7 Ways to Fight MS Fatigue With Your Fork

Dehydration contributes to fatigue, so water is an important tool. “Individuals with MS often have neurogenic bladder, which affects the ability to properly control bladder emptying. As a result, they may refrain from drinking enough water, which can lead to dehydration,” says Nina Eng, RDN, the chief clinical dietitian at Northwell Health Plainview Hospital in Plainview, New York.

According to the Food and Nutrition Board of the National Academy of Sciences, men should drink about 3.7 liters of total water a day, and women should drink around 2.7 liters (total water can include drinking water, water-containing beverages, and water-containing foods). And if you are exercising vigorously or if the weather is hot, you may need more than that.

“Protein is a macronutrient that provides the body with fuel,” says Dr. Eng. It’s known to have multiple roles in the body, including helping to repair cells and build new ones.

Protein also activates cells that help keep you awake, according to research. Researchers found that energy levels depend on a group of brain-stimulating cells called orexin cells, which respond better to amino acids in proteins than to other nutrients.

Eng recommends protein-rich options such as nuts, beans, and lean animal proteins.

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Snacks can help boost and sustain energy throughout the day by keeping your blood sugar from dipping too low.

“Good options include 100 percent whole-grain crackers or bread sticks with low-fat cheese; fresh fruit; plain, low-fat, or fat-free yogurt; low-fat granola; a glass of low-fat or skim milk; and frozen blueberries,” says Elizabeth Somer, RD, a nutritionist and the author of several books on nutrition, including Eat Your Way to Happiness.

She recommends steering clear of high-sugar snacks, which cause a spike in energy and then a fast crash, which worsens fatigue.

Omega-3 fatty acids, found in high amounts in fatty fish such as salmon, may reduce inflammation in the body and reduce the risk of stroke and heart disease.

So far, studies of omega-3 supplements in people with MS suggest benefits for people with relapsing-remitting MS, according to the NMSS, but the results of those studies have not been statistically significant. Nonetheless, foods containing omega-3s are considered part of a healthy diet, and preventing heart disease is a worthwhile goal for anyone.

“Fish, including wild salmon, mackerel, anchovies, and tuna; ground flaxseed; flax oil; leafy green vegetables; and walnuts are all good sources of omega-3 fats,” Eng says.

A good breakfast can help improve concentration, strength, and endurance, but what is “good”?

Eng advises, “Look for foods that contain at least 3 grams of fiber per serving.” Those might include oatmeal, whole-grain breads or pancakes, high-fiber breakfast cereals, and grains such as brown rice or quinoa. Add some fruit or vegetables for more nutrients and fiber.

Include some protein — from foods such as eggs, low-fat dairy products, soy milk, seeds, nuts, and nut butters — and a small amount of healthy fats in your meal, too, to feel satiated longer.

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According to the NMSS, research is increasingly showing that low vitamin D levels in the blood may be a risk factor for developing MS, though more research is needed to find out whether vitamin D has any impact on disease activity in people with the condition.

But experts do know that getting enough vitamin D and calcium is key for bone health among people who already have MS.

“It’s a good idea to incorporate foods high in vitamin D and calcium into your diet, especially if you have been on steroids for a long time,” Eng says, because one side effect of steroids is poor bone health. Low levels of weight-bearing activity, such as walking, can also lead to weak bones and a higher fracture risk.

Steroids are often prescribed only as a short-term, first-line treatment for MS exacerbations — usually for three to five days via IV, and sometimes followed by a tapering oral dose for one to three weeks.

But some comorbid conditions that are common in people with MS, including inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, require long-term steroid use. And per the NMSS, steroid treatment can lead to bone loss if used for prolonged periods of time.

Good food sources of vitamin D include fortified milk and orange juice, cod liver oil, and fatty fish. Small amounts of vitamin D are naturally present in egg yolks and cheese.

To get calcium, Eng suggests eating cheese, yogurt, milk, sardines with bones, dark leafy greens, fortified cereal, and soybeans. And for any calcium-containing foods you choose, Bostick recommends sticking to low-fat options.

“Since 99 out of 100 Americans don’t meet the standards for a balanced diet, I recommend taking a moderate-dose, broad-range multivitamin every day,” Somer says.

And while B-vitamin supplements are sometimes touted as energy boosters, she says that a multivitamin contains enough B to do the trick for most people.

Vitamin D supplements may also offer some benefits for people with MS, including improved symptoms and quality of life, according to the Mayo Clinic. Taking vitamin D is likely safe for people with MS, but doses that are too high could affect your calcium levels, the Mayo Clinic says.

Before taking supplements of individual vitamins or minerals, talk to your doctor about whether you should take them and how much to take. Some supplements can interact with MS medications or other drugs you may be taking.

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Additional reporting by Christina Vogt.