Diet & MS Guiding Patient Choices Denise Nowack, RD National Multiple Sclerosis Society Southern California & Nevada Chapter Los Angeles, California denise.nowack@nmss.org As a result of this session participants will learn: What patients want to know Role of nutrition in MS a holistic approach How practitioners can influence healthy nutrition behaviors 1
What patients want to know Is eating good for my MS? Gut Bacteria Antioxidants Focus on: Type of food/food component or supplement Positively impacting disease/treatment Omega 3 Green Tea Extract Salt What patients want to know Is there a diet for MS? Fruits Vegetables Grains Proteins Dairy Oils Swank Diet Yes Yes (Limit avocado, olives) Plant based (e.g.mcdougall) High protein Paleo Antiinflammatory Gluten Free Yes Starch based + other brightly colored vegetables Fresh fruit; Avoid high sugar juices fruits) Fruits with lower glycemic load Fresh vegetables No starchy vegetables vegetables) Brightly colored preferred; Antioxidant rich herbs and spices No crackers, baked goods with fat Whole grains, unrefined flour, egg free pasta No grains ot cereals Whole & cracked grains, pasta, No barley, wheat, rye Popular Diets Promoted for MS Limit portion size of poultry, fish, lean means Beans, peas, legumes (No animal protein sources) Grass produced meats, fish/ seafood, eggs, nuts, seeds (No legumes) Fish/Seafood Whole soy foods (Limit animal protein: Eggs, poultry, lean meat) Non fat dairy No No Natural cheese/ yogurt (Limited to 1 2x s/week) No solid fats; (Limit daily intake of fats) No added fats; no nuts/seeds Olive, walnut, flaxseed, coconut oils) Healthy fats; nuts, seeds 2
Role of Nutrition: An Expanded View Health Related Quality of Life Symptom Management Course of MS Role of Nutrition in Comprehensive MS Management Osteoporosis Ensure adequate levels of vitamin D Calcium intake 1,200 mg /day Supplement as needed Dairy products Fish with bones Fortified foods Beans Vitamin K rich kale, Swiss chard, spinach & broccoli may also help in bone building Caffeine Bladder Dysfunction Ensure adequate intake of fluids (8 glasses/day) Build fluid intake into everyday activities Avoid drinking late in evening Water Non sugary fluids 20% of daily fluids comes from foods High water content fruits & vegetables Caffeine, aspartame, alcohol and citrus Bowel Dysfunction Ensure adequate fluid & fiber intake Aim for 20 35 g/day Experiment with whole grains Include beans, peas, lentils Make snacks count fruit, raw veggies, nuts Eat the skin on fruit Increasing fiber in diet too quickly Bennett, S et al., Comorbidities breakout group discussion. Report of a CMSC Consensus Conference, 2012 Sept 15. Int J MS Care, 2014; 16: 19 24. 3
Nutritional Status in MS Patients Depression Increased intake of high fat foods, sweets Increased appetite due to antidepressants Eating out of boredom or food for solace Loss of appetite Fatigue Lack of motivation to eat Too tired to cook Tendency to skip meals Decreased activity/calorie expenditure Mobility & Activity Limitation Difficulty shopping & preparing meals Difficulty eating Swallowing Difficulties May need feeding modifications to prevent weight loss and nutrient deficiencies Malnutrition Influencing Healthy Nutrition Behaviors Subjective & objective understanding of patient health/nutrition status & beliefs Understanding Fostering Self Efficacy Confidence & motivation to change Skill building Developing habits Intervention strategies Practice plan Self Management 4
Guiding Patient Choices Patients have a great interest in dietary approaches for MS even where there may not be definitive evidence. Diet recommendations may not look the same for everyone and may change throughout the lifespan. Determine the nutritional needs of an individual considering symptoms and nutritional status. Promoting self management skills and focusing on self efficacy can help foster healthy nutritional behaviors. 5