Multiple sclerosis and diet

Multiple sclerosis (or plaque sclerosis) is a demyelinating neurological disease, that is, it causes the loss of white matter (myelin) from the brain and spinal cord. Neurons are the basic cells of the central nervous system (brain and spinal cord) and are characterized by having a body that is usually triangular in shape that is continued by a more or less long cylinder called an axon through which nerve impulses travel, that is, , the information that allows us to think, retrieve memories, move a limb, speak ... The axons are surrounded by a fatty layer called myelin sheath or simply myelin, which greatly facilitates the transmission of that information. Demyelination is the loss of the myelin sheath with relative conservation of the axons. Morphologically, this disease forms lesions ("plaques") of hardened tissue ("sclerosis"), visible as spots on brain computed tomography (CT) and magnetic resonance imaging. Involvement of myelin causes nerve communication to be delayed or interrupted. Plaques are usually multiple and can appear anywhere in the central nervous system ("multiple").

The cause of multiple sclerosis is not well known; there appears to be an attack by the myelin antibodies. It has been speculated that some unknown environmental factor could trigger the process of formation of antibodies against myelin in susceptible individuals. It is known that the risk of suffering from multiple sclerosis appears to be higher in individuals who are underweight for their height and in individuals who consume high energy in the form of animal fats (saturated fats).

Most cases appear between 20 and 40 years of age, affecting more women.

• Eye problems: double vision, blurred vision, uncontrolled eye movements, which may be accompanied by pain behind the eyes.
• Difficulty articulating words.
• Tremors
• Loss of strength and gait and coordination abnormalities, with difficulty walking, inability to maintain balance and coordination, shuffling, etc.
• Loss of sensation (tingling, pricking, cramping) located in any part of the body.
• pain in the face and painful tics or spasms.
• Loss of control to urinate or defecate.

These symptoms (all or some) appear in the form of "flare-ups" and then disappear totally or partially. Outbreaks usually last several weeks. Neurological symptoms can worsen with fatigue, stress, physical exercise, and heat. However, these outbreaks can be repeated over time; although years can pass between one outbreak and another. Other times, the flare-ups do not go away or only improve slightly and the initial neurological symptoms (as a consequence of new flare-ups) progress over the years, producing physical disability (physical sequelae), emotional disturbances, intellectual impairment, and memory and concentration problems.

However, there are asymptomatic forms of multiple sclerosis. These are patients who have never presented neurological symptoms but when performing a brain CT or MRI for another reason, plaques are discovered, or, when doing the autopsy, demyelinating lesions are found in the central nervous system.

Multiple sclerosis is a chronic disease that can become disabling and cause difficulties in eating. Nutritional treatment, in these cases, and from the first moments after diagnosis, is very important. The nutritional recommendations are as follows:

• Reduce the amount of fats of animal origin (red meat, sausages and cold cuts) as well as whole dairy products. Skimmed milk and white cheeses are advisable.
• Remove all apparent fat (sebum from meats) and skin before cooking meats and poultry.
• Use techniques such as steaming or microwave cooking, which reduce the fat content of food.
• Animal fats will be replaced by vegetable oils (olive oil, sunflower oil, etc.) and fish (two or three servings of fish a week at least).
• Consume at least two pieces of fruit and two servings of vegetables (one raw and the other cooked) daily.
• Increase your intake of legumes, cereals, bread, pasta, and brown rice.
• You can consume up to two eggs per week.
• Alcoholic beverages aggravate fatigue, weakness or balance disorders, so it is recommended not to drink alcoholic beverages. Alcohol can be substituted for water, natural fruit juices and herbal teas.

In advanced phases of the disease, with physical difficulties in using cutlery or with problems swallowing solid or liquid food, the help from the nutritional point of view includes the following recommendations:

• Cut into small pieces or shred the food.
• Use thickeners with liquids. Pharmaceutical thickeners, gelatins, or cornmeal can be used.
• Administer foods in pureed or porridge texture.
• Soften solid foods by adding liquids (milk, broth, sauces) to achieve smooth textures.
• Modify the way you eat: eat small amounts of food at one time, chew well and slowly, and allow enough time for swallowing; do not add food in the mouth, without having swallowed the above.
• Avoid sticky foods and those that spread through the mouth, such as cookies.
• Do not speak while eating or drinking.
• Adapt the house by eliminating obstacles and adapting it as the patient's disability evolves.
• The adapted cutlery, plastic cups and plates, bibs or large napkins can be used.
• Prepare diets to eat with your hands, such as croquettes, meatballs or squid a la romana.

In addition to these nutritional tips, the patient should be advised to follow a regular meal schedule, maintain social activities, and have a regular night's rest.