The question about nutrition and lifestyle to alter the course of this chronic and untreatable disease has been frequently asked by patients and scientists. Patients want to learn about nutrition and lifestyle interventions, but they’re more difficult targets for scientific research. While different diets are currently studied, there is no diet specifically recommended to MS patients at this point.
The important role of diet has been investigated in many different diseases, some of which (like diabetes) can be directly affected by the correct diet. The research in diet and MS focuses on the role of gut microbial flora (microorganisms present in the gut), its role in immunity regulation and its effect on MS disease course. Research suggests that a Western-style diet — rich in calories, red meat, fat and sugar and low in fiber — has a potential to increase systemic inflammation, change microbial flora in the gut and thus change the immune profile toward the more inflammatory one. This inflammatory gut microflora has been shown in research to worsen the disease.
The importance of diet in MS is further underlined by research suggesting an increased risk of MS in obese adolescents and worse symptoms in MS patients who consume high amounts of salt.
No drastic diet changes to exclude various food components are specifically recommended to MS patients. Current clinical practice is to encourage eating a low calorie, heart-healthy diet rich in fruits and vegetables, lean proteins and fiber. The World Health Organization also recommends less than two grams of salt per day for patients with MS.
The role of vitamin D in the regulation of immunity has already been discussed. This vitamin is the most promising target for dietary treatment options, but the research is still ongoing. As vitamin D deficiency is commonly found among the general population, vitamin D supplementation is now routinely recommended by all clinicians for MS patients.
Omega-3 fatty acids and polyunsaturated fatty acids, both present in olive oil, vegetables, seafood and fish, are desired alternatives to fats of animal origin present in the Western diet. Omega-3 fatty acids and polyunsaturated fatty acids both have anti-inflammatory effects in the body.
Previously seen as inappropriate for MS patients because of increasing fatigue and worsening symptoms, exercise is now recognized as an inexpensive and beneficial lifestyle modification and therapy approach. Exercise in the form of physical therapy is now uniformly used in the vast majority of patients and has been shown to decrease fatigue and improve endurance, strength and balance at any stage of the disease. Apart from the obvious mechanistic benefits related to muscle activity, exercise is also believed to exert benefits on a molecular level by reducing the production of chemicals responsible for promoting inflammation in the body. This effect is possibly further enhanced by calorie reduction.
Various models of exercise regimens have been studied and recommended for MS patients. Cardiorespiratory exercise has been proven to show benefits in as little as four weeks. Exercise modes using stationary cycling, swimming or aquatic exercise have been shown to improve endurance; patients with high functionality may prefer treadmills or elliptical trainers. Low endurance, seen in many MS patients at the outset of exercise program, can be managed by including short periods of rest during exercise sessions. Intermittent rest periods help to prevent fatigue and heat sensitivity, which in turn can transiently worsen MS symptoms.
Aquatic exercises are highly popular among MS patients, mainly due to the prevention of heat buildup, ease of balance and support provided by water. Hydrotherapy techniques can help address limitations in strength and mobility otherwise present when exercising on land.
Strength training, such as weights, push-ups or elastic bands exercises, should be gradually incorporated into any exercise program. This type of exercise improves strength, tone and endurance. Flexibility exercises are important in any MS patient. They address increased muscle tone and cramps, both frequently experienced by many. Repeated short stretching sessions (10 to 15 minutes long) throughout the day offer better results than a single stretching session. Gentle stretching performed before and after any other exercise is also important.
Based on these facts, clinical practice currently recommends at least mild exercise two to three times a week with adequate hydration. Due to known heat sensitivity in some MS patients, cooling strategies, such as precooling with cold showers and air-conditioned facilities, are also recommended.