Unlock the Power of an Anti-Inflammatory Diet to Transform Multiple Sclerosis Management

Multiple sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system (CNS), characterized by inflammation and neurodegeneration. While there is no cure for MS, medications and lifestyle changes, including diet, can help manage symptoms. A growing number of studies have explored the link between diet and MS, investigating whether dietary changes can improve symptoms like fatigue and potentially slow disease progression. The anti-inflammatory diet is a balanced, sensible way of eating that influences inflammation and provides the body with adequate energy, vitamins, minerals, healthy fats, and fiber.

The Role of Diet in Managing MS

When you have multiple sclerosis (MS), it’s important to follow a healthy diet because your diet plays a significant role in your cardiovascular and overall health, both of which can have an impact on your MS symptoms and your daily functioning. Scientists are looking into the connection between diet and MS, and how different foods may affect inflammatory processes in the body.

Laura Piccio, MD, PhD, a professor of neurology at the University of Sydney in Australia, notes that while there are suggestions that diet may be important, there isn’t any robust clinical evidence that allows us to suggest one specific diet over another for patients with MS. However, she recommends following a diet that’s rich in vegetables, fruits, whole grains, and legumes and low in sugar, salt, saturated fat, and processed foods. Such a diet will affect the cardiovascular system, indirectly benefiting MS.

How Diet May Impact Inflammation in MS

Inflammation definitely plays a role in MS, probably both in the development of the disease and in the subsequent clinical course. When inflammation occurs without purpose or is persistent, it can cause damage and illness. Many factors contribute to chronic inflammation including stress, exposure to toxins such as cigarette smoke and dietary choices.

General Dietary Recommendations for MS

UNC Health neurologist Irena Dujmovic Basuroski, MD, recommends the Mediterranean diet for MS patients because it’s largely plant-based and limits saturated fats and sugar while emphasizing anti-inflammatory foods such as fruits, leafy green vegetables and olive oil. She also suggests considering financial and cultural issues, recommending small but consistent changes over time.

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Margaret Mangan, a UNC Health registered dietitian, says that your best choices are fresh vegetables and fruits, whole grains, nuts and lean meats. People should enjoy the foods they eat, and healthy foods can become comfort foods, depending on how you cook and season them. “You want to fill your body with goodness,” Mangan says.

Key Components of an Anti-Inflammatory Diet

Fruits and Vegetables: Choose a wide variety of colors, opting for fresh, in-season, or frozen options.
Healthy Fats: Use olive oil or canola oil for cooking and snack on nuts, avocados, and seeds.
Lean Proteins: Choose lean meats to get protein from meat, and also eat plenty of fish, beans or pulses to make sure you’re getting enough protein in your diet.
Whole Grains: If you’re going to eat bread, go with a whole-grain option.
Tea: Drink about 2 cups of white, green, or oolong teas daily, as they contain catechins, compounds that reduce inflammation.

Foods to Limit or Avoid

Saturated Fats: Some cuts of meat are very high in saturated fat.
Processed Foods: Limit your intake of processed foods, which are often high in sugar, salt, and unhealthy fats.
Red Meat: Red meat leads to the formation of nitrous compounds increasing chronic inflammation. Red meat also contains arachidonic acid, which participates in inflammatory pathways by activating Th17 cells.
Sugar-Sweetened Beverages and Refined Cereals: A high consumption of these leads to the production of insulin, which is responsible for the upregulation of synthesis and the production of arachidonic acid.
High Salt Intake: High salt intake can induce the production of Th17 cells and proinflammatory cytokines.

Specific Diets and MS

Several specific diets have been proposed for managing MS, although scientific evidence supporting their effectiveness varies.

Paleo Diet

Paleo diets are based on foods that are thought to have been common in the Paleolithic era, before humans started farming. So they include meats, fish, nuts, vegetables and fruit. The idea is that our bodies are best adapted to eating these kinds of foods. Following a Paleo diet wouldn’t generally be considered bad for you, although you’d have to make sure you were getting all the nutrients you need. Cutting out cereals and dairy could mean you miss out on some B vitamins, vitamin D and calcium. And if you have high energy needs or you’re underweight, excluded foods might make it harder to get the energy you need.

A recently published study found that a paleo diet may be useful in the treatment of MS, reducing perceived fatigue, improving mental and physical quality of life, increasing exercise capacity, and improving arm and leg function. However, some researchers have suggested this work as having a high risk of bias.

Wahls Diet

The Wahls diet is based on a Paleo diet, and it’s part of what’s called the Wahls Protocol. This combines the diet with vitamins, meditation, and exercise. There are also newer versions of the Wahls diet, including a ketogenic (keto) diet. One small but well-designed research study suggests a Wahls diet might help with fatigue.

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Ketogenic Diet

Keto diets (also called ketogenic diets) are low in carbohydrates. The idea is to get more of your calories from fats and protein instead. Early studies have suggested intermittent fasting and keto diets might have a positive effect on the immune system and the bacteria in the gut which affect it. Keto diets don’t provide all the vitamins and minerals we need, without supplements. Serious problems are rare, but the way the body gets energy from keto diets could lead to problems with the pancreas and liver. If you cut down on carbohydrates, your diet will be lower in fibre too. We need fibre for a healthy gut and to avoid constipation.

A pilot study reported by Brenton et al. suggests that a modified ketogenic diet may benefit patients with MS. Despite a small study sample, it has been shown to alleviate fatigue and depressive symptoms, reduce body fat and pro-inflammatory adipokines.

Swank Diet

The Swank diet is named after Dr Roy Swank, who developed the diet in the 1940s. It limits the amount of fat you can eat: no more than 15g of saturated fat a day, and between 20-50g of unsaturated fat. It limits your intake of red meat and oily fish, although you can eat as much white fish as you like. One small but well-designed research study in 2021 suggests the Swank diet might help with fatigue. Following the Swank diet or a similar diet would not generally be considered bad for you. Not eating too much saturated fat is widely accepted as good health advice. Cod liver oil has a blood-thinning effect, so it should be taken with caution if you take aspirin or anticoagulant medications such as warfarin, or if you have a bleeding disorder. Cod liver oil also contains high levels of vitamin A, so you shouldn’t take it if you also take supplements containing vitamin A, or if you eat liver regularly. This diet can be low in energy, so you might lose weight.

Overcoming MS (OMS) Diet

The Overcoming MS (OMS) diet was developed by Dr George Jelinek in 1999 following his own diagnosis with MS. The OMS diet recommendations are similar to the Swank diet. It advises cutting out dairy and meat, and eating less fat - particularly saturated fat. Following the OMS diet isn’t likely to be considered bad for you as long as you’re sure to include the missing nutrients.

Mediterranean Diet

A Mediterranean diet is based on foods traditionally eaten in that part of the world. It usually includes a lot of vegetables, fruits, nuts, beans, cereals, grains, fish, and unsaturated fats like olive oil. Regular - but moderate - amounts of red wine are also sometimes recommended. There hasn’t been much research into MS and Mediterranean diets in particular, and the small amount of evidence we have doesn’t prove that they affect the course of MS.

Best Bet Diet

The Best Bet diet was developed by Ashton Embry, a geologist whose son has MS. This diet recommends avoiding several different food types, including all dairy, grains and legumes (beans and pulses). It also recommends taking lots of supplements, including calcium and vitamin D. The diet is based on the assumption that partly digested food protein can pass through from the intestines into the bloodstream. Current research doesn’t support cutting out any of these food types completely. The Best Bet diet restricts a lot of foods and can be low in energy, so it might not be suitable for you if you have high energy needs or if you’re already underweight.

McDougall Diet

The McDougall diet is a low-fat vegan diet. It was inspired by the Swank diet, but it cuts out meat, fish and dairy completely. You might need to take supplements. You could lose weight with this diet, and it might lower cholesterol and blood pressure.

The Gut-Brain Axis and MS

The gut-brain axis represents a bidirectional communication system between the CNS and the gastrointestinal system that includes the CNS, the enteric nervous system, the autonomic nervous system, the immune system, and the gut microbiota. The role of gut microbiota is crucial because of its impact on regulating and maintaining the normal function of the innate immune system.

Studies on the experimental model of MS show the possible association of gut microbiota with the severity of the disease, indicating a possible protective role as well as a role in inducing pathological mechanisms in the context of immune dysregulation in CNS autoimmunity. The presence of gut commensal microbiota is necessary for the occurrence of CNS autoimmunity.

Diet comprises a main factor determining the synthesis and metabolism of gut microbiota, thus enabling the host to defend against pathogens. The role of gut microbiota is also significant for the regulation of the immune system by affecting the overall activation status of T cells and other cells of the innate and adaptive immunity.

Practical Tips for Implementing Dietary Changes

Be a Smart Shopper: Use a heart-healthy grocery list to guide shopping decisions and avoid impulse buys.
Choose Soft, Moist Foods: If you have difficulty swallowing, make smoothies with Greek yogurt, protein powder, berries, nut butters, flaxseeds, and anything else you enjoy.
Don’t Overlook Canned Products: You can add lots of things to canned soup. If you don’t like low- or no-sodium versions, buy regular canned soup and dilute it (4 cups of water to 1 regular can of soup).
Get Help with Groceries: If fees for grocery delivery aren’t in your budget, ask family members or friends to shop for you.
Make Every Bite Count: If you don’t have much appetite, or you need to put on a few pounds, nibble on nutrient dense foods with healthy fats in small amounts throughout the day.
Meal Prep Once a Week: Cut up fruits and vegetables to have throughout the week.
Shop the Frozen Foods Section: Frozen fruits and vegetables (without added salt or sugar) have similar nutrients as fresh produce.
Consult a Registered Dietitian: A dietitian can make recommendations based on your food preferences and issues like difficulty swallowing or loss of appetite

Additional Lifestyle Factors

Staying active can help prevent flares of symptoms. Do exercises at home, physical therapy, and walk regularly, at least three times a week. Look for everyday opportunities to move your body, such as walking, gardening, dancing, and bicycling.

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