Food for Thought The National Multiple Sclerosis Society · of nutrient-rich foods. The choices are...

Staying Well

Food for Thought

For Information: 1-800-FIGHT-MS nationalmssociety.org

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The National Multiple Sclerosis Societyis dedicated to ending the devastatingeffects of multiple sclerosis.

For information1-800-FIGHT-MS (1-800-344-4867)Web site: nationalmssociety.org

MS and Nutrition

For Information: 1-800-FIGHT-MS nationalmssociety.org

The National Multiple Sclerosis Society isproud to be a source of information aboutmultiple sclerosis. Our comments arebased on professional advice, publishedexperience, and expert opinion, but donot represent individual therapeuticrecommendations or prescription. Forspecific information and advice, consultyour personal physician.

The Society publishes many other pamphletsand articles about various aspects of MS. Toask for these, or for other information, call theNational MS Society at 1-800-FIGHT-MS(1-800-344-4867).

Some of our popular pamphlets include:

Vitamins, Minerals, and Herbs in MS:An IntroductionExercise as Part of Everyday LifeControlling Bladder Problems inMultiple SclerosisBowel Problems: The Basic Facts

National Multiple Sclerosis Society733 Third Avenue, New York, NY 10017-3288Tel: (212) 986-3240 Fax: (212) 986-7981Web site: nationalmssociety.org

Denise M. Nowack, RD, is director of chapterprograms, Southern California Chapter ofthe National MS Society.

Jane Sarnoff is a professional health writer.

Cover: Rosanne Dawer and her daughterJanice. Photograph by Bill Stanton.

This publication is supported by contribu-tions to the National MS Society from itsmembers and friends.

Reviewed by the Client Education Committeeof the National Multiple Sclerosis Society’sMedical Advisory Board.

© 2003 National Multiple Sclerosis Society

Food for ThoughtMS and Nutrition

by Denise M. Nowack, RD, with Jane Sarnoff

Helping yourself to a healthier life

MS is an unpredictable disease that affectseach person differently. But a person’s qualityof life can often be improved by focusing onthose aspects of health that can be changed.Good health has a lot to do with what you puton your plate at every meal, so diet is an areawhere you can be in control.

Nutrition basics

Eating for good health is as simple as A-B-C.

Aim For FitnessMake a healthy weight your target. There aremany reasons why a person with MS may gainor lose weight—but controlling weight is thesame story for everyone: watch the caloriesand do regular physical activity. Calories are ameasure of the energy locked inside the carbo-hydrates, fats, and proteins found in foods.This energy fuels our body but what we don’tuse gets stored as fat, and over time results inextra weight.

Physical activity and good nutrition are per-fect partners in managing weight. Not only

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see what 1/2 cup really looks like. If your por-tion sizes have crept way up, you may want toswitch to smaller plates and bowls.

Build A Healthy BaseTranslating good nutrition to your table takesplanning, attention, and some innovation. Letthe U.S. Department of Agriculture’s FoodGuide Pyramid provide a starting point. Eachpart of the pyramid provides a building blockof nutrient-rich foods. The choices are manyand they’re all yours!

Make a variety of grains, fruits, and vegeta-bles the foundation to your diet plan. Choicesfrom these groups are rich in vitamins, miner-als, carbohydrates, and other substancesimportant for good health—most help create afeeling of fullness and satisfaction to keep thesnack urge quiet.

Whole grains—such as whole wheat, brownrice, oats and whole grain corn—provide afiber boost to the carbohydrates in your diet. Asingle serving from this group provides about70 calories. You can find that in a half-cup ofcereal, rice or pasta, or one slice of bread.

When it comes to fruits and vegetables, enjoy

does physical activity burn calories, it can helpyou:

Make the most of your potential musclestrength, or even build strength, dependingon your program.Increase your endurance.Maximize range of motion and jointflexibility.Strengthen your heart.Decrease feelings of fatigue. (Really. Evenwith MS.)Decrease symptoms of depression.Maintain regular bowel and bladderfunctions.Minimize the risk of skin breakdown andirritation.Protect your weight-bearing bone mass.

High fat foods and uncontrolled portion sizesare leading contributors to weight gain. High-fat foods contain more calories per portionthan their carbohydrate or protein counter-parts. To cut back on calories look at ways totrim the fat. Also, keep tabs on portion sizes.Do a little measuring with raw rice or water to

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five a day—at least three servings of vegeta-bles and two servings of fruit. It doesn’t takemuch to make a serving—just one cup of rawleafy vegetables, a half-cup of other vegetablesor fruit, or six ounces of fruit juice. Choosedark-green leafy vegetables and brightly col-ored fruits and vegetables often.

Next add low-fat choices from the protein anddairy level of the pyramid to the nutritionalgroundwork you have laid. This includes leanmeats, fish and poultry, low-fat or non-fatdairy products, dried beans, tofu, and otherplant sources of protein.

Choose SensiblyThere are many ways to build a personalpyramid … and lots of room for choice. Whenin doubt, go easy on fat, the sugar, and thesodium.

Trimming the fat from your diet—especiallysaturated fat—not only cuts calories, but maycut your risk for chronic diseases, such asheart disease and stroke. Use vegetable oils asa substitute for solid fats like butter and hardmargarine. Choose fat-free or low-fat dairyproducts and lean meats. Trim the skin frompoultry. The Nutrition Fact Label on food

Variations on the pyramid pictured abovecan be found on pages 9, 12, 18, and 26.

The basic principles can be applied to manytraditions. Bon appetite!


products can be a useful tool for finding foodslower in total fat—as well as sodium andcholesterol.

It’s OK to enjoy sweets occasionally. But don’tlet soft drinks or sweets crowd out importantfoods you need.

To lower salt or sodium intake experimentwith low-sodium condiments, herbs, spices,and seasonings. And if you drink alcoholicbeverages, do so sensibly. Make water anddecaffeinated beverages your first choice.


ing new foods. There are many low-fatrecipe books and magazines on the market,as well as televised cooking shows, whichcan inspire new ideas. Be flexible. Balance what you eat with yourphysical activity over the span of severaldays. Don’t focus on just one meal or oneday.Be sensible. Enjoy what you eat. Practicingmoderation doesn’t mean crossing all yourfavorite foods off your list forever. Thinksmaller amounts, less frequently.Be active. Choose activities that you enjoyand that fit into the rest of your life.

Make a move!

Physical activity comes in different shapes andsizes. Aerobic activities raise your heart rateand breathing, and help promote cardiovascu-lar fitness. Other activities develop strengthand flexibility. For example, lifting weightshelps develop strength and can help maintaingood bone health. Activities like yoga and gen-tle stretching can improve flexibility.

Have a conversation with your doctor aboutexercise, your target weight, and special

Meeting the challengesof changing your diet

The A-B-C of good nutrition is the goal. Butfood is not just about nutrition—it’s aboutemotions, culture, socializing. Because whatand how we eat is so personal, changing eat-ing habits can be difficult. Special diets andradical fitness programs sometimes promisethe quick fix—or even the cure. But the bestadvice for people with MS continues to bewhat is recommended for everyone. Eat a low-fat diet with a variety of grains, vegetables,and fruits, along with some high-protein foodslike meat or dairy products—and balance calo-rie intake with physical activity. For moreinformation on special diets, see page 25.

Deciding to change is the first step. But thechanges don’t have to happen overnight. Startwith the easy changes. Then, one by one, addmore kinds of vegetables, reduce portion sizes,introduce more low-fat foods.

Here’s a checklist:

Be realistic. Make small changes over time.Small steps can work better than giantleaps.Be adventurous. Expand your tastes by try-


needs. If possible, get a referral to a physi-cal therapist to help you begin a program.Commit to doing what you can do on a con-sistent basis. Choosing activities you enjoywill help you keep to your fitness plan.Start slowly. If you haven’t been active,introduce your body to a low level of inten-sity for short periods of time. As your bodyadapts, gradually build the intensity andduration of your program.Keep your cool. Overexertion and over-heating can temporarily increase MSfatigue and other MS symptoms. Drinkplenty of fluids before, during and after youractivity. Try exercising in cool water or in air-conditioned space. For some, using a coolingvest or neck wrap helps keep the core bodytemperature at an appropriate level.Join a group! Exercising with others maygive you the motivation and support to keepgoing. Contact your chapter of the NationalMS Society for referrals to physical activityprograms in your community.

Feeding your special needs

Good nutrition is essential for everyone, butpeople with MS may have special considera-


depression-related fatigue, and MS lassitudecan be particular to people with MS. Thesetypes of fatigue can be treated with medica-tions, management strategies and therapy.People with MS also get fatigued from every-day life—like everyone else. Fatigue mayresult in a decrease in appetite, activity, andless interest in food preparation. If fatigue isinterfering with your activities, discuss theproblem with your doctor.

Here are some tips to ensure that you get thenutrition your body needs when fatiguebecomes a challenge:

If the thought of three large meals is toomuch, try eating more frequently—five tosix smaller meals if your appetite is small.Resist the urge for low-nutrient conven-ience foods. Keep your refrigerator andcupboards stocked with healthful items likestring cheese, low-fat crackers, peanut but-ter, dried fruit or raisins, small cartons offruit juice, individual cartons of low-fat ornon-fat yogurt or cottage cheese, or baggedsalads and pre-cut raw vegetables.Keep a stack of menus from places thatdeliver healthy meals!Make the most of your freezer. Stock up on

tions and needs. Your MS symptoms or yourmedications can impact your nutritional well-being. Talk to your nurse or doctor about drymouth, fatigue, and other symptoms thatinterfere with eating.

MS symptoms can also reduce mobility orphysical activity. If your eating habits remainthe same while activity drops off, the usualresult is weight gain. Added weight canincrease fatigue, further limit mobility, put astrain on the respiratory and circulatory sys-tems, and increase your risk for other chronicillnesses. Ask a registered dietitian or doctorto recommend an optimal weight, and reason-able daily calorie intake. To get extra weightunder control, put the physical activity anddiet partnership into action!

Being underweight can also compromise yourhealth, especially if it is caused by lack ofappetite or fatigue that limits food intake. It’simportant that you meet your daily nutritionalneeds to ensure that your body is able to fightoff infection.

Managing fatigueEveryone gets tired. However, certain typesof fatigue, such as neuromuscular fatigue,


How user-friendly is your kitchen? An occu-pational therapist can suggest ways torearrange your kitchen to make mealpreparation easier. There are utensils, stor-age systems, reaching aids, and adaptedstovetops that increase efficiency. Ask yourdoctor for a referral to an occupational ther-apist who can help you adapt your kitchento best meet your needs.

Removing doors underneath cabinet coun-tertops allows you to sit while fixing food.Just make sure any hot pipes are wrappedwith insulation.

Eating and emotionsMany people with MS struggle with depres-sion at one time or another. When depressionhits, it can have an adverse effect on motiva-tion, sleeping patterns, eating habits, andenergy. Each of these can, in turn, affectnutritional well-being.

Some people turn to food for solace when theyare depressed. Certain foods create a sense ofcomfort. These may be old familiar favoritesfrom childhood—a scoop of mashed potatoes,macaroni and cheese, a cup of steaming soup,a bowl of rice pudding. The danger is going

flavorful, low-fat dinners that can be quick-ly microwaved or heated.

When you do shop and cook … save energy:

Make a shopping list before you head out tothe store.Stock up on basics. Fill your pantry withchopped tomatoes, prepared sauces, mus-tards, canned beans, tuna, and other itemsthat you use regularly.If you have difficulty carrying food home,find delivery services, shopping services orfriends and relatives who will shop fromyour list.When you cook, try to make more than youwill eat in one meal so you can store orfreeze the rest for another meal.Don’t want to chop? Packaged pre-choppedvegetables can cut down your preparationtime. There are also shredded cheese, jarsof minced garlic, ginger root, sliced olivesand diced peppers.Streamline cleanup! Paper plates can be alifesaver when energy is low. Enlist familyand friends as extra hands—and save yourenergy for socializing after the meal.


overboard with these favorites. The extra fat,sugar, and calories can add up.

Other people experience a loss of appetitewhen they are depressed. It is important torecognize these feelings and understand howthey might be affecting your health. Eatingwith others can help keep you connected. Butif self-help strategies don’t work, seek profes-sional help. Serious depression is a treatablemedical condition.

Reducing bladder concernsBladder problems can be treated. If you havesymptoms, consult your doctor at the first signof trouble. Keep in mind though that what youeat and drink can help.

Pour on the water! Quite often fear of urinaryfrequency or loss of bladder control causespeople with bladder problems to limit theirfluid intake. This can contribute to otherproblems such as dehydration, dry mouth,difficulties with swallowing, loss of appetite,constipation, and even deficiencies in certainnutrients. Be sure to drink 6 to 8 eight-ounceglasses of water or other fluids every day.

Try these strategies to make sure you get thefluid you need:


Bowel managementWhether constipation is a result of your MS oryour habits, don’t despair. The following tipscan help keep things moving.

Fiber counts … add it up! Dietary fiber is asubstance found in foods like cereal grains,nuts, seeds, vegetables, and fruits, and isnot digested or absorbed by the body.(Animal food products do not contain anydietary fiber.)

A diet that provides 25–30 grams of fibereach day is recommended for good bowelfunction. There’s an added benefit for theweight conscious—fiber provides a morelasting sense of fullness, helping you cutback on what you eat.

Start slowly. Fiber should be added into thediet gradually. Adding too much fiber toofast can cause gas, cramps, diarrhea…anddiscouragement. The foods toward the bot-tom of the Food Guide Pyramid tend to bethe highest in fiber.

These ideas might help you fit fiber ontoyour plate:

Start your day with a high-fiber break-fast cereal.Switch to whole-grain breads.

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Take water breaks during the day. If youpass a water fountain … take a drink!

Travel with your own personal supply ofbottled water.

Refresh yourself at meals and snack timewith juice, milk, or sparkling water.

Limit caffeine-rich beverages like coffee,tea, cola and other soft drinks. Caffeine actsas a diuretic and should be avoided bythose with bladder problems.

Use alcohol prudently. Alcohol provideslittle nutrition and many calories. It func-tions as a central nervous system depres-sant, and can increase balance and coordi-nation problems. It may also irritate thebladder and aggravate problems withurgency.

If you are prone to urinary tract infections,drinking beverages that help to increase theacid level in urine can help prevent them.These include cranberry, apple, apricot, andprune juices. Limit foods and beverages thatmake urine more alkaline. These include cit-rus fruits and juices (orange, grapefruit),tomatoes, potatoes, lima beans, and antacidsthat contain sodium bicarbonate.


breaks through or leaks around a blockage. Besure to discuss bowel problems with your doc-tor or nurse. You don’t need to accept them aspart of your life with MS.

Preventing bone lossPeople with MS may be at risk for osteoporo-sis—a condition where the bones graduallybecome brittle due to the loss of calcium andother minerals. Lack of weight-bearing activi-ty due to immobility or fatigue, a diet low incalcium, smoking, heavy drinking and use ofsteroid drugs may all contribute to loss of bonemass. Talk to your doctor to determine if youmight be at risk.

To prevent bone loss:

Count on calcium. Calcium-rich foodsinclude low-fat dairy products, dark greenleafy vegetables, fish with edible bones, andsome fortified foods like orange juice andcereals. Keep your intake of sodium, caf-feine, and protein moderate. They all caninterfere with calcium absorption.Be sure to get enough vitamin D. Thisimportant nutrient helps calcium depositin the bones. The body makes much ofthe vitamin D it needs when the skin is

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Eat more beans, peas, and lentils.Take advantage of ready-to-usevegetables.Experiment with whole grains—likebrown rice, barley, and whole-wheatpasta.Make snacks count—eat dried fruits,raw veggies.Eat fruit at every meal.

If you find it difficult to reach the recom-mended level, fiber supplements can beused. One tablespoon of these commercialproducts provides 15 grams of fiber. Re-member, these are not laxatives but fibersupplements. Be sure to consult your physi-cian before using any of these products.

Don’t forget the fluids. Fiber absorbs water,so as you increase the fiber in your diet,you need to increase your fluid intake aswell.Just move! In addition to the many otherbenefits of physical activity, exercise canalso aid in preventing constipation.

Bowel incontinence can be aggravated bydietary factors. Surprisingly, in MS, bowelincontinence is often caused by constipation. Asudden loss of control occurs when the stool


Eat small, frequent meals so that you don’tbecome tired from chewing and swallowing.Taking smaller bites can help reducefatigue and the risk of choking.

MS ... plus another diagnosisPeople with MS can have other health prob-lems. Diabetes, high blood pressure, or highcholesterol may require special diets or drugtreatments. If you have other health problemsand more than one doctor, make sure eachhealth-care provider understands your specialneeds. A registered dietitian can help bringtogether all the pieces of your dietary puzzle.Dietitians can provide professional, reliable,objective nutrition information, and canhelp you separate facts from fads.

A look at “special” diets

Never before have there been more nutritiontheories or diets that claim to treat MS. Theseinclude diets low in gluten, high in polyunsat-urated fats, or high in certain vitamins, aswell as diets which assume that every individ-ual is allergic to certain types of food.

Some of these diets, such as Dr. Roy Swank’slow-fat diet, are consistent with accepted

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exposed to sunlight. But people with MSoften avoid the sun to avoid heat. Foodsources are the safest choice. Excess use ofvitamin D supplements can cause serioushealth problems.Be active. Get advice about a regularweight-bearing activity you’ll enjoy.

Chewing and swallowingDiscuss swallowing problems with your doctor.You may be referred to a speech pathologist, aspecialist who can suggest changes in the wayyou prepare foods or in the way you sit andbreathe while you eat. You may need tochange the form of your foods in order to eat anutritionally sound diet.

Thicker drinks tend to be easier to swallow.Such drinks might include milk shakes,juices in gelatin form, fruit sauces, sher-bets, and puddings.Foods that crumble easily can cause chok-ing. Avoid chips, crackers, toast, and cakes.Soft foods need less chewing. Eat mashed orbaked potatoes instead of fried, cooked veg-etables and stewed fruits instead of raw.Make use of a blender or food processor toget foods to the texture easiest for you tohandle.


dietary guidelines, and pose no nutritionalrisk for people with MS. Other diets thatclaim to be therapeutic may actually workagainst the principles of proper nutrition.Before considering any special diets, seekinformation from your doctor or a registereddietitian.

Some researchers do believe that nutritionplays some yet to be determined role in MStreatment, but so far no diet, vitamin, ordietary supplement has been proven to havetherapeutic value. There is no evidence that anutrition-related factor plays a part in theorigin or cause of MS.

The best food for thought is a well-balancedand nutrient-rich diet, based on the FoodGuide Pyramid. Inform yourself about foodchoices, make a commitment to healthy eat-ing, and develop menus you enjoy.

Find the diet you can live with ... and then eatwell ... for the health of it!


APPENDIX—FIBER FACTSWithout guidance, it can be difficult to know howto consume 25-30 grams of fiber daily. Use thistable to choose a variety of high-fiber foods toboost your daily intake. The foods toward thebottom of the Food Guide Pyramid are usually thehighest in fiber. Try to include five to seven serv-ings of fruits and vegetables each day, and atleast two servings of whole grain products.

Food Portion Fiber(grams)

Breads & Crackers (Check food labels and compare.)Seven-grain 2 slices 6.5Whole wheat 2 slices 6.0Dark rye (whole grain) 2 slices 5.8Bran muffin 1 large 4.6Tortillas, corn 2 4.0English muffin (wheat) 1 whole 3.7White 2 slices 1.9Ry-Krisp 3 2.3Wheat Thins 6 2.2Water Crackers 4 0.0

Cereals (Check food labels and compare.)All-Bran ½ cup 10.4 Oatmeal ¾ cup 7.7


Bran flakes with raisins 1 cup 6.0—without raisins 1 cup 5.0

Shredded wheatspoon size 1 cup 4.4

Puffed wheat 1 cup 3.3Bran meal 1 tbsp 2.0Cornflakes ¾ cup 2.6

Fruits (Eat fruits with the skin left on when possible.)Apple, raw 1 med 4.0Apricots, raw 1 whole 0.8

—dried 2 halves 1.7Banana 1 med 3.0Blackberries, raw ½ cup 5.0Cantaloupe ¼ 1.0Cherries, sweet, raw 10 1.2Dates, pitted 2 1.2Figs, dried 3 10.5Grapes 20 1.0Orange 1 large 2.4Peach, raw 1 med 2.3Prunes, pitted 3 1.9Raisins 1 tbsp 1.0Raspberries, red ½ cup 4.6Strawberries 1 cup 3.0Watermelon 1 slice 2.8



Legumes (Dried beans, peas and lentils are alsoexcellent sources of low-fat protein.)Baked beans ½ cup 8.0Black beans, canned ½ cup 9.7Chickpeas (garbanzos) ½ cup 6.0Kidney beans, canned ½ cup 9.7Lima beans, canned ½ cup 5.8Pinto beans, canned ½ cup 9.4Lentils, brown, cooked 2/3 cup 5.5

—red, cooked 1 cup 6.4Green peas ½ cup 9.1Black-eyed peas ½ cup 8.0Split peas, cooked ½ cup 6.7

Nuts & Seeds (Sprinkle over dishes and salads.)Almonds, sliced ¼ cup 2.4Chestnuts, roasted 2 large 1.9Peanuts, dry roasted 1 tbsp 1.1Peanut butter 1 tbsp 1.1Walnuts, shelled,

chopped 1 tbsp 1.1


Vegetables (When possible, eat raw and unpeeled forvalue-added fiber.)Artichoke 1 large 4.5Asparagus ½ cup 1.7Avocado 2 slices 0.9Beets, cooked, sliced ½ cup 2.5Broccoli, cooked ¾ cup 7.0Brussel sprouts ¾ cup 3.0Carrots, cooked ½ cup 3.4Celery, raw ¼ cup 2.0Corn on the cob 1 ear 3.4Greens, cooked ½ cup 4.0Green beans (snap) ½ cup 2.1Lettuce, shredded 1 cup 0.8Mushrooms, raw 5 small 1.4Onion, cooked ½ cup 1.5Peppers, green, raw 2 tbsp 0.3Potatoes, baked 1 med 5.0

—boiled 1 med 3.5—mashed ½ cup 3.0—sweet, baked 1 med 4.0—yams, baked in skin 1 med 6.8

Sauerkraut, canned 2/3 cup 3.1Spinach, cooked ½ cup 7.0Tomatoes, raw 1 small 1.4Turnip, cookedZucchini—raw ½ cup 3.0

Sources of additional informationand other services

1-800-FIGHT-MS (1-800-344-4867) can beused to reach the National MS Society chapternearest you. Your chapter offers local refer-rals, education programs, counseling, self-helpgroups, and booklets and brochures on manyaspects of living with MS.

If you join the Society, you will receive ournational magazine, InsideMS, a quarterlypacked with news and features of interest toanyone affected by MS, and MS Connection,a newsletter from the Society office closest toyou, which covers nearby events andresources.

For the best MS information online, consultthe National MS Society Web site. You canfind information on diagnosis, treatments,medications, clinical trials, research news,issues in coping and management, MS publi-cations, news on advocacy, events and servicesoffered by your chapter, MS clinics, and howyou can join the Society. Log on to:<nationalmssociety.org>.


Food for Thought The National Multiple Sclerosis Society · of nutrient-rich foods. The choices are...

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