Diet & Nutrition with Dr. Ellen Mowry & Denise Nowack, RD

This month, we’re launching an exciting new and interactive feature on the community. We know many of you are interested in how to live your best lives right now. That’s why we’re bringing together people with MS, those who care about them and experts on a variety of important topics to talk about issues that matter most to you. Each month, you will have an opportunity to submit your thoughts, tips and questions related to that month’s theme.

We’re kicking things off with a conversation about diet and nutrition. Maintaining good health is very important for people with MS. A well-balanced and planned diet can help achieve this goal, but with so many to choose from, and differing opinions on which are most effective, it can be a challenge to know where to start, let alone how to stick with one long enough to know if it’s helping.

We’re talking with registered dietician, Denise Nowack, and Dr. Ellen Mowry about eating well, following specific diets, where research is headed, and more. See what they have to say about diet below, read their responses to specific questions, and then share your questions, thoughts and tips with the community. And check back at the end of the month for a follow-up conversation with the experts.

Dr. Ellen Mowry

I’m very interested in exploring factors in the environment that we can control as modulators of the MS course. It’s exciting to think about factors that people with MS may be able to actively participate in and change in order to make their MS better. And I think in general, diet changes are of particular interest because more and more is being understood about how the foods we eat might impact the immune system through many different mechanisms. For example, the foods that we eat might directly talk with immune cells in or near the gut where they are being digested to change how the immune cells work.

The food that we eat can also change the bacteria in our gut, which in turn can influence and educate our immune system about what belongs and what doesn’t. Since MS is an autoimmune disease, in which the immune system attacks the wrong thing (i.e. parts of our central nervous system rather than specifically honing in on things like viruses and bacterial infections, diet is an exciting area of research in terms of its potential to impact MS.

That being said, it is also really difficult to study well, and there haven’t been many good studies of specific diets in MS. Those that have been done haven’t been very conclusive about whether or not a specific diet should be implemented for people with MS. Unfortunately, there is no evidence at this time to support the use of one diet or dietary intervention over another. This can be pretty frustrating – while it’s exciting to think about the potential of research to help us better understand diet, for someone who is newly diagnosed with MS or is noticing progression and hoping that maybe a dietary change could have a positive impact, we don’t have any definitive answers at this point.

There’s some really interesting work being conducted by a number of investigators. One of them is Dr. Ruth Ann Marrie, who has looked at how having other medical illnesses in addition to MS influences the course of MS. She has found that having other illnesses can have a negative impact on MS as well. This is important information, because we know there are dietary recommendations that have been shown to be good for overall health.

There are a few different explanations for why people with MS may feel better when they start a particular diet. One explanation may be that the diet is effective for MS, and we just haven’t thoroughly studied it yet.

Another explanation is that our overall health is improved by eating healthy foods, instead of junk food. People who start a diet – with our without MS – often feel better when they are on the diet. Often times before starting a diet, people may be eating a more typical American diet with a little too much junk food. By cutting out processed foods that can be high in sugar, fat and salt, you can feel markedly better.

Third, with any intervention you make in which you’re hoping to have a particular outcome, just knowing that you’re doing it is associated with a placebo effect. That’s why we have placebo-controlled trials of any intervention as the best way of assessing if the intervention is helpful. Studies have shown that even those people who are on a placebo have some improvements in their outcomes.

Finally, there are also people who have confounding problems. One example would be people who have autoimmune problems related to gluten tolerance. These people in particular would feel much better on a gluten-free diet – not because it is necessarily impacting their MS, but because they also had an ongoing gluten intolerance.

This is not to say that I think that diet can’t be helpful. Given the scientific link between foods and the immune system, there is a good chance it may be. At this time, we just don’t have evidence that any one diet is the right. And I commend The National MS Society for taking this on and making this a research priority in the next few years.

** Read Dr. Ellen Mowry’s responses to your questions about diet and nutrition here. **

Denise Nowack, RD

There are a lot of specific diets that have been promoted for MS over the past five decades. They range from a diet that is low in saturated fats with really limited portion sizes of lean meat, fish and poultry to a completely vegan diet, to a diet that is predominately high protein with no grains or cereals. And with all these different recommendations, it can be really challenging for a person with MS to know how to eat.

Before I get into the specifics of things to consider in a healthful diet, I would like to take a step back and take a look at how one views diet. Is a person viewing the way they eat and perhaps a specific diet as a cure or a form of treatment that slows down the disease process? If that is the case, the answer is that we don’t know yet – more research needs to be conducted in this area. If we consider other factors that are important about diet – nutritional approaches that are impacted by MS or through which MS is benefited or MS symptoms are benefited – that’s a different story.

Let’s overlay symptoms as an example. We know that people with MS are really susceptible to nutritional deficiencies and malnutrition, because of the course of the disease. If a person is dealing with depression or fatigue or their mobility is limited, or they have difficulty swallowing, all these different factors that come into play that can impact how they eat – missing meals, overeating, not getting the nutrients that they need.

I encourage people to be aware that there may be factors related to their MS that affect their nutritional health. And malnutrition can significantly impact the immune system, mental function, muscle strength, and specific deficiencies like vitamin D. People often recognize the impact of their symptoms in the quest for the perfect diet.

There may also be nutritional interventions that can benefit specific symptoms. For osteoporosis, it is important that you incorporate adequate calcium and vitamin D into your diet to maintain good bone health. For bladder issues, you need to make sure there are plenty of fluids in your diet to flush out the bladder and risk of infection. For bowel dysfunction, a high fiber diet with plenty of fluids and fiber sources can be valuable in managing constipation.

This can require a tailored approach that takes into account a person’s symptoms as well as other conditions. If someone has diabetes or high blood pressure, you have to consider that as well. While it can be tempting to look for one perfect diet for people with MS, it’s not a one size fits all disease.

** Read Denise Nowack’s responses to your questions about diet and nutrition here. **

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