This presentation was part of the 2023 Holistic Health and Wellness Forum for MS held on May 17 in Southfield, Michigan.

Sarah Johnson, BS, MS, FNP-BC, MSCN works at the Michigan Institute for Neurologic Disorders. Diet is an important factor in living a healthier life with MS. What you eat plays a role in the long term health of your nervous system and may affect the progression of your disease activity.

There is no one specific diet recommended for individuals with MS and diet doesn’t replace disease modifying therapies. But regardless of which MS diet you choose, following a healthy diet is a good add-on that leads to better outcomes clinically and increase quality of life.

Many diets have been studied for MS. Some individuals who do well with rules and guidelines find that prescriptive diets such as the Swank diet, Wahls’ Protocol, Best Bet Diet or Living Well with MS Program may be helpful. For others who want to create their own diet plan, the best question to ask is: “What is sustainable for me?” Nutrition and diet is a lifestyle. To reap the benefits, it has to be ongoing and consistent for the rest of your life.

Diet tips for MS to implement in your life

Prioritize protein to help maintain and build muscle

Protein makes you feel full and satisfied. It helps regulate energy, appetite and hunger. Good sources are fish, chicken breast without the skin, lean pork, lean beef, tofu, eggs, and Greek-style or plant-based yogurt. Make it a goal to eat protein at every meal.

Increase fiber

Vegetables, fruits and whole grains are full of fiber which helps with digestion, feeing fuller longer, increasing the bulk of food, and sustaining energy throughout the day. Getting a minimum of 35g of fiber in a day is the recommendation. If you increase your intake to 25g to 30g that is a great start as the average American only gets 15g each day. Sarah eats a cup of blueberries every morning, which has 4g of fiber.

Carbohydrates are not all bad, but they’re not created equally

Healthy carbs are found in vegetables, fruits, and whole grains. Some vegetables are low in calorie and carbohydrates but high in fiber (broccoli, peppers, celery, green leafy vegetable, etc.) Other vegetables are wet and starchy. These are the healthiest types of carbs (sweet potatoes, peas, squash, beans, and legumes.) The calories in beans mostly come from healthy, filling carbohydrates, but they have protein as well. The key is to eat whole food that’s unprocessed or minimally processed.

Fat in moderation

Limit saturated fat and eliminate tras fatty acids (which are found in red meats, butter, ice cream and all processed foods.) These foods should be seriously limited or better yet, eliminated from the diet. Instead, choose unsaturated fats found in fish, avocados, extra virgin olive oil, nuts, and seeds.

Decrease processed foods

A lot of people struggle to eat whole food. They want a quick convenient meal when they’re hungry and tired. It’s easy to fall back on something quick and fast like chips, fast food, white pasta and white bread. These foods cause inflammation in the gut and can contribute to increased symptoms in patients that have MS.

Consistency, not perfection

Stop labeling food as “good food” or “bad food.” There’s healthier food and less healthy food. Create a healthy relationship with food. If you eat extremely healthy 80% of the time then and 20% of the time you can be more lenient (holidays, birthdays, when you go out to dinner with friends.) These special events are times to make exceptions and indulge in white pasta, cake, and ice cream. Then the next day, get back to your healthy eating program.

Plan ahead

Meal prep is essential to eating healthy all the time. Have breakfast ready for when you wake up. Prep lunches for the whole week so you already have things that are healthy ready in the fridge. It’s easier to eat healthy at home than when dining out. Food at restaurants (and not just fast food restaurants) are higher in calories, fat, sugar and salt than home-cooked meals.

Healthy breakfasts for MS

Overnight oats – Make it ahead of time for the whole weeks on Sunday evening Mix 1/2 c oats 1/2 c almond milk 1/2c Greek-style or plant-based yogurt, protein powder and put it in the fridge. Add almond butter and 1/2 c blueberries when you’re ready to eat

Egg scramble – Mix a few eggs with any vegetables you prefer and serve with a fruit like berries on the side

Healthy lunches for MS

Prep on Sundays your lunches for the week.

Salad – Make a big salad and divide it day by day with greens, vegetables, and protein like lentils, chickpeas, hummas or hard boiled eggs

Protein bowl – (like Chipotle) Make a taco salad with brown rice, beans, corn, vegetables and salsa

Mediterranean salad – Mix your favorite dark leafy greens with tomatoes, olives, cucumbers, onions and the fish of your choice like tuna, mackerel or grilled salmon

Healthy dinners for MS

Be creative: combine a lean protein (fish, tofu, beans), lots of fiber (from vegetables), healthy carb (from potatoes, brown rice, brown pasta, bulgar wheat, quinoa, barley, etc.), healthy fat (olive oil, fatty fish, avocado). The options are endless.

Try not to graze or snack throughout the day. Don’t skip meals or your will be ravenous by 4pm and lack the will power to eat healthy food.

Stay hydrated

Drink more water. It helps with energy, all vital aspects of a healthy brain and mind. Limit or eliminate coffee, tea, sugary drinks and alcohol. Adults should drink six to eight 8oz glasses of water every day. If you have a bladder symptoms, it’s even more important to stay hydrated. Talk to your your healthcare provider to get help with bladder symptoms through medication, pelvic floor exercises, bladder retraining, botox, or sacral nerve stimulation.

Movement and exercise

People with MS sometimes struggle with fatigue and finding the motivation to exercise. Addition constraints can be reduced mobility, and lack of transportation. Whatever that movement looks like – swimming, walking, stationary bike, resistance bands at home, or daily free yoga classes with Yoga Moves MS. Daily movement is very important for brain health and to improve mobility and flexibility.

Lifestyle habits for a healthy life with MS

• Sleep 7 hours or more every night (which is a struggle for a lot of adults.) If it’s hard to get to sleep or stay asleep, talk to your health care provider.
• Go outside to get sunlight daily, especially in the morning. Sunshine helps regulate your circadian rhythm and helps your body make melatonin to help with the sleep/wake cycle.
• Supplement with vitamin D. Many people are chronically deficient. Vitamin D levels can be checked with a simple blood test and supplementing up to 5,000iu per day is recommended for people with MS
• If you smoke, stop immediately. Smoking leads to progressive symptoms in MS. If you are having trouble quitting, talk to your healthcare provider about programs or medications that can help.
• Maintain a healthy weight. Being obese increases a person’s chances of developing MS and being overweight or underweight can exacerbate MS symptoms.
• Practice stress management by incorporating relaxation, reflection and meditation into your daily life. Stress in inflammatory and exacerbates MS symptoms.
• Peer to peer support is invaluable. COVID lockdowns were very isolating for many people with MS and it’s important to have social interaction for mental health.

Preventative care

In addition to your neurology team, it’s important to stay up to date with your internist or GP that oversees all of your health such as lab work and preventative screenings. Not every symptom is caused my MS and it’s important to make sure any comorbidities are also being managed.

Sarah Johnson is a board-certified nurse practitioner at the Michigan Institute for Neurological Disorders (MIND) in Farmington Hills, MI. She earned her Bachelor of Science in Nursing from Bradley University in 1998 and her Master of Science in Nursing from the University of North Carolina in 2005. She is a Multiple Sclerosis Certified Nurse and has been working in Neurology since 2012. Sarah provides care for patients with MS and participates in MS clinical research.