Diet & MS: An interview with Dr. Allen Bowling

Following our June 11 webcast, Living Well with MS: Lifestyle, Diet and Complementary Therapies, we sat down with Dr. Allen Bowling to get answers to your most popular questions about diet and MS.

I hear about all these different diets for people with MS. How do I know which one I should follow?

There’s a quotation that I love by nutrition writer, Michael Pollan – I think about it personally every day and share it with my patients as well. He summarized thousands of pages of writing with these seven words:

Eat food. Not too much. Mostly plants.

Diets that promote cutting back on saturated fat and enhancing polyunsaturated fat – especially omega-3 fatty acids – have undergone the most extensive study, with mixed results. Results of the most recent study were pretty negative, but there have been studies with positive results in the past. There’s some scientific rationale to support this diet’s anti-inflammatory effects, which is what we want with MS. Vegetarian and vegan diets fit quite well with a low saturated fat diet, but it can be challenging to get omega-3 fatty acids with a pure vegetarian diet. So, you may want to consider fish oil or other omega-3 supplements if you follow a vegetarian diet.

Even if a person doesn’t have celiac disease, there is a possibility that he or she can still have sensitivity to gluten, which can bring out neurological symptoms of MS. This area, known as “non-celiac gluten sensitivity,” is talked about a lot but has not been extensively studied in MS or many other medical conditions. Some of my patients with MS have reported feeling better with a gluten-free diet. It used to be very expensive and laborious to experiment with a gluten-free diet, but now there are so many more options, making it a lot easier to do. If you find that you feel better with a gluten-free diet, you’ll want to make sure you don’t have celiac disease – as that’s a condition that will need to be evaluated and treated by a physician. Other potentially serious conditions can go along with celiac disease, such as iron deficiency, vitamin D deficiency and osteoporosis.

As Dr. Banwell mentioned in her interview, people with MS should be cautious about supplements that activate the immune system. These include echinacea, astragulus, ashwaganda, cat’s claw, high doses of antioxidants over a long period of time, and zinc.

Can you talk about diet and fatigue?

There isn’t a lot of scientific information about diet and fatigue. However, there’s anecdotal information that people with MS have less fatigue if they eat smaller meals more frequently. Every time we eat a meal, our blood sugar levels go up, and then start to drop – often to below baseline levels. That can be fatiguing for anyone, and for people with MS who are prone to fatigue, that dip in blood sugar can be even worse. If you have smaller meals more frequently, the elevation of blood sugar is less severe and the bottoming out can be less severe as well.

How does salt consumption affect MS?

This is potentially a very exciting area. I’m always intrigued by areas in science and medicine that are so simple and may have large beneficial effects. Recent laboratory studies indicate that high intake of salt may activate very specific components of the immune system in a way that could activate the disease process. These early animal studies will likely lead to studies in people with MS. In the meantime, the American diet is generally excessively high in salt, which may have various adverse health effects. It certainly wouldn’t be a bad idea for everyone to cut back on salt.

This new area of research highlights that, with MS and other disease processes, we can get so focused on medications a person is taking and how they impact MRIs and blood tests. And in the midst of all of that, we sometimes forget to think about how someone is living their life and what impact lifestyle decisions may have on their MS.

How can I distinguish between fact and opinion when it comes to diet and nutrition?

As a general rule, I think it’s helpful to be your own psychologist. Get a read on the person who’s providing the information to you. Do they seem like they’re genuine? Do they have facts to back up the claims that they’re making? Have there been studies about the diet specific to people with MS?  I would be cautious if any of the following are true:
  • the person promoting a particular diet seems to have a strong rebellion against science or conventional medicine,
  • there’s a strong dependence on testimonials or anecdotes,
  • the ingredients of a particular supplement or remedy are secret,
  • one diet claims to help a hundred different diseases.
I also wouldn’t recommend using diet to the exclusion of definitively effective medications.

Additional information and resources:
Eating healthy to take charge of your life
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s there an MS diet?
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nacks boost energy
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ood for Thought - MS and Nutrition
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eurology Care - Complementary & Alternative Medicine
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Allen

Allen Bowling, MD, PhD

Dr. Allen C. Bowling is Medical Director of the Multiple Sclerosis Service and Director of the Complementary and Alternative Medicine Service at the Colorado Neurological Institute (CNI).  He is also Clinical Professor of Neurology at the University of Colorado.