Multiple sclerosis, or MS, is a chronic, autoimmune disease of the central nervous system. In patients with MS, the immune system attacks the body’s myelin, which is the insulating layer around nerves that sends signals to and from the brain. As communication from the brain to different parts of the body progressively becomes disrupted, symptoms can range from relatively benign to devastating in some cases.
Signs of multiple sclerosis typically begin with blurred vision or other issues with sight, and then progress to muscle weakness in extremities and difficulty with coordination or balance. How quickly this progression happens depends on the individual’s case. The disease may also be accompanied with other debilitating symptoms such as cognitive impairments, partial or complete paralysis, pain and strange sensory feelings in the body.
While there is no cure for MS, there are a number of ways to help alleviate symptoms. Although there’s no official MS diet, what you eat may play a role in managing symptoms.
Diet for MS
Diet is important in MS, much the same way that we know diet is important for brain health or heart health, says Dr. Rebecca Straus Farber, an assistant professor of neurology in the division of neuroimmunology at Columbia University Irving Medical Center in New York City.
“That’s not to say that diet doesn’t make a difference,” she adds.
Research has been limited in investigating the association between multiple sclerosis and dietary intake.
“Experts still don’t know what exactly triggers MS or what foods might be culprits,” says Julie Stefanski, a registered dietitian nutritionist and spokesperson for the Academy of Nutrition and Dietetics. “International experts have not determined a dietary protocol that consistently benefits individuals with MS. There is no single food that causes MS or any supplements that cure it.”
Alternatively, food triggers are not clearly understood either.
“Is it possible that there are foods that worsen MS symptoms? Yes,” she says. “Do we know exactly what those foods are? No.”
“The nutrition-related theories and research that is currently ongoing to unravel the autoimmune puzzle focuses on micronutrient status — vitamin D in particular — inflammation, gut health and food triggers,” Stefanski says.
[READ: Best Foods for Your Brain]
Immune-Related Disorders and Gut Health
“There are reasons to believe that diet is particularly relevant to immune-related disorders, which includes MS,” Straus Farber says.
One of the main reasons — and also a focus of Straus Farber’s research — is the relationship between your diet and the gut microbiome, which consists of millions of bacteria living within the intestines.
“Right on the other side of those intestinal walls are where a lot of immune cells essentially grow up, where they’re trained to recognize what’s self versus what is foreign,” Straus Farber says. “We’re learning that metabolites produced by the gut — like the bacteria in the gut — have a huge influence on the immune system and how these immune cells are trained, so we have a lot of reason to believe that by influencing gut microbiome, healthy diets can retrain the immune system.”
For example, research published in 2017 shows a connection between the gut and the immune system. According to the findings, an impaired interaction between the gut microbiome and the mucosal immune system — the largest component of the immune system — is associated with the development of inflammatory diseases.
Foods to Avoid With MS
Here are six foods to avoid with MS when planning your meals:
Research on the role of the gut microbiota in health has exploded over the past 20 years. In particular, experts believe an imbalance of harmful bacteria — called dysbiosis — may play a role in the development of autoimmune conditions, Stefanski explains.
“Some experts feel that gluten may impact the strength of the junctures between the cells in our small intestine and that autoimmune conditions (other than celiac disease) may be helped by reducing gluten consumption,” Stefanski says. “This is still a growing area of theories and research, but an option — such as a gluten-free diet, which is safe for individuals to try — is appealing to many people.”
Gluten is a protein commonly found in wheat products, like bread, pasta or cakes. You can typically find gluten-free alternatives at any grocery store.
Highly processed foods
“We generally recommend to avoid highly processed foods,” Straus Farber says, as they have negative impacts on the gut microbiome and can cause inflammation in the body.
The U.S. Department of Agriculture defines a processed food as one that’s undergone any changes to its natural state. For example, that could mean including other ingredients, like preservatives, flavors or other food additives. Foods can be categorized into four categories: unprocessed or minimally processed, processed culinary ingredients, processed foods and ultra-processed or highly processed foods.
Highly processed foods go well beyond merely adding salt, sweeteners or fat. These are typically foods that have gone through many processing steps and contain several food additives to promote shelf stability, preserve texture and increase palatability.
“Many foods have research showing they contribute to inflammation, and other studies showing that the same foods help reduce inflammation,” Stefanski says.
Omega-6 fatty acids — a type of polyunsaturated fat often found in plant oils, nuts and seeds — fall into this category. These types of oils are used extensively in processed foods and restaurant meals, such as French fries or fried chicken.
“Most Americans consume a lot of omega-6 fats and not enough omega-3s,” Stefanski says.
With omega-6s outpacing omega-3s in consumption for the average American, the imbalance may contribute to chronic inflammation. However, “omega-6 fats and omega-3 fats are both essential to health,” Stefanski says. “Including more omega-3 fats may help to reduce inflammation.”
Fatty fishes are a great source of omega-3s. Aim to include fish — like sardines, mackerel, salmon, herring or tuna — in your menu at least three to four times per week.
“Americans rely on highly processed grains for many meals and lack the minimal servings of vegetables and fruits needed for optimal health,” Stefanski says.
Highly processed grains, also referred to as refined grains, have been milled — meaning they have the bran and germ removed. This is done to give grains a finer texture and improve shelf life. However, this process removes several essential vitamins and nutrients, including fiber.
Refined grains include white bread, types of noodles or pasta, white rice, white flour, potatoes, corn grits and milled barley. Swapping refined grains for whole-grain alternatives is a good option. Examples of whole-grains foods include brown rice, quinoa, whole-wheat pasta or bread and farro.
“Saturated fats are unhealthy fats that have pro-inflammatory effects on the body,” says Wendy Lord, a registered dietitian and medical author at Health Reporter.
In general, food groups that are linked with inflammation should be avoided, she says.
One study looked at the association between dietary patterns and the risk of developing MS. Findings suggest that a dietary pattern high in animal fats, meat products, sugars and hydrogenated fats (typically found in food products like margarine, baked goods or fried foods) and low in whole grains, spices and poultry without the skin is related to a higher risk of MS development.
“These types of fats are commonly found in animal-based foods,” Lord says.
Limiting your intake of foods like red meat, cow’s milk and cheese may benefit MS patients.
Eating fewer processed foods and less meat is beneficial for the brain as a whole. Though just because it’s plant-based, it doesn’t mean it’s good for you. Foods like coconut oil and cocoa butter are high in saturated fats.
“It’s difficult to avoid any specific food or ingredient completely, but you can limit the intake of certain foods that cause inflammation in the body,” Lord says. “Consuming foods that contain coconut oil or cocoa butter occasionally is fine. However, be sure you are eating plenty of fruits and veggies to keep inflammation under control.”
“We think that (high-salt foods) have a pro-inflammatory effect on the immune system,” Straus Farber says.
In fact, a 2014 study published in the journal Neurology suggests that high quantities of sodium may contribute to a flaring of MS symptoms. Though researchers found a positive correlation between sodium intake and MS disease activity, they looked at a relatively small sample size and more follow-up research is needed.
The best data out there is showing that dietary plans similar in nature to the Mediterranean diet and that are low in salt are brain protective in people with MS, Straus Farber says. These diets correlate with less rate of shrinkage in key brain areas in people with MS.
Foods high in salt may include soups, salad dressings and snacks like chips, popcorn and pretzels. Cut down on your sodium intake by making homemade soup, searching for low-sodium labeled canned soups at the store, asking for your salad dressing on the side, skipping the salt on your popcorn or grabbing unsalted pretzels or chips at the store.
“Foods that are loaded with artificial sweeteners, including beverages, promote inflammation and fatigue, which can collectively trigger MS symptoms,” Lord says.
Therefore, people with MS may benefit from limiting foods with high amounts of refined sugar, which are typically highly processed. That may include beverages like soft drinks or sports drinks, sweets like candy or cookies and some sauces like tomato sauce, salad dressings and condiments.
In addition, alcohol in larger quantities can aggravate MS symptoms, including bladder and coordination problems, Lord adds.
Challenges of Elimination Diets
“I don’t know that we have enough evidence yet to say … certain foods or certain food groups need to be entirely avoided,” Straus Farber says. “It’s important to keep in mind that not every symptom or reaction of the body can be attributed to what you’re eating.”
Many factors contribute to symptoms and a lot goes into managing a medical condition, particularly when it comes to nutrition. Taking a comprehensive, well-rounded approach is essential, and rarely is there a quick fix for an ongoing chronic and complex medical condition like MS.
“If nutrition advice is only focused on what to avoid and not what to include, that’s a red flag,” Stefanski says.
When cutting out foods or food groups, following a restrictive diet or an elimination protocol, Stefanski emphasizes that the minimal nutrient needs of the body must still be met.
“Mineral and vitamin supplementation is often needed with an elimination diet, especially if multiple foods are being restricted in the diet,” she says. “Good sources of calcium, omega-3 fatty acids, iron and B vitamins are eliminated when food variety is limited.”
Why You Should Work With a Health Care Provider
An overall healthy, well-rounded diet is specifically important for MS.
“It’s important for overall health to not only look at the foods being avoided, but what nutrients are being provided by the beverages and foods your modified diet is based on,” Stefanski says. “The key to improving your health is to personalize your nutrition recommendations to your own symptoms.”
If your health provider recommends eliminating or avoiding certain foods, a registered dietitian can help identify what elimination diet protocol to follow and how to still maintain good nutrition.
“Ideally, it’s important to establish your health care team prior to starting an elimination diet, especially while you’re still having symptoms,” Stefanksi says. “Every person’s body is different. You don’t want to eliminate a food or food group simply because a popular influencer did it.”
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Update 01/20/23: This story was published at an earlier date and has been updated with new information.