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?
S
nacks boost energy
F
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.

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    43 Comments

  • Ruby Hernandez   Jun 24, 2013 12:15 PM
    Great information, I,have a son who is 19 who has MS and was diagnosed when he was.16 all this very encourging for us.
  • Kathy Crudele   Jun 24, 2013 12:15 PM
    I met Dr. Bowling and also read his book. He is very knowledgeable about MS. would recommend getting his book.
  • Kerry   Jun 24, 2013 12:38 PM
    I have just been diagnosed recently with MS is there any advice?
  • Angela Lindsey   Jun 24, 2013 3:42 PM
    Is their a neurologist that specialize in the nerves.
  • RKB-NJ  Jun 25, 2013 8:20 AM
    Angela - all neurologists specialize in nerves. All of them treat MS but what you need is a neurologist who is an MS specialist. I'm sure you can find names at MS websites. Or, just try to google neurologist, MS and your home area name. Good luck
  • RKB-NJ  Jun 25, 2013 8:25 AM
    Kerry - There's so much information out there that you could drown in advice. Check out MS websites and definitely buy "MS for Dummies." It's a really good start for someone who was just diagnosed.
  • kdmunger1  Jun 25, 2013 9:02 PM
    I have a son that was diagnosed 11 years ago at the age of 21. He was on rebif for a year and stopped because it made him so sick. We are now looking for a neurologist that specializes with MS and takes Medicaid. It has been very difficult and he needs to get some help and back on some meds to make him feel better.
  • sherihanyehia  Jun 28, 2013 5:25 AM
    diet , yoga, physical therapy really control MS and its attacks?
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    naneus  Jun 28, 2013 9:33 AM
    I just finished my MS story in my profile and then after reading this blog I realize there is a lot I did not put in my story. One of my weaknesses is bread. I used to eat a lot of it. I had really gastrointestinal problems. I had multiple tests done by Tinker Air Force Base Clinic, but everything came back normal/negative. I was in so much pain and felt I could not get any relief. I just knew there was something wrong with me besides MS. I move to Riverton Wyoming in 2008. I went to my new small city doctor and asked her about my problems of having so many stomach problems. She says "have you tried a gluten free diet". I said 'what is that? I have seen the gluten free store, but never knew what "gluten" meant" She explained it to me. I went wheat free for a month and all my stomach problems went away!!! I have gluten products now but VERY little. I try to stay away from it as much as possible. I feel so much better without it.
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    naneus  Jun 28, 2013 10:10 AM
    I also wanted to add that though a gluten free diet has helped me feel better I do not have Celiac Disease, although I have always been anemic and recently tested low for vitamin D. I take iron every day and vitamin D. I am a vegetarian and have been for 20 years, however I do eat fish, especially Salmon. I have had MS for 19 years and have been told I am very healthy considering. I also have recently been given a preliminary diagnosis of COPD. Probably due to smoking (very light smoker for years), which I quit cold turkey once getting that depressing news.
  • peggy glaze   Jun 28, 2013 1:05 PM
    are they ever gonna find a cure, ms sucks
  • Josephine Connaughton   Jun 28, 2013 6:39 PM
    I just want to relay something about salt. I was diagnosed with MS in March 2009 and as my symptoms have never changed but have progressed so I have been told that I have Primary Progressive. I never had any problem with my bloods since then but for one which is Sodium going dangerously low for which I have to take a supplement every now and again. I have now started to use extra salt to avoid this happening again. All this has happened since I was diagnosed.It might be of interest to you.
  • Ruth Furtado   Jul 3, 2013 1:02 PM
    I was initially diagnosed with RRMS in 2001 and in 2012 was told I've gone to SPMS. I've been mostly following a Paleo diet aka the modern hunter-gatherer diet since then which consists of veggies (especially leafy greens), fruit, fish, and grass fed meats. I no longer eat grains, dairy or legeumes. I take calcium and vitamin d supplements daily. I do cheat occasionally but mostly stick to the plan. I have been able to walk short distances without my cane and my walker now serves as a rolling cart. I've also lost about 35lbs (not the goal but a nice fringe benefit) I also find my craving for grains and dairy, formerly favorites, is mostly gone and I'd rather have a cup of frozen grapes than ice cream and a salad with yummy roma tomatoes than a bowl of pasta. It takes a commitment to change but I find it's worth it as i feel so much better now and many of my MS symptoms have noticably improved.
  • Shawna Staggs   Jul 4, 2013 11:58 AM
    This is a question not a comment what diet would be good for some one with MS, Hypothyroidizem and Diabetes.
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    Lin  Jul 6, 2013 6:32 PM
    Nice article. I am an RN of 35 yrs. now with DX. of MS, Secondary Progressive. Had to retire. No neurologist since loosing medical.
    Appreciate this site to help me take better care of myself until I have a doctor. I have many questions.
  • purpleterry3  Jul 7, 2013 7:17 PM
    I have just started playing with my diet almost 8 weeks ago. I am experiencing subtle changes. Better balance, more energy, and just generally feeling better. I am eating gluten-free, dairy free. I eat chicken, salmon and other types of fish and seafood. I also include beans in my diet. I have always cooked from scratch so I am able to find recipes that are enticing.
  • Avatar
    Katrina-Renee  Jul 8, 2013 2:19 AM
    It seem's like any type of salt or bread just makes me feel awful. But coming off it is very hard for me.. It is very imperative that I get this under control fast with me being on steroids on and off every couple weeks. My relapses are frequent and I have gained 30lbs since March. I try to exercise but I only have strength enough to bike stationary, How can I get my carbs, like bread under control?
  • Earlene Cacciola   Jul 12, 2013 3:22 PM
    Before I was diagnosed with MS 10 years ago, then diagnosed with Dilated Cardiomyopathy 6 years ago, I have been traveling an up hill battle with diet, additives, foods to eat, supplements to take and/or avoid, but I am glad that there is always something new to learn (at least for me.) Thank You Dr. Bowling for your comments in this blog.
  • Sheri Tosto-Lombardi   Jul 15, 2013 12:14 PM
    Hello I'm writing in regard to your recommendation to a diet of six small meals planned throughout the day for me. I have Asthma, Multiple Sclerosis, Hyperthyroidism and now a Pre-diabetic UGG!!! I as well had been diagnosed with irritable bowel syndrome in the past but feel that was possibly my MS at a flare at the time not being diagnosed. Never less have a very slow digestive system magnesium seems to be a plus in my diet.
  • GINNIE   Jul 17, 2013 1:27 PM
    IM 42 YRS OLD, DX WITH MS IN 2009. WAS AN RN FOR 15 YRS, WORKED IN SURGERY,BUT HAD TO RETIRE 1 1/2 AFTER DX. MY IMMEDIATE SYMPTOMS WERE BLINDNESS( LASTED 5 WEEKS).NOW JUST BLURRY VISION,DIFFICULT WITH HEARING, MAJOR FATIGUE, NO TIME CONCEPT,EASILY AGITATED, CAN FOCUS ONLY ON 1 THING AT A TIME, PLUS NUMBNESS IN FINGERS( DROP THINGS ALOT) & DIFFICULT WITH WORD RECALL. ....AND THAT IS NOT WITH A FLARE UP OR ACTIVE LESION. ( WHICH I PREFER TO SAY " FRAYED NERVES").
    SO IN RESPONSE TO DIETING: I CUT OUT 'Dairy' PROTEIN, SUGAR, SPLENDA, ( USED STEVIA), CHANGED TO ORGANIC COFFEE & EGGS. ALSO CHANGED TO ONLY GREEN TEA. WITHIN 24 HOURS...MY VISION WAS SO MUCH BETTER!! Not near as blurry and didn't have to make font on computer screen 150%! It worked for me! I still cheat and every once in a while drink black tea and eat cheese. Blurriness comes back but goes away when stop. .....Worth a try if you're willing. Ps the Proteins in dietary is different than red meat protein. Good luck. Would like to know if anyone tries this & has good results.
  • donna doak   Jul 17, 2013 1:47 PM
    Thank you for the info on suppliments. I was not aware ashwaganda should be avoided. I have been taking it daily for over a year. I will stop taking it. Thank you.
  • Joy Elder   Jul 17, 2013 2:11 PM
    Was diagnosed with RRMS in 2001. In recent years have been suffering with 'MS Chest Hug' (severe TIGHTNESS around my torso) which worsens when going up & down stairs. The painful TIGHTNESS is more prevalent in the Fall/Winter than in the Spring/Summer (not sure why). Does anyone else suffer from 'MS Chest Hug'? Relief suggestions??
  • Frank   Jul 18, 2013 9:22 AM
    what do you think about Terry Wahl's, MD - diet, home exercise program, and electrical stimulus? in her book "Minding My Mitochondria"?
  • Carole Gilliland   Jul 18, 2013 11:22 AM
    Carole - Was DX 2002, but have had strange things for lots of years - I exercise daily (in water) & eat as natural as possible - eat lots of fish, nuts & sweeten with local honey (hubby is beekeeper - he calls them his girls - r n backyard) I take 50,000 units Vit D per week, vitamins & mineral
    NECESSITES ARE FEW - WANTS ARE ENDLESS. SMILE - GET MOUTHFUL OF RAIN. SIT LESS - LIVE LONGER.
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • Terri C.   Jul 18, 2013 2:35 PM
    Regarding, metabolism; are there any foods that can speed up the metabolism to set off weight gain. Do most people with MS experience a metabolism change that it gets slower?
  • elizabeth lambert   Jul 18, 2013 4:30 PM
    I am morbidly obese and welcome diet info. I was told to do a high protein diet by a dietician when considering bypass surgery. I was wondering if that is advised/safe with MS. Not easy to do proper diet on fixed income with limited food availability in this area I don't drive (strictly power chair)
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    lilylc30  Jul 19, 2013 1:54 PM
    I just turned 29 this month and I found out Tuesday July 16th that I had M.S. stage B or 2 that was perceived to be a stroke. I'm looking for a set of vitamins to take on a daily basis. I was looking into Vitamins A to E and omega 3s ... But I was wondering if there is a daily combo pack I can get with all these pills in it. I also started a diabetic style diet to help maintain an lose weight. I was wondering if anyone has any advice more advice to help me out.
  • liza   Jul 19, 2013 7:48 PM
    Hi I'm. Very intrested in all of the information provided since I have MS since 2007 And last year was when I. Was diagnose with it in this year I. Have been in the hospital. 4 times and every. Time it's worries. Me more its spreading more.I'm so afraid. I need help.
  • Avatar
    zacherydellis  Jul 30, 2013 6:57 PM
    Hi my name is Zach ellis I was diagnosed with ms at the age of 8 and now 16 I am going into my first year of high school.
  • Avatar
    zacherydellis  Jul 30, 2013 6:58 PM
    this is Zach ellis I drink a lot of v8 and juices
  • Jenn Meewis   Jul 31, 2013 2:59 PM
    Thank you for the clarity! After 2 years of being diagnosed, busy with two kids, ages 3 & 2, I've been in denial/hope that I don't really have MS. Two days ago I had my first injection of Avonex -what a thrust into reality! I've had a lot of fear and anxiety since, which has been worsened by contradicting "facts" and options. I came to the conclusion that no one knows anything and that, of course, there's nothing I can control -certainly not the future. So, in an effort to do what I can, I just want to live my best healthy life I can. I find your article helpful and practical, which is comforting. Thank you.
  • SA Sanford   Aug 3, 2013 12:17 PM
    Speaking of salt, has there been any testing done comparing regular table salt with Sea Salt. The latter isn't iodized. I notice using a small amount of iodized table salt in my cooking seems to make me feel a little better. Of course it may be connected to hot, humid weather more than the iodine in the table salt. I am mostly wondering if iodine in our diets makes a difference to MS patientes or if it's even been studied?
  • Ellen Hopkins   Aug 7, 2013 1:34 PM
    Dear Doctor, Have you ever heard of agarita tea made from the agarita bush, which grows wild in West Texas? I've been making and drinking it for two months while continuing the MS meds. My energy level and balance have improved significantly. No kidding! My neurologist and I were both skeptical, but there seems no other explanation. Please check on this. Thank you.
  • Britni N. Dunn   Aug 14, 2013 12:20 AM
    This blog is awesome. I have been following a plant based diet for a few months and have noticed a huge difference in my MS. My walking has improved tremendously, my breathing has improved, I don't experience fatigue, I no longer have pain, emotions and moods have enhanced, energy has improved and dizziness has decreased, and more.
  • Lana   Aug 18, 2013 6:30 AM
    I am 71 years old with digestive problems as well as ms. What kind of diet is good for me.
  • Marina   Sep 21, 2017 9:21 AM
    Hello Dr. Bowling, I was diagnosed recently with MS. I was also just tested for Food Sensitivity and surprisingly gluten was not one of the irritants. I have been trying to be gluten and dairy free for the past 2 month or so. My question is this: if i don't have sensitivity to gluten and have MS diagnosis, should I be still gluten free?
    Thank you very much for your response