Question: My mother was diagnosed with multiple sclerosis (MS) over 20 years ago.

 She is, of course, receiving official and regular treatment and taking the prescribed medications. A few years ago, while we were still receiving the association’s newsletter, she read an article about the harm of phosphates for MS patients.

I’d like to know:

1. Should MS patients avoid foods containing phosphates?
2. Does this apply to all types of phosphates?
3. To what extent should they avoid them?
4. Specifically, should iron supplements containing pyrophosphate be avoided?

Answer: Phosphate is a natural substance found in food but is also used in the food industry as an emulsifier, such as in sausages and processed meats, which are not recommended, especially for MS patients.

For MS, maintaining a healthy gut microbiome is crucial to prevent “leaky gut,” which can activate the immune system and trigger an autoimmune response. Phosphates in processed foods (e.g., sausages) are absorbed at 100% efficiency and negatively impact the digestive system and immune response. In short, avoid them as much as possible.

The amount of phosphate in supplements like iron is minimal, so there’s no need to avoid supplements containing phosphates.

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Question: Can I use pills or injections to lose weight? I’m currently taking Cipralex and Wellbutrin. What options are available?

Answer: For combining medications, consult your family doctor (who may consult a clinical dietitian). From what I know, many patients take weight-loss injections alongside Cipralex. I am not certain about Wellbutrin.

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Question: What foods are recommended, and which combinations should be avoided for MS patients?

Answer: Generally, recommended foods for MS patients include:

• A variety of vegetables
• Fruits (up to three per day)
• Proteins such as poultry, fish, tofu, legumes, eggs, and tuna
• Whole grains like brown rice, bulgur, quinoa, and whole-grain bread
• Healthy fats like nuts, almonds, and avocado

Avoid:

• Saturated fats (e.g., fatty cheeses or meats)
• Processed foods rich in sugar and salt

You can find a summary of dietary recommendations in the position paper linked here: https://shorturl.at/Yvug7

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Question: I’m 54 years old and have recently gained almost 10% of my body weight. I now weigh 66.5 kg, and my height is 166 cm. I cannot engage in high-intensity activities like walking, running, or cycling. I’m also experiencing menopause symptoms. My questions:

1. Are there any specific foods to avoid, aside from the obvious (e.g., processed, fried, or refined foods)?
2. Should I add certain foods to my diet?

Answer: During menopause, the body burns fewer calories daily (metabolism slows), so weight gain is expected. The solution is to adjust your diet to contain fewer calories overall. You are still within a healthy weight range. However, weight gained during menopause often accumulates around the abdomen, which is less healthy.

I recommend avoiding processed foods, sugar, and salt, as these contribute to weight gain. Instead, include:

• Calcium-rich foods like leafy greens, tahini (from whole sesame seeds), sardines, and calcium-enriched yogurt.
• Foods rich in phytoestrogens, such as soy, quinoa, rye, oats, and legumes, which may help alleviate menopause symptoms like hot flashes for some women.

Additionally, perform muscle-strengthening exercises you can do at home and ensure adequate protein intake to maintain muscle mass. Also, check your vitamin D levels.

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Question: Is there a specific diet for MS?

Answer: Yes, you can find a position paper with detailed nutritional guidelines here: https://shorturl.at/cqUsT

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Question: Are there foods known to be harmful?

Answer: Yes, harmful foods include:

• Foods high in saturated fats, such as fatty cheeses, fatty meats, and coconut oil
• Foods high in salt and sugar

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Question: When is it necessary to take dietary supplements?

Answer: Supplements are necessary in cases of deficiencies, such as:

• Vitamin D
• Vitamin B12
• Magnesium
• Calcium (if bone density is low)

A clinical dietitian can review your diet to determine if additional supplements are needed, as not all deficiencies are evident in blood tests.

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Question: I lack motivation for dieting. Are there appetite-suppressing pills I can take?

Answer: Yes, but it’s worth noting that many people struggle with motivation for dieting. The most effective weight-loss treatment today is injections, not pills. However, keep in mind that these injections are for chronic, lifelong use, and appetite returns if you stop them.

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Question: What is recommended for MS patients with progressive MS?

Answer: For progressive MS, it’s important to follow these principles:

• Ensure adequate protein intake to maintain muscle mass.
• Prevent comorbidities like diabetes and heart disease by maintaining a healthy weight and balanced diet.
• Follow an anti-inflammatory diet to reduce inflammatory markers in the body, including:
  • A variety of vegetables
  • Whole grains
  • Lean proteins like fish, poultry, legumes, and tofu
  • Healthy plant-based fats such as nuts, almonds, and avocado

It’s advisable to consult a dietitian to customize these recommendations to your preferences.

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Question: Should I avoid chicken, fish, dairy, all types of grains, or consume only organic eggs?

Answer:

• It’s not recommended to avoid chicken and fish, as they are excellent protein sources. Avoiding them could accelerate muscle loss.
• Regarding grains, the recommendation is to consume whole grains, which help balance blood sugar, support a healthy gut microbiome, and provide satiety.

There is no recommendation to switch to organic or free-range eggs based on current research on MS patients.