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The Mediterranean diet is the most well researched and highest ranking of all the dietary patterns and the Overcoming Ms. Diet is very similar and the research for people with Ms. Is, is consistent with the growing consensus on the importance of diet on brain health for everyone. And this rise in the Western diet is going alongside the rise in chronic health conditions as I've mentioned, including other neurodegenerative diseases like Alzheimer's, dementia and Parkinson's disease, and increasing levels of depression and other mental health problems in the general population.

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Welcome to Living well With Ms. This show comes to you from Overcoming ms, the world's leading multiple sclerosis healthy lifestyle charity which helps people live a full and healthy life. Through the Overcoming Ms. Program, we interview a range of experts and people with multiple sclerosis. Please remember, all opinions expressed are their own. Receive monthly tips and ideas about Living well with Ms. By signing up for our newsletter@overcomingms.org Newsletter and now let's meet our guest.

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My name is Karen Lee, I'm an Overcoming Ms. Programme facilitator, also a nutritionist and I'm joining you this evening from Mid Devon in the uk. We're going to be discussing the Overcoming Ms. Diet. We're going to be joined by community member, cookbook author and program facilitator Ingrid Adelsberger who will be sharing her experience of the diet pillar. I was diagnosed with relapsing Ms. Back in 2016. At the time I was working as intensive care nurse. Very soon after that retired from that work workplace. But I was already a qualified nutritionist and working as my alter ego which is a sensitive foodie. So I teach people about eating whole food, plant based diets, I create recipes and I'm an author as well. Before we go into the diet in detail, I just want to give you a little overview of the Overcoming Ms. Program as a whole. And as I'm sure you know that Ms. Is influenced by a mix of genetic and environmental factors and there's not just one gene involved here. The Ms. Trust state that there's over 200 genes have been recognised as influencing the risk of the onset of Ms. And it does. The risk does increase slightly if it's already in the family. But as genes take time to change and the number of people with Ms. Continues to increase, it's known that environmental factors seem to have a bigger influence and it's things like smoking, low vitamin D, stress, lack of exercise, poor diet. All of these lifestyle factors do increase the risk of Ms. As well as other chronic health conditions like heart disease. And we know that other chronic health issues also increase the risk of developing Ms. In the first place. And they also fuel disability and disease progression. And this is where the Overcoming Ms. Program really comes in. It's a research backed lifestyle modifications that can turn or can transform these negative environmental influences into positive ones. So I won't go into diet now because obviously we're going to be covering it in a moment but getting out in the sun and supplementing with vitamin D is, is important and we, we recommended to aim to keep our blood levels between 100 to 150 nanomoles per liter and that's in the UK, physical activity. So this includes basically moving in whatever way you enjoy and works for you. So the standard guidelines for exercise is to get 150 minutes per week. That can obviously be broken down into lots of different sessions. So it could include cardio if you like, so swimming or running, it could be working out at the gym, doing some resistant exercises, Pilates. It could also be chasing after the children or grandchildren, walking the dog, gardening. It's basically making sure that we keep moving. Stress management Stress has a major impact on Ms. And we recommend a daily mindfulness practice, ideally for 30 minutes medication. This includes disease modifying therapies if you choose to take them, but also other medications like it could be some painkillers or supplements that you choose to take. And family health is all about encouraging your siblings or your children to stay as healthy as possible to reduce, reduce their risk of developing Ms. So this includes encouraging them to take supplement with vitamin D or get outside and to eat healthily, to exercise and to manage their stress as well. And then the change your life for life pillar. Well this is probably the most important one really because Ms. Is a, is a condition that is with us for life and therefore the actions that we take need to be new habits and a changed mindset that enable us to live well even though we've got Ms. So what we eat is important for everyone, not just for people with Ms. And the old saying, you are what you eat is actors. We are literally made from the compounds taken from the food that we eat. When it comes to health, it's not over dramatic to say that every meal can either heal or harm. The rise in the western diet eating pattern over the last 80 years has coincided with a huge increase in chronic health conditions and obesity. You know, it's not just ms, it's affecting. The western diet is formed of cheap, low quality products which are high in saturated fats and refined sugars, high in animal products, low in fibre and low in fresh fruit and vegetables. And a poor quality diet fuels inflammation and cell degeneration, which are the underlying processes in Ms. And all chronic health conditions. So eating food that supports the body to stay well is now an important part of disease management. And how do we know that? Let's look at the research. So these two studies highlight that diet quality is key. Now, they don't recommend one specific dietary pattern, but quality is defined as one that's high in fruit, vegetables, whole grains and healthy fats, low in saturated fat, fine foods and red and processed meat. And both these studies conclude that diet can improve outcomes for people with ms, whether or not it's lessening disability and symptom burden, or reducing fatigue and increasing quality of life. All of which I think you'll probably agree are important things. And if you've been told there's no evidence that diet impacts MS, then remember this paper from 2023 that concludes that there really is sufficient evidence and it should be recommended as part of a disease management program. And getting the right support is key. And one of the wonderful things about the Overcoming Ms. Is that there is plenty of support in all sorts of different ways, and I'm going to cover those a bit later on. At Overcoming ms, we promote a brain healthy diet packed full of delicious, healthful food that nourishes the body and promotes healing. So it's low in saturated fat and it's full of healthy, healthier, unsaturated fats. It's packed full of whole plant foods and includes fish and seafood if you desire. It also includes a daily supplement, 20 to 40 mils of cold pressed flaxseed oil as a source of anti inflammatory omega 3 fats to the Mediterranean diet. And it matches the diet that is currently recommended by the American Heart association as a healthy diet. And the food included in the Overcoming Ms. Diet can be adapted to all budgets, cultures and cuisines. And this is so important as Ms. Affects people from all communities around the world. So it's a nutritionally sound framework that doesn't necessitate the need to buy expensive products and expensive supplements. And it can be adapted to the whole family. And I think something that's accessible, adaptable and affordable is really important. So what is the problem with saturated fat? So let's start with Dr. Roy Swank. So he hypothesized that a high saturated fat diet fueled disease progression for people with Ms. Now this was back in the early 1950s. He recruited 150 PET onto a trial and he told them to eat 20 grams or less of saturated fat a day. Now in the scheme of things, nuts, not actually that low. The current American Heart association guidelines to reduce cholesterol for example, is to eat only 11 to 13 grams of saturated fat a day. But despite this, half the participants couldn't reach this 20 gram target. So whilst there wasn't a control group, but the, the participants actually self selected into two groups for him to compare. And this study is outstanding because it ran for an incredible 34 years, which is a long time in research terms. And the early results indicated that those in the low saturated saturated fat group, and especially those eating 16 grams or less, had a significant drop in relapse rates after just one year. 95% drop after five years. And remember, this is way before there were any disease modifying therapies. So this is a time if you were diagnosed with ms, you were basically told that's it, it's nothing to do, just, just go home and you know, do your best. So it's really, must have been really exciting. The trial continued for an incredible 34 years and at the end those in the low saturated fat group remained mainly well with limited disease progression compared to the other group because out of those who were still alive they, they had much more severe disease progression and disability. And he concluded that this consuming a lower level of saturated fat and a higher level of polyunsaturated fats was particularly important as they supported this anti inflammatory pathways. So I just wanted to touch on about saturated fat in, and which is really abundant in the western diet. So it's found in processed foods in the form of palm oil, coconut oil, cocoa butter, in animal fats and in, in, in all sorts of meat products as well, whether or not that's red meat, processed meat, even poultry. And they're mainly found in what's called long chain fatty acids. So these are really stable and stiff fats. You may have heard of ones like lauric acid or aridonic acid and they're solid at room temperature, but they're also mainly solid at body temperature as well. And this is important when it comes to cell membranes. So cell membranes are the thin outer layer that are keeping the, the contents inside the cell. And they, our cells are constantly turning over throughout the body. Some are faster than others. And when this happens a new cell membrane is formed using the fats that gained from, from the food that we eat. So if you have a high amount of saturated fat in the diet, it gets incorporated into the cell membrane. Now we need a little bit in there because it helps with the structure of the cell. But if you have too much, the membrane becomes really rigid and sticky and it reduces the, its ability to function properly and the cells tend to clump together and this promotes an areas of cell degeneration. Now this obviously applies to all cells in the body, but specifically for ms, this includes cells in the myelin sheath, in our neurons and in our immune cells. Now polyunsaturated fatty acids or this PUFA here, they're fluid at room temperature and at body temperature and so they, when they get incorporated into cell membranes, they tend to be more flexible and enable them to function better. So the cells actually regenerate with healthier, less inflammatory fats. So I hope that that kind of sort of helps you understand that. So hopefully you've heard about the holism study. So this was started back in 2011 by Professor George Jelinek and his team at the Neuroepidemiology Unit in Australia, in Melbourne in Australia. And they were set up in order to look at the modifiable lifestyle risk factors of people who live with Ms. So he's looking at what can be changed to reduce the risk of progression and help to manage the disease. And this includes participants from all around the world who complete evaluation questionnaires about their diet and lifestyle, the things that they're doing that affect their Ms. And it's created this huge database from which over 40 different peer review papers have been reviewed. One of the things that's really important is this is independent, unbiased research for, specifically for the diet side of things. Some of the headlines is that they found that when you eat a low sat, low saturated fat, a polyunsaturated fat Diet, there's a 42% less chance of disability. And really interestingly is that when we supplement with flaxseed oil, there's a 60% reduction in relapse rates, which is quite phenomenal when you consider that a lot of DMTs or disease modifying therapies, you know, the, even the, the more powerful ones, that's the kind of figures that you get with Art and this latest study that came out from the holism or using the data focused on just over 600 people and they were looking at the relationship between their diet when the recent study started then and what they've been eating as they've gone along compared to where they are at the, the kind of the assessment date to monitor the disease progression. And they're followed up every two and a half years. So this half years, so we, we're getting at Some really good long data. And what was found was that frequent fish consumption and omega 3 supplementation was strongly associated with improved quality of life and reduced disease, activity and disability. But the those who ate meat and dairy had poorer outcomes. So, and this is really important because it showed that the importance of dietary habits over time, you know, so this comes back to this changing life for life. It's really important that to just to keep going and eating really great food, really, that helps reduce the progression of this condition. This study here, this study looked at different types of Ms. Diet because there are various ones. And I just wanted to highlight the fact that both the Mediterranean style diet and the swank diet were mentioned as having some good evidence and being nutritionally balanced, whereas others didn't fare as well. This one from the using the UK Biobank, which sourced a huge number of thousands of people, they found that a Mediterranean style diet that included oily fish had a protective effect for people with Ms. And then this study, initially, rather unsurprisingly, they looked at the Mediterranean diet and they found that it was easier for people to follow and also those that did follow it had less disease severity. This was a very small study, but interestingly it really focused on fiber as being important, which is really good for gut health. The Mediterranean diet is the most well researched and highest ranking of all the dietary patterns. And the overcoming Ms. Diet is very similar. And the research for people with Ms. Is consistent with the growing consensus on the importance of diet on brain health for everyone. And this rise in the Western diet is going alongside the rise in chronic health conditions as I've mentioned, including other neurodegenerative diseases like Alzheimer's, dementia and Parkinson's disease, and increasing levels of depression and other mental health problems in the general population. So let's dive into what we're going to be eating. So, so go first with my favourite, which is fresh fruits and vegetables. So you might be surprised to hear that just 20 or 9% of adults in the UK hit the 5 a day target. And that's actually supposed to be good. Apparently it is worse in some other countries, but it's still a real challenge. Fruits and vegetables are an amazing source of powerful nutrients that help support the body and reduce inflammation. And there's so many to choose from that even the fussy eaters can find something to enjoy. And don't forget that herbs and spices count in this group as well. So they're packed full of vitamins, minerals and phytonutrients and the really healthy compounds and every color carries different properties that support the body. And this makes eating the rainbow every day not only good for the taste buds, but great for the body too. And one particular group of compounds, which is polyphenols, also great for the microbiome. And fresh produce can be more expensive. So do try to buy what's in season because when, when it's, you know, there's a good harvest of something, there's just more available at better prices. Frozen fruit and vegetable is also a great option because it would, they're frozen very soon after harvest so it retains the nutrients well. But also if you're low in time and energy, you don't have to spend time doing lots of peeling and chopping as well. Whole grains are included, both gluten and non gluten containing grains. Now there's no conclusive connection between gluten and Ms. Specifically, but we know that some people like to avoid it. It could be due to another autoimmune condition or an intolerance, or you might just want to do a just in case policy and avoid it. Whole grains are very different to refined white grains and they're full of complex carbohydrates which are packed full of fibre. They also give us our calories for energy. There's also lots of minerals, there's protein, healthy fats even. And there is so many to choose from. And then beans and pulses or beans and lentils, this is another really, really healthy group. This is where you can get your main sources of plant protein from. They also contain minerals and fibre and complex, lots of complex carbohydrate where we get energy from and polyphenols and other antioxidants as well. And I love beans and lentils because they are super cheap and tinned are, are, are okay to eat as well, which is great because it means you don't have to spend hours soaking and cooking them so you can knock up some really quick and easy meals. And research tells us they're actually one of the healthiest foods that you can eat. A paper that was published in 2023 concluded that by eating beans regularly or every day, you can reduce obesity, it reduces low grade inflammation and it may play a role in immune related disease risk factors, you know, managing immune problems. Now one of the things I would say, however, is if you're not used to eating a high fiber diet, then you might want to go a little bit carefully on beans to start off with because they do have a win factor. And to start off with, once you're, once you're used to them, you're used to eating more fibre and your microbiome has finished partying on them, then things should settle down. So let's go on to healthy fats. So there's lots of whole food sources of this mainly in in nuts and seeds, but also fruits like avocados and olives. They have much higher levels of unsaturated fats, including omega 3 and omega 6 essential fatty acids. But they also contain protein and fibre, fat soluble vitamins and other antioxidants as well. And as I mentioned, flaxseed oil, the holism study showed a fantastic reduction in relapse rates. And when we're supplementing with that, you can also use extra virgin olive oil in, in your food as well in your meals. And that's high in polyphenols as well, so it's got that antioxidant effect. But just make sure that you don't directly heat these oils. They need to be added on rather than put on direct heat in a pan. You can also eat oily fish three times a week if you would like. And by oily fish we mean sardines, mackerel, anchovies, salmon, herrings and trout. Smaller fish are better because toxins and heavy metals can build up in the larger fish due to pollution in the water. So try to go for the smaller ones. And in all of these foods you, there is saturated fat in there, but there's a lot more unsaturated fat and like I say, you, you need it. We can't avoid saturated fat in our food and nor do we want to because we need to make sure that we have some just in much lower. And as for other food, well, there's fish and seafood which is a great protein source. There's lots of different types of fermented foods like sauerkraut, kimchi, miso. They provide gut benefits, can help digestion and also add flavour. It's another one though that if you're not used to fermented foods to build them up gradually rather than just sort of eating five different types because you might get some unexpected side effects. There's also lots of things to add in flavours. So there's different types of pickles and vinegars. And then on the drink side of things there's tea and coffee is absolutely fine and cocoa powder, cocoa's got a high level of flavonoids which is a type of antioxidant, and magnesium as well in the mineral. And interestingly, there was a small study done in 2019 that showed that people with Ms. Who had a hot chocolate every day for six weeks had improved fatigue. And then what to avoid? Well, we're going to, we want to avoid meat, especially red and processed meat, including poultry. It's high in saturated fat. There's no fiber in there at all. It promotes inflammatory compounds. Dairy we want to avoid as well, and that's dairy from cow, goat or sheep. There is saturated fat and a lot of dairy, but it's not just the fat. There is debate is still out about the, about what the issue is, but it's thought that butyrophylline, which is a protein in dairy, is very similar to protein on our oligodendrocytes on the myelin sheath. And when the immune system is overwhelmed and confused, it can start attacking proteins which are similar. So it starts attacking our own protein rather than the one that's being in, taken from, from dairy. And this process called manecular mimicry. So if we don't have the dairy, then that molecular mimicry is, is avoided. Egg yolks are also avoided and they're high in saturated fat as well. But egg, egg whites are fine and you'll find some protein in there. And then there's all of the shop bought pastries, cakes, snacks. Oh, that's far food, fast food. I mean we know that it's packed with saturated or adulterated fats which have this negative inflammatory effect in the body. Coconut, now it's promoted as being healthy, but, but it's really high in saturated fats so we, we, we want to avoid that as much as possible. Coconut water and coconut sugar are fine, so you can include those. And whilst cocoa powder is okay, chocolate itself is set with cocoa butter which is highly saturated. So that's off the menu as well.