Presented By:Anahita Dehbozorgi RD

18/09/13Chelsea & Westminster Hospital

MS – Condition of central nervous system (degenerative)

Damage to nerve fibres (myelin)

Partial or complete (lesions or plaques)

Disruption/delays in message signaling leading to disability over time

Symptoms:

Physical: vision problems, balance/dizziness, fatigue, stiffness/spasm, bowel/bladder problems, speech/swallowing difficulties, tremors

Memory/thinking/emotions: difficulty remembering recent events, problem solving

Swallowing difficulties - damage to any part of the brain that controls swallowing, or the connections between the brain and the spinal cord ‘brainstem’

May come and go, can happen during a relapse & improve, or disappear completely

Swallowing problems may include:

1. Changes in your speech

2. Problems chewing

3. Food sticking in your throat

4. Food or drink coming back up

5. Sluggish movement of food going down, or difficulty moving food back through your mouth

6. Coughing and spluttering during and after eating

7. Excessive saliva, which may cause dribbling

Good posture when eating & drinking – stay upright 30mins after each meal

Relaxed atmosphere

Eat slowly

Chew well

Alternate liquid with solid – keep food moist

Avoid speaking when eating

Severe swallowing difficulties: texture modified diets/nutritional supplements/NG and PEG feeds

Following a swallow Ax by speech and language therapies, you may need the texture of your food and drinks to be modified

You may require:Pureed/Fork mashable/ Soft meals

Thickened Fluids such as syrup thick/custard thick

Weight loss or dehydration - 2ndry to swallowing difficulties

Unsafe swallow , risk of aspiration

ONS (Oral Nutrition Support) may be indicated – if tolerating OI

Short term (<3-4 weeks) ‘nasogastric tube feeding’ - Liquid food passes through a very thin tube through the nose and into the stomach

Long term: Percutaneous endoscopic gastrostomy (PEG/RIG)–liquid diet to go directly through a tube into the stomach

Nutritionally balanced meals helps the body work to its full potential

poor growth

poor development

poor physical and mental health

infections

disease

or even death

Vit supplements - not required if a balanced diet consumed

? Reduce relapse rate or improve quality of life

No conclusive evidence to suggest effectiveness

Include:

Swank diet,

Best Bet diet and

George Jelinek's Overcoming MS programme

Developed in 1940s, known as ‘low fat diet’

Fat intake to no more than 15g of saturated fat/day, and between 20-50g of unsaturated fat

Intake of red meat and oily fish, white fish

Caution: Meat and dairy foods to reduce saturated fats a shortfall in protein

Research – number of studies (high drop outs) shown no benefits of diet

Developed by Dr George Jelinek in 1999

Combines a number of different elements; diet, exercise, meditation, Vit D & medication

Similar to Swank diet: saturated fat + supplementation of Omega 3 (in the form of fish oil or flaxseed oil) + vitamin D if limited exposure to sunlight

Research – no conclusive evidence of its benefits

2 main components:

1. Avoiding potential “problem” foods

2. Taking vitamin, mineral and herbal supplements

To avoid any foods with proteins that resemble those in myelin that are attacked by the immune system

o Dairy: Avoid all animal milk, all butters, cheeses, yoghurt and any products that contain them

o Gluten: Avoid all wheat, rye and barley

o Legumes: Avoid all beans, peas, peanuts, soybean

o Refined Sugar: This is also avoided because of general inflammatory properties, with the suggestion of using other sweeteners instead, such as honey, maple syrup

o Eggs: The idea here is to limit, rather than strictly cut out

o Yeast: limited quantities are allowed

Research – no conclusive evidence of its benefits

Some studies - low levels of omega-3 fatty acids were found in people with MS

Decrease certain immune reactions, reducing inflammatory responses

In very small studies of 10 and 16 participants, omega-3 supplementation relapse rate & improved expanded disability status scale (EDSS) score

In a larger placebo-controlled study (1989) relapse & disability progression but results not statistically sig.

Dietary sources:

Flaxseeds and flaxseed oil

Nuts, such as walnuts

Avocados

Fatty fish, such as salmon, tuna, mackerel, sardines, anchovies

Dark, leafy greens (such as kale, spinach)

Side Effects:

>3 grams/day

o Increased risk of bleeding complications

o Gastrointestinal symptoms

o Increased LDL cholesterol levels

o Elevated blood sugar in patients with diabetes (although in normal dosages, blood sugar levels are lowered slightly in healthy people)

Aim for a healthy, balanced diet including all major food groups:

Proteins – for growth and tissue repair

Carbohydrates and sugars – for energy

Fats – to absorb certain vitamins and for essential fatty acids

Fibre – for healthy digestion

Vitamins and minerals; tissue repair, bone strength and the absorption of other nutrient

Fluids –carries nutrients around the body

Help control weight

Decrease fatigue

Maintain regular bowel and bladder function

Keep teeth/gum & bones healthy and strong

Improve muscle strength and range of motion

Increase flexibility

Reduce the risk of certain diseases such as heart disease, stroke, osteoporosis and certain cancers

Weight loss risk of malnutrition & muscle weakness

Contributing factors:

o Posture/swallowing/fatigue/tremors

o Reduced appetite

o Stress & anxiety

o Depression

Weight gain difficulty mobilizing/co morbidities

Contributing factors:

o Medication such as steroids

o High intake of sugary drinks/fruit juices

o Stress & anxiety – comfort eating

o Depression

WHO Classification BMI Risk of Death

Underweight Below 18.5 Low

Healthy weight 18.5-24.9 Average

Overweight (grade 1 obesity) 25.0-29.9 Mild increase

Obese (grade 2 obesity) 30.0-39.0 Moderate/severe

Morbid/severe obesity(grade 3)

40.0 and above Very severe

World Health Organisation. Obesity: Preventing and Managing the Global Epidemic. Geneva: WHO, 1997 [3]

Planning:

Planning a menu for the week to reduce shopping trips, and reduce food wastage

Cooking double batches and freezing

A ‘likes and dislikes’ list to ensure you’re getting a good mix of meals that are to your taste

Shopping:

Shop online as all the major supermarkets offer a delivery service

Make a master shopping list of things you regularly buy, and print off multiple copies. And if you’re having a bad day with your MS, someone else can use the same list.

Delegate tasks – can someone else in your household, or a friend, do the shopping for you

Preparing food:

Before cooking – gather all ingredients needed

Clearing up:

Use a dishwasher if possible

Share tasks with others

Thank you for listening

Any questions?