Nutrition in Multiple Sclerosis Disease
Multiple sclerosis (MS) is a chronic disease that affects the central nervous system and is thought to be autoimmune. Antibody production against myelin that protects nerve fibers is held responsible for Multiple Sclerosis disease. As a result, myelin destruction (demyelination) and axon damage occur. Multiple Sclerosis disease usually affects young adults and is one of the leading causes of disability in young adults. Its incidence is 2-200 / 100,000, although it varies according to geographical features. It is estimated that there are over 50,000 Multiple Sclerosis disease patients in our country. Common symptoms in MS are fatigue, visual disturbances, gait disturbances, balance disorders, muscle weakness, muscle tension or muscle spasms, forgetfulness, bladder and bowel problems.
There are 4 clinical types of MS, which are;
- MS with attacks (Relapsing-Remitting Multiple Sclerosis – RRMS): It is a type of MS in which complete or almost complete recovery is observed following acute attacks and no progress between attacks is observed.
- Secondary Progressive MS (SPMS): It is a type of secondary progressive MS with attacks and improvements, usually after a period of 5-6 years, the number of attacks and recovery decreases, and disability gradually increases.
- Progressive Relapsing MS: It is a clinical picture in which continuous clinical progress is observed from the beginning, although attacks are observed.
- Primary Progressive MS (PPMS): It is a type of MS that has a progressive course without improvement from the beginning of the disease.
Our main principle when diagnosing MS is to show the spread of the lesions in the CNS (Central Nervous System) and the clinical picture they cause in time and place, and to exclude alternative diseases with similar characteristics by clinical and/or examination methods. In some cases, diagnosis can be made easily with clinical and laboratory findings. But for some, it is not that easy. Diagnostic difficulties are experienced especially in the KiS period and in patients with atypical clinical features and MRI images. In such cases, the diagnosis is sometimes confirmed at the end of clinical and radiological follow-up. Since there are no pathognomic clinical or laboratory findings to make a definitive diagnosis of MS, studies have been carried out for years to establish diagnostic criteria and were revised with McDonald’s diagnostic criteria in 2017.
When making a diagnosis, auxiliary laboratory tests are definitely used. Cerebrospinal fluid (CSF) examination, Evoked potentials (VEP-SEP-BAEP) contribute to cases with suspicion of the diagnosis. Especially with the 2017 McDonald diagnosis criteria, the importance of BOS has been understood once again.
MS treatment; It can be classified as an attack, preventive and symptomatic treatment. Steroids are used in the treatment of attacks and plasmapheresis is used in severe attacks. Preventive treatment options have been increasing in recent years and are planned considering the patient’s clinic, attack frequency, attack severity, MRI findings, and many other factors. In symptomatic treatment, there are many different treatment methods and methods for the symptoms that occur as MS dependent, each problem should be evaluated separately and the most appropriate treatment modality should be determined for the patient.
Nutrition Principles in Multiple Sclerosis Disease
For the body to meet its own energy needs, it must maintain functions and receive a wide variety of nutrients. These are fats, carbohydrates, vitamins, minerals, vital elements. All nutrients need to be taken in sufficient quantities to be balanced. It is recommended that the nutrients we need be taken in sufficient quantities, being varied, neither too much nor too little, in a suitable combination. A balanced diet is essential.
It is necessary to eat as much as the body needs. You should take time to eat and foods should not be eaten without chewing.
You must finish 2 hours before going to bed. Dinner at 8 o’clock, snacks at 10 o’clock, and sleep at 12 o’clock.
Our daily calorie needs are as follows:
AGES MEN WOMEN
AGE 15-19 1820 Kcal 1460 Kcal
AGE 19-25 1820 Kcal 1390 Kcal
AGE 25-51 1740 Kcal 1340 Kcal
51-65 AGE 1580 Kcal 1270 Kcal
> 65 AGE 1410 Kcal 1170 Kcal
* Valid for Inactive People.
The effect of fat consumption has been studied for a long time. Fatty acids are the key to an anti-inflammatory diet. It has been suggested that immunomodulatory activity is the basis for the use of omega-3 and omega-6 fatty acids.
Saturated and unsaturated fatty acids are of great importance as an energy provider. These support the immune system and provide resistance to many diseases. Saturated fatty acids are found in large amounts in animal fats. It is known that unsaturated fatty acids greatly reduce the risk of coronary heart disease.
Linoleic acid, omega 3 and omega 6 fatty acids are essential fatty acids. Essential fatty acids are lowering blood fat and cholesterol. The important polyunsaturated fatty acids are omega 3 and omega 6 fatty acids. Linoleic acids are densely found in olive oil, soybean oil, linseed oil, hemp oil, and black seed oil, at a concentration close to 70 percent.
In general, omega 3 fatty acids should be taken sufficiently in the diet. The most excellent places to be found are fatty fish such as krill, salmon, and mackerel, which, unfortunately, do not have much in our diet. Omega 6 fatty acid sunflower oil is found in wheat germ oil and especially in vegetable diet margarine. Of particular importance in nutritional physiology is the proportion of omega 3 fatty acids and omega 6 fatty acids, rather than the amount. Omega 6 fatty acid intake should be reduced as much as possible.
Trans fatty acids: Trans fat is obtained by hardening vegetable oils. These are spread on the bread in its heated form. They are hand-shaped and durable. However, trans fats have toxic effects on the body and should not be consumed in any way. Artificial trans fats increase the risk of alesclerosis and cause an increase in heart and intestinal diseases. Mixed ready-made spices, chips, desserts made with trans fat, fast food should not be eaten. Some of the packaged foods contain high amounts of trans fat. You should read the label information of packaged foods carefully. You should prefer the ones that do not contain trans fat.
Polyunsaturated fatty acids have a positive effect on human health. Monounsaturated fats are abundant in products such as fish and nuts. Since vascular occlusion increases the risk of heart attack, trans fats should be completely removed from our kitchen.
What Are Antioxidants?
An antioxidant is the chemical component that selectively prevents the harmful oxidative products of other substances. As an antioxidant effect experiment, drop a lemon on a freshly peeled apple and the apple quickly turns brown, as the antioxidant vitamin C is present in the lemon. For this reason, various vegetables and fruits should be consumed regularly to provide the antioxidants necessary for the body. Unbalanced unilateral diet, nicotine, or alcohol consumption can increase oxidative stress.
Free radicals occurring in the body cannot be sufficiently caught by antioxidants and are converted into harmful oxygen radicals. Also, excessive intake of artificial antioxidants is harmful. Gallates are added to oils and margarine in production to preserve flavor and prevent staling. Also, today’s cosmetic products contain antioxidants. It is applied because it has a positive effect on the aging process of the skin.
The 5 most effective antioxidants:
- Trace elements
- Phytonutrients (also called bioactive herbal ingredients or phytochemicals)
Phyto foods are plant extract molecules found in fruits, vegetables, spices, nuts, and seeds that actively support human health. These molecules create the plants’ immune system by giving the plants their colors and aromas. A single fruit or vegetable can contain more than a hundred phytonutrients.
Free radical scavengers Vitamin A, Vitamin, C, Vitamin E, and β-carotene
Vitamin A, Vitamin C, Vitamin E, and β-carotene are important antioxidants that participate in the destruction of free radicals. These inhibit the conversion of the damaging inflammatory messengers to arachidonic acid. These vitamins are sufficient for healthy people on a balanced diet. In chronic inflammatory diseases such as multiple sclerosis, the need for Vitamins C, E and β-carotene may be higher, because free radicals increase during the inflammatory process. Thus, care should be taken to ensure that these vitamins are taken in sufficient quantities so that free radicals do not continue or perhaps trigger the inflammatory process. All components of the detoxification circuit can prevent inflammation only when taken in sufficient quantity. It should be known that these vitamins also support the drug therapy taken in a healthy diet. Food supplements should only be taken after the doctor’s recommendation.
β -carotene (Provitamin A) Vitamin A
Since β-carotene is one of the fat-soluble vitamins, it enters the body when taken with absolute fat. -carotene is found especially in yellow-orange vegetables and fruits.
Vitamin C (Ascorbic acid)
Vitamin C is important for the connective tissue, the immune system, and the structure of various hormones and collagen formation. It also increases the absorption of iron from the intestines. It protects against the attack of free radicals with its antioxidant effect. Vitamin C is found especially in the skins of fruits.
Vitamin E (Alpha-tocopherol)
Vitamin E is one of the important antioxidants in our body. In combination with Vitamin C, it is a highly effective oxygen radical hunter. Only vitamin C together with vitamin E becomes active. Vitamin E is found in plant seeds and oils and fats derived from it. Wheat germ oil sunflower oil, almond oil sunflower seed, hazelnut, canola oil}, peanuts, walnuts are abundantly found.
Vitamin B 12
Vitamin B 12 plays a key role in myelin formation and is essential in protecting nerve cells, as well as having an immunomodulatory effect. Vitamin B 12 deficiency can lead to impaired myelin production. This condition is associated with decreased immunomodulatory and neurotrophic activities. Fish, red meat, eggs, cheese, liver, spinach, and tomatoes contain plenty of vitamin B 12. Our daily need is at the level of 2400 ng.
Antioxidant consumption rules:
- Bio-grown foods are safe. Fresh fruits are better and cheaper.
- Foods should not be kept cut and crushed for a long time.
- Food should be bought and consumed as fresh as possible from the consumer.
- More attention should be paid to consuming organic foods.
- Food should be prepared as little as possible and heated slowly.
- Bad combination: Milk prevents antioxidants (especially Davonoids) from doing their antioxidant functions. Therefore, he should not drink tea or coffee with milk or take milk desserts with coffee. Even if you want to get the antioxidant in cocoa, you shouldn’t drink cocoa with milk. Milk chocolate takes the antioxidant in cocoa, instead, dark chocolate with plenty of cocoa should be consumed. There is a similar situation with yogurt, plain yogurt should be consumed instead of yogurt sauce on salads.
Tips for an antioxidant-rich diet:
- Choose plain milk or yogurt instead of fruit yogurt.
- Eat 1 apple (green or red) every day.
- Choose grapefruit instead of oranges, and fresh grapes instead of raisins.
- Instead of chips cookies, take sunflower seeds, chinchillas, walnuts, hazelnuts.
- Consume lemon tea, turmeric tea, licorice tea (only for those who do not have high blood pressure),
- Drink plain green tea or green tea with ginger
- Season your meals with turmeric and black pepper.
- Choose greens, consume foods such as green leafy vegetables and salads.
The Role of Nutrition in the Development of Multiple Sclerosis disease
Familial affinity in MS is seen in a small number of cases. Geographical location and diet are environmental factors that affect the incidence of MS. Epidemiological studies suggest that the prevalence of nutrition Multiple Sclerosis disease increases from the equator to the poles, and this may be related to vitamin D.
Vitamin D cholecalciferol is responsible for the regulation of calcium and phosphate balance in the body as well as the strength of the bone. There are two important vitamins D. One of them is herbal D2, the other is D3 which is animal. With the help of UV rays from the sun, the body produces it through the skin.
It is mostly found in fatty fish. Vitamin D deficiency can lead to bone resorption and painful bone fractures, most commonly due to calcium metabolism. Recent studies show that vitamin D is more important than ever thought. Vitamin D deficiency also appears to play an important role in the development of infections.
There is no activation reaction in vitamin D deficiency. The immune system is weakened. Vitamin D deficiency is associated with a 40 percent higher risk of even the common cold. The sun affects the formation of vitamin D. The body meets 90 percent of the daily need of 5 micrograms from sunlight through endogenous synthesis. Approximately 30-60 minutes of sunlight penetrating hands and face is sufficient for daily needs.
Vitamin D in the sun is not enough in the winter months. As a result, to keep the vitamin D level high, fatty fish should be consumed in the diet and sunlight should not be neglected.
Trace elements are found in very small amounts in our bodies. Some of them are vital to the body. Since our body cannot produce it by itself, take it regularly from food, drinking water, and respiration. In healthy people, trace elements adequately meet their daily needs through diet. There may be a greater need for this in immune-related diseases. But most of this need is met through a healthy diet. Food supplements are recommended in some cases. These preparations should only be taken with the approval of the physician as always, as some excess here may damage other trace elements. Trace elements such as copper, selenium, and zinc increase the effectiveness of antioxidant enzymes.
Copper: Especially found in whole grains, nuts, coffee, tea, cocoa, some green vegetables, fish, and shellfish.
Selenium: Especially found in fish, meat, eggs, grains, and nuts.
Zinc: It is mostly found in animal foods, cheese, meat, some fish types, especially shellfish, whole grains, and nuts.
Calcium: The leading causes of osteoporosis in Multiple Sclerosis disease are generally inactivity and inadequate exercise. During the illness, fatigue may become worse, and with the fear of imbalance and falling, the patient gradually loses his movement. One consequence of this can lead to bone fractures, as a result, the patient cannot be treated and rehabilitated.
Also, cortisone medication is taken in MS also causes calcium deficiency. Therefore, osteoporosis is more common in MS patients. About 1000 mg of calcium per day is sufficient for a person. Poppy, sesame, soybeans, flax seeds, cabbage, cocoa, beans, broccoli, milk, and dairy products are foods rich in calcium.
Which Diet Should and nutrition Multiple Sclerosis disease Have?
We see that many diets are widely used and strongly recommended in internet research for diets recommended for the treatment of MS.
For years, many diets such as the Swank diet and the Kousmine diet (low in animal fats and rich in polyunsaturated fatty acids) have been widely suggested. Allergen-free, gluten-free, sucrose-free and tobacco-free, raw food, pectin-free and fructose-restricted, Cambridge and other liquid-restricted diets and Hebener diets have been recommended. Evening primrose oil, fish oils, vitamins, minerals, cerebrosides, aloe vera, and “enzymes” and “mega ascorbic” treatments are also common.
Nutrition problems in patients with Multiple Sclerosis disease can cause the immune system to deteriorate. This in turn affects mental function, muscle strength and increases the risk of specific nutrient deficiencies, and this may increase the clinical symptoms of MS. Obesity and nutrition problems can also be seen in Multiple Sclerosis disease. Many factors cause overweight in patients, including inactivity, insufficient energy expenditure, steroids, antidepressants, and inactive daily life. On the other hand, obesity and unhealthy nutritional behavior may lead to complications such as pressure sores or thrombosis in bedridden patients and worsen the existing disability.
As a result, we recommend that our patients should definitely regulate their diets under the supervision of a dietician and doctor and replace the missing vitamin and mineral values accordingly. Nutrition is just as important as preventive treatments and physical rehabilitation that we use in the treatment of Multiple Sclerosis disease.