Every week there seems to be media coverage of a new piece of research, suggesting that what you eat or drink could make a difference to how your MS progresses. But diet is a hugely controversial topic in the MS world, partly because it’s so hard to do research. As two new large scale studies of diet begin in the US, we put some of your questions to Dr Conor Kerley, a registered dietitian who was diagnosed with MS when he was 16.
I’m considering improving my diet. Where should I start?
I’d recommend that people speak to a healthcare professional, like a local dietitian. The best place to start is to simply increase your fruits and vegetables because the evidence we have shows that fruits and vegetables are beneficial for your heart, your brain, your muscles, your bones and so on. I don’t think it’s very difficult to say, “let’s eat more fruits and vegetables”. I think a good rule of thumb is to try and include fruits and vegetables in every single meal. So you know, some berries with your breakfast, some salad on your lunch, some chopped vegetables with your dinner, something like that. It can be a simple thing to do. If someone’s already eating fruit and vegetables at each meal, try to increase it; so if someone is eating one portion at each meal, maybe aiming for 2–3 portions at each meal might be a good goal.
Is there a link between reduced iron intake and MS?
A recent study published found that children and teenagers who developed MS had consumed less iron in their diets - but this doesn’t mean there’s a straightforward link. Anybody who went on to develop MS and had a low iron intake might have had lots of other differences from those who did not develop MS. Iron is really important, particularly for our blood cells which help carry the oxygen which give us energy. If someone has a low iron intake, the first major issue is going to be a low energy problem. However, simply improving iron does not always help that energy issue. We need enough iron, but too much iron is not a good thing.
If you are concerned about your iron levels, it’s best to speak to a healthcare professional, preferably a dietitian, because there are small little things we can do to increase our iron absorption. For example, not having tea or coffee with meals.
Is there any proof that any dietary advice other than “eat a well-balanced diet” has any effect on MS?
This is a tricky question because in science we look at evidence and there’s lots of different types of scientific studies which provide different levels of scientific evidence. The gold standard is what we call a double-blind trial. This means that we have two different people in two different arms of the study – so the participant and the researcher – and neither of them know which treatment they’re getting. But obviously if I randomised someone to a gluten free diet versus a low fat diet, they’re going to know which diet they’re on. This has led a lot of doctors and scientists to say that research on particular diets isn’t reliable because it wasn’t done in this manner.
So proof is really hard to come by, particularly when we talk about a complicated illness such as MS. We do not have definitive proof but we certainly have studies which show how a certain diet can work which would make sense. Then we have small studies, which are not perfect, but all suggest that a diet low in saturated fats (found in butter, cheese and red meats), high in polyunsaturated fats (found in seeds, nuts and fatty fish like salmon, sardines and mackerel) and heavily based on fruits and vegetables – maybe with the addition of whole grains (oats and wholemeal bread) and legumes (chickpeas and lentils) – is going to be quite well balanced and perhaps beneficial for MS. Also, it does seem that sunlight and vitamin D are quite important as well as aspects like exercise, stress reduction, mindfulness and sleep.