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

This month, we’re launching an exciting new and interactive feature on the MSconnection.org 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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    30 Comments

  • Tom Biel   Jul 16, 2014 4:54 PM
    Along with diet it will be very helpful if you can provide information about appropriate supplements that can be included for health maintenance for those of us living with MS. Vitamin D-3 seems to make sense for people who live in cold and cloudy places. I'm looking forward to following this Blog.
    Thank you,
    Tom
  • Avatar
    refusetoquit  Jul 16, 2014 6:31 PM
    There's common dinominater's in 'diet's' between proper nutrition and vitamins as I've discovered in my interest in eating for the body. LIESTYLE and EATING change are a must first...........common sense in what IS known about how 'nutrition' is needed for ANY person.........is a great start. There's no 'easy answer', but does that mean we WAIT for 'THE' answer? I choose to be pro-active and responsible with what goes in my mouth...........I appreciate this topic, expecting great information from many.
  • Deb Davis   Jul 16, 2014 7:06 PM
    I am also interested in your opinion of vitamin supplements. Vitamin D3 is encouraged for everyone living in our area, with or without MS. I also take Tumeric and Ginger Root. I have not been able to incorporate tumeric in my diet, so I believe the next best thing is the supplement. I add a chunk of ginger root in my home brewed green tea along with a few slices of oranges and lemons. I don't think that is enough, so I add a ginger root supplement to my diet. I also add a flaxseed oil and coconut oil supplement along with a multivitamin. What are your thoughts on these? I look forward to following this as I am fairly newly diagnosed (6 months) and am actively attempting to loose weight for overall better health and MS health. I am willing to have any type lifestyle change to add productive years to my life. I do not have a love for food.
  • Avatar
    marshina  Jul 16, 2014 8:51 PM
    I have eaten a Mediterranean diet, without red meat or pork for the last 46 years. I eat three servings of wild fish a week, chicken that is organic and light on dairy. I love cheese but try to stick with goat cheese. I drink coffee, and wine daily. I take Vit d3 but no other supplements. I don't believe in Vitamins. I believe one gets healthy with whole foods. White flour and white sugar is not in my home. Pasta is whole wheat or brown rice pasta. Dark chocolate is my treat . I eat no butter but use plenty of extra virgin olive oil. I am a cook. With the progression, lack of mobility, exercise is almost impossible. I've cut my portions, the size of my plate, and no seconds of anything. I still have 10lbs I'm selling cheap. Menopause gave me that unwanted gift. I'm going to be 68 and I'm pretty darn healthy beside arthritic knees and stiffness.
  • carole bisker   Jul 16, 2014 9:28 PM
    I decided to go gluten free four months ago, something that I thought I would never be able to do. I thought there was too much there that I liked to stop gluten. It's actually not very hard at all. And two weeks ago, I started to feel a difference in my walking. It's subtle, but definite. I can walk longer with my walker without my legs weakening and can even walk some amount with just my cane. I am often now choosing to just use the cane. And I usually don't have that stumbling walk that used to occur almost all the time. I still most definitly have MS, but I am functioning better with it. There are still times of that hugging-the-wall, wall-walkng, but I have other times too.
  • Gerri   Jul 16, 2014 9:28 PM
    I eat well - meal, fish, veges, salad.
    I like my wine as it keeps me calm. I also take Tecfidera, Vit D, Fish Oil, Multiple vitamins. I also like my snacks - cheese, crackers, chips, veges. At 71 I'm doing pretty good but dieting is just not in my forte as nothing really works. I would like to know what are the best nutritional foods to eat that will really make a difference in controlling MS? Thanks.
  • Laura   Jul 17, 2014 1:09 PM
    I would be interested in any tips regarding a healthy diet that would help in weight loss .
  • Laura   Jul 17, 2014 1:09 PM
    I would be interested in any tips regarding a healthy diet that would help in weight loss .
  • aileenchoate  Jul 18, 2014 9:44 AM
    Which vitamins are FDA approved? I take prescription Lavazza (fish oil). Are there any that you support?
  • Jutta  Jul 18, 2014 12:38 PM
    Am trying to eat in a healthier manner, make better food choices. My mobility is limited; am interested in learning about portion control suggestions. When I exercise I burn a frustratingly small number of calories so please advise.
    Interested in hearing about supplements in addition to VitD3.
  • Polly   Jul 18, 2014 12:44 PM
    This is a wonderful topic to explore !! I don't follow any particular diet. I try to eat unprocessed foods, fish ( salmon is a favorite ) and, when I imbibe--it's usually red wine, although that has unfortunate side effects when it comes to my IBS--no problem if it is liquor-hmm??!! )
    I do take a probiotic , D3, B-12 complex as well as Phosphatidyl Choline for brain and liver health daily. Looking forward to this Blog !! Thank you !!
  • laurir124  Jul 18, 2014 1:27 PM
    hi there, as mentioned above I am "trying" gluten free. I wish that I could eat fish but HATE salmon!! go figure I live in the Pacific Northwest and my family are all avid sports fishers.... Oh well, I am wondering about the use of Vit D? I take 5000 iu. I attended a talk with a well know Dr, that said he even took Vit D so am thinking there may be something to it. I exercise 5 days a week and walk with my doges 6 days per week. I am looking forward to this conversation, I am, like all of you, wanting to do better for my health...... I look forward to this new journey!
  • Trish   Jul 18, 2014 4:52 PM
    Love this opportunity to share info. I am recently diagnosed and having a difficult time balancing exercise with fatigue. I feel like its a call between exercising and being able to get any physical work done. Tough call. Am eager to learn more suggestions also regarding nutrition. Surely there must be foods that discourage myelin issues.... isn't there?
  • Suzanne   Jul 18, 2014 6:39 PM
    Even before I was diagnosed in 2013, I was cutting down on or eliminating foods that cause inflammation (flour & sugar, basically!) as I also have arthritis. Now I have mostly cut out grains, eat lots of greens & bright colored veggies (not starchy ones like corn, potatoes or peas), healthy fats (avocado, olive oil in salads, coconut oil for cooking), grass-fed meat, organic chicken & eggs (preferably more grass fed than grain), some wild fish (I like salmon!), seaweed for iodine, limited fruit (to limit fructose), and a square of organic 72% dark chocolate most days. I take quite a few supplements, mostly anti-inflammatory and antioxidant ones, along with a multi, probiotics, and the requisite D3 and B12. Several of my diet ideas came from Dr. Terry Wahl (as discussed on Dr Mercola's web site) and Elana of Elana's Pantry web site. They both have MS and have found great success with diet. Dr. Wahls calls it feeding the mitochondria. I have also learned about the importance of a healthy gut on Dr. Mercola's web site so have included fermented veggies and water kefir in my diet. All of their diet ideas are not so much "paleo" style as they are "ketogenic" as they feature veggies and healthy fats as much if not more so than healthy protein. I've been interested in food and nutrition since I was a teenager, so it's empowering to apply that interest to what may help with MS. I have been to two neurologists so far and the first put no stock at all in any special diet. The one I go to now is more interested in nutrition, but focuses more on supplements than food. Doctors don't get much training on nutrition sadly, but I'm glad there is some research on this for MS now, and that this is the first issue being discussed in this new MS Connection!
  • mahmoud   Jul 19, 2014 11:54 AM
    hi dear i am a reasercher in ms for 10 years work I found all things about ms like why sm start from eye and what happened in ms deasese I managed to recognaiz patient from healthy in my lab with an special ms antibody and antigen for more data please contact me best regards dr Mahmoud doctor mahsa doctor tina sedaghati
  • Janet Best   Jul 19, 2014 12:56 PM
    I try to eat as healthy as I can, but I stumble. I have no portion control and I need some advice for that. I know how to eat well, but am wondering how much an organic or gluten free diet would help. I'm on a very strict income and I know that organic food is much more expensive. Going gluten free seems like a really hard thing to do. I walk my dog twice every day, but as he is getting older, my walks are getting slower. I try to work out 3x/week. I'm also getting new bike tires on my bike so that I can start riding. I have enormous fatigue issues. I do take Vit. B3 and I just started B12, but no more energy has come from the B12. I also live in the Pacific NW and I love salmon. There are times too where I have severe leg pain and restless leg every day when I take my naps. Any help or suggestions would be greatly appreciated. Thanks.
  • julie   Jul 19, 2014 9:07 PM
    I have had alot of swallowing issues and was on "only thru the straw" intake for 6 yrs. Now I still frequently choke and am wondering about going back to drinking Ensure liquid in place o maybe 3 meals a week? I'm very active with swimming 3-5 times a week. However, I have severe MS fatigue and wonder how I can lose some weight? I moderate my portions but sometimes I don't feel like eating anything at all. None of my doctors have any advice other than "keep active and eat healthy"!!! Thank you in advance!
  • Ricki Becker   Jul 20, 2014 12:52 AM
    I was diagnosed in 1987. I have lived with MS for 29 years.
    Take care of yourself, eat well & exercise any way you can to keep
    Exacerbations as limited as you can. That's where the damage is done!
    So whatever medicines your doctor has you on, take it religiously.
  • pesky5  Jul 20, 2014 2:24 PM
    I have been living with MS for 9 years now. I have gone from being a runner and running road races to not being able to do much for physical activity. I am a pro-active person, when I came to the realization that my life long passion of working out and running came to an end, I knew I needed to make a new approach. I decided on changing my diet, staying positive and acupuncture. First, I decided to give up gluten 4 months ago as well as most dairy. I have found a great change with my physical and mental health. I have added plenty of fresh fruits and vegetables daily and have been drinking almond milk for 2 years along with plenty of water. I have cut back on meat and have smaller portions at meal time. These have been positive changes. Second, I began acupuncture 3 months ago, I go faithfully 2 times a week. This has been amazing, from sleeping soundly at night, to living practically stress free, not to mention an incredible change in my mobility and stamina. I highly recommend it. There is a practice in Stoneham Mass and North Andover Mass called NECA, (New England Community Acupuncture). Highly qualified acupuncturists and very affordable for a fixed income. I needed to share these life changes that I have chosen and hope it can help somebody else that has come to a cross road.
  • Leslie   Jul 22, 2014 2:18 PM
    I changed my eating and it has helped me alot. I have never liked exercise, but eating better has really helped. I eat more fruit & vegetables, no meat, bread or sweets & drink only water. I have lost about 45 lbs in over a year and I feel good. I have good and bad days, but the good out ways the bad.
    I would like to begin some type of exercise, but not sure exactly what to do. Any suggestions are appreciated.
  • Ann LaFontaine, MA, RD, LD, CDE   Jul 22, 2014 7:31 PM
    I am a registered dietitian, nutritionist with MS. Believe me, if there was a specific diet out there for MS, I would be on it. I think many people are just in denial, or use diet as an excuse not to take DMT.
  • Avatar
    amenta  Jul 23, 2014 12:10 PM
    I jusy recently had an MRI showing no new lesions on my brain..I am also seeing a ne neurologist who advised me that there is no definitive way to evaluate what stage of MS i am currently experiencing; however, he would like to se me try a disease modifying therapy for 6 months-1 year to see if it has any impact(if yes, still relapsing remitting, if no, it has moved to secondary progressive ??). I am one that says, "if I don't have the runs...I wouldn't take Imodium, making it hared for me to consider a drug to help my possible relapsing/remitting MS. He recommended either copaxone or rebif?
    One thing I am unsure of is if this will ease some of my symptoms or not,and I know a lot of that is purely experimental!?

    Please give me feedback if you are using these medications and/or have an y thoughts for me.
    Thanks,
    Amber
  • Avatar
    amenta  Jul 23, 2014 12:10 PM
    I jusy recently had an MRI showing no new lesions on my brain..I am also seeing a ne neurologist who advised me that there is no definitive way to evaluate what stage of MS i am currently experiencing; however, he would like to se me try a disease modifying therapy for 6 months-1 year to see if it has any impact(if yes, still relapsing remitting, if no, it has moved to secondary progressive ??). I am one that says, "if I don't have the runs...I wouldn't take Imodium, making it hared for me to consider a drug to help my possible relapsing/remitting MS. He recommended either copaxone or rebif?
    One thing I am unsure of is if this will ease some of my symptoms or not,and I know a lot of that is purely experimental!?

    Please give me feedback if you are using these medications and/or have an y thoughts for me.
    Thanks,
    Amber
  • Avatar
    amenta  Jul 23, 2014 12:23 PM
    I jusy recently had an MRI showing no new lesions on my brain..I am also seeing a ne neurologist who advised me that there is no definitive way to evaluate what stage of MS i am currently experiencing; however, he would like to se me try a disease modifying therapy for 6 months-1 year to see if it has any impact(if yes, still relapsing remitting, if no, it has moved to secondary progressive ??). I am one that says, "if I don't have the runs...I wouldn't take Imodium, making it hared for me to consider a drug to help my possible relapsing/remitting MS. He recommended either copaxone or rebif?
    One thing I am unsure of is if this will ease some of my symptoms or not,and I know a lot of that is purely experimental!?

    Please give me feedback if you are using these medications and/or have an y thoughts for me.

    Thanks,
    Amber

    PS Anyone studied Dr Terry Whls story...thoughts??
  • izzie  Jul 25, 2014 5:34 PM
    hi....i was dx. in 2000. i am interested in some specfic diets....i am having lots of problems ....i can't walk or much more....i'm having a lot of bowel movement problems....i just don't know what to do any more..., please help me
  • Avatar
    refusetoquit  Jul 26, 2014 12:58 PM
    I hate the word 'diet',.........how about lifestyle change.....it's continuous. There are so many GOOD idea's out there..........ALL have SOMETHIBNG you won't do, or like, giving you the 'opportunity' or 'excuse' to not start. WHY NOT, .....START making small choices first. You KNOW you need to do SOMETHING, you KNOW you don't want TOO BIG OF LIMIT'S.

    Think of what a good 'food intake' you CAN have,........not what you can't. Combining good information for YOUR need's. Keep it simple until it's second nature, making good, sound decision's for yourself.

    BOWEL problem's .............ADD fruit's and veggies........don't like veggies? Here in lies the problem.........we swallow pill's to get better, but we won't eat simple nutrition to get us better...........I drink a green soup EVERY DAY........like MEDICINE and found my balance on elimination. If you want change without changing anything, nothing changes.

    EXERCISE..........change (that word again) how you preceive what exercise is.............MOVEMENT. Easy on the body, movement. The FELDENKRAIS METHOD (pronounced 'felden christ') The 'no-excuse' not to exercise, EXERCISE. The man that it's named after, had good idea's. ATM AWARENESS THOUGH MOVEMENT

    The MS journey can be LIBERATING
  • courtney-james  Jul 28, 2014 3:19 PM
    I have recently been diagnosed with MS and have read several articles on how diet and exercise can significantly improve MS symptoms. I currently take D3 and B12 and have been on it for a while now even before diagnosis of MS. I am curious on what would be the best route to go with nutrition. I exercise regularly and am eating no dairy or meat after reading several articles. Also limiting gluten. I haven't noticed much of a difference yet, but know I have only just started doing this. I still have my numb/tingly right hand, with my left hand have bouts of tingles and weakness where my hand curls up and the nerves fire off. I think it may be the heat with that arm though. Not really sure as this is all new to me. I would love any suggestions on things that would help.
  • courtney-james  Jul 28, 2014 3:19 PM
    I have recently been diagnosed with MS and have read several articles on how diet and exercise can significantly improve MS symptoms. I currently take D3 and B12 and have been on it for a while now even before diagnosis of MS. I am curious on what would be the best route to go with nutrition. I exercise regularly and am eating no dairy or meat after reading several articles. Also limiting gluten. I haven't noticed much of a difference yet, but know I have only just started doing this. I still have my numb/tingly right hand, with my left hand have bouts of tingles and weakness where my hand curls up and the nerves fire off. I think it may be the heat with that arm though. Not really sure as this is all new to me. I would love any suggestions on things that would help.
  • SUSAN   Jul 30, 2014 1:43 PM
    I have had MS and RA for a long time ,MS 25 YEARS RA MAYBE 10 YEARS AS FOR FOOD I CAN DO VEGHAN ANYDAY DOES NOT BOTHER ME AL ALL ;INFACT I DON'T EAT RED MEAT NOT GOOD .I BUT ORGANIC WHEN EVER I NEED ;MY HUSBAD CAN EAT ANYTHING I CAN'T SO BUYING ORGAINIC IS NOR EXPENSIVE ;JUST DEPENDS WHAT YOU NEED ;I DON;T EAT BIG PORTIONS OF FOO NEVER HAVE ;I PREFERE TO EAT SMALL AMOUNTS BUT FEW TIMES A DAY ;FRUIT ;VEGATABLES ;NOW I LOVE SWEETS AND CAKES THAT IS SO HARD TO GIVE UP ;BUT I DON;T EAT THAT MUCH I AM NOT A PERSON WHO EATS A LOT AT ONE TIME ;I MAY BUT A CHOCOLATE BAR AND HAVE IT WEEKS A LITTLE AT A TIME .BUT I HAVE HEARD ALL ABOUT THE VEGHAN DIET AND I AGREE WITH IT ;IF YOU CAN EAT THIS AND LESS MEDS I AM THERE 'WHO WANTS MEDS I DON'T EVEN THOUGH I AM TAKING THEM AS OF NOW .BUT I AM GOING TO HAVE TO TRY THIS THE RIGHT WAY AND WE SHALLL SEE WHAT HAPPENS .
  • SUSAN   Jul 30, 2014 1:43 PM
    I have had MS and RA for a long time ,MS 25 YEARS RA MAYBE 10 YEARS AS FOR FOOD I CAN DO VEGHAN ANYDAY DOES NOT BOTHER ME AL ALL ;INFACT I DON'T EAT RED MEAT NOT GOOD .I BUT ORGANIC WHEN EVER I NEED ;MY HUSBAD CAN EAT ANYTHING I CAN'T SO BUYING ORGAINIC IS NOR EXPENSIVE ;JUST DEPENDS WHAT YOU NEED ;I DON;T EAT BIG PORTIONS OF FOO NEVER HAVE ;I PREFERE TO EAT SMALL AMOUNTS BUT FEW TIMES A DAY ;FRUIT ;VEGATABLES ;NOW I LOVE SWEETS AND CAKES THAT IS SO HARD TO GIVE UP ;BUT I DON;T EAT THAT MUCH I AM NOT A PERSON WHO EATS A LOT AT ONE TIME ;I MAY BUT A CHOCOLATE BAR AND HAVE IT WEEKS A LITTLE AT A TIME .BUT I HAVE HEARD ALL ABOUT THE VEGHAN DIET AND I AGREE WITH IT ;IF YOU CAN EAT THIS AND LESS MEDS I AM THERE 'WHO WANTS MEDS I DON'T EVEN THOUGH I AM TAKING THEM AS OF NOW .BUT I AM GOING TO HAVE TO TRY THIS THE RIGHT WAY AND WE SHALLL SEE WHAT HAPPENS .