Diet can be a ‘proactive’ way to engage patients with MS in their long-term care

SAN DIEGO — Physicians should emphasize the importance of diet and lifestyle change in patients with MS and consider home environment, cultural challenges and other factors when making recommendations, a presenter noted at ACTRIMS 2023.

“There’s a sense among people diagnosed with MS of a loss of control over one’s body,” Ilana B. Katz Sand, MD, associate professor of neurology at the Icahn School of Medicine at Mount Sinai, told attendees. “But this is something people who are living with this disease can do for themselves to be proactive.”

People with MS want evidence-based answers to questions relating to disease progression and nonpharmaceutical solutions that complement traditional disease-modifying therapies, Katz Sand said. Clinicians should recognize that environmental factors, such as diet, play an important role in disease outcomes, and should advocate for resources to help their patients.

It is important for those with MS to take an active role in their diet since indirect effects like obesity, cholesterol levels and other vascular risk factors, as well as direct effects such as metabolism and health gut microbiota, can influence disease course, she noted.

According to Katz Sand, several dietary patterns, including low saturated fat, plant-based, low fat, caloric restriction/intermittent fasting, modified paleolithic, ketogenic and Mediterranean diets, are being investigated for their efficacy in boosting overall health.

Katz Sand singled out the Mediterranean diet, as evidence of its health benefits is well-established and hard data supports its beneficial effects on cognitive aging. Plus, she said, long-term adherence is feasible due to its budget-friendly nature, possibility for whole household involvement and benefit as a lifestyle change, rather than just a dietary modification.

Katz Sand made several practical recommendations for patients with MS and their families, including preparing meals at home, adding fruits and vegetables on a daily basis, selecting whole grains over refined grains, and avoiding processed foods and added sugars when possible. She added that a nurse practitioner or other dietary-trained clinician could aid the process if a patient does not have access to a dietitian.

Physicians should remember to start small and offer constructive feedback and positive reinforcement, emphasizing the idea of a lifestyle change, she noted.

“It’s really important to consider the home environment when doing this type of counseling, thinking about other people who live at home, time and space restrictions, access to grocery stores and fresh foods — that is a huge issue,” Katz Sand said. “A lot of our patients live in areas that are food deserts, and we have to think creatively of ways we can support them. It’s important to recognize cultural and community challenges.”