Presentation to the Chelsea and Westminster MS Group

1. Nutrition & MS
(Multiple Sclerosis)
Presented By:
Alastair Lynn RD
26/09/14
Chelsea & Westminster Hospital

2. Background
 MS – Condition of central nervous system
 Damage to nerve fibres (myelin)
 Partial or complete (lesions or plaques)
 Disruption/delays in message signaling leading
to  disability over time
 Symptoms:
1. Physical: vision problems, balance/dizziness, fatigue,
stiffness/spasm, bowel/bladder problems, speech,
swallowing, tremors
2. Memory/thinking/emotions: difficulty remembering recent
events, problem solving

3. Signs & Symptoms: Swallowing
 Swallowing difficulties - damage to any part of the
brain that controls swallowing, or the connections
between the brain and the spinal cord ‘brainstem’
 May come and go, can happen during a relapse &
improve, or disappear completely
 Swallowing problems might include:
1. Changes in your speech
2. Problems chewing
3. Food sticking in your throat
4. Food or drink coming back up
5. Sluggish movement of food going down, or difficulty moving
food back through your mouth
6. Coughing and spluttering during and after eating
7. Excessive saliva, which may cause dribbling

4. Managing swallowing difficulties
 Good posture when eating & drinking – stay
upright 30mins after each meal
 Relaxed atmosphere
 Eat slowly
 Chew well
 Alternate liquid with solid – keep food moist
 Avoid speaking when eating
 Severe swallowing difficulties: texture modified
diets/nutritional drinks/NG and PEG feeds

5. Texture modified diet
 Soft
stews, cottage/sheppherds pie, mince, boiled fish, well cooked
pasta/noodles, moussaka, chilli con carne, omlette/scrambled
egg, dips, egg mayonnaise, mousse, cheesecake, ice cream
 Fork-Mashable
Similar to soft (still requires chewing before swallowing)
 Puree
Does not require chewing
No bits, lumps, fibres (may be sieved)
No loose fluid
Texture of rice pudding

6. NG & PEG Feeding
Weight loss or dehydration - 2ndry to
swallowing difficulties
 Unsafe swallow ,  risk of aspiration
 Short term (<3-4 weeks) ‘nasogastric tube
feeding’ - Liquid food passes through a very
thin tube through the nose and into the
stomach
 Long term: Percutaneous endoscopic
gastrostomy – liquid diet to go directly through
a tube into the stomach

7. Importance of good nutrition
 Nutritionally balanced meals helps the body
work to its full potential
 Energy Levels
 Immune Function
 Recovery
 Vitamin supplements - not required as a
balanced diet usually provides enough
vitamins and minerals for most people
 No evidence that high doses of vitamin
benefit people with MS

8. Special diets
 ? Reduce relapse rate or improve quality
of life
 No conclusive evidence to suggest
effectiveness
 Include Swank diet, Best Bet diet and
George Jelinek's Overcoming MS
programme

9. Special diets: Swank Diet
 Named after Dr Swank – developed in 1940s
  Fat intake to no more than 15g of saturated
fat/day, and between 20-50g of unsaturated
fat
  Intake of red meat and oily fish,  white fish
 Caution:  Meat and dairy foods to reduce
saturated fats  a shortfall in protein + other
nutrients
 Research – number of studies (high drop outs)
shown no benefits of diet

10. Special diets: George Jelinek's
Overcoming MS programme (OMS)
 Developed by Dr George Jelinek in 1999
 Combines a number of different elements; diet,
exercise, meditation, Vit D & medication
 Similar to Swank diet:  saturated fat +
supplementation of Omega 3 (in the form of fish
oil or flaxseed oil) + vitamin D if limited exposure
to sunlight
 Research – no conclusive evidence of its benefits

11. Special diets: The Best Bet Diet
 2 main components:
1. Avoiding potential “problem” foods
2. Taking vitamin, mineral and herbal supplements
 To avoid any foods with proteins that resemble those in
myelin that are attacked by the immune system
o Dairy: Avoid all animal milk, all butters, cheeses,
yoghurt and any products that contain them
o Gluten: Avoid all wheat, rye and barley
o Legumes: Avoid all beans, peas, peanuts, soybean
o Refined Sugar: This is also avoided because of general
inflammatory properties, with the suggestion of using
other sweeteners instead, such as honey, maple syrup
o Eggs: The idea here is to limit, rather than strictly cut out
o Yeast: limited quantities are allowed
 Research – no conclusive evidence of its benefits

12. Omega-3 Fatty Acids and Multiple
Sclerosis
 Some studies - low levels of omega-3 fatty
acids were found in people with MS
 Decrease certain immune reactions, reducing
inflammatory responses
 In very small studies of 10 and 16 participants,
omega-3 supplementation  relapse rate &
improved expanded disability status scale
(EDSS) score
 In a larger placebo-controlled study (1989) 
relapse & disability progression but results not
statistically sig.

13. Omega-3 Fatty Acids
 Dietary sources:
 Flaxseeds and flaxseed oil
 Nuts, such as walnuts
 Avocados
 Fatty fish, such as salmon, tuna, mackerel,
sardines, anchovies
 Dark, leafy greens (such as kale, spinach)

14. Omega-3 Fatty Acids
Side Effects:
 >3 grams/day
o Increased risk of bleeding complications
o Gastrointestinal symptoms
o Increased LDL cholesterol levels
o Elevated blood sugar in patents with
diabetes (although in normal dosages,
blood sugar levels are lowered slightly in
healthy people)

15. Healthy Eating
Aim for a healthy, balanced diet including all major
food groups:
 Proteins – for growth and tissue repair
 Carbohydrates and sugars – for energy
 Fats – to absorb certain vitamins and for essential
fatty acids
 Fibre – for healthy digestion
 Vitamins and minerals; tissue repair, bone strength
and the absorption of other nutrient
 Fluids –carries nutrients around the body

16. Eat Well Plate

17. Importance of a balanced diet
 Help control weight
 Decrease fatigue
 Maintain regular bowel and bladder function
 Keep teeth/gum & bones healthy and strong
 Improve muscle strength and range of motion
 Increase flexibility
 Reduce the risk of certain diseases such as heart
disease, stroke, osteoporosis and certain cancers

18. Maintaining a healthy weight
Weight loss   risk of malnutrition & muscle
weakness
 Contributing factors:
o Posture/swallowing/fatigue/tremors
o Reduced appetite
o Stress & anxiety
o Depression

19. Maintaining a healthy weight
Weight gain   difficulty mobilizing/co
morbidities
 Contributing factors:
o Medication such as steroids
o High intake of sugary drinks/fruit juices
o High intake of fatty, fried and processed
o Stress & anxiety – comfort eating
o Depression

20. What is a healthy weight
BMI = Weight(kg)/Height(m)2
WHO Classification BMI Risk of Death
Underweight Below 18.5 Low
Healthy weight 18.5-24.9 Average
Overweight (grade 1
obesity)
25.0-29.9 Mild increase
Obese (grade 2 obesity) 30.0-39.0 Moderate/severe
Morbid/severe
obesity(grade 3)
40.0 and
above
Very severe
World Health Organisation. Obesity: Preventing and Managing the Global Epidemic.
Geneva: WHO, 1997 [3]

22. Practical solutions
 Planning:
Planning a menu for the week to
reduce shopping trips, and reduce food
wastage
Cooking double batches and freezing
 A ‘likes and dislikes’ list to ensure you’re
getting a good mix of meals that are to
your taste

23. Practical solutions
 Shopping:
Shop online as all the major supermarkets
offer a delivery service
Make a master shopping list of things you
regularly buy, and print off multiple copies.
And if you’re having a bad day with your
MS, someone else can use the same list.
Delegate tasks – can someone else in your
household, or a friend, do the shopping for
you

24. Practical solutions
 Preparing food:
Before cooking – gather all ingredients
needed
 Clearing up:
 Use a dishwasher if possible
 Share tasks with others

25. Thank You
Please ask any questions