Nutrition And Diet In The Clinical Management Of Multiple Sclerosis

How Often Should The Assessment Of Dysphagia Be Repeated

Considering Diet in Multiple Sclerosis Treatment

Recommendation 7

During the first days of illness the CBA can be repeated in dysphagic stroke patients on a daily basis. If dysphagia persists, CBA can be carried out thereafter at least twice per week and before discharge . If the CBA is indicative of an improvement or a worsening of swallowing function an additional instrumental assessment can be considered .

Recommendation 8

If dysphagia persists after discharge, assessment can be done at least once per month for 6 months after stroke manifestation .

During the first two weeks after stroke a substantial improvement of dysphagia is seen in a high number of patients, in particular in those with supratentorial lesions . On the other hand, stroke recurrences, which are seen in 5 to 10% of patients within the first weeks , may cause a worsening of swallowing function. Therefore, a regular dysphagia assessment is necessary in acute stroke patients. From the therapeutical perspective, early initiation of swallowing rehabilitation is also indicated. Thus, Carnaby et al. have shown in their prospective randomised study, that early behavioural swallowing intervention was associated with a marked reduction of infectious complications and a significant increase of the proportion of patients regaining swallowing function .

Neurologylive: Generally What Do You Feel The Role Of Nutrition Is In People With Ms Especially In Those With Other Comorbidities

Mona Bostick, RDN, LDN, MSCS: Nutritionthe role that it plays in keeping people generally healthyis a very important thing, and that becomes particularly important in people living with multiple sclerosis. At this point, although there is no therapeutic diet that has been shown by science to directly impact the disease process itself, comorbidities are where nutrition can have an enormous impact. My presentation addressed the role of registered dietitians using nutrition interventions to treat and manage comorbid health conditions. There’s a lot of evidence that suggests that by managing those conditions well, we can improve the health outcomes of people with multiple sclerosis.

What Is The Wahls Protocol

The diet is a version of the Paleolithic diet. That’s based on the idea that humans should eat more like our ancient ancestors and avoid the foods we started eating in the past several hundred years, like wheat and processed foods.

On the Wahls Protocol, you eat lots of:

  • Vegetables, especially green, leafy ones
  • Brightly colored fruit, like berries
  • Fat from animal and plant sources, especially omega-3 fatty acids

But you don’t eat:

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What To Tell The Family

Although there is no known cure for MS, some evidence suggests that disease progression may be slowed if the saturated fat intake is less than 10 grams daily. Family members can assist the patient in reducing saturated fat and may improve their own health by following a similar diet. Limiting or avoiding animal products and tropical oils is usually necessary to reach this goal, and a dietitian can aid in following this diet regimen.

Boost Your Energy By Following A Healthy Diet

The Multiple Sclerosis Best Bet Diet

The majority of people with MS experience fatigue that can interfere with daily activities.

Some find that following a balanced diet helps increase their energy level. Generally speaking, this means eating sufficient calories but not too many! from a mix of lean proteins, whole-grain carbohydrate sources, and healthy fats .

For Jennifer and Dan Digmann, a married couple who live with and blog about MS, there isnt necessarily one food that gives them more energy. They concentrate on having an overall healthy diet fruits, vegetables, protein intake, and drinking more water for energy.

Nicole Lemelle, who was diagnosed with MS in 2000 and writes the blog My New Normals, uses wholesome foods to keep her going throughout the day. Egg whites, whole-grain breads and bagels, and cereal for breakfast help me sustain my morning potency until lunch, Lemelle says. I eat almonds and cashews as a snack when I need a boost between meals. Coffee also helps Nicole battle her fatigue.

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Dietary Patterns In Multiple Sclerosis

In considering the effects of macro or micronutrients and singular foods or food groups, it is important to note that these individual components are not ingested in isolation. Rather, the diet is comprised of many components ingested together as part of an overall program and there are likely significant interactions. Therefore, examination of the effects of global dietary patterns is extremely important.

Dietary Management In Multiple Sclerosis

Published online by Cambridge University Press: 28 February 2007

Nuffield Laboratories of Comparative Medicine, The Zoological Society of London, Regent’s Park, London NW1
P. Budowski
Nuffield Laboratories of Comparative Medicine, The Zoological Society of London, Regent’s Park, London NW1
A. G. Hassam

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When And How Should Nutritional Risk And Of Stroke Patients Be Assessed

Recommendation 10

All stroke patients should be screened for nutritional risk within the first days after hospital admission .

Recommendation 11

Stroke patients at nutritional risk and/or with dysphagia should be assessed more deeply .

Malnutrition is present in about 24% of stroke patients, with studies reporting prevalences between 8 and 48% depending on patient cohort and assessment technique . Causes for reduced food intake and subsequently impaired nutritional status are various and range from dysphagia to functional disability, impaired consciousness, perception deficits and cognitive dysfunction up to depression . As malnutrition is known to worsen the outcome of various patients groups , it should be screened for in stroke patients. The NRS 2002 is the most suitable screening tool for the acute situation of stroke patients, but other screening and assessment tools may as well be applicable .

Keep An Open Mind About Food

Ask an MS Expert: The Role of Nutrition in MS

Since medicine and nutrition are constantly evolving fields, its important to keep an open mind about what might help and what will never work.

At the same time, be wary of regimens or cures that sound too good to be true.

Because MS is so individualized, Lemelle cautions, a diet that helped someone else may not work for you. While there are general rules, which aid in good nutrition, there is no one-size-fits-all diet. Its best to consult your physician and registered dietitian when making a plan. They will base a regimen on your symptoms and your type of MS.

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Books Magazines And Other Publications

This article on diet, appearing in the flagship publication of the Multiple Sclerosis Foundation and written by Matt Cavallo, speaks frankly about the difficulties of changing your diet after an MS diagnosis. MS Focus is one of several of the foundations quarterly publications that can be mailed to your door for free. MS Focus also maintains a free lending library that includes lots of books on diet, as well as MS Focus Radio, which offers on-demand, audio-based discussions of MS research and other topics.

This seven-step recovery program was developed by George Jelinek, MD, after he was diagnosed with MS in 1999, and is based on the work of Roy Swank, MD, who started researching diet and MS in 1950. Step 1 is to adopt a plant-based diet that includes oily fish for the omega-3 fats they supply. In addition to presenting the key dietary recommendations, the website features a helpful What to Eat/Not to Eat guide, as well as a number of recipes to help you stick to the diet.

Additional reporting by Susan Jara, Laura McArdle, and Christina Vogt.

Which Kind Of Grading Should Be Provided By The Dysphagia Assessment

Recommendation 9

Dysphagia assessment cannot be restricted to categorically observing whether dysphagia is present or absent but can provide a graded evaluation of dysphagia severity. Dysphagia assessment can be directly linked to appropriate protective and rehabilitative measures and can systematically offer nutritional recommendations .

Grading dysphagia is the prerequisite for a differentiated dysphagia management covering both protective and rehabilitative measures. Apart from that, it offers a reliable initial finding allowing to determine changes of the patients swallowing ability during the further clinical course . Depending on the method of dysphagia assessment chosen there are different scales to be taken into consideration, for example the GUSS, or the FEDSS .

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When Should Nutrition Therapy Start In Stroke Patients With Swallowing Difficulties

Recommendation 14

Severe swallowing difficulties that do not allow sufficient oral food intake and are anticipated to persist for more than 1 week require early enteral nutrition via feeding tube .

From a practical point of view, it is not feasible to start tube feeding on the first day of treatment for most patients, especially in an uncertain situation with possible complications like cerebral hemorrhage or need of ventilation. On the other hand, an early start of enteral nutrition in acute disease does have several advantages: the barrier function of the gut mucosa is kept intact and bacterial translocation of gut-bacteria into the systemic blood flow is thus reduced, leading to less infectious complications with tube feeding compared to parenteral nutrition .

Clinical Nutrition: 6 Management Of Nutritional Problems Of Patients With Crohn’s Disease

Nutrition Facts in Multiple Sclerosis


Ms. C is a 40-year-old woman with Crohn’s disease involving the terminal ileum who complains of lower abdominal cramps and diarrhea after eating a normal meal. The pain starts within 30 minutes of the meal and is followed by 34 loose stools some 11/22 hours later. These symptoms, which began about 2 years ago, are associated with reduced appetite and weight loss. Over the past year, she has lost about 9 kg, including about 1 kg in the last 2 weeks. Her current weight is 52 kg and her height, 1.62 m. Apart from her weight loss, the patient has no signs of clinical wasting. She has not been taking medication that could have caused some of her symptoms. How would you assess and treat Ms. C’s nutritional problems?

    Table 1.

    This article describes a simple approach to assessing malnutrition in patients with Crohn’s disease, then enumerates useful strategies for managing these problems.

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    Nutritional Approaches In Multiple Sclerosis

    The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
    Recruitment Status : Active, not recruitingFirst Posted : April 25, 2018Last Update Posted : July 29, 2021
    • Study Details
    Condition or disease
    Behavioral: ketogenic dietBehavioral: Intermittent therapeutical fastingBehavioral: Active comparatorNot Applicable
    Layout table for study information

    Study Type :
    Nutritional Approaches in Multiple Sclerosis
    Actual Study Start Date :
    Patients receive a ketogenic diet, which is carbohydrate-reduced with a high amount of fat.
    Experimental: Intermittent therapeutical fasting Behavioral: Intermittent therapeutical fastingPatients fast for 1 week every six months. Additionally, the patients do an intermittent fasting, that is to say they do not eat for at least 14 hours a day.
    Active Comparator: Control groupThe control group is receiving a vegetarian-focused diet according to the current recommendations of the German Society for Nutrition for MS patients. Behavioral: Active comparatorThe control group is receiving a vegetarian-focused diet according to the current recommendations of the German Society for Nutrition for MS patients.

    Multiple Sclerosis Pathophysiology: Opportunities For Dietary Effects

    There are at least three overarching aspects of MS pathophysiology that represent opportunities for influence on disease outcomes. Interventions may modulate the inflammatory state, protect against neurodegeneration, or promote nervous system repair.

    The pathophysiology of MS is complex and incompletely understood . Supporting the hypothesis that MS is at least in part related to peripheral autoimmunity, genome-wide association studies have mapped MS risk to loci related to the immune system . MS was once considered strictly related to T cell dysregulation however, many components of the innate and adaptive immune systems have now been shown to be relevant to MS immunopathology . The complexity of MS pathophysiology is reflected by the myriad therapies approved for relapsing MS, each with a distinct immunomodulatory mechanism yet all effective at preventing clinical disease relapses and new lesions on MRI. Dietary factors that are able to promote regulatory as opposed to inflammatory immune cell differentiation and cytokine production therefore have the potential ability to reduce new inflammatory lesion formation and clinical relapses utilizing pathways similar to traditional disease-modifying therapies for MS.

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    Other Vitamins And Antioxidants

    Seven studies, all clinical trials, showed the influence of other vitamins and antioxidants . The studies sought a direct association between blood concentrations of these vitamins and MS or significant differences between the dietary intake of foods rich in vitamins and their use as a supplement for the clinical treatment of the disease. Two articles referred to vitamin A , 3 studies showed the effects of vitamin B-12 , and 1 studied the intake of vitamin-rich and antioxidant-rich foods . One article looked at the benefits of the coenzyme of -lipoic acid for its cytokine profile and its use as an antioxidant .

    Vitamin B-12 deficiency is associated with MS due to its role in the formation of the myelin sheath, in addition to its immunomodulatory effect . Several studies have shown that plasma concentrations of vitamin B-12 and folate decreased in patients with relapsing-remitting MS, but homocysteine concentrations increased significantly . Other authors claimed that there was no correlation between vitamin B-12 deficiency and the timing of the onset and duration of MS symptoms and the disability types generated .

    Do Patients With A Decreased Level Of Consciousness And Mechanically Ventilated Stroke Patients Profit From Tube Feeding

    Dietary Approaches to Treating Multiple Sclerosis Related Fatigue in 2021

    Recommendation 12

    Patients with a decreased level of consciousness and mechanical ventilation often require enteral nutrition for a longer period of time and tube feeding can therefore start early .

    There are no systematic trials investigating this issue. Since it is mandatory to artificially feed patients with a relevant decrease of consciousness, it only remains to be decided whether parenteral or enteral nutrition is superior. There are no systematic evaluations comparing parenteral and enteral nutrition in stroke patients. Based on data in other critical care patients, an advantage of tube feeding in stroke patients can be assumed but an influence on mortality has not yet been proven .

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    In What Kind Of Stroke Patients Can Tube Feeding Improve Prognosis

    Ten to thirty percent of all patients after acute stroke are tube fed during the initial phase. It is not yet clear which stroke patients will benefit from tube feeding. Stroke patients with a decreased level of consciousness, severe dysphagia or severe palsy are substantially handicapped in their food intake and are therefore at high risk for malnutrition and likely to benefit from tube feeding. The same is true for patients with severe pre-existing malnutrition.

    The second part of the FOOD-trial, including 859 stroke patients, demonstrated a tendency towards a reduced mortality in dysphagic stroke patients by 5.8% in the group with early tube feeding, initiated within seven days after stroke . It is a limitation of the study that patients were only included when the attending physician was unsure about the adequate nutrition therapy. Hence, patients with a clear indication for early tube feeding were not recruited. The results of this study indicate a potential benefit of an early initiation of tube feeding in such patients, but it remains unclear whether tube feeding may improve prognosis in stroke patients.

    Video And Multimedia Nutrition Resources

    This website project of the Consortium of MS Centers offers a number of videos created both for and by those living with MS. One of these videos features Allen Bowling, MD, PhD, of the University of Colorado Hospital, discussing the missed opportunity of not accounting for diet in treatment of MS and recommending some healthy diet choices. While youre there, check out the other videos posted on the website. They range from helpful to heartwarming, and all are worth watching.

    Aaron Boster, MD, is a neurologist and founder of the Boster Center for Multiple Sclerosis in Columbus, Ohio, but if you cant make it there to see him, his YouTube channel is regularly updated with videos on a wide range of topics related to MS. Dont miss his video on the best diet for MS, in which he reviews some of the American Heart Associations heart-healthy diet recommendations. Once youve finished, check out some of his other videos, including his live MS Q& A sessions.

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    How To Control Your Weight When You Have Ms

    The challenges posed by MS can make it tough to maintain a healthy weight.

    Some people with MS have trouble moving due to the condition or are depressed because of it, Gochnour says. Mobility challenges or mood disorders that make exercise difficult and reduce energy expenditure often lead to weight gain.

    Difficulty shopping and preparing meals may also lead a person with MS to rely more on processed, ready-to-eat foods or takeout, which are often high in calories, sodium, and fat, and low in nutritional value. So much so, in fact, that research published in the Journal of Clinical Neuroscience has suggested that malnutrition is not uncommon among those with MS.

    Still, people with MS can maintain a healthy weight and lose weight if necessary by controlling portion sizes and cutting down on junk food and eating out.

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