Other dietary concerns
Vitamin D and calciumPeople with MS have been shown to be at a higher risk of osteoporosis, a condition of the bones which mean they are more prone to fractures than normal, or of osteopenia, a reduction in bone density or mass.[7,8] Factors that increase the risk include difficulties in mobility and weight bearing, long-term exposure to corticosteroids – often used to treat MS relapse – and, in women, when post-menopausal, as the hormone oestrogen is known to protect against osteoporosis.
Osteoporosis tends to be under-recognised and under-diagnosed, so it is important to ensure that regular screening is requested from your GP if you have any of the risk factors listed above. Blood calcium levels do not show whether you are likely to have osteoporosis. Bone density needs to be measured by, for example, DEXA scan. However, provision of these scans varies considerably across the UK and waiting times can be very long.
Osteoporosis is also associated with an inadequate intake of vitamin D and calcium. Vitamin D is manufactured by the skin when it is exposed to sunlight. However, heat sensitivity and living in the UK may mean that many people with MS do not get enough exposure to sunlight to gain their vitamin D in this way. Calcium is vital to build and maintain healthy bones.
Vitamin D is also found in oily fish such as salmon and mackerel, and in dairy products. Calcium is mainly found in dairy products, with some in green leafy vegetables such as broccoli and cabbage. If dairy products are avoided, calcium fortified soya products can increase the amount of protein and calcium in the diet, as well as adding variety. Additionally, a range of vitamins and minerals are present in many vitamin fortified breakfast cereals.
Vitamin B12
Vitamin B12 deficiency can mimic the symptoms of MS. Vitamin B12 is needed to maintain myelin, and there has been discussion about its relationship to MS for many years.
There have been some studies showing that some people with MS are also deficient in vitamin B12. One study showed that vitamin B12 levels in the blood were normal, but were lower than usual in the cerebrospinal fluid of people with MS, suggesting that they might not be able to metabolise vitamin B12 in the same way as other people. Another placebo-controlled trial of vitamin B12 in combination with other substances found small and statistically insignificant benefits from vitamin B12 therapy. [9,10]
Other vitamins and minerals
Various research studies have examined possible relationships between other vitamins and minerals and MS. It is beyond the scope of this factsheet to consider all this research, but the MS Trust Information Service is happy to investigate the published literature in response to enquiries about specific vitamins and minerals.Fluids: Adequate fluid intake is essential to prevent dehydration. Too little fluid can increase the risk of urine infections, tiredness, headaches, constipation, and thus worsen existing MS symptoms. Recommended guidelines are one and a half litres or eight glasses of fluid a day. Caffeinated drinks such as tea, coffee, cola and caffeine fortified soft drinks are best consumed in moderation, eg no more than four mugs of coffee a day, as caffeine can irritate the bladder. The same is true of alcoholic drinks.
Specific diets for MS
Many diets are promoted in terms of managing or even improving MS. The majority of these diets are exclusion diets. Exclusion diets suggest that you stop eating one or several groups of foods, or that some foods are not combined with other foods. Those who recommend some exclusion diets state that food allergies are common in MS; there has not been any research that upholds this theory. If a food allergy is suspected, your GP should be able to refer you to an NHS allergy clinic, although waiting times for these can be long.Two of the most widely-known diets are:
- Swank diet: In 1948, Dr Roy Swank began treating people with MS on a very low fat diet, because of the apparent association between dietary fat and MS. Results were reported in 1970 and again in 1990. 144 people were followed for up to 34 years, with good results reported in the long-term level of disability. Those people who adhered strictly to the diet and were experiencing mild symptoms when they started had slower disability progression than those who had not adhered strictly to the diet. However, there are problems with this trial. It did not conform to modern expectations, in that there was no comparison group and there was no ‘dummy’ treatment. It is possible that people who did not continue with the diet perceived no benefit from it because they were deteriorating, so we cannot know whether the good results represent a genuine improvement over other groups of people with MS or were a lucky chance.
- Best Bet Diet: The Best Bet Diet is a strict exclusion diet developed by Ashton Embry PhD. It is based on the hypothesis that MS is caused by intact food proteins escaping from a leaky gut, which causes the immune system to malfunction. There have not been any clinical trials of this diet, and results have not been published in any peer-reviewed journal. Anecdotal reports from people with MS suggest that the Best Bet Diet works for some people but does not work for others. There are concerns about how easy it is to achieve a balance of all the food groups whilst following this diet. The diet recommends consuming large quantities of supplements, which can be expensive and which is not necessary with a normal balanced diet.
Supplements
Dietitians consider that a balanced diet should contain the full range of normal vitamins and minerals for healthy living. Supplements in themselves cannot replace a balanced diet. When taking large doses of supplements it is also possible to overdose on some vitamins, which may be harmful. If you are concerned about a specific deficiency, consult your GP or ask for a referral to a Registered Dietitian.(published with permission in writing from:http://www.mstrust.org.uk)
