Expert Voices: Diet and nutrition for people with multiple sclerosis

In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked registered dietitian Mona Bostick to answer some of your questions related to diet and nutrition for people with multiple sclerosis (MS).

Bostick, who has MS, works in private practice in Greensboro, North Carolina, where she helps people take back control from fear and confusion around eating well with MS so they can confidently add joy back to the menu. Visit her website at msbites.com.

Mona is a member of the National MS Society Nutrition Wellness Subgroup and has served as a consultant and speaker for organizations such as Can Do MS and the National MS Society. She has been featured on MS Teamworks, LiveWise MS  as well as in publications such as Everyday Health, IOMS News, and Momentum magazine.

As a person with MS, what were you most surprised to realize while studying nutrition?

Mona Bostick is a registered dietitian specializing in multiple sclerosis care. She also has MS. (Photo courtesy of Mona Bostick)

Nothing in my education surprised me. The surprise was waiting for me in the field. I have been surprised there is so much interest in the role of nutrition in multiple sclerosis, and yet registered dietitians have not been included in the interdisciplinary MS healthcare team. While there is no “MS diet,” nutrition plays a large role in preventing or managing chronic comorbid conditions that are associated with poor health outcomes in people with MS. Registered dietitians are uniquely qualified to fill this gap in patient care.

What misconceptions have you come across about diet as it relates to MS? 

I think the biggest and most impactful misconception is the notion that “diet” is an alternative treatment for multiple sclerosis. 

Nutrition, like other fields of science, involves research and the use of scientific methods to answer specific questions. Research on the role of nutrition in multiple sclerosis is inconclusive at this point. There is no credible evidence that recommends nutrition as an alternative treatment for multiple sclerosis. “Diets” just may not be therapeutic. That misunderstanding may be due to the preponderance of alternative health providers utilizing “diet” in an unconventional way. And since registered dietitians have not been a part of the clinical conversations around this topic, this misconception has become quite pervasive.

Are there any diets trending in the multiple sclerosis community that should be cautioned against?

There is no diet or nutrition intervention that has been shown to impact the MS disease course. Yet, there are many diets, regimens, and protocols that offer very vague promises to heal, beat, or reverse MS. In the context of a disease with no known cause and no known cure, that’s a head-scratcher. They are very difficult to follow and when they don’t deliver, the person trying the “diet” feels as if they failed. But, in truth, it is the “diet” that failed. It was always a false promise.

Eating well should be both physically and emotionally nourishing. If your diet requires cheat days, you might want to break up with it. 

Do you endorse any specific diet?

No. Eating well does not mean something different because of a multiple sclerosis diagnosis. Eating well may be more difficult due to the unpredictable way that MS shows up in your life with symptoms like pain, fatigue or cognitive issues. But the basics of eating well are the same. “Diets” promoted as beneficial for MS lack the support of research, tend to be difficult to follow, include expensive ingredients, and suggest the removal of numerous foods from your eating pattern. And then the promoter of the diet offers to sell you the supplements to replace the important nutrients. Skip the diets, just eat: 

• a wide variety of colorful vegetables and fruits
• a variety of lean proteins 
• beans, legumes, nuts, and seeds
• whole grains more often than not
• heart-healthy unsaturated fats
• low-fat calcium foods, which are important for bone health

Do this while limiting saturated fats, sodium, added sugars, highly refined foods, and avoiding trans fats entirely.

If MS symptoms have made eating well consistently more challenging, consider working with an occupational therapist to help you develop strategies to navigate MS symptoms in the kitchen.

Are there particular vitamins or nutrients people with MS should pay special attention to?

Vitamins and minerals are important and play numerous important roles in human function. Eating a wide variety of foods is the way to ensure our eating pattern provides adequate amounts of these nutrients. 

There are some vitamins that are tough to get entirely from food, though. Vitamin D is one of them. Vitamin D plays several important roles, including an important role in our immune system. A great many of us in the modern world are likely to be vitamin D deficient, including people with MS. Correcting this deficiency is important and supplements play a role here, but it is important to remember that everyone absorbs vitamin D differently and that the dose needed to correct a deficiency will be very individual.  Supplementation should be monitored by your physician. 

What should a patient keep an eye out for when starting a new diet?

I created a list of questions some time ago, food for thought around this very idea. 

• How are you eating now? What changes are you considering and why?
• What outcomes are you hoping for?

Things to ask yourself when considering any dietary intervention:

• Will the intervention result in the outcome you are hoping for? Is there any credible evidence to suggest it will? 
• Are there any potential unintended risks or side effects associated with the intervention? (Nutrient deficiencies? Increased food budget?)
• Is your expected outcome realistic? 

On a practical level:

• Do you like the foods?
• Does your family? Will they be joining you or will you now need to prepare separate meals?
• Do you feel deprived? Does your family?
• Are the foods and or supplements affordable?
• Are they readily accessible?
• Do the restrictions prevent you from participating in celebrations or social gatherings that involve food?
• Can the intervention become your forever diet? (30-day diets do not provide any lasting benefit.) 
• Is it worth it?

Something to think about: Often the most impactful nutrition interventions are not flashy, restrictive, and expensive. They are usually pretty boring. That is because, unlike the sellers of a “diet,” they lack an advertising budget, and the only beneficiary is you! 

Are there any diet-building apps or resources you recommend?

Yes, I love the Start Simple with MyPlate app. It is free and helps you to make small nutrition-related goals while tracking your progress. One of the things that I really like is the focus on addition of foods that we just don’t seem to get enough of, like colorful vegetables, fruits, and whole grains. In addition to accountability, the app also offers a lot of useful and credible information to help us as we build our meals.

Scientists are finding evidence that gut bacteria affect MS. How should this affect our thinking about diet?

Research into the gut microbiome is exciting, but is in its very early days. There is much work ahead because there is much we still do not know. I would argue that it is too early in the process to have an impact on our food choices. 

We know research suggests that the microbial contents of the gut (microbiome):

• can be altered by diet (as well as other factors)
• may affect the immune system
• and people with MS may have a different microbiome than the non-MS population

But we don’t know how to modulate this, and the goal remains unknown. In other words, we need to know what makes a favorable and unfavorable microbiome, and discover the best approach to alter the microbiome.

While the researchers continue to answer these questions, you can support your gut with lots of prebiotic-rich fiber from vegetables, fruits, whole grains, and beans. Prebiotics are carbohydrates that are nearly or wholly indigestible, and when they are consumed (in food), they promote growth of beneficial bacteria (probiotics) in the digestive tract. In other words, if you want your healthy gut bacteria to be well-fed, eat plenty of prebiotic-rich foods.

What types of conversations do you wish more people with MS would have with their nutritionist or dietitian?

I wish people with MS had easy access to registered dietitians who understand the challenges of living with multiple sclerosis. While there is no science to support the efficacy of an “MS diet,” there is an abundance of research that highlights the importance of preventing or managing chronic comorbid conditions such as type 2 diabetes, cardiovascular disease, hypertension, gastrointestinal disorders, disordered eating behaviors, and others. Doing so will not cure MS, but will help people with MS live well with MS. Registered dietitians can help with this. Find a registered dietitian near you by using this tool.

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Expert Voices is a monthly series involving a Q&A with an expert in the MS space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. 

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.