut raw vegetables.

        Keep a stack of menus from places that deliver healthy meals!

        Make the most of your freezer. Stock up on flavorful, low-fat dinners that can be quickly microwaved or heated.

When you do shop and cook … save energy:

        Make a shopping list before you head out to the store.

        Stock up on basics. Fill your pantry with chopped tomatoes, prepared sauces, mustards, canned beans, tuna, and other items that you use regularly.

        If you have difficulty carrying food home, find delivery services, shopping services or friends and relatives who will shop from your list.

        When you cook, try to make more than you will eat in one meal so you can store or freeze the rest for another meal.

        Don’t want to chop? Packaged pre-chopped vegetables can cut down your preparation time. There are also shredded cheese, jars of minced garlic, ginger root, sliced olives, and diced peppers.

        Streamline cleanup! Paper plates can be a lifesaver when energy is low. Enlist family and friends as extra hands—and save your energy for socializing after the meal.

        How user-friendly is your kitchen? An occupational therapist can suggest ways to rearrange your kitchen to make meal preparation easier. There are utensils, storage systems, reaching aids, and adapted stovetops that increase efficiency. Ask your doctor for a referral to an occupational therapist who can help you adapt your kitchen to best meet your needs.

        Removing doors underneath cabinet countertops allows you to sit while fixing food. Just make sure any hot pipes are wrapped with insulation.

The Traditional Healthy
Mediterranean Diet PyramidEating and emotions

Many people with MS struggle with depression at one time or another. When depression hits, it can have an adverse effect on motivation, sleeping patterns, eating habits, and energy. Each of these can, in turn, affect nutritional well-being.

Some people turn to food for solace when they are depressed. Certain foods create a sense of comfort. These may be old familiar favorites from childhood—a scoop of mashed potatoes, macaroni and cheese, a cup of steaming soup, a bowl of rice pudding. The danger is going overboard with these favorites. The extra fat, sugar, and calories can add up.

Other people experience a loss of appetite when they are depressed. It is important to recognize these feelings and understand how they might be affecting your health. Eating with others can help keep you connected. But if self-help strategies don’t work, seek professional help. Serious depression is a treatable medical condition.

Reducing bladder concerns

Bladder problems can be treated. If you have symptoms, consult your doctor at the first sign of trouble. Keep in mind though that what you eat and drink can help.

Pour on the water! Quite often fear of urinary frequency or loss of bladder control causes people with bladder problems to limit their fluid intake. This can contribute to other problems such as dehydration, dry mouth, difficulties with swallowing, loss of appetite, constipation, and even deficiencies in certain nutrients. Be sure to drink 6- to 8-ounce glasses of water or other fluids every day.

Try these strategies to make sure you get the fluid you need:

        Take water breaks during the day. If you pass a water fountain … take a drink!

        Travel with your own personal supply of bottled water.

        Refresh yourself at meals and snack time with juice, milk, or sparkling water.

        Limit caffeine-rich beverages like coffee, tea, cola, and other soft drinks. Caffeine acts as a diuretic and should be avoided by those with bladder problems.

        Use alcohol prudently. Alcohol provides little nutrition and many calories. It functions as a central nervous system depressant, and can increase balance and coordination problems. It may also irritate the bladder and aggravate problems with urgency.

If you are prone to urinary tract infections, drinking beverages that help to increase the acid level in urine can help prevent them. These include cranberry, apple, apricot, and prune juices. Limit foods and beverages that make urine more alkaline. These include citrus fruits and juices (orange, grapefruit), tomatoes, potatoes, lima beans, and antacids that contain sodium bicarbonate.

Bowel management

Whether constipation is a result of your MS or your habits, don’t despair. The following tips can help keep things moving.

  • Fiber counts … add it up! Dietary fiber is a substance found in foods like cereal grains, nuts, seeds, vegetables, and fruits, and is not digested or absorbed by the body. (Animal food products do not contain any dietary fiber.)
  • A diet that provides 2530 grams of fiber each day is recommended for good bowel function. There’s an added benefit for the weight conscious—fiber provides a more lasting sense of fullness, helping you cut back on what you eat.
  • Start slowly. Fiber should be added into the diet gradually. Adding too much fiber too fast can cause gas, cramps, diarrhea … and discouragement. The foods toward the bottom of the Food Guide Pyramid tend to be the highest in fiber.

These ideas might help you fit fiber onto your plate:

—Start your day with a high-fiber breakfast cereal.

—Switch to whole-grain breads.

—Eat more beans, peas, and lentils.

—Take advantage of ready-to-use vegetables.

—Experiment with whole grains—like brown rice, barley, and whole-wheat pasta.

—Make snacks count—eat dried fruits, raw veggies.

—Eat fruit at every meal.

If you find it difficult to reach the recommended level, fiber supplements can be used. One tablespoon of these commercial products provides 15 grams of fiber. Remember, these are not laxatives but fiber supplements. Be sure to consult your physician before using any of these products.

        Don’t forget the fluids. Fiber absorbs water, so as you increase the fiber in your diet, you need to increase your fluid intake as well.

        Just move! In addition to the many other benefits of physical activity, exercise can also aid in preventing constipation.

Bowel incontinence can be aggravated by dietary factors. Surprisingly, in MS, bowel incontinence is often caused by constipation. A sudden loss of control occurs when the stool breaks through or leaks around a blockage. Be sure to discuss bowel problems with your doctor or nurse. You don’t need to accept them as part of your life with MS.

Preventing bone loss

People with MS may be at risk for osteoporosis—a condition where the bones gradually become brittle due to the loss of calcium and other minerals. Lack of weight-bearing activity due to immobility or fatigue, a diet low in calcium, smoking, heavy drinking, and use of steroid drugs may all contribute to loss of bone mass. Talk to your doctor to determine if you might be at risk.

To prevent bone loss:

        Count on calcium. Calcium-rich foods include low-fat dairy products, dark green leafy vegetables, fish with edible bones, and some fortified foods like orange juice and cereals. Keep your intake of sodium, caffeine, and protein moderate. They all can interfere with calcium absorption.

        Be sure to get enough vitamin D. This important nutrient helps calcium deposit in the bones. The body makes much of the vitamin D it needs when the skin is exposed to sunlight. But people with MS often avoid the sun to avoid heat. Food sources are the safest choice. Excess use of vitamin D supplements can cause serious health problems.

        Be active. Get advice about a regular weight-bearing activity you’ll enjoy.

Chewing and swallowing

Discuss swallowing problems with your doctor. You may be referred to a speech pathologist, a specialist who can suggest changes in the way you prepare foods or in the way you sit and breathe while you eat. You may need to change the form of your foods in order to eat a nutritionally sound diet.

        Thicker drinks tend to be easier to swallow. Such drinks might include milk shakes, juices in gelatin form, fruit sauces, sherbets, and puddings.

        Foods that crumble easily can cause choking. Avoid chips, crackers, toast, and cakes.

        Soft foods need less chewing. Eat mashed or baked potatoes instead of fried, cooked vegetables and stewed fruits instead of raw. Make use of a blender or food processor to get foods to the texture easiest for you to handle.

        Eat small, frequent meals so that you don’t become tired from chewing and swallowing.

        Taking smaller bites can help reduce fatigue and the risk of choking.

MS ... plus another diagnosis

People with MS can have other health problems. Diabetes, high blood pressure, or high cholesterol may require special diets or drug treatments. If you have other health problems and more than one doctor, make sure each health-care provider understands your special needs. A registered dietitian can help bring together all the pieces of your dietary puzzle. Dietitians can provide professional, reliable, objective nutrition information, and can help you separate facts from fads.

The Traditional Healthy
Vegetarian Diet PyramidA look at “special” diets

Never before have there been more nutrition theories or diets that claim to treat MS. These include diets low in gluten, high in polyunsaturated fats, or high in certain vitamins, as well as diets which assume that every individual is allergic to certain types of food.

Some of these diets, such as Dr. Roy Swank’s low-fat diet, are consistent with accepted dietary guidelines, and pose no nutritional risk for people with MS. Other diets that claim to be therapeutic may actually work against the principles of proper nutrition. Before considering any special diets, seek information from your doctor or a registered dietitian.

Some researchers do believe that nutrition plays some yet to be determined role in MS treatment, but so far no diet, vitamin, or dietary supplement has been proven to have therapeutic value. There is no evidence that a nutrition-related factor plays a part in the origin or cause of MS.

The best food for thought is a well-balanced and nutrient-rich diet, based on the Food Guide Pyramid. Inform yourself about food choices, make a commitment to healthy eating, and develop menus you enjoy.

Find the diet you can live with ... and then eat well ... for the health of it!

Download Fiber Facts chart (PDF)

For additional information

* Staying Well

Copyright National Multiple Sclerosis Society, 2003

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