Diet & Healthy Eating

Research has proven that diet can be a positive factor in managing MS.

All of us are, literally what we eat. The food we eat is broken down by the digestive system and used either to build or replace body tissues, including the tissues in the central nervous system.

It therefore makes good sense for everybody to think about what they are eating and to make sure that they give the body everything it needs to maintain good health. It makes even better sense to do so if there is a condition such as MS present.  A number of trials have shown that attention to diet can affect the progress of the MS condition.

MS people need to aim at the very least to have a diet that is varied and follows present healthy eating recommendations for everybody. These recommendations are to eat less fat, sugar and salt and more fibre.

The dietary trials that have been carried out have shown that making changes to the type of fat eaten is of benefit to people with MS. The specific MS diet aims to limit saturated (animal) fat whilst encouraging the Essential Fatty Acids (EFA's) found in polyunsaturated fat (vegetable fat and fish oils).  It also aims to provide generous levels of other nutrients eg. vitamins and minerals, to meet the body's increased needs.

Food has a large social, as well as nutritional role to play in people's lives. It is important that your diet provides all the nutrients that the body needs to combat the effects of MS as it has been proven that the correct diet can lower the relapse rate and slow deterioration.  The correct diet also provides general well-being - a very important factor when health is impaired.

There is much scientific evidence indicating that an appropriate nutritional balance and diet have a positive role in MS. Studies looking at the area of the world where MS occurs have shown that its incidence is closely correlated to the consumption of saturated fats. These are present in full fat dairy products, meat and confectionery.

The brain and nervous system are composed of approximately 60% fat, a large proportion of which is derived from the essential fatty acids. Investigations have shown that the levels of essential fatty acids in the blood have tended to be low in some people with long-standing MS.

One of the essential fatty acids is linoleic acid which is found in polyunsaturated oils such as sunflower and safflower. It has been demonstrated that patients given unsaturated fats can experience a reduced number and severity of relapses and Professor R.L. Swank in the USA has been advising MS people to adhere to the low-fat diet for over 30 years. His findings of reduced relapses and slowing of the disease progression compare favourably with the natural history of patients on a normal diet.

In the diet recommended by the Therapy Centres, the consumption of essential fatty acids is increased and that of saturated fats decreased. This nutritional programme also includes increased consumption of vitamins, minerals, trace elements and fibre which are important for general health.

A  three-year study on this diet indicated reduced frequency and duration of relapses plus no significant deterioration in patient's condition.

These tried and tested recipes are a great start to healthy eating.
They have been produced by dietitians for Multiple Sclerosis National Therapy Centres. Use together with the booklet "Healthy Eating for Multiple Sclerosis", available from MS Therapy Centres or from MS National Office.

The following tips will help you adjust your usual recipes to make them healthier too.
• Grill, bake, steam, boil or microwave in preference to frying.
• Measure out polyunsaturated oils.
• Use less oil than the recipe states, or "dry fry" in a lightly greased, non-stick pan.
• "Dry roast" potatoes and vegetables in a hot oven,
  scratching the surface and adding a sprinkle of salt.
• Choose lean meats, trim off fat before cooking.
• Roast meats on a grill, so the fat drips away.
• Use vegetable water for gravy instead of the fatty juices from meat.
• Remove the skin from the chicken.
• Let soups, stews and casseroles cool so the fat can be skimmed off.
• Add pulses (dried peas, beans, lentils, etc) to soups, stews, etc. and use less meat.
• Thicken sauces with cornflour, instead of using fat and flour.
• Use skimmed milk instead of full cream milk in cooking.
• Instead of cream, try low fat yoghurt or fromage frais.
• Swap butter for polyunsaturated spread.
• Use smaller amounts of cheese. Choose one with a strong flavour or buy sunflower oil cheese.
• Serve the main meal with plenty of starchy foods (pasta, rice, bread, potatoes) and large portions of
   vegetables or salad. Reduce the meat portion.
• Try more fish recipes, especially oily fish.
• Swap white flour for wholemeal, or a mixture of both.

It is recommended that you see a dietitian for individual advice, particularly if you are under or overweight, or have any additional diet related problems.

Various diets have been recommended over the years, but the MS healthy eating plan has proved most beneficial for the majority of people.

The aim is to eat less fat, particularly saturated fat (generally hard animal fat).  However, you still need adequate amounts of polyunsaturated fat (soft vegetable based fats and fish oils). Polyunsaturated fats are made up of smaller units known as essential fatty acids (EFA's). Our bodies are unable to manufacture them. They have many important functions; for example they are vital to the immune system, brain and nervous system.

There are two main groups of EFA's known as the "Omega 3" and "Omega 6" groups.

Oily fish are rich sources of the Omega 3 group. Some pure vegetable oils, such as Sunflower and Safflower oils, are rich sources of the Omega 6 group (including linoleic acid). The body uses linoleic acid to make another Omega 6 - arachidonic acid.  Liver is an excellent source of arachidonic acid.

This way of eating is low in fat and should include foods rich in fibre, vitamins and minerals.  Following the healthy eating plan will benefit the whole family (children under 5 years will need more fat and less fibre).  Similarly dietary recommendations are made for reducing the incidence of heart disease, certain cancers and for the treatment of diabetes.

Healthy eating is based on research

1. The incidence of MS varies from country to country. It seems to be lower where polyunsaturated fats are eaten in preference to saturated.
2. Scientific research has shown that those who followed the healthy eating plan carefully had fewer, less severe relapses. General health either improved or stayed the same.
3. People with MS tend to have an altered pattern of fats in the blood. This can be corrected, as long as the healthy eating plan is followed.

Dietitians give expert advice to tailor your diet to your life style.  They provide information on suitable foods, recipes and meals, and what to look for on food labels.  If you want to lose or gain weight, or are unable to follow certain parts of the healthy eating plan, it is a good idea to consult a dietitian.

You may need information on supplements or possible food allergy or intolerance. Long term motivation can be a problem, so regular reviews are available. Reviews also provide an opportunity to tell you about any new changes recommended or different foods available.  Computer dietary analysis, providing a printout of your average nutrient intake compared to dietary reference values, can also be helpful. This is available at some therapy centres.

Choose
Fats and Oils

Polyunsaturated margarines, fats and oils, for example Sunflower or Soya spread and Sunflower, Corn, Safflower and Soya oils in moderation. Try not to use the oil for frying more than 3 times. French dressing with suitable oil and polyunsaturated salad dressing. Monosaturates occasionally, such as Olive Oil or monounsaturated spreads.

Fish
Oily fish such as mackerel, herrings, kippers, sardines, whitebait, trout, salmon, at least three times a week.
White fish, Tuna and shellfish

Meat and meat alternatives
Lean red meat, poultry, game and offal.  Try to include ¼lb of liver per week. If you really dislike liver, have 2 to 3 servings of lean meat.
Quorn, soya and tofu. Pulses - peas, beans, lentils, baked beans, soup made with pulses.

Fruit and Vegetables
Aim for 5 portions a day (1lb / 500g). Fresh fruit, vegetables (fresh or frozen) - particularly salad/raw vegetables and green leafy vegetables.
Potatoes - jacket, boiled or mashed and, occasionally, roasted or home made chips cooked in suitable oil (use oil a maximum of three times). Oven chips in Sunflower oil, up to once a week.

Dairy Products
Low-fat dairy foods. Skimmed milk preferably, or semi-skimmed.  Low fat yoghurt / fromage frais, cottage cheese.  Cheese made with polyunsaturated fat (such as "Flora") in moderation. Eggs (up to 3 or 4 a week). 'Healthy Eating' Ice Creams and Sorbets.
Hard cheese (preferably half fat) no more than ¼lb/100g a week.

Avoid
Fats and Oils
Frequent fried foods, blended cooking oils, butter, lard, hydrogenated vegetable oil, suet, dripping, low fat spreads, mayonnaise or salad dressings made with saturated fats (check the label).

Fish
Fried fish, (shallow fried in suitable oil may be eaten occasionally). Fish in batter, cream sauce or butter.
Fish tinned in unspecified oil.

Meat
Fatty meat, processed meat such as sausages, burgers, corned beef, luncheon meat, meat pies or pasties and poultry skin (remove poultry skin or meat fat before cooking).

Fruit and Vegetables
Chips. Fried vegetables. (A stir fry with suitable oil is OK).

Dairy Products
'Gold Top' milk, full cream ('silver top'). Greek yoghurt, thick and creamy yoghurt, whole milk bio yoghurts.  Excess hard cheese, including vegetarian.
'Ordinary' ice cream, cream.

Choose
Grains
Bread, preferably wholemeal. Breakfast cereals, preferably wholegrain, such as Weetabix, Branflakes, Porridge and Muesli, Pasta and Rice. Wholemeal and wholegrain products contain more fibre, vitamins and minerals.  Home-made cakes, biscuits and pastries made with polyunsaturated fat and (ideally) half wholemeal flour. Bread sticks, water biscuits, crispbreads, tea cakes, crumpets.  Shop bought plain biscuits and muesli bars, in moderation.

Pulses
Peas, beans, lentils and baked beans.  Soups made with pulses.

Nuts and seeds
Sunflower, pumpkin, sesame seeds, hazelnuts, chestnuts, almonds and walnuts.

Sugar
Sugary foods should be used in moderation unless extra calories are needed for weight gain. (It does not provide any other nutrients, so should not replace other foods).

Drinks
Decaffeinated tea and coffee, herbal tea, soft drinks, water and 'low fat' bedtime drinks. Make sure that you drink at least 6 to 8 mugs (9 to 12 cups) of fluid a day.

Alcohol
Aim to have no more than 1 to 2 units daily, with 2 or 3 alcohol free days a week. A unit is equivalent to ½ pint of beer or a glass of wine.

Extras
Soup (not 'cream of'). Low fat crisps, or those cooked in sunflower oil, once or twice a week. Sugary sweets which are low fat eg boiled sweets, pastilles, peppermints, jelly sweets.

Avoid
Grains
Muesli with coconut, added vegetable fat, croissants. Bought cakes and biscuits, slimming biscuits or bars.

Nuts and Seeds
Brazils, coconut, cashews, peanuts, peanut butter.

Drinks
Excess tea, coffee or cocoa (that is more than 4 cups containing caffeine in a day). Full fat bedtime drinks such as drinking chocolate.

Extras
"Cream of" soups.  Crisps and similar savoury snacks.  Keep chocolate, including carob chocolate, to an absolute minimum. High fat sweets eg toffee, fudge.

Supplements
This way of healthy eating should contain all the vitamins, minerals and EFA's you need, if followed closely.  Supplements can be expensive.  High doses can sometimes prove dangerous.

Evening Primrose Oil may be taken if desired, but is generally unnecessary because the EFA content is small. Adequate linoleic acid is provided by the polyunsaturated oils in your diet.

Cod Liver Oil is a valuable source of EFA's but has a high Vitamin A content. It should be avoided if you are eating the recommended ¼ lb of liver a week or taking other supplements which contain vitamin A. Fish oil supplements not containing vitamin A, such as Maxepa, Pulse or Omega 3 fish oils, may be taken if you cannot eat oily fish.

Golden Linseeds are rich in EFA's and high in fibre and can be a useful addition to the diet, particularly if you suffer with constipation.

Vitamin Supplements and single nutrient supplements are best avoided unless you have a deficiency or are advised by your GP or dietitian. Multivitamins may be considered if you are unable to eat a well balanced / varied diet. If you wish to take a multivitamin, choose one which provides the recommended daily amount (RDA) for a wide range of nutrients. Do not take multivitamins containing vitamin A if you are eating liver regularly. Your Dietitian will advise as to which supplements are suitable for you.

Remember no amount of supplements can undo the harm done by an unhealthy diet!

How to get started
Useful Ideas
It may take some time to change how you eat, particularly if quite a few alterations are needed.
1. Keep a food diary, recording all food and drink taken in a typical week, it can help you decide what changes are necessary.
2. Make a plan of action with targets to aim for and a time scale eg:
     Week 1 change to polyunsaturated margarine and skimmed milk.
     Week 2 start to increase fish meals
     Week 3   start to include one liver meal.
3. Plan menus and shopping lists so you will have appropriate ingredients and meal ideas at your fingertips.
4. Get family and friends on your side. Explain that by offering encouragement, they are doing something positive to help control your MS.
5. Your dietitian can give you advice on foods to choose when eating out, suitable convenience meals and takeaways etc.

Ideas for meals

Breakfasts
Muesli, bran based, oat or whole wheat cereal with skimmed milk, fresh fruit and a few linseeds.
Wholemeal toast with Sunflower spread and jam, marmite or tomato. Baked Beans on toast. Kippers and wholemeal bread with Sunflower spread.

Snacks
Fresh fruit, muesli bar, mixed fruit and suitable nuts, wholemeal tea cakes, home-made fruit cake. Fruit scones.

Quick Meals
Wholemeal sandwich. Sunflower spread and suitable filling such as fish, lean meat, cottage cheese. Mackerel salad. Jacket potato with filling. Quick pasta. Tuna bake. Lentil or thick vegetable soup with wholemeal roll. Sardines or Pilchards on toast.

Main Meals
Lean meat (liver once a week). Fish pie. Lean meat casserole with extra beans or lentils. Turkey savoury rice. Healthy eating convenience meals. Jacket potato, pasta or brown rice as accompaniments AND PLENTY OF VEGETABLES WITH EVERY MEAL.

Desserts
Fresh fruit salad. Tinned fruit in natural juice. Wholemeal fruit crumble with skimmed milk custard. Sorbet and fruit. Meringue nest filled with fruit. Low fat rice pudding. Low fat yoghurt with fresh fruit

Top Ten Jacket Potato Fillings
1. Tinned or smoked mackerel, mixed with a little natural  yoghurt or low fat fromage frais.
2. Low fat soft cheese or cottage cheese with diced peppers and pineapple.
3. Crunchy low calorie coleslaw.
4. Diced roast chicken or chopped chicken roll with sweetcorn and a little natural yoghurt.
5. Baked Beans.
6. Chopped hard boiled egg and tomato.
7. Tuna and sweetcorn or peppers mixed with a little natural yoghurt.
8. Curry sauce with chopped chicken, sultanas and chopped banana.
9. Sardines in tomato sauce.
10. Ratatouille (chopped vegetables in tomato sauce).

If you are underweight, or have a poor appetite it is important that you do not over restrict your intake of fat, or avoid sugar. A booklet is available from MS National Therapy Centres.

A healthy eating recipe booklet has been prepared by MS National's dietitians. Ask at your local centre, or write to MS National Therapy Centre, Bradbury House, 155 Barkers Lane, Bedford MK41