Symptom Awareness: Weight Management and MS
by Maryann B. Hunsberger
I lost count of how many nutrition shakes I drank as a teen in an attempt to gain weight. If I didn’t consume 3,000 calories a day, I’d shrink to 97 pounds – too low for my 5’4″ frame. My father kept feeding me steak and potatoes, saying it would “fill me out.” Yet, no matter what I ate or drank, I couldn’t get past 105 pounds. As an adult, I stayed the same weight, wearing a size-5 wedding gown and size-5 maternity clothes.
After becoming disabled at age 35, I couldn’t stand up long enough to prepare healthy meals, so I began relying on convenience foods. My activity level dropped, as I could barely move some days. Adding symptom-relieving medications to that mix was a prescription for weight gain. Lots of it. Within four years, the size-5 girl became the size-3X woman.
“This scenario is common for people with disabilities, including MS,” notes Gillian Goodfriend, a registered dietician at the University of Illinois at Chicago (UIC)’s Department of Disability and Human Development. “People choose fattening convenience foods because of difficulty standing, lack of energy, and sometimes stress and depression brought on by MS. Inactivity, reduced activity, and certain medications also put weight on.”
Individuals with MS can take steps to prevent weight gain or reduce weight. Goodfriend emphasizes the importance of eating three meals each day. “People shouldn’t deprive themselves by skipping meals. Skipping breakfast causes people to eat too much at lunch, because they are starving. Their metabolism also slows down from not eating. ”
In her book, Apples and Pears: The Body Shape Solution for Weight Loss and Wellness, Marie Savard, MD, points to studies showing that people who eat breakfast are half as likely to be obese as people who don’t eat breakfast. So, what’s good to eat for breakfast? Goodfriend says the healthiest, most satisfying breakfast is one that combines protein and whole grains or fruits. “Protein helps keep people more satisfied and less hungry. Whole grains and fruit provide filling fiber. ”
A common mistake dieters make at lunch is eating something that isn’t satisfying, such as a salad with no protein or fat. “The protein in some added chicken or beans and the fat in salad dressing provide a feeling of fullness, ” states Goodfriend.
The same balance of protein, fat, and fiber should make up dinner. Goodfriend continues, “When MS causes fatigue, people can’t stand each night in the kitchen to cook. They can make a large pot of soup or chili Sunday and divide it into containers for the week. A soup or chili made with vegetables, beans, and lean ground turkey is ideal. These foods are good for losing weight, depending on portion size. ”
Yet, portion sizes can be tricky. Most people eat an entire can of soup, while one-half can is a serving. A large banana or large apple provides two servings, although many people think of any fruit as one serving. Goodfriend notes, “At first, people should weigh and measure how much they eat until they can eyeball it. It’s surprising how we pour ourselves a double portion of cereal without realizing it. ”
At a time when “super-sizing” is the norm, Cindy Richman, senior director of services at the Multiple Sclerosis Association of America, says that education about portion control is more important than ever. “On TV commercials and in restaurants, portion size is so large. When people go out together, they should think about sharing their portion. ”
In order to help control portion size, Savard reminds readers to avoid buffet restaurants. She also advises to put extras back in the refrigerator before serving the meal, and to buy small packages of snack food to control serving size.
The Massachusetts Institute of Technology has a guide to portion sizes at their website, which can be helpful to those battling skyrocketing weight: http://web.mit.edu/athletics/sportsmedicine/wcrservings.html.
With all of the diet books on the market, how can someone with MS know which diet is best? Richman points out that a balanced diet recommended by a specialist familiar with MS is best. “Weight is an individual issue. People need to make complete lifestyle changes, since they won’t be able to follow fad diets for any length of time. It’s better to consult a nutritionist or take courses about food groups and different choices at health and wellness centers. It’s all about balance. If ordering chocolate cake when out with friends Saturday night, eat less the next day. ”
Counting calories is helpful for many people with weight loss. To lose weight, people should shoot for 20 to 25 calories per kilogram each day. To determine kilogram weight, divide weight in pounds by 2.2. To maintain the same weight, 25 to 30 daily calories per kilogram is appropriate. To gain weight, consume 35 to 40 daily calories per kilogram. This translates to roughly 10 calories per pound to lose weight; 12 calories per pound to maintain weight; and 17 calories per pound to gain weight. Using www.fitday.com or www.sparkpeople.com makes it easier to track calories.
Editor’s note: Readers are strongly advised to consult their physician before making any changes to their diet. A doctor can also help determine the exact number of daily calories that are specifically appropriate for an individual.
I lost 126 pounds using techniques recommended by my doctor’s nurse practitioner. To prevent cravings caused by blood sugar surges, I replaced simple carbohydrates (such as white rice, white bread, and sugar) with complex carbohydrates (including brown rice and whole grain bread). I maximized fruit and vegetables to increase my fiber and feel full. To lower both weight and cholesterol, I decreased animal fats (red meat, full-fat dairy). I gave up second helpings and limited portion sizes. To track my food and calorie intake, I used fitday.com as a journal. I removed junk food from my kitchen, planned my menus one week in advance (in writing), bought only the items listed on the menu, and found new, tasty recipes to prevent boredom. I also relied on my grocery store’s online delivery service to prevent fatigue.
Some people with MS have the opposite problem – they lose too much weight. Goodfriend says that weight gain and weight loss stem from many of the same reasons. “The biggest factor is loss of muscle from lack of movement and pain. Decreased muscle mass leads to decreased strength and energy. Fatigue can cause inability to go shopping for food or to prepare complete meals. Medications, stress, or depression can also cause lack of appetite. ”
To gain weight in a healthful way, eating three balanced meals a day plus snacks is important. Goodfriend recommends taking a balanced multiple vitamin (one that includes no more than 100 percent of the recommended daily allowances). Underweight people should also eat healthy foods, but in larger portions. The following strategies, with a doctor’s approval, may help put on weight:
- Add healthful fats, such as olive oil, olives, avocadoes and nuts
- Include calorie-dense, nourishing foods, such as dried fruit and fruit juices
- Add dry powdered milk to a casserole or a cup of milk
- Try a nutritious protein or meal-replacement drink, such as Carnation Instant Breakfast ® or Ensure®, between meals (please note that these types of drinks may be high in sugar; some sugarless varieties are available)
- Combine milk, yogurt, and fruit in the blender as a snack
If someone takes in more calories than he or she burns, weight gain occurs. If a person burns more calories than he or she eats, this causes weight loss. Exercising helps the body burn calories while promoting balance and flexibility in people with MS, so it’s good for both people needing to lose and gain. Physical activity with most disabilities can be complicated, and MS is no exception.
Richman recommends having a physical therapist create an exercise plan. “Most health club programs are not designed for people with MS. For example, a trainer may possibly do more harm than good. Personal trainers may tell people to do more repetitions, which may add to a patient’s fatigue. Unless the personal trainer is experienced in working with MS, the ideal option is to consult with a physical therapist. If insurance won’t pay for the ongoing therapy, the therapist can explain how to do exercises at home. ”
Since fatigue is a major factor, the exercise plan for someone with MS must be flexible. People who nap after lunch could exercise in the morning. Late sleepers might prefer evening strolls. Wheelchair users might like aquatic therapy. People with MS should listen to their bodies. Richman explains, “When a person is very tired or in pain, exercise may be skipped for that day. Most of all, people with MS should consult a physician before embarking on a diet and exercise program. A condition unrelated to MS, such as a thyroid disorder, could cause weight change. A doctor, an occupational therapist, a physical therapist, a nutritionist, and the patient all need to be part of a team working together. ”
What Do I Eat?
Whether a person with MS needs to gain or lose weight, it’s important to eat healthful foods. Some healthy, balanced ideas for breakfast, lunch, dinner, and snacks – with recommended serving sizes – have been included in the following list. Be sure to eat larger portions if trying to gain weight. Please note that any changes to one’s diet and exercise regimen should only be made under the supervision of a qualified physician.
- A small apple with 8 ounces low-fat yogurt
- ½ cup low-fat cottage cheese with ½ banana
- A bowl of high-fiber cereal (at least 5 grams of fiber per serving) with soy/skim milk and a peach
- Whole-grain toast topped with 2 tbsp. peanut butter
- Scrambled egg white/egg substitute and 1 ounce low-fat cheese sautéed with tomatoes, mushrooms, and onions; and a pear
- Oatmeal (1/3 to ½ cup before cooking) with ¼ cup nuts and 1 cup berries
- A salad should contain many vegetables, a protein source like beans or chicken, and only a small amount of cheese
- A serving of low-fat yogurt increases protein
- A slice of whole-grain bread provides extra fiber
- Avoid ranch or blue cheese dressings, as they contain saturated fats. Use balsamic vinaigrette or Italian, which emphasize healthful fats
- An open-face sandwich cuts calories. Good toppings are tuna salad with fat free mayonnaise; low-fat cheese and vegetables; and sliced turkey or chicken
- Baked, grilled, or broiled salmon and chicken breast are good main dishes
- Add grilled chicken to whole-grain pasta with vegetables and sauce
- One-pot meals like stir-fried vegetables and tofu with brown rice make preparation easier
- Carrots dipped in 2 tbsp. hummus
- Part- skim string cheese stick with ¼ cup nuts
- Air-popped popcorn
- Fat-free pudding in individual serving containers
- Low-fat yogurt with one fruit serving