Healthy Eating

The balance of good health

A well-balanced diet can help you maintain a healthy lifestyle, lessen fatigue and minimise the chance of getting infections. It doesn't have to be restrictive, difficult or expensive.

What is a balanced diet?

A balanced diet should give you all the nutrients you need to stay as healthy as possible.

Essential food groups

Every day you should try to eat a variety from each of the four food groups detailed below:

• Proteins are important for muscle building and energy. You should try to eat at least two or three portions each day. High protein foods are: lean meat, fish, beans and pulses, and dairy products.
• Carbohydrates are starchy foods which provide energy and should form the basis of your diet. They are found in cereal-based and high fibre foods. Fibre helps to maintain healthy digestion and minimise constipation. Good sources of carbohydrates include: wholemeal bread and flour, cereals (wheat, oats, corn, etc), pasta amd rice, beans and pulses, potatoes, fresh and dried fruit.
• Dairy products are a good source of calcium, protein and vitamins A, D, E and B (especially folic acid and B12), but are high in saturated fats (which rise cholesterol levels) so choose low fat versions where possible. Dairy products include: milk, yoghurt, cheese, and eggs (which should always be well-cooked).
• Fruit and vegetables are an important source of vitamins A, C and E (anti-oxidants), and minterals such as potassium, magnesium and calcium. You should eat five portions of fresh fruit and vegetables each day. Some people may prefer organic produce. Frozen ones are a nutritious alternative. Don't overcook - steam or boil them in as little water as possible to avoid destroying vitamins and minierals.

Fats - good or bad?

Small amounts of fat are an important source of energy. There are three types, but they all have the same calorie content:

• Saturated - associated with raised cholesterol levels. Found mainly in animal products (i.e. dairy products and meat), processed foods, palm and coconut oil. Keep intake to a minimum.
• Monounsaturated - not as closely linked with higher cholesterol levels as saturated fats. Found mostly in avocados, olive oil and nuts (e.g. peanuts, hazelnuts, almonds).
• Polyunsaturated - essential fatty acids found mainly in vegetable oils and seeds (e.g. sunflower, soya, safflower, corn and maize), oily fish and fish oils. Try to eat these in preference to other fats.

All fats are high in calories, so if you are overweight you should limit your intake, especially of saturated fat. Use low fat products such as low fat spreads, low fat cheeses, and semi-skimmed or skimmed milk.

Nutrition for MS

You may want to pay particular attention to the following key aspects of what you eat if you have MS.

Essential fatty acids (EFAs)

Essential fatty acids are polyunsaturated fats, such as linolenic acid. They play an important role in maintaining the central nervous system and the myelin sheath, so although there is no definitive evidence of long-term benefit, it makes sense to ensure a good intake of EFAs if you have MS.

Linolenic acid is found in sunflower, safflower and soya oils, and margarines such as Flora and Linusit Gold which have no hydrogenated fat.

Alpha-linolenic acid is mainly found in dark black leafy vegetables (e.g. broccoli, black cabbage, spinach, kale, brussel sprouts, black peppers, parsley and lettuce), soya and edible linseed oils, oily fish (e.g. tuna, salmon, mackerel, pilchards and sardines) and fish oils.

Supplements rich in EFAs, such as evening primrose, starflower, and wheat-germ oil are available over the counter, but can be expensive.

Vitamins and minerals

You don't need to take special vitamin supplements if you eat a healthy and varied diet. However, certain vitamins, such as folic acid and B12, are important for a healthy nervous system, so make sure you have a good intake of these in your die.

Vitamins are easily destroyed by storage and cooking, so eat fresh fruit and vegetables as soon as possible and don't over-cook them.

Good sources of vitamin B12 are: red meat (especially liver), oily fish and dairy products (i.e. cheese, yoghurt, milk, etc).

Good sources of folic acid include: liver, leafy black vegetables, high fibre breakfast cerals (fortified with B12 and folate), beans, pulses and nuts, and dairy products.

Antioxidants

Betacarotene and vitamins A, C and E are antioxidants which help to minimise the risk of heart disease and some cancers, as well as maintaining a healthy nervous system. To ensure you are getting enough of these vitamins you should eat at least five portions of fruit and vegetables daily.

If you are concerned about your intake of vitamins and minerals, talk to your doctor or ask to be referred to a dietician.

Is there a special diet for MS?

Claims have been made for many diets said to help MS - low fat, gluten-free, dairy-free, etc. So far, no controlled studies have been carried out, so there is no conclusive scientific evidence of any being beneficial.

Some diets can be very restrictive and expensive. They may be bad for your health if followed without supervision by your doctor or dietician.

You should get advice from a healthy professional if you are, or are planning to be, pregnant. A dietary supplement of folic acid, for instance, is known to be beneficial.

Managing meals and fatigue

Preparing meals and snacks can be difficult if you are fatigued, but there are several ways to make things easier for yourself.

Tips for managing fatigue

Fatigue is a common symptom of MS, so it is important to use your energy wisely.

• Take frequent rests.
• Plan ahead.
• Cut out unnecessary tasks.
• Organise space and materials to save energy.
• Learn good postural habits.

If you are too tired to eat a complete meal, for example, you could eat in two stages (i.e. save your lunch dessert for tea) or eat smaller but more frequent meals. Rather than missing meals, it is worth using convenience foods from time to time, or eating frequent snacks.

Healthy snacks and convenience food

Fresh fruitis the best convenience food there is - apples, pears, oranges, etc, are full of goodness and easy to eat. Choose starchy foods (carbohydrates) such as cereals, pasta or a baked potato to give you energy, rather than fatty or sweet things.

If you eat snacks, beware of processed foods, biscuits and cakes, which can be high in saturated fat and low in nutitional value. If you use ready prepared meals, try things like cottage pie, pasta, curries, or fish cooked in sauce, which are easily available, easy to chew and can be heated in a microwave. Use low fat and low sugar alternatives whenever possible.

Tips for managing your health

If you have MS there are a number of ways in which your diet can influence your sense of well-being.

Drink plenty of water

Many people with MS experience bladder problems at some point. Ensuring a healthy fluid intake can help to minimise the risk of problems or infections.

Some people make the mistake of drinking less liquid to cut down on visits to the toilet, but this can actually make problems worse. Low amounts of concentrated urine encourage infection and irritate the bladder. Low fluid intake can also cause constipation.

There is limited evidence that a daily intake of one to two glasses of cranberry juice can help reduce urinary tract infections. Large quantities may cause kidney stones, however, so you should never drink more than one litre a day.

The importance of fibre in your diet

Fibre is necessary for a healthy bowel and helps prevent constipation. You should eat a wide variety of high fibre foods daily.

The recommended five daily pieces of fruit and vegetables should prevent constipation. Fibre absorbs fluid, so if you increase your fibre intake you should drink more liquids. Talk to your doctor or a continence advisor if problems persist.

If you are over or underweight

People with MS may lose weight through loss of appetite, or put on weight if they become inactive, and may need to pay particular attention to diet. If you have serious weight problems, your doctor may be able to refer you to a dietitian.

Looking after your skin

The skin is the body's external protective barrier. It is especially important to keep it in good condition if you have mobility difficulties or loss of sensation. A balanced diet and plenty of liquids will help maintain healthy skin, which needs to be well-nourished and supple. Dry, flaky skin is more likely to crack and break down. It can help to use a moisturising cream or lotion after bathing.

Alcohol

Many people enjoy a drink with friends. You can still drink alcohol if you have MS, as long as it is in moderation. That means a maximum of two units a day for women and three units a day for men, although Department of Health guidelines for the general population allow slighly more. One unit is equal to a small glass of wine or half pint of beer.

Alcohol should not be taken with certain drugs. Ask your pharmacist or doctor for advice.

If swallowing is difficult

Some people with MS sometimes find difficulty in swallowing (known as dysphagia), particularly when they are tired. This can include food sticking in your throat, coughing or regurgitation.

Difficulties are usually due to weakness or poor co-ordination of movement. If you find you have problems swallowing, try taking smaller mouthfuls and eating soft, minced or easy-to-chew foods with sauce or gravy. Try to make sure that drinks are not too cold or too hot.

© MS Society