Health and Wellness: Nutritional Tips for Individuals with MS

by Maryann B. Hunsberger

I wanted my family to eat more healthfully when my son was born, but I had no idea where to start. It began one day at a friend’s house. She offered me some sugar-free, caffeine-free soda. “If there’s no sugar or caffeine in it, what is in it?” I asked. Puzzled, she said that she had no idea. The next morning, I opened my cabinet to prepare breakfast and saw an assortment of cereals. I wondered whether eating cereal was a good way to start my day. Looking at lists full of ingredients that I couldn’t decipher didn’t help matters.

I wasn’t alone in my confusion. People know it’s better to eat broccoli than a candy bar, but what about all those gray areas in between the two? It’s even more complicated when a person has MS. Which foods are best to eat for optimal health?

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 types of foods and number of daily calories that are specifically appropriate for an individual.

What to Eat

According to Nancy Davis, a noted spokesperson on multiple sclerosis and the author of Lean on Me, a diet low in saturated fats and high in fiber is the foundation for a healthy eating plan. A good way to follow this plan is to eat fiber-packed fruit and vegetables. Fresh and frozen are best, but sodium-free canned vegetables and sugar-free canned fruit are also good. If canned produce without sodium and sugar isn’t available, rinsing canned produce in water is helpful. Whole fruit contains more fiber, less sugar, and fewer calories than fruit juice, so whole fruit is the better option.

Gillian Goodfriend is a registered dietician at the University of Illinois at Chicago (UIC)’s Department of Disability and Human Development. To begin a healthy diet, Goodfriend advises adding one or two more servings per day of fruit and vegetables. “Slowly work your way up to five to six servings each day. A large banana is two servings. Two cups of salad is two servings. Big Red Delicious apples count as two servings. Reaching your goal is more achievable when you think of it that way. ”

Beans, nuts and seeds are good sources of fiber and protein. Low sodium or salt-free varieties of nuts and seeds are best. One-quarter cup of nuts per day – or two tablespoons of peanut butter – should be a limit for people with weight problems, but others can choose to eat more. Adding one-half cup of canned beans to a salad or soup each day provides plenty of fiber. Having a cup of split pea, lentil, or bean soup with a meal; topping whole-grain toast with fat-free refried beans and salsa; or eating a soy burger are easy ways to incorporate beans.

What about the much-maligned carbohydrates? The carbs that affect health negatively are the simple ones, such as sugar, white flour, white rice, and white potatoes. “If something is white or sugary, the manufacturing process has done part of the digesting for you. The sugar goes into the bloodstream more quickly, so you get hungrier and it raises your blood sugar, ” Goodfriend explains. Davis recommends avoiding refined sugars altogether, since these simple carbohydrates slow down, rather than speed up, the recovery process in people with MS.

Complex carbs, on the other hand, are nutritious. Whole grains, such as brown rice, barley, 100-percent whole-wheat bread, and old-fashioned oatmeal, digest more slowly, don’t cause blood sugar surges, and have more vitamins and fiber. What if someone just can’t give up the occasional treat? “I’m not saying to never eat a cookie or a bagel. Just include whole-grain foods as much as you can, ” says Goodfriend. At least three whole-grain servings each day provide ample fiber and nutrients.

Three servings per day of fat-free or low-fat dairy products provide bone-strengthening calcium, whether an individual has a weight problem or not. Recommending low-fat cheese for thin people might seem odd, but even underweight individuals shouldn’t consume too much cholesterol-raising saturated fat from meats and full-fat dairy. “Saturated fat should not be the main source of your fat. It can lead to heart disease, ” states Goodfriend.

In his book, The Multiple Sclerosis Diet Book, Roy L. Swank, MD, PhD, recommends consuming no more than 15 grams of saturated fat per day. He advocates consuming dairy products with no more than one-percent fat.

Transfats, which raise bad cholesterol and lower good cholesterol, should be avoided. Goodfriend notes, “Transfats are a double whammy. Avoid these as much as possible; it’s important to read ingredients. The rule is, if a serving of food has less than 0.5 grams of transfats, the makers can put zero grams on the label, even though it still might have hydrogenated oil in the ingredients. ”

Margarine contains transfats, while butter contains saturated fats. Transfat-free spreads are a better choice. Goodfriend continues, “Spreads such as Benecol®, Smart Balance®, and Take Control® are great choices. The plant sterols and stanols in them work by blocking absorption of bad LDL cholesterol in the small intestine. Research has shown, however, that the amount of sterols and stanols needed to achieve this health benefit is usually more than people would consume. However, they are still a healthy choice. People need to monitor the serving sizes of these products if their goal is weight control, as these products are high in calories. ”

Other healthy fats are the ones that stay liquid at room temperature, such as olive oil and canola oil. About five to six teaspoons per day provide essential fatty acids. Weight-conscious individuals shouldn’t consume more than this. Avocados, olives, nuts, and seeds also provide healthful sources of fats. “These types of fats raise good cholesterol and lower bad cholesterol,” says Goodfriend. However, these foods are high in calories and sometimes sodium. Arthur Agatston, MD, author of The South Beach Diet, recommends not exceeding 15 olives and one-third avocado per day. Swank suggests limiting unsaturated fats to 20 to 50 grams per day.

Meats provide protein, but also contain saturated fats and cholesterol. This means avoiding fatty cuts of beef like brisket, prime rib, rib steaks, ground chuck, or chuck roast. Instead, Agatston recommends opting for lean cuts, such as round, sirloin, or flank steaks; extra lean ground beef; top loin; T-bone and tenderloin. Three to four ounces of lean meats at lunch and dinner – about the size of a fist – is a good amount to eat each day.

White-meat poultry contains less fat and cholesterol than dark meat, especially with the fatty skin removed. When eating ground poultry, the extra lean type made from breast meat, is best. Bacon, sausage, lunchmeat and hot dogs made from poultry are less fatty than beef and pork varieties, but still contain high amounts of sodium.

Loin and tenderloin are the lean cuts of pork. Pork tenderloin has roughly the same amount of saturated fats and cholesterol as skinless, white-meat chicken. Ham is generally lean, but high in sodium. Watch out for fatty cuts of pork, which are just as high in fat and cholesterol as the fattier beef products.

People watching cholesterol can eat egg whites or egg substitute in place of whole eggs. To make a lower-cholesterol egg salad, discard half of each yolk and use fat-free mayonnaise.

According to James Rimmer, a professor at the University of Illinois at Chicago’s Department of Disability and Human Development, and the director of the National Center on Physical Activity and Disability, people with MS can gain’water weight’ (when the body retains extra water) from steroids. Since sodium also contributes to water weight, lowering sodium intake is important – particularly if you are taking steroids and if recommended by your doctor. To reduce sodium intake, Rimmer advises to start by removing the salt shaker from the table. Sodium-free bouillon powder and spices are tasty alternatives to salt when cooking. Avoid hidden sources of sodium by rinsing canned vegetables or buying no-salt-added or low-sodium canned vegetables, soups, broths, pasta sauces, and cheeses.

Since bowel dysfunctions are common in people with MS, Rimmer points out that consuming adequate fiber and fluids is important. How much fluid is enough? In his book, Managing the Symptoms of Multiple Sclerosis, Randall T. Schapiro, MD, states, “Many experts have advocated drinking eight glasses of water a day, but there is no magic number. Drinking enough to satisfy thirst and prevent dehydration, along with preventing constipation, is necessary and may differ from person to person. ” Schapiro says the important thing is to drink more water and minimize sugary drinks such as soda.

In addition to sugary drinks, minimizing drinks with caffeine may also be a good idea. Caffeine can affect hydration, which can play a role in other symptoms as well. Goodfriend stresses the benefit of avoiding caffeine. She notes, “Caffeine is a diuretic that can cause dehydration, and the aftereffect is that it can make fatigue from MS worse. ”

How to Shop

The perimeter of a grocery store – the areas along the four walls – is where stores keep fresh fruits, vegetables, low-fat and fat-free dairy products, and lean meats. Stick to the perimeter as much as possible to avoid junk food in the aisles. But you can’t get everything you need along the perimeter, and buying nuts, seeds, beans, oils, and frozen vegetables means venturing into that dangerous territory. Therefore, it’s best to shop when not hungry and tempted to buy a quick hunger fix.

When buying canned, frozen, or other processed foods, shoppers should learn to read the nutritional and ingredient labels. The healthiest products are those with recognizable foods listed. If a package of chicken breasts lists “chicken breasts, chicken broth, water, and salt” as the ingredients, it’s a better bet than a package that needs a chemist to translate the ingredients.

Will My Family Eat Healthfully?

Nobody wants to cook two meals for picky family members, especially when disability makes meal preparation difficult. If the kids don’t like vegetables, you can “hide” them in other foods. Ideas include:

• Make a pot of chicken soup chock full of vegetables, beans and brown rice. Mix vegetables in a blender and add back to the pot.
• Add tomatoes, bell peppers, and low-fat cheese to an omelet.
• Add shredded carrots and zucchini to meatloaf or meatballs.

You can also make healthier versions of family favorites:

• Use whole grain pasta, low-fat cheese, and fat-free milk to make macaroni and cheese.
• Buy boneless chicken tenderloins and bread them with seasoned whole wheat bread crumbs for healthier chicken fingers.
• Cut potatoes in the shape of fries, then toss with olive oil, sprinkle with seasonings and bake.

Buying healthier snacks for the whole family is also achievable. Instead of potato chips and candy, purchase popcorn, fruit, carrot sticks, yogurt, fat-free pudding packs, nuts and seeds, part-skim string cheese sticks, low-fat turkey pepperoni, baked tortilla chips, and whole-grain crackers.

Making Healthful Eating Easier for People with MS

Leftovers are a lifesaver for people who have difficulty cooking. Making an extra serving of dinner to eat for lunch the next day saves time and energy. I always double the amount of side dishes I prepare, so they will last for two days. That way, I only have to prepare a main dish on in-between days.

Some people cook only on weekends. Portioning a large pot of soup, stew, or chili into individual containers and freezing for the week can yield seven days’ worth of lunches. Baking a quiche can provide breakfast for five days. Using different cooking methods means two to three main courses can cook at once. While a large meatloaf is baking in the oven, a chicken can spin on the rotisserie and chili can simmer in the slow cooker, providing three main courses for the week.

The person who prefers to cook each day can add broiled chicken breast strips to a large salad for an easy meal. A can of black beans, a package of Success ® brown rice, and a package of frozen green beans is an easy vegetarian meal. Salmon cooked on the grill, coupled with frozen broccoli and a salad makes a quick, healthy dinner. Pork loin chops baked in the same roasting pan with fresh mushrooms and carrots is easy to do.

Changes need not be immediate or overwhelming. I needed two years to change my family’s eating habits. According to Davis, eating even small amounts of fruits and vegetables at each meal will have beneficial effects.

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HEALTHY RECIPES

Hearty, healthy meals use wholesome ingredients. Three of my favorite recipes follow. They incorporate foods that the experts say are best.

Breakfast
Whole-Grain Breakfast
1 slice whole-grain bread
1 thick tomato slice
1/4 tsp. oregano
1 slice fat-free or low-fat cheese

Toast bread. Top with tomato, oregano, and cheese. Place in broiler until cheese lightly browns. Serve with a piece of fruit.

Lunch
Split-Pea Soup with Spinach
1 bag split-green peas
2 onions, diced
2 cups carrots, diced
4 stalks celery, diced
1 box frozen chopped spinach (defrosted, drained, and dried)
1 can sodium-free diced tomatoes
5 tsp. sodium-free chicken bouillon powder
7 cups water
3 cups vegetable or low-fat chicken broth
1/2 tsp. each thyme and basil
1/4 tsp. red pepper flakes
1 tsp. Liquid Smoke

Add all ingredients to a large soup pot. Bring to a boil. Lower heat to a simmer and cover pot. Cook for one hour. Serve with salad. Freeze leftovers in individual containers.

Dinner
Garlic-Lime Chicken
4 boneless, skinless chicken breasts
2 Tbsp. olive oil
1/4 tsp. each black pepper, thyme, and parsley
1/8 tsp. each paprika and onion powder
2 tsp. garlic powder
3 Tbsp. limejuice

In a small bowl, mix spices together. Sprinkle spice mixture on both sides of chicken breasts. Heat olive oil in a skillet. Saut é chicken until golden brown, about six minutes on each side. Sprinkle with lime juice. Cook five minutes, stirring frequently to coat evenly with sauce. Serve with broccoli and brown rice.

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HEALTHY CHOICES

A Quick List of Foods to Maximize, Minimize, and Avoid

To learn more about recommended daily allowances of each food group, go to the following website: choosemyplate.gov.

[Copy and link updated by MSAA 2/2020]
[Editor’s note: Before making any changes to one’s diet, readers are strongly urged to consult their physician.]

Generally speaking, the following foods may be “maximized” for healthier eating:

• Vegetables
• Whole fruit
• Whole-grain products
• Beans
• Low-fat or fat-free milk, yogurt, or cheese
• Skinless white meat chicken or turkey
• Fish
• Egg whites or egg substitute
• Olive or canola oil

Generally speaking, the following foods should be “minimized” for healthier eating:

• Fatty meats
• Processed pastries
• White flour products
• Foods high in sodium or sugar
• Empty calorie foods like chips and soda
• Alcohol
• Caffeine
• Full sodium canned soups

Which foods are best to avoid?

• Foods containing hydrogenated oils (which become transfats)
• Foods containing high-fructose corn syrup

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