The role of diet and lifestyle in managing multiple sclerosis

While there’s currently no cure for multiple sclerosis, a lot of new treatment options have become available—many in just the last few years. There are pills and capsules taken daily or even a few times a year, injections you can give yourself at home or intravenous infusions given monthly or biannually.

These therapies can reduce relapses, prevent permanent damage and manage symptoms. But along with medical treatment, simple diet and lifestyle changes can improve symptoms and help slow the progression of MS for many patients.

MS is an inflammatory autoimmune disease of the central nervous system, and managing it can get more complicated if you have other conditions, like diabetes, hypertension, heart disease or chronic obstructive pulmonary disease. These issues can also cause MS to progress more quickly, leading to disabilities.

Taking steps to reduce inflammation and control other conditions can make a big difference in managing MS. That’s where making healthy changes in your life can help.

Adrienne Castillo, an advanced practice registered nurse at the Rush Multiple Sclerosis Brain Health Center, educates MS patients on how they can improve their brain health and helps them manage their condition.

“Together, patients and I identify areas they’re motivated to change,” she says. “We make smart goals and develop individualized treatment plans.”

Along with treatment, understanding how diet, exercise and other lifestyle changes affect MS can empower you to take positive steps that will improve your health.

What are the best diets for someone with MS?

Diet can play a big role in both reducing inflammation in your body and keeping other conditions that affect MS under control.

“The best foods to include in a diet for managing MS symptoms are those in the MIND diet,” Castillo says. “These are healthy, non-inflammatory foods that keep inflammation at bay.”

MIND stands for “Mediterranean-DASH Intervention for Neurodegenerative Delay,” and the diet combines elements of the popular Mediterranean diet and the DASH diet, which aims to manage high blood pressure.

Research suggests that the MIND diet, developed at Rush, protects brain tissue from further damage in people with MS. It is scientifically proven to have positive effects on brain health and may improve cognition.

According to the MIND diet, the best foods to include in a diet for managing MS symptoms are the following:

• Green, leafy vegetables
• Other vegetables, such as zucchini, cauliflower and bell peppers
• Nuts
• Berries
• Beans and legumes
• Whole grains
• Fish (not fried)
• White meat poultry (skinless and not fried)
• Avocado
• Extra virgin olive oil

The MIND diet calls for mostly plant-based meals with five to six servings of fruit and vegetables per day. These are also good sources of fiber, which promotes gut health.

The diet also suggests sticking to unsaturated fats. These are the “healthy” fats that are anti-inflammatory, such as extra virgin olive oil and avocado. Dairy should only be eaten in careful moderation.

Because the MIND diet can help improve gut health and lower blood pressure, it has the added benefit of helping control other conditions that influence the management of MS, like hypertension, diabetes and heart disease.

“While diet will not cure MS, it can make a significant difference in how well you are doing on a day-to-day basis,” Castillo says.

On the other hand, foods that cause inflammation or worsen other conditions should be avoided.

If you have MS, Castillo says you should limit or avoid the following foods:

• Red or fatty meat
• Butter and stick margarine
• Whole fat cheese
• Saturated fats
• Added sugars
• Salt
• Fried foods
• Highly processed foods
• Pastries, candies and sweets

Other than the MIND diet, are there any other popular diets that will help with MS? Unfortunately, for many trendy diets, there is no research that focuses on the potential benefits for MS patients.

Diets with no scientific backing for improving MS include ketogenic diets and intermittent fasting. It’s possible that these diets could help with weight loss or with managing other conditions that affect MS, but more research needs to be done to determine how they influence MS patients.

What are the best exercises and routines for someone with MS?

Like diet, exercise will not cure MS. But it will benefit people with the disease in several ways.

“Exercise can provide important improvements in walking, balance, cognition, fatigue, depression and quality of life for people with MS,” Castillo says. “There is some evidence of more extensive benefits, including effects on disease pathophysiology and brain structure and function.”

For adults with MS who have mild to moderate symptoms or disability, Castillo recommends starting off by doing the following:

• Moderate-intensity aerobic activity for 10–30 minutes, two times per week. Some suggestions include upper body exercises, such as arm cycling, lower body exercises, such as leg cycling, or combined upper and lower body exercises, such as using an elliptical trainer. Other types of exercise that may bring benefits include water aerobics, dancing, yoga and calisthenics.
• Strength training exercises for major muscle groups two times per week. Try to do 10–15 repetitions, or one set, of each exercise. Gradually work up to doing two sets of each exercise. Use free weights, weight machines, elastic resistance bands or your own body weight.

Once you are comfortable doing so, you should add more moderate aerobic activity to your routine. “A good goal is to reach 150 minutes per week of moderate intensity aerobic exercise,” Castillo says.

Make sure to choose activities that you can do safely. If you have bad knees or hips, for example, you may want to choose a lower-impact exercise like swimming or riding a stationary bike over running or dancing.

What other lifestyle changes can benefit someone with MS?

Beyond diet and exercise, other habits and routines, like those around stress and sleep, can affect MS symptoms.

“Often, people living with MS say that their symptoms increase with stress,” Castillo says. “Increasing stress resiliency is something that can help manage stress.”

If you’re living with MS, Castillo recommends reframing the way you view stressful situations and practicing mindfulness. Some of her stress management tips include the following:

• Adopt an attitude of gratitude. This means consciously expressing thanks for the good things in your life that you may sometimes take for granted. They can be small, like having running water in your home, or large, like having great relationships. This will help you focus on the positive rather than dwelling on the stressful.
• Treat each problem as a learning process. Think of how much you’ve learned by solving or coping with problems in the past. Perhaps you had the opportunity to try something new or broaden your perspective. Maybe the problem you encounter now could be a chance to gain wisdom, empathy or new skills.
• Nurture a positive view of yourself. Avoid comparing yourself to others, and grant yourself patience and kindness. Try to eliminate negative self-talk. Instead, do some positive affirmations. Notice the things you like about yourself. Set achievable goals, and celebrate yourself when you reach them, whether they are big or small.
• Find a healthy go-to stress management technique. Castillo suggests putting your hand over your heart and taking three slow, deep breaths when stress starts to overwhelm you. You can also try a few moments of mindful meditation, getting some fresh air outside or doing some light exercise. Stick to whatever works for you.

Castillo also recommends paying attention to your sleep habits.

“The long-term effects of sleep deprivation are significant,” she says. “It can impair a person’s mental ability, lower their quality of life and may place their physical health at risk.”

People 17 or older need about seven to nine hours of sleep per day.

Tips Castillo recommends for MS patients to improve their sleep habits include the following:

• Put down screens at least 90 minutes before bedtime.
• Exercise daily.
• Control caffeine intake.
• Reduce or avoid alcohol consumption.
• Avoid nicotine.
• Sleep when you need to, even if that means an early bedtime.
• Get comfortable. Try setting the thermostat to a cooler temperature.

“Getting a good night’s sleep is one of the most important things people can do for their overall health and well-being,” Castillo says.