The MS Recovery Diet by Ann Sawyer and Judi Bachrach

17 Frequently Asked Questions and Answers

These are short answers compiled from emails and our previous blog entries. If you scroll through our website blogs you will find more information on the following topics.

1) What exactly is MS?
2) What is the MS Diet?
3) How can the diet be implemented simply?
4) For whom will it work?
5) What about testing for food sensitivities?
6) How does the diet work if you are a vegetarian?
7) Please discuss legumes.
8) Can stress result in symptoms?
9) How do you know if recent flare-ups are due to incorrectly following the MS diet or stress?
10) I started the diet and now I feel worse? Is the diet not working?
11) At first I recovered, but now I am as bad as ever. What is that about?
12) Do I have to exercise while doing the diet?
13) Do I really have to keep resting, when I feel like I don’t do anything already?
14) Will I have physical problems the rest of my life?
15) How can I more easily do the diet? I don’t get to the store very often and have little energy to cook.
16) What are the pitfalls in beginning the diet?
17) Food Questions:

1) What exactly is MS?
MS is a confounding, complex disease that fits no definition or category. Before there is any outward sign of it, postulated to have happened early in life, the contributing factors of genetics, environment, geography, an early infectious event, and the template of molecular mimicry all set the stage. The disease can then be dormant for many years. The first manifestation usually follows some illness, injury or a time of great stress.

The symptoms come at first in fits and starts (relapsing-remitting), followed by constant degeneration (secondary) or as primary progressive. The damage is thought to be caused by activated immune cells passing through the blood-brain barrier into the central nervous system (CNS). In the CNS, there are two distinct disease pathways; myelin (the fatty sheath protecting the nerve cells) and the underlying nerve cells are attacked causing inflammation and damage (sclerosis), but the other pathway of axonal apoptosis (long nerve cells that act like the fiber optic cords die) for no apparent reason more determines the disability. The nerve damage/destruction prevents proper message conduction and symptoms result. The disease process overwhelms the body’s ability to heal and repair making MS a degenerative disease.

2) What is the MS Diet?
The main principle of the diet is that food (also illness, stress, fatigue) activates the immune cells that start the cascade of events that lead to symptoms. Food doesn’t cause the disease as such, but fuels the disease process after it manifests. This can be stopped by not eating those foods which activate the immune system and, as important, by eating foods that help the body repair, restore and recover.

The first step is to stop eating the trigger foods that activate the disease process. Reduce intake of saturated fats- keep to less than 15 grams per day- and sugar in great quantities. There are 5 food groups to which people with MS are found to be most often sensitive. These are gluten-containing grains and wheat, dairy, eggs, legumes and yeast. Each person has a unique food sensitivity profile, which can include foods not among the usual suspects. Digestive tract health is crucial so use caution or cease to use: tobacco, caffeine, NSAIDS (aspirin, Tylenol), antibiotics, antacids, and alcohol as they can be damaging to the digestive system.

It is very important to be well nourished with nutrient dense foods. The following will help to heal the digestive system (leaky gut) and speed recovery: lean protein, vegetables/fruits, foods rich in antioxidants, raw foods for enzyme support, and probiotics. Drink plenty of water; get sunshine (vitamin D), and exercise. As time goes on you can reclaim movement, sensations, your cognitive abilities, and full energy.

3) How can the diet be implemented simply?
The fastest and most effective way, for the first several months is to stop eating the five usual suspects as well as limit saturated fat and sugars as described above. This, along with eating full, nourishing meals, resting and limiting stress will result in improvement quite quickly.

The initial healing will be with ups and downs. The return of abilities is fragile at first and setbacks happen easily due to stress, fatigue, illness. Don’t be discouraged. Keep following the diet. When subtle changes in symptoms can be discerned, you can begin testing foods to see if they are triggers for you. As you continue to progress, you will refine and individualize the diet for your healing. Begin to exercise more as your healing becomes more solid and permanent.

For the best healing make sure you eat enough nutrient dense food with an emphasis on protein and vegetables. Keep stress to a minimum. Remember that sleep and rest are treatments. When you have a return of energy or abilities, don’t overdo it. You still need to use your body’s energy continue to heal.

4) For whom will it work?
A good research study has never been funded to explore all the aspects of this treatment, so we don’t know for sure. Over the fifty years that this diet has been evolving, especially in the present form, the recovery diet seems to work for everyone who really follows and works with it.

How quickly improvements are seen is highly variable. The road is bumpy, but if you stick with it and listen to your body, you will heal and recover. Most people return to full functioning with no lingering symptoms after a few years. It takes time, persistence, patience and determination.

5) What about testing for food sensitivities?
Some people want to begin approaching the elimination of foods by doing an Elisa test that measures some food sensitivities, specifically the IgE and IgG antibodies that appear when a blood sample is exposed to 190 different foods. The results can be helpful if you remember they are not perfect and that you have to be careful in interpreting them. As we explained in the chapter on Maintaining Your Recovery, allergic reactions can be dulled or stopped, and the immune cells can subsequently ‘forget’. So, if you have been on the diet for a month or two, not ingesting say, any dairy, and then take the ELISA test, the results might come out that there was no reaction to dairy. You then think that dairy is fine and you eat it--symptoms may well result if you have a large enough serving or if you have it more than once. Your final guide is always your body.

To have this test done, you need a health care practitioner, alternative or conventional, contact a testing lab like the Meridan Valley Clinical Laboratory, 515 Harrison Street, Kent, Washington 98032, or any other lab that offers this test. They will send a kit to your health care professional who then draws a blood sample and mixes it as directed by the lab and sends it back. The results will come to your professional. The test is not too expensive, probably now around $200. You will still need to refine for yourself what foods you can and cannot ingest.

Note: For folks in the UK: The ELISA test is York6 in UK, not available on NHS, and costs around £200 private. It is usually covered by medical insurance.

6) How does the diet work if you are a vegetarian?
If you eliminate eggs and dairy from your diet, how does a vegetarian meet their needs for protein if they must also give up legumes? Since our food responses are very individual, it may be that legumes are not going to be problem for you. On the other hand, they might be, and remaining a vegetarian may pose a problem if you are one of those people who have their symptoms triggered by legumes. (Even the Dalai Lama now eats meat on the advice of his doctor for his own health reasons.) If eliminating your MS symptoms is your primary goal then try to have an open mind and see what will work best for you.

You might need to become a vegetarian in your mind, but not your body. Eating fish and poultry might become necessary if you cannot digest most legumes properly. After you have recovered sufficiently on the diet (at least 6 months to a year), you might be able to eat a small amount of soy and goat dairy products without having a negative reaction or rotating and moderating foods might allow you to eat some of the foods that you could not before. The immune system may stop finding those foods objectionable after enough time has elapsed.

7) Please discuss legumes.
Why are all of these particular foods named as the usual culprits, especially legumes? There is no one simple answer, but this is what science postulates. The five usual culprits; wheat and gluten-containing grains, dairy, eggs, legumes and yeast have several things in common. They all contain protein. It is postulated that there is a three way molecular mimicry in which the immune cells mistake myelin for a foreign invader.

Another factor that is cited is that all of these foods are relatively recent to the human diet, being introduced since agriculture began about 10,000 years ago in the Middle East. Interestingly, it wasn’t until about 6,000 years ago that agriculture reached northern Europe, like Scandinavia, where the incidence of MS is very high.

All of these named culprits seem to be also troublesome in other diseases and often named as allergens. Peanuts, a legume, are well known as a potentially deadly allergen. Wheat and legumes, in particular, contain substances known as lectins, proteins that are often hard for us to digest and often to some degree toxic to us. It is thought that these substances have to key to the receptors on the cells of the blood-brain barrier as well as the endothelial cells of the gut, essentially allowing them access to the blood stream where they may activate the immune cells and then the central nervous system where the immune cells wreak their havoc.

There is so much that isn’t known—obviously not all foods, even in one category like the legumes, are created equal or cause equal problems in MS.

From the science and theory, let’s go to how this applies to the MS recovery diet. Legumes are not troublesome to everyone; on the list they seem to rank below fat, wheat, dairy, eggs and sugar. However, they are triggers to many people. As you work with the diet and your body, you should be able to tell fairly soon if legumes are a problem for you. If they aren’t one of your triggers go ahead and eat them, but use some judgment on how often and how much.

8) Can stress result in symptoms?
So much is written about stress in our lives today, emphasizing the toll it takes on all of our health. If you need proof of its power, consider this; stress can increase symptoms in someone who has just started following the diet, despite their adherence to every restriction. This doesn't seem to be the case once your recovery is farther along, fortunately. But, be aware of the stress load you are carrying when you are starting out. It might be hurting your progress in recovery. Stick to the diet through these times as once the stress abates your body will reclaim its healing progress.

9) How do you know if recent flare-ups are due to incorrectly following the MS diet or stress?
Check your food choices very carefully. If they are relatively constant, then the reversal of symptoms that are now bothering you are probably not food related, but stress related.

Check to see if you recently experienced changes or distress in any of the following areas- Relationships: Jobs: Money: Children: Sudden Crises with Self/Friends/Family: Time Management. There are, of course, other areas, but those are typical focuses for worry, anxiety, anger and depression.

The MS diet works at optimal efficiency when we eat well, rest well, exercise well, and relax well. Stress makes it difficult to stick to the Recovery Diet but that is when our bodies most need the right foods. Use the diet as a stabilizing force in the midst of turmoil. Remind yourself of the gains you have made and try not to focus on the temporary setbacks that life's stress-makers might be causing you right now. Find support where you can, and know that when the stressful issues resolve themselves, your body will be ready to get back to healing and repairing on the MS Recovery Diet once again.

10) I started the diet and now I feel worse? Is the diet not working?
A number of people report that at first they started feeling worse before they began to feel better. We do not have all the answers and do not know why this should be so. Our guess is that it shows the body is rearranging - we are all unique chemical vessels with complex interactions. When we make changes, even adding or dropping an herbal supplement, let alone changing our foods, our sensitive responses show up in many ways. I would suggest keeping your curiosity antenna open and wiggling to alert you to all that is shifting inside and out. If you are determined to keep going you will see what can happen next.

If you have had spastic (overly tight) musculature keeping you upright and ambulatory, those same muscles may now release and lose their tone and become weaker for a while (too loose). That actually is a good sign and means that healing those neuromuscular connections can now begin. We have also heard from those same concerned folks that then their symptoms shifted in a positive direction- and we certainly hope it will be the same for you.

11) At first I recovered, but now I am as bad as ever. What is that about?
Recovery at first is fragile and can be easily lost while your improvement becomes more solid and permanent. That is why rest, sleep and limited stress are so important at first. It gives your body the time and free energy to continue the healing process. The other factors listed above to be avoided are also important.

Though we can’t answer specifically to your situation, let us give some examples of what has happened in some cases. One woman wrote that she had made 80% recover in her legs, then had a bad infection for which she took antibiotics for a month. After that she was as bad as ever. What happened? In this case, recovery was very slow to start in the first place because of the time it took to heal her digestive system, which in her case is very reactive and easily damaged. The MS cycle had begun again, so she needed to re-heal her digestive system to get recovery going again.
Another woman, who had made good progress, was very discouraged when she lost it. I saw her after a couple of months, doing better again. She said I was right when I suggested it was stress.
A common reaction once you start getting better is to go out and do all that you want to do before you are strong enough and your recovery is more firmly established. It may be hard, but you need to take it easy, rest and sleep to get your recovery stronger so it can resist these challenges.

If you are experiencing a set back, analyze what you are doing with the food, rest and stress.

12) Do I have to exercise while doing the diet?
Exercise is important once you are on the recovery path, but not at the expense of rest and sleep. Do not fatigue yourself to the point that your improvement is in jeopardy. The art of recovering lost muscle function as you make progress on your recovery diet, is the essence of joyful creativity. No matter what exercise approach you take- working with a rehabilitative physical therapist, practicing yoga, aerobics, swimming, dancing, walking, or any other physical modality- it is noticing and enhancing the return of function that lets you know your MS symptoms are retreating and healing has begun.

If you are in a wheelchair, you want to transfer more easily and ultimately stand up and get walking again. If you walk with an aid, you want to leave it behind you. If you still tire rapidly you want to increase your stamina and endurance.
No matter what your level of disability is, the process of recovery needs you to start challenging yourself to move. Our book contains many exercises for all stages of recovery. The brain is able to rewire itself and repetitive movements make and strengthen new neurological connections. If you are exercise phobic, start by breathing deeply whenever you think of it. Our muscles need oxygen to do their jobs. Sitting or walking outside may help you to change your relationship to exercise. Remember that your goal is to progress in your recovery process, no matter where you begin in your level of mobility. Joining ongoing classes appropriate for your level may help some of you to work out your own exercises to get yourself strong and moving well again.

13) Do I really have to keep resting, when I feel like I don’t do anything already?
Yes, rest remains important for maximum recovery. When you are pushing yourself to keep “doing”, that uses all your energy, which could be better used for healing; you are draining off energy that could be used to heal. The recovery process, first a glimpse of a return of ability, yet fragile, that needs to be solidified asks a lot of the body—we need to give it the time it needs and not put too many other demands on it. Bottom line: think of rest as an effective medicine.

14) Will I have physical problems the rest of my life?
Most recovered people don’t, but there can be some interesting, but easily handled challenges.

Ann recently discovered some finer points to finishing her recovery that she hadn't considered before, namely getting her best and healthiest movement patterns back. Since she can walk just fine, it never occurred to her that her walk, which had changed during her MS years, had stayed that way because of muscle memory. What brought this to her attention was her proclivity to repeatedly sprain her ankle. You can imagine her upset that after successfully fighting MS, she was hobbling about due to a sprained ankle.

She is now retraining her walk and gait--undoing the tendency to flat-footedness that she acquired during her MS years, retraining her left foot to roll and push off as she walks. It has been really quite exhilarating to rediscover and may save her future problems with hips, knees and ankles. We suspect this kind of problem goes beyond MS, as injuries and weight gain or loss causes us to change how we move.

15) How can I more easily do the diet? I don’t get to the store very often and have little energy to cook.
Consider buying bags of frozen vegetables, canned vegetables, frozen chicken breasts, turkey breasts, and frozen fish, bags of rice and sweet and white potatoes, and hard winter squashes as your main foods. Rutabaga, turnips and parsnips are often coated in wax so they keep. You can roast them and they make good fillers. All you would have to do is to boil or bake to have a meal. There are a lot of combinations in the bags of frozen vegetables, so you would have variety. Following this diet, you would also be free of eggs, which can be very troublesome. The advantage of following this is that you would not have odd ingredients snuck in by any pre-prepared foods even they promise saving preparation time. The above would be very effective and would fit with your requirements that the food last for a month and would be easy to fix.

Also consider that if you have someone who can help you cook just once a month, they could help you roast whole chickens and turkey breasts, and then cut up meal-sized portions to put in your freezer for you. A pot of cooked rice lasts for a week. Apples and citrus fruits may not last for a whole month in the fridge but they will if they are fresh enough. Frozen fruit slices are also available in most grocery stores. These days, vegetables and fruits are bagged and fresh frozen or canned on site and may often contain more digestible nutrients then foods that are picked green and then shipped long distances so that they ‘appear’ to be ripe by the time you buy them. No one need forgo the benefits of the diet if they can shop wisely.

16) What are the pitfalls in beginning the diet?
After reading the book, following the diet can seem pretty overwhelming. The first impulse is often to simplify things, which can be counterproductive. The first common mistake is to eat the same things for each meal every day. Over exposure to the same foods, especially if your digestive system is still compromised, can result in more food sensitivities. If you read about leaky gut in the book, you'll understand why. Rotation is always a good idea. Along with that, keeping the serving size moderate also reduces your chance of over exposure to one food or another.

The next common mistake is to not watch how much saturated fat you are ingesting. This can be challenging since fat is everywhere. The healthy oils all contain a gram or two, nuts are full of saturated fats, and they are plentiful in chips. Even what can look like healthy, baked chips are not advised on this diet, at least in the beginning of eating this way. When any oil is heated to a high degree it changes chemical composition. It is best to keep the amount of saturated fat to under 15 grams a day, which is very little considering it is found in such a wide variety of foods.

Some people have recovered from MS by just cutting their saturated fat-- that is how important it is to watch your intake. Sugar is also ubiquitous and needs to be watched for many people. Fructose, glucose, and sucrose are all sugars and their effect is cumulative.

Above all, listen to your own body. None of us are alike and our paths to healing reflect this.

17) Food Questions:
Sweeteners come in many forms, both artificial and natural. We do not recommend artificial sweeteners as the chemicals used can interfere with the delicate process of recovery and can have unpredictable side effects. Rice syrup, sorghum, maple syrup, beet sugars, cane sugars, fruit sugars and honey are all natural but high in glucose content. Some people with MS are very sensitive to the inflammatory nature of glucose- that is why we recommend using sweeteners of any kind sparingly and only occasionally. The ones we suggest in the book-agave nectar, stevia and xylitol- are only low in glucose, not devoid of glucose. We suggest limiting all sweeteners of any kind when you are beginning the diet, especially those of you with a ‘sweet tooth’, those of you with optic neuritis, and those of you with serious symptoms who want to give the diet its best chance to help you in your recovery. When you are beginning the diet you might even want to restrict yourself to only 1 piece of fruit per day. Diabetics should do well therefore, on this diet.

Fats play an important role in the MS Recovery Diet. The recommendation is to limit saturated fat intake to less than 15 grams a day and then to ingest between 4-10 teaspoons of the healthy oils daily. (Swank) The question naturally follows; exactly what are these fats and oils?

Bad Fats: Saturated and Transfat
Saturated fats are mainly animal fat found in meat, whole milk dairy products (Cheese, milk, yogurt, and ice cream, etc.), poultry skin and egg yolks. It is also found in coconuts and coconut oil, and palm oil. Saturated fats are usually solid at room temperature.

The term, saturated, comes from the type of chemical bond that exists between atoms that make up the fat molecule and the number of hydrogen atoms in it. In MS, saturated fat molecules form emboli in the microcirculatory system that can damage the blood-brain barrier. (Swank) It is hard to avoid saturated fats totally since they are found in small amounts in even the healthiest oils. This needs to be taken into account as you develop your diet.

Transfat is the result of processing oils by adding hydrogen to it. Food labels will often list "hydrogenated oil" as the ingredient; it is transfat. Many margarines as well as processed foods contain transfat as it keeps better than the other types of fats and oil. Transfats should be avoided not only because of MS, but for general health. There is a move to ban them from the human diet because of their harmful effects on health.

Good Fats
Unsaturated fat contains one of more double bonds and there are no hydrogen atoms in the molecule. There are two categories of unsaturated fat: Monounsaturated and polysunsaturated fat.

The best source of monounsaturated fat are canola oil, olives and olive oil, sesame seeds, pumpkin seeds, caashews, macadamia nuts, hazelnuts, pistachios, and pine nuts. These are beneficial foods.

Polyunsaturated fats (aka PUFAs-polyunsaturated fatty acids or essential fatty acids) can be broken down further into two categories; Omega 3s and Omega 6s. In the modern diet, it is hard to maintain the healthy ratio of 1:4, Omega 3: Omega 6.

These oils are liquid at room temperature and even under refrigeration. They are some of the building blocks for cell walls, nerves and myelin, all crucial to MS recovery. These oils easily oxidize and become rancid so they need to be refrigerated. Also, read the label for what temperatures they can tolerate for cooking purposes.

Omega 3s are found in fish, especially cold, deep ocean white fish, salmon, sardines, tuna, flax seed and flax seed oil, walnuts and walnut oil.

Omega 6s are found in most vegetable oils like corn, safflower, sunflower, soy. To keep closer to the recommended 1:4 ratio with the Omega 3s, mix in the other monosaturated oils in your cooking.

To follow the MS Recovery Diet simply substitute a healthy oil wherever you previously used a saturated fat. It works very well and can make a big difference in your recovery.

Gluten is to be avoided until you find out if you are reactive to it. Spelt flour contains gluten! It is used in our book in some recipes because many people can tolerate its’ low gluten content. Others of you may not tolerate any gluten at all, so all of the spelt flour recipes should be avoided until you discern your trigger foods.

Oatmeal has been determined by the Celiac Foundation to contain no gluten. However, some people do react to oatmeal’s sticky nature as if it were glutinous. If you suspect gluten is a problem for you and if you want to be strict on this diet in the beginning- avoid oatmeal! Then you will not be taking a chance on it triggering symptoms for you.
There are other hot cereal substitutes- for instance, cream of rice or buckwheat (buckwheat is gluten free).

Rice does not contain gluten. However, white rice especially can be problematic for some people with MS. Until you know that rice is not a problem for you, keep a careful watch on your symptoms when you eat rice in the beginning of the diet. Wild rice is a distant cousin to rice and can usually be well tolerated. Also try soaking the rice grains for up to an hour and then rinsing them before you cook them- you may need to shorten the simmering cook time by 10-15 minutes. This may also help to make rice more digestible for you.

Dairy is problematic because of its protein molecules- not because it is lactose free or skim or has low fat content. The proteins in goat, sheep and water buffalo products can be tolerated more easily than in cow dairy products by some people with MS. Until you are sure that dairy is not a trigger for you- avoid all dairy no matter what form.

Eggs can be bought from organically fed, free-range chickens or other poultry and still they are high on the list to be avoided when starting out on the diet. It is the protein molecules in the whites and the yolks that are the problem, not how healthy the chickens are. Until you know that eggs are not a problem for you, avoid all whites and yolks. See the question on vegetarianism if this is an issue for you.