1. FATIGUE & DIET

2. Fatigue & Diet Role of the Dietitian An appropriate diet can help to maintain the nutritional status and health of people with M.S Dietary management in M.S should commence at diagnosis with an assessment of nutritional status and appropriate healthy eating advice. Follow-up assessments arranged as appropriate.

3. The role of food in managing your MS Not a cure but can help you manage your symptoms Aim to have a healthy balanced food and fluid intake

5. The Eatwell Plate Fruit and Vegetables –5 a day –Essential vitamins and fibre Starchy Carbohydrate Foods –Regular meals –Choose higher fibre sources Dairy and dairy alternatives –3 portions per day –If you are using non dairy choose calcium enriched products Meat, Fish, Beans –Choose lean cuts –Aim to have 2 portions of red meat per week and 1 portion of oily fish (unless vegetarian) Sugar and Fats –Source of essential fatty acids –Sugar provides empty calories

6. Causes of Fatigue Fatigue can be caused by numerous factors i.e. anaemia, infections …. Lack of exercise, sleep disturbances and anxiety may also contribute. With regard to dietary intake, it can be caused by dehydration, inadequate intake and eating disorders.

7. Factors to consider with Fatigue Eat a healthy balanced diet Drink adequate amounts of water Limit high fat and sugar foods Exercise gradually and steadily Set priorities and manage your time Reduce stress

8. Dietary intake Diet is crucial to overall health and eating a well balanced diet that provides an appropriate amount of macro and micro- nutrients is good advice for all. Your intake does not have to be restrictive, difficult or expensive.

9. Basic principles of eating for more energy Stock up on energy, dont limit your intake Ensure adequate protein intake Eat plenty of fruit and vegetables Reduce/Eat a low fat diet Drink plenty of water Resist the temptation to have sugary/fatty foods

10. FLUIDS Ensure you have an adequate fluid intake –8–12 cups per day –Reduce alcohol and caffeine – these are dehydrating and will increase your need to go to the toilet –Having enough fluid will help to keep your bowels functioning well and will help to prevent urine infections –More fluid doesnt always mean more trips to the toilet! –Being dehydrated may increase fatigue

11. Coping with Fatigue Keep a food diary of what and when you eat every day Take advantage of when your appetite is best Plenty of fluids See a dietitian Exercise as recommended

12. The Balance of Good Health Based on the 5 commonly accepted food groups Important to eat a variety from each of these groups Choosing different foods from within each group, provides a range of different nutrients

13. Carbohydrates Form the basis of your diet Important source of energy and B vitamins Include fibre rich foods Sources are: bread, potatoes, rice, pasta, cereals……..

14. Protein Important for growth and maintenance of body structure Aim for 2-3 portions a day Sources are: Meat, Poultry, Fish and alternatives Avoid fatty/processed meats

15. Dairy Products Important source of vitamins, minerals and protein These foods can be high in saturated fats and therefore choose low fat varieties Sources are: Milk, Cheese, Yoghurt Too little calcium can risk of osteoporosis

16. Fruit and Vegetables Provide vitamins and minerals (antioxidants) Increases fibre intake Aim for at least 5 portions a day Dont overcook these

17. Fats and Sugars Small amount of fat is important as it provides fat soluble vitamins 3 main sources of fat Saturated – animal products Poly-unsaturated – veg. oils/seeds Mono-unsaturated- olive oil, nuts Sugary foods are empty calories

18. Managing meals and fatigue Important to use your energy wisely Plan ahead Take frequent rests Cut out unnecessary tasks Organise space and materials to save energy Learn good postural habits

19. If too tired to eat a complete meal, eat in 2 stages or smaller and more frequent meals Rather than missing meals, worth using convenience foods from time to time or frequent snacks

20. Healthy snacks and convenience foods Fresh fruit is best Choose carbohydrate snacks i.e. crackers, rice, pasta, bread, cereal bar… Beware of processed foods, biscuits and cakes – high in fat Suitable ready-made meals are convenient e.g. – cottage pie, fish in sauce

21. Save energy in the kitchen Ensure good lighting and ventilation Use labour-saving gadgets Slide heavy items along work surface Line baking pans with foil to save on cleaning Soak pots and pans instead of scrubbing

22. Sit/Perch while preparing food Prepare double amount and freeze for later Prepare food early if tired at end of day Organise kitchen so utensils and ingredients are within easy reach Use internet shopping

23. Practical Tips Internet shopping Good kitchen layout Labour-saving devices e.g. Dishwasher Delegation ! Microwaves – less heat and heavy pans Ready prepared foods Practical equipment e.g. Jar openers, kettle tipper

24. Should vitamin and mineral supplements be taken? No evidence MS is result of nutritional deficiency Supplements cannot undo harm caused by unbalanced diet Overdosing of some supplements can be harmful Specific deficiency? Consult doctor or dietitian

25. Vitamin D Link between vitamin D and one of the genes associated with MS Emerging evidence that supplementing with vit D before birth or in early childhood may lower the risk of developing MS High doses can have adverse effects e.g. kidney stones, renal disease, hypercalcaemia Safe doses 1000 iu (25mcg) daily

26. Supplements Not required with a healthy balanced diet Beware of interactions with medications Avoid immune system stimulating supplements Weigh up benefits and risks carefully Use advice from safe sources e.g. MS Trust and Society

27. Exclusion diets e.g. Best Bet, gluten free, dairy free, Swank Little evidence to support exclusion diets Can result in dietary insufficiencies Often cost implications Can lack essential components of a healthy diet and exacerbate fatigue Often time consuming Unsociable Can be challenging and a constant reminder of MS

28. Reflecting on your diet…. What changes could you make to your diet? Are you getting the balance right? Are you taking 5? Are you getting enough calcium? Do you eat and drink regularly? Do you use energy saving techniques in the kitchen?

29. Any Questions?

30. References Enjoy good food, Gillian Reeves. MS Society, 1989. Enjoy Healthy Eating, Balance of Good Health. Food Standards Agency. Food as Medicine, Health 24-co-za. Coping with Fatigue. Cancer bacup.

31. Diet and Multiple sclerosis, Klaus Lauer. Neurology 1997,49(suppl 2):S55-S61. MS research in Nutritional Science, Current evidence for dietary factors in MS. Multiple Sclerosis Society. Multiple Sclerosis and Healthy Eating, Guidelines for a balanced diet.