When I first met Stephanie in March, she was like any healthy 28-year-old coming in to see me for a nutrition consult. Her positive attitude and bright smile filled the room as she told me about her job as a grade school teacher and the new apartment she just moved into with her boyfriend of seven years.
“We are a great team,” she said. “Little did he know that his law school wouldn’t be the biggest challenge we’d face as a couple.”
Stephanie was diagnosed about a year ago with multiple sclerosis (MS), and behind her beautiful eyes and strong spirit, I could sense her pain at the discovery of the most recent spinal cord lesions after she complained to her doctors of new nerve pain in her feet. She will be starting steroid infusions in a few weeks, and together we hope to design a nutrition and lifestyle plan that will support her health and healing, and preserve her quality of life.
Nerve pain is hard to grasp and relentless in its unpredictability. The nerve damage associated with MS has been linked to causative factors including dysbiosis of the gut microbe, autoimmune responses, and increased inflammation, all leading to an attack on the nervous system by the body’s own immune cells.
In “The Gut Microbiome in Multiple Sclerosis,” an opinion piece published in Current Treatment Options in Neurology in April 2015, two Dartmouth researchers state: “The gut microbiome has been shown to have profound effects on the development and maintenance of immune system in both animal models and in humans. A growing body of evidence has implicated the human gut microbiome in a range of disorders, including obesity, inflammatory bowel diseases, and cardiovascular disease. Animal studies present compelling evidence that the gut microbiome plays a significant role in the progression of demyelinating disease, and that modulation of the microbiome can lead to either exacerbation or amelioration of symptoms.
“Differences in diet, vitamin D insufficiency, smoking, and alcohol use have all been implicated as risk factors in MS, and all have the ability to affect the composition of the gut microbiota.”
A holistic relationship links the nervous system with the brain and the gut microbiome. The microbiome is a delicate ecosystem of microbes that live in and on the human body, and each person has a unique one. Understanding its subtlety is key in adopting and adapting techniques for health and healing.
This philosophy has strong roots in the Eastern wellness and longevity sciences of Ayurveda (the traditional Hindu system of medicine) and Chinese medicine. Within these systems, nutrition takes on a different meaning when discussing how digestion and assimilation refer to nutrients. They imply and reinforce the importance of discerning what environmental influences we allow into our bodies through the senses, and the capacity with which they program the cells. It is important to recognize and respect the connectivity and influence nature has on the mind, body, and spirit.
The food we put into the body is a powerful antecedent for physical and emotional well-being, and diets high in sugar, alcohol, and gluten are triggers that disturb the delicate balance of the microbiome, compromising immunity, cognitive functioning, and cellular integrity.
Among studies into the relationship between diet and MS is the “Australian Multi-centre Study of Environment and Immune Function,” or the Ausimmune Study. This multicenter case-control study investigates the role of environmental factors in the development of first demyelinating events — a precursor to MS. Questionnaires detailing the quality and quantity of foods were analyzed, and the findings concluded people eat in two main patterns. The first is a “Mediterranean Style diet,” which is healthy and high in fish, eggs, chicken, turkey, legumes, and vegetables. The second is a “Standard American Diet (SAD),” high in full-fat dairy foods and red meat. These findings were supported by the North American Research Committee on MS (NARCOMS)
, where a survey suggests healthier diet and lifestyle choices lessen the burden and severity of MS symptoms and potential progression, lending support to the impact food has on our overall functioning.
Exploring specific macronutrient and micronutrient breakdown further, fats and antioxidants, specifically, are essential nutrients to consider. Fats protect and are the building blocks of myelin sheaths, and antioxidants help diffuse oxidative damage, the unstable chemical metabolites of oxygen metabolism caused by poor diet and environmental factors.
Prebiotics (fiber) and probiotics (live bacteria and certain yeasts) support gut integrity — the balance of good and bad bacteria in the intestines that is necessary for microbial harmony. Certain microbes like Candida (a yeast species linked to fungal infections), which are harmless in normal amounts, have been shown to trigger an inflammatory immune response that may contribute to the breakdown of the myelin sheath during periods of Candida fungal overgrowth in the body. Anti-microbial nutrition interventions, such as garlic, aloe vera, fermented foods like kombucha, coconut oil, and curcumin (turmeric), have been shown to keep overgrowth at bay.
So, how can we utilize food and lifestyle as medicine when it comes to managing MS?
Working with Stephanie, I designed a basic outline of important nutrients and guidelines, and the space for her to get creative with her choices:
- Consume unprocessed foods as often as possible.
- Include medium-chain fatty acids in cooking or in smoothies for the brain and nervous system as they support energy, metabolism, and cognitive health. Examples are coconut oil and palm oil.
- Eat the rainbow. Fruits and vegetables that range in color contain phytonutrients, such as organic sulfur compounds, polyphenols, and carotenoids. Together these foods help rid the body of toxic chemicals and infuse essential nutrition to reduce inflammation and preserve cell integrity. The best sources of organic sulfur compounds are cruciferous vegetables like Brussels sprouts, bok choy, broccoli, dark leafy greens, kohlrabi, horseradish, cabbage, kale, radishes, mustard greens, cauliflower, and watercress.
- Polyphenols are naturally occurring chemicals found in plant foods that function as powerful antioxidants. Examples are flavonoids, phenolic acid, stilbenes, and lignans, and are found in tea, legumes, berries, dark chocolate, soy, and red wine. Note to reader: Food-based sources are less risky than supplements, but consideration should always be given to medications being used. Iron status should be looked into as well, as absorption may be compromised when including these micronutrients into the diet.
- Red and orange foods contain carotenoids and the powerful, but often under-appreciated, nutrient lycopene. Lycopene is found in cell membranes and is an important line of defense when the cell is under assault from exogenous or endogenous toxins. The best sources are found in tomatoes, red carrots, watermelon, sweet potatoes, grapefruit, and winter squash. It is best to eat these foods cooked, and with a fat like olive oil, because the bioavailability of lycopene is increased through cooking and the nutrient is fat-soluble, meaning it requires fat to be absorbed.
- Omega-3 fatty acids come from DHA/EPA marine sources, such as wild salmon, tuna, mackerel, herring, marine algae, and fish oil supplements. Plant-based ALA sources such as chia, hemp, and krill oil are essential but have a low conversion rate to EPA and DHA. About 650 mg/day fulfills the nutritional requirement.
- Probiotics and prebiotics. Probiotics are “good” bacteria strands found in fermented foods such as kefir, yogurt, kombucha, miso, and kimchi. Prebiotics are fiber-rich raw foods, such as dandelion greens, raw garlic, leeks, legumes, banana, asparagus, jicama, artichokes, and sunchokes. These prebiotic foods serve as an energy source for probiotics and are required to ensure they are able to exert their influence.
- High-fiber foods from ancient and whole grains include millet, teff, sorghum, buckwheat, and amaranth. They are packed with protein, vitamins, and minerals that impact immunity and enzyme function, and help control blood sugar levels. These grains can be used for breads, crusts, granola, and even added to smoothies for texture.
- Think choline. Sources found in egg yolks, sunflower seeds, and soybeans are essential precursors to acetylcholine, a neurotransmitter found throughout the nervous system and required for brain and muscle function.
- Vitamin D and magnesium. 1,000 IU daily of vitamin D is essential for immunity, and magnesium from leafy greens, fatty fish, nuts, seeds, legumes, and bananas enhances its absorption.
A study published in the Iranian Journal of Neurology in 2014 indicated that women who take 400 IU daily of vitamin D, the dose typically found in daily multivitamin supplements, are 40 percent less likely to develop MS compared with those who are not. Research has also shown immune disorders are more common in areas with fewer hours of sunlight. For example, MS is more common in Canada and the northern U.S. than in its southern states.
It is important to remember to look at the human as a whole being; it is hard to deconstruct and treat symptoms only. The holistic philosophy places equal emphasis on creating and cultivating a foundation of health utilizing mental, physical, spiritual, and emotional therapeutic supports. We are what we eat, but also what we breathe, see, touch, hear, smell, and spend our energy doing. Investing in self-care methods, such as meditation, acupuncture, cupping, breathwork, psychotherapy, massage, and other stress-reduction approaches are essential nutrition for healing and remain priceless allies on the journey.
Alana Kessler, MS, RD, CDN, E-RYT, is a registered dietitian, nutritionist, weight management expert, and an accredited member of the CDR (Commission on Dietetic Registration) and the American Dietetic Association. She is also a yoga and meditation teacher, Ayurveda specialist, and the founder of the New York City-based fully integrated mind, body, and spirit urban sanctuary, BE WELL. Alana’s BE WELL ARC System and Method Mapping technique is a holistic multi-disciplinary approach to health and wellness that blends Eastern and clinical Western diet and lifestyle support to effect long-lasting behavior change.
A graduate of NYU with a BA and MS in clinical nutrition, Alana is dedicated to helping others learn how to nourish themselves, create balance, and understand their true nature through nutrition, yoga, and inner wellness. She leads Yin Yoga workshops and trainings as well as wellness retreats at international locations. Her health, fitness, and lifestyle expertise has been featured in Aaptiv.com, Droz.com, EatThis.com, RD.com, Redbook, WomensHealthmag.com, and Vogue. For more information, visit her website at bewellbyak.com.