Multiple Sclerosis and Nutrition

Multiple sclerosis:

Multiple sclerosis (MS) is a chronic, inflammatory, and autoimmune disease of the central nervous system (CNS), leading to widespread focal degradation of the myelin sheath, variable axonal and neuronal injury, and disabilities in young adults, mostly women.


Two main forms of the disease:

  1. The relapsing-remitting MS (RRMS; about 85% of clinical cases)

  2. The primary-progressive MS (PPMS; about 15% of the clinical cases)


RRMS, which usually evolves in secondary-progressive MS (SPMS), relapses are associated with increased systemic inflammation and formation of lesions in the brain, followed by more or less complete remissions, whereas the pathogenesis of PPMS is characterized by progressive neurological damages rather than relapses and remissions.




Common Symptoms:

  • Fatigue

  • Muscle-related symptoms

  • Bowel and bladder symptoms: Frequent urination, urinary urgency or hesitancy, incontinence, constipation, and/or frequent urinary tract infections

  • Cognitive dysfunction

  • Depression

  • Sexual Dysfunction

  • Vision Problems

  • Vertigo

  • Pain and other sensory symptoms




Etiology:

Exact etiology Unknown.


MS has a multifactorial nature and various environmental factors or metabolic conditions may have a role in its development


Environmental factors

· Viral infections

· Heavy metal poisoning

· Smoking

· Childhood obesity

· Low vitamin D status

· Incorrect lifestyle, including wrong dietary habits


Other risk factors:

· Geographical distribution: MS is more prevalent in Western countries with the highest income and most distant of the equator. Features of these countries are sedentary lifestyle, high-calorie diet rich in saturated fats of animal origin (Western diet), and low sunshine exposure.

· Effect of migration: With the migration from an area of high incidence of MS to another place with low incidence before age of 15 years, the low risk is acquired, while the migration after this age does not change the level of risk. This aspect may be linked with nutritional, rather than with infectious or toxicological environmental factors.

· Low availability of vitamin D: availability of vitamin D. Patients with MS have a low content of vitamin

· Postprandial inflammation: High animal fat/high sugar and refined carbohydrate diet is associated with postprandial inflammation

· High body mass index: High body mass index (BMI) before age 20 is associated with increased risk. Note that BMI is correlated with gut microbiota status.

· Similarity with other inflammatory diseases related to wrong dietary habits: MS has some similarities with inflammatory bowel disease.



Multiple Sclerosis and Nutrition:

Dietary factors and lifestyle may exacerbate or ameliorate MS symptoms by modulating the inflammatory status of the disease both in relapsing-remitting MS and in primary-progressive MS


What increases inflammation are hypercaloric Western-style diets, characterized by high salt, animal fat, red meat, sugar-sweetened drinks, fried food, low fiber, and lack of physical exercise

A significant association between inflammation and neurodegeneration has been observed in the brain not only in acute and relapsing MS but also in the secondary and primary progressive MS


The components of the diet whose intake must be controlled to avoid the rise of inflammatory processes in MS, as well as in other chronic inflammatory diseases, are as follows:

  • Saturated fatty acids of animal origin;

  • Unsaturated fatty acids in the trans configuration (hydrogenated fatty acids);

  • Red meat;

  • Sweetened drinks, and in general hypercaloric diets rich in refined (low-fiber) carbohydrates, in addition to animal fat;

  • Increased dietary salt intake; 6. Cow’s milk proteins of the milk fat globule membrane (MFGM proteins).


Bioactive dietary molecules that are able to counteract the effects of pathogenic microbial agents and downregulate the expression of inflammatory molecules:

  • Polyphenols and carotenoids from vegetables

  • n-3 PUFA from fish

  • Vitamins D and A

  • Thiol compounds such as lipoic acid

  • Oligoelements such as selenium and magnesium


However, it is now known that dietary antioxidants have additional biological properties going far beyond the simple antioxidant activity. Indeed, they are able to counteract the negative effects of microbial agents and saturated or trans fatty acids, downregulating the expression of proinflammatory molecules, oxidative stress, and angiogenesis.



All polyphenols—which are present in vegetables, cereals, legumes, spices, herbs, fruits, wine, fruit juices, tea, and coffee—have anti-inflammatory, immune-modulatory, anti-angiogenic, and antiviral properties and stimulate the catabolic pathways


Other compounds and elements that may be useful as supplements in MS are the vitamins D, A, E, C, B12, and niacin, and oligoelements such as selenium and magnesium.





Some key points:


Ø Mediterranean diet is recommended in patients with MS (and not only)


Ø Vitamin D has immune-modulatory roles and represents the most promising dietary molecule for the treatment of chronic inflammatory diseases such as MS. A low vitamin D intake or low exposure to sunlight, its most important source, has been associated with a high risk of developing MS, as well as worsening of the disease and an increased risk of relapses


Ø n-3 PUFA inhibit inflammatory processes and the synthesis of fatty acids and cholesterol, and instead they stimulate the oxidation of fatty acids. On this basis, in chronic inflammatory diseases such as MS, n-3 essential fatty acids (EFA) and n-3 PUFA should prevail in the diet over the n-6 fatty acids. It is interesting to note that DHA is present in high concentrations in the brain and its levels decrease in patients with MS.


Ø Patients with MS showed improved muscle metabolism and resistance to fatigue during moderate exercise if they consumed green tea catechins


Ø There was no association between caffeine intake and MS risk


Ø The risk of MS in offspring may decrease if pregnant women consume 2 –3 glasses of milk/d (37), although a study by Munger et al. (39) concluded that the intake of whole milk, an important source of dietary vitamin D, was associated with an increased risk.


Ø MS is a possible cause of secondary osteoporosis, and these is a consensus in the literature that vitamin D supplementation may be useful for the prevention and treatment of this disorder



Diet and dietary supplements should not be treated as drugs and as a substitute of therapy. Similarly, proinflammatory food is not toxic and there is no need to exclude it completely. You can eat a nice steak or fried food without risk or guilt, if you are in a basically healthy condition. What hurts are the wrong eating habits in the long run


Multiple Sclerosis and Physical Activity:

Physical exercise is now an almost accepted practice also for MS patients and is commonly applied in order to decrease the symptoms of chronic fatigue and prevent or slow the onset of disability. However, the importance of physical exercise goes beyond that of simple muscle activity and should be rather considered in a holistic context in which diet, exercise, therapy, and social interchange, all play a role for the wellness of MS patients




References:

  • Riccio P, Rossano R. Nutrition facts in multiple sclerosis. ASN Neuro. 2015 Feb 18;7(1):1759091414568185. doi: 10.1177/1759091414568185. PMID: 25694551; PMCID: PMC4342365.

  • Pozuelo-Moyano B, Benito-León J. Dieta y esclerosis múltiple [Diet and multiple sclerosis]. Rev Neurol. 2014 May 16;58(10):455-64. Spanish. PMID: 24819942.

  • Bagur MJ, Murcia MA, Jiménez-Monreal AM, Tur JA, Bibiloni MM, Alonso GL, Martínez-Tomé M. Influence of Diet in Multiple Sclerosis: A Systematic Review. Adv Nutr. 2017 May 15;8(3):463-472. doi: 10.3945/an.116.014191. PMID: 28507011; PMCID: PMC5421121.



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