Diet for multiple sclerosis: products, recommendations

The National Multiple Sclerosis Society defines multiple sclerosis (MS) as an immune-mediated process in which the body's immune system responds to the central nervous system (CNS).

The central nervous system consists of the brain, spinal cord and optic nerves. The exact antigen—the target that immune cells are sensitized to attack—remains unknown. This is why many experts consider multiple sclerosis to be “immune-mediated” rather than “autoimmune.”

What is multiple sclerosis?

Multiple sclerosis (MS) is an autoimmune disease in which the protective sheaths of nerve fibers are gradually destroyed.
These coverings are called myelin sheaths. Over time, this disease can permanently damage your nerves, disrupting communication between your brain and body ().

Here are the symptoms of multiple sclerosis ():

fatigue
tingling and numbness
bladder and bowel dysfunction
difficulty moving and spasticity
visual impairment
problems with learning and memory

MS is very complex, and the disease's progression varies from person to person. Scientists are still not sure what causes multiple sclerosis and how to cure it ().

Although diet cannot cure multiple sclerosis, some research suggests that dietary changes may help people with multiple sclerosis better control their symptoms. This, in turn, can improve their quality of life (, ).

Conclusion:
Multiple sclerosis (MS) is a neurological disease that gradually destroys the protective sheaths called myelin sheaths that surround nerve fibers. Scientists do not fully understand the disease, and there is no cure.

Multiple sclerosis: patients can really be helped

Multiple sclerosis is one of the most dramatic and difficult areas of clinical neurology. This chronic, progressive disease of the nervous system usually affects young and middle-aged people (15-45 years). It is based on an autoimmune demyelinating process, that is, a condition in which the immune system begins to destroy the sheath of nerve fibers - myelin. A feature of multiple sclerosis is the simultaneous damage to several parts of the nervous system, which leads to the appearance of a variety of neurological symptoms in patients. In typical cases, multiple sclerosis is characterized by a relapsing course - alternating periods of deterioration (exacerbation) and improvement (remission). Progress in medical science and pharmacology today makes it possible to significantly prolong the remission stage, and research into the human genome gives hope for the emergence in the future of fundamentally new treatments for this mysterious disease, which leads to irreversible damage to the central nervous system.
The number of patients is underestimated

The diagnosis of multiple sclerosis has always been a tragedy for the patient and his loved ones. Young people who have not previously complained about their health gradually develop problems with coordination, sensitivity, vision, and intelligence, their muscle strength decreases, it becomes difficult for them to move, and the functions of the pelvic organs are disrupted. For many decades, multiple sclerosis was considered an incurable disease, almost inevitably leading to profound disability and greatly reducing life expectancy. In recent years, effective means of preventing its dangerous complications have appeared, but for this, patients must begin to be treated as early as possible. However, this often comes with big problems. This conclusion can be made based on an analysis of the prevalence of this disease in Russia, carried out by employees of the Department of Neurology and Neurosurgery of the Russian State Medical University, which is headed by a world-famous neurologist - Academician of the Russian Academy of Medical Sciences Evgeniy Gusev.

“On the permanent register in our country there are mainly patients with severe stages of multiple sclerosis, as a rule, these are disabled people of the 1st-2nd group,” says Alexei Boyko, professor of the Department of Neurology and Neurosurgery of the Russian State Medical University, chief neurologist of the Moscow Government Health Committee. “Their share turns out to be significantly higher than in Western countries, so, apparently, the true number of patients in our country is underestimated. Patients with early manifestations of multiple sclerosis, for whom the most effective methods of pathogenetic therapy have been developed, fall out of the field of view of doctors. In general, the prevalence of multiple sclerosis in Russia ranges from 30 to 70 per 100 thousand population. The influence of the ethnic composition of the population is very strong; among Europeans the disease occurs much more often than among representatives of other races. Our department, together with the Russian Scientific and Methodological Center for Multiple Sclerosis (headed by Professor Igor Zavalishin), coordinates research and ensures that it is carried out according to a specific methodology. Diagnostic standards are well known, they are absolutely unified and were previously based on the international criteria of 1983, and now the new McDonald criteria, published in 2001, are used. Nevertheless, we often have to deal with errors of neurologists on the ground. In clinically complex cases, magnetic resonance imaging is necessary to clarify the diagnosis, which, unfortunately, is not available in all regions of the country. And where there is a possibility of carrying it out, the other extreme occurs - doctors make a diagnosis only based on the MRI “picture”, observing multifocal brain damage, but forget about the main significance of the clinic.

Towards an understanding of etiology

For a long time, the etiology of multiple sclerosis was considered unknown. Of course, many questions remain unresolved today, but the generally accepted opinion is that multiple sclerosis can arise as a result of a random combination of a number of unfavorable external and internal factors in a given person. External factors include frequent viral and bacterial infections; influence of toxic substances and radiation; nutritional features; frequent stressful situations. Genetic predisposition to multiple sclerosis is probably associated with a combination of several genes in humans that cause disturbances, primarily in the immunoregulatory system.

“The viral etiology of multiple sclerosis is more than likely,” notes Professor A. Boyko. - But, apparently, the autoimmune process is “triggered” not by any one virus, but by a combination of them. Among them there may be both primary viruses and reactivated ones. For example, the genomes of endogenous retroviruses or herpes viruses can be integrated into human DNA and transmitted through inheritance. There is no doubt about hereditary predisposition. Recent results of human genomic screening have shown that the onset of multiple sclerosis can be traced to the contribution of several genes, that is, it is a polygenic disease. The greatest role in all ethnic groups is played by the set of genes for the major histocompatibility complex - HLA on chromosome 6 (in multiple sclerosis, the DR2 haplotype is most often determined). There are genetic factors that determine predisposition to multiple sclerosis, and there are those associated with the severity and characteristics of clinical manifestations. The genetics of multiple sclerosis is now being actively studied in all developed countries, we are also carrying out this work together with the Department of Molecular Biology and Biotechnology of the Russian State Medical University (headed by Professor Olga Favorova). We are currently studying the role of eight genetic markers, and are accumulating data on the connection between their combination and clinical features. The same work is being carried out in other regions of the country - after all, each patient population has its own characteristics. Among the external factors in the development of multiple sclerosis, I would put infectious influences in first place, and in second place the influence of environmental conditions on the immune system, and, possibly, dietary habits (the predominance of meat products).

Effective treatment is expensive

Today, the diagnosis of “multiple sclerosis” no longer seems as scary as, say, just a decade ago. Of course, it cannot be cured, like most other chronic diseases, but progress in understanding immunopathogenesis and experimental studies of the autoimmune process lead to the birth of new drugs and treatment methods. In particular, today it is quite possible to reduce the activity of the process, prolong the remission stage, and reduce the frequency of exacerbations by 30%. In the last decade, several drugs have been developed and used, the main effect of which is the regulation of the immune response: suppression of the production of pro-inflammatory and stimulation of the production of anti-inflammatory cytokines by activated immunocompetent cells. These drugs include primarily beta interferons (1b and 1a) and glatiramer acetate. They are prescribed primarily to patients with relapsing-remitting disease, and beta interferons are also effective in secondary progressive multiple sclerosis.

The main problem is that these effective drugs are very expensive (an annual course of treatment costs 10-12 thousand dollars). But at the same time, according to a study conducted by British economists, the results of which were published in the journal PharmacoEconomics, the expensive treatment of multiple sclerosis with interferon beta is cheaper than treating regular exacerbations and neurological disorders with conventional means. And in the USA, when a diagnosis of “active relapsing-remitting multiple sclerosis” is made, it is considered unethical for a doctor not to prescribe beta-interferons, otherwise he may get into trouble with the society of patients (by the way, such societies are playing an increasingly important role in Russia).

“In our country, in recent years, centralized purchases of beta-interferons have been carried out through both the Russian Ministry of Health and territorial health authorities,” continues Professor A. Boyko. — For example, the Moscow Government Health Committee purchases these drugs for 250 patients, and the Ministry of Health provides about 200 more Moscow patients with drugs (in total there are about 5 thousand patients with multiple sclerosis in the capital). It should be noted that the government and the Moscow Health Committee pay great attention to this, seeking considerable funds for the treatment of patients with multiple sclerosis and thinking about their future. In other regions of the country, unfortunately, the situation is much worse. Each of them, based on their economic capabilities, can adopt their own, more stringent criteria for prescribing these drugs. I note that this practice is also common in richer countries, for example in Italy. All patients should be divided into three groups: for the first, treatment with beta-interferons is mandatory, for the second it is desirable, for the third this type of therapy is not indicated. This depends not only on the stage of the disease, but also on the activity of the autoimmune process (beta-interferons are prescribed to patients who have had at least two exacerbations in the last two years). So the prescription of drugs is strictly individual, the decision on this is associated with great responsibility and is made only on a collegial basis.

Of course, it can be difficult for doctors to explain to a patient that beta interferons will no longer help him. But even in this situation there is a reserve - well-thought-out symptomatic therapy. Previously, many doctors dismissed it, considering it useless, but now there is growing confidence that the individual selection of such drugs can significantly improve the quality of life of patients. It should be noted that patients with multiple sclerosis in Moscow can receive almost all necessary symptomatic medications using preferential prescriptions. As with other diseases, the experience and knowledge of doctors is crucial, so special attention has recently been paid to educational programs for neurologists in the city. Modern medications can reduce the severity of paresis and changes in muscle tone, coordination problems, dizziness and other manifestations of the disease. In case of exacerbations, treatment with metipred and the prescription of immunosuppressants is indicated. For large lesions and in malignant cases, the issue of a course of cytostatics is discussed.

The number of patients with multiple sclerosis is increasing, largely due to the fact that their life expectancy is increasing due to the success of pharmacotherapy. But at the same time, the disease is getting younger: once multiple sclerosis in children was considered an out of the ordinary case, now this will not surprise anyone. In the psychoneurological department of the Scientific Center for Children's Health of the Russian Academy of Medical Sciences (headed by Professor Olga Maslova), active research is being conducted on childhood multiple sclerosis. In world practice, beta-interferons for the treatment of multiple sclerosis in children until recently were almost not used, there were only isolated reports, and the work of the employees of the Scientific Center for Children's Health is one of the first in this direction. The results of a study on the genetics of this disease in children, conducted by employees of the Scientific Center for Disease Control of the Russian Academy of Medical Sciences and the Russian State Medical University, were published in Neurology, perhaps the most authoritative international neurological journal.

What's ahead?

Today, research is being conducted in leading countries around the world that could become the basis for new effective treatments for multiple sclerosis. The discovery of an enzyme that plays an important role in the mechanism of its development may lead to the creation of effective drugs for the treatment of this severe neurological disease. According to researchers from the famous American Mayo Clinic, by blocking the work of this enzyme, known as myelencephalon-specific protease (MSP), tissue destruction can be stopped. This enzyme was discovered by Isobel Scarzbrick's group in 1997, and they were able to develop tools for its detection in order to begin experimental studies of the role of this enzyme in the process of destruction of the myelin sheath of nerves. When studying tissue from people and animals suffering from this disorder, scientists found a sharp increase in MSP levels in cells associated with the process of inflammation. It is also known that the enzyme can affect the processes of oligodendrocytes - the cells through which the myelin sheath is formed. It is noteworthy that in a healthy body this enzyme promotes the functioning of oligodendrocytes.

As Dr. Scarzbrick explained, scientists are not presenting the results of the study as a discovery that will lead to a cure for multiple sclerosis. However, this enzyme could become a target for the development of new methods of treating a disease that affects up to 330 thousand people in the United States alone. The results of this study, supported by the National Multiple Sclerosis Society, were published in the journal Brain.

American scientists have also proposed a way to help patients with multiple sclerosis, for whom traditional therapy has proven ineffective. Many people call this treatment method risky and invasive, but it may be the last hope. It is based on the complete destruction of the human immune system, and then its reconstruction from stem cells. This method was proposed by a team of researchers led by George Kraft, director of the Multiple Sclerosis Clinical Center at the University of Washington in Seattle. As the scientist said, the method was tested on 26 patients. Doctors completely destroyed the cells of their immune system. First, the patients were exposed to radiation, then chemotherapy drugs were used, and the remaining cells were destroyed using special antibodies.

Before radical treatment began, blood stem cells were taken from the patients, from which the entire immune system was subsequently recreated. As a result, the progression of the disease stopped in many participants in the experiment, improvements occurred in six, and deterioration continued in five, but, as scientists say, at a slower pace. One patient died after receiving the antibodies. Previous studies that used such a radical technique showed that the risk of death could reach 10%, reports the Mednovosti.ru news agency. A European working group has now been created to study this method of treating malignant rapidly progressive multiple sclerosis, but given the high risk of fatal consequences, this method is a “therapy of despair” when all other treatments are ineffective and the disease progresses very quickly.

And scientists from the University of California at Irvine have focused their efforts on combating the chemokine CXCL10, the level of which is especially sharply increased in multiple sclerosis. They created an antibody that captured and neutralized this chemokine and injected it into mice with a disease similar to multiple sclerosis. Antibodies prevented further destruction of the nerve fiber sheaths and even helped restore those already destroyed. As a result, the mice were able to move actively again. However, the effect was short-lived, probably because the immune system neutralized the antibodies. Now scientists hope to create other antibodies that will not cause a reaction from the immune system. They believe that this technique can help people too. In general, blocking chemokines is a fairly promising direction. Now different groups of scientists are trying to block seven chemokines and five types of receptors for them, reports the Journal of Immunology.

Surely not all of this research will find practical application in the future, but such a search in many areas of science is justified. We don’t yet know where exactly scientists can expect success. However, the knowledge accumulated about multiple sclerosis in recent years suggests that a breakthrough is just around the corner.

Fedor SMIRNOV.

How does diet affect multiple sclerosis?

There are currently no official dietary recommendations for people with MS.

No two people with MS experience the disease the same way ().

However, scientists believe that a combination of genetic and environmental factors may cause the disease, and that diet may have an effect. The fact that multiple sclerosis is more common in Western countries than in developing countries is one clue that diet may play a key role ().

This is why dietary recommendations for people with multiple sclerosis should be aimed at helping manage symptoms and improve overall quality of life.

Diet can help with multiple sclerosis in several ways, including by preventing or controlling its progression, relieving its symptoms, and reducing flare-ups.

Ideally, an MS-friendly diet should be high in antioxidants to fight inflammation, high in fiber to help with bowel movements, sufficient calcium and vitamin D to fight osteoporosis, and contain plenty of vitamins and minerals to help with bowel movements. fight fatigue and improve health.

You should also limit your intake of foods that have been linked to chronic inflammation and other poor health effects, or those that simply make daily activities difficult for a person with MS.

Some evidence suggests that other diets, including ketogenic diets, may help relieve symptoms in people with MS. However, this research is ongoing and scientists need to continue studying the role of diet in MS.

Healthy eating

Finding the perfect diet for you will take some effort. Unfortunately, there is no ready-made formula for healthy eating that suits everyone. It is necessary to evaluate the changes specifically in your body in practice.

Here are some facts that can convince you to pay attention to your diet: • lack of vitamins and minerals worsens the course of multiple sclerosis; • skipping meals can significantly increase symptoms such as chronic fatigue; • it is known that excess weight is one of the factors that increases the symptoms of multiple sclerosis, namely: respiratory problems, problems with joints; • Even minimal amounts of alcohol can worsen symptoms such as poor balance and coordination.

A balanced diet means that a person receives all the necessary nutrients in sufficient quantities. An imbalance in the diet can negate its benefits. For example, even with sufficient calcium in food, it will not be absorbed by the bone structure if a person does not receive the required amount of vitamin D.

Moreover, according to modern research, vitamin D deficiency may be associated with the development of MS. Therefore, it must be obtained in the right quantity.

The question immediately arises: “Is it possible to use food supplements and vitamins?” Research suggests that pills are not a substitute for a healthy diet.

Dietary recommendations

According to the recommendations of the US National Multiple Sclerosis Society, first of all, the diet should be balanced: rich in fiber and low in fat.

The tips below will help you create a healthy diet: • Aim for 5 servings of fruits and vegetables (1 standard serving is a 125 ml cup) and 1 serving of greens per day (1 standard serving of raw greens is a 250 ml cup). These are sources of vitamins, minerals, antioxidants and fiber. • Use vegetable (sunflower, olive) oil instead of animal oil. Polyunsaturated fatty acids support the health of the nervous and cardiovascular systems. • Avoid frying, prefer boiling and baking. This will reduce your fat intake and calorie intake. • Choose lean meats. Foods like bratwurst and sausage can be high in fat and salt. If you are not a vegetarian, it is better not to give up meat. It is a valuable source of iron, zinc, B vitamins, and protein. • Limit the amount of saturated (animal) fat, hydrogenated vegetable oil (use non-hydrogenated margarine). Eat less pastries. Saturated fatty acids increase the risk of heart disease. • Eat at least two servings of fish per week. It is a source of protein, vitamins and many minerals (selenium, iodine). The fatty acids it contains are beneficial for blood vessels and skin. • Consume low-fat dairy products, milk with a fat content of 1% or less. A serving of cheese or yogurt should contain no more than 3 grams of fat. • Give preference to whole grain products (bread, cereals). Carbohydrates are necessary for the body; it is better to get them not from sugar and white bread, but from complex carbohydrates. In addition, grains are a source of fiber and vitamin E. • Drink enough, dehydration is very harmful in multiple sclerosis. You need to drink about 2-3 liters of water. You should not indulge in caffeinated drinks. They, like alcohol, help remove water from the body. • Read food labels and choose low-salt foods. • Cook your own meals whenever possible. • Use spices instead of salt to enhance flavor. • Avoid processed and canned foods and opt for fresh and frozen foods.

Very close to these recommendations is the Mediterranean diet, which is now often recommended for the prevention of heart disease. It is dominated by plant products (fruits, vegetables, legumes, grains, nuts) and vegetable oil, mainly olive oil.

It involves regular consumption of fish and poultry, as well as reducing the amount of red meat and animal fats. Many people quickly begin to experience the benefits of following the principles of proper nutrition. For example, some people notice that their mood has improved, their energy levels have increased, and their fatigue has disappeared. However, new eating habits should definitely be discussed with your doctor!

RU/OCRE/1904/0038

https://www.edimdoma.ru/jivem_doma/posts/20915-tochnyy-raschet-kak-pravilno-sostavit-sbalansirovannyy-ratsion-pitaniya

https://www.medicalnewstoday.com/articles/315227.php

https://www.nationalmssociety.org/Research/Research-News-Progress/Diet

What foods should you eat if you have multiple sclerosis?

An MS-friendly diet should help people with MS control their symptoms.

In particular, it should help control the progression of the disease and minimize the impact of common symptoms of multiple sclerosis on overall quality of life.

Here is a list of foods to include in a multiple sclerosis-friendly diet:

Fruits and Vegetables : All fresh fruits and vegetables.
Grains : All grains such as oats, rice, buckwheat and quinoa.
Nuts and Seeds : All nuts and seeds.
Fish : All fish, especially fresh and oily fish such as mackerel, herring and salmon, as they are rich in omega-3 fatty acids and vitamin D.
Meat and Eggs : Eggs and all fresh meats such as beef, chicken, lamb, etc.
Dairy products : milk, cheese, yogurt and butter.
Fats : Healthy fats such as olive oil, flaxseed oil, coconut oil, and avocado oil.
Foods rich in probiotics : yogurt, kefir, sauerkraut and kimchi.
Drinks : water, herbal teas.
Herbs and Spices : All fresh herbs and spices.

In short, recommendations for an MS-friendly diet are similar to eating a generally healthy, well-balanced diet. However, she emphasizes eating more plant-based foods and grains.

This is because plant foods and grains contain more fiber, vitamins, minerals and fluids, which can help with symptoms of multiple sclerosis such as constipation, fatigue and bladder dysfunction.

They also contain more plant-based compounds that act as antioxidants, molecules that help protect your cells from free radical damage and inflammation. These compounds may help fight inflammation and potentially slow the progression of multiple sclerosis (, ).

Fish, especially fatty fish such as mackerel and salmon, appears to be beneficial for MS, possibly because they are high in anti-inflammatory omega-3 fatty acids. It's also rich in vitamin D, which, when combined with calcium, can help keep your bones strong (, ,).

Current research on the effects of red meat and saturated fat consumption on MS symptoms shows mixed results. However, moderate consumption of red meat, with an emphasis on eating more fruits, vegetables and grains, is likely to be beneficial for people with MS (, ).

Dairy products also show mixed results. However, they are a good source of calcium, vitamin D, vitamin A and potassium, so you can include them in moderation in an MS-friendly diet (,).

Additionally, some research suggests that people with multiple sclerosis may have a higher risk of developing celiac disease, an autoimmune disease that causes damage to the small intestine when gluten is consumed ().

Gluten is a group of proteins found in wheat, barley and rye.

If you have multiple sclerosis and experience severe discomfort when eating gluten-based foods such as bread, pasta, cookies, and other baked goods, it is important to notify your doctor to find out if you have celiac disease.

People with multiple sclerosis who do not have celiac disease can still benefit from healthy grains in their diet.

Conclusion:
Eating plenty of fruits, vegetables, grains and fish can help manage the symptoms of multiple sclerosis. A person with multiple sclerosis may want to eat red meat and dairy products in moderation, as current research on their effects is mixed.

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EMBRY DIET. Recommendations and menus for multiple sclerosis

These recommendations for dietary changes were developed based on diverse and reliable scientific evidence that shows the relationship of various dietary factors to the manifestation and progression of multiple sclerosis

What you need to know before starting the Embry Diet

The goal of this diet is to stop the consumption of foods whose molecular structure is so similar to the human body's myelin that it can trigger autoimmune processes. These include dairy products, gluten and legumes. Eggs and yeast are allowed in limited quantities unless a person is allergic to them. At first, this diet may seem quite restrictive compared to regular eating, but fortunately, these tips will help make the transition to new eating habits easy.

Exclude:

Products containing proteins that can cause autoimmune reactions. These include: all dairy products (milk, butter, cheese, yogurt, etc.);
cereals containing gluten (wheat, rye, barley, etc.);
legumes (beans, soybeans, peanuts, peas);

Products that can cause allergic reactions that manifest themselves clinically or only in blood tests. These foods may help increase intestinal permeability and immune reactivity.

Sweets, carbonated drinks (Coca-Cola, Pepsi, etc.) and any other foods high in sugar. These products can affect the intestinal microflora, which can cause loose stools and increased immunoreactivity.

Limit:

Foods containing saturated fats. Include red meat (lean meat) in your diet once a week.
Intake 6-omega unsaturated fats, which are found in margarine, salad oil and baked goods. For fats, use olive oil (monounsaturated fat).
Gluten-free grains such as corn and oats. Use mostly rice, but it should be consumed in moderation.
Alcohol consumption. Best of all, wine in moderation, and the complete exclusion of beer.

Increase:

Eating chicken (breast, without skin), other poultry and fish to replenish protein. Salmon and mackerel are good for omega 3 fatty acids.
Content in the diet of vegetables and fruits containing carbohydrates and fiber.
Taking various supplements to support immune system autoregulation, increase antioxidant activity, and avoid deficiencies.

Additional Nutritional Factors

An important part of the nutritional strategy for Multiple Sclerosis is a system of supplements in the daily diet. The basic supplement recommendations presented below are completely safe and can have significant benefits.

Necessary (hereinafter dosage per day):

Vitamin D3 - 4000 IU; best taken separately from vitamin A;
3-omega unsaturated fatty acids - 3 grams EPA + DHA. The best option is fish oil, such as salmon. It is also possible to consume a teaspoon of cod liver, but it is not known whether it contains more than 5000 IU of vitamin A. Taking an additional 1 teaspoon of flaxseed oil may also be helpful. Flaxseed oil contains linoleic acid, which is a precursor to EPA and DHA;
Calcium - 1000 t - 1200 mg;
Magnesium - 500 - 600 mg.

Vitamins:

Vitamin A – 5000 IU;
Vitamin B complex – 50 mg;
Folic acid – 1 mg;
Vitamin B12 – 100 mcg;
Vitamin C – 1 g;
Vitamin E – 400 IU.

Minerals:

Zinc – 25 – 50 mg;
Copper – 1-2 mg;
Selenium – 200 mcg;
Manganese – 20 mg

Antioxidants:

Ginko Biloba - 120 mg;
Grape seed extract - 2-4 capsules;
Coenzyme Q10 - 60-90 mg.

Probiotics:

Acidophylline – 6-9 capsules (2-3 with each meal)

Optional Additives

Some specific supplements may have potential value. They can be quite expensive and are therefore included in a separate list.

R+ alpha lipoic acid – 500 mg. Powerful antioxidant. There are varying opinions regarding its use, but no side effects have been reported.
N-acetylcysteine – 500 mg. May cause glutathione levels to rise, resulting in increased antioxidant activity.
EGCG Max (epigallocatechin-3-gallate) – 2 – 3 capsules (700 mg each). Strong antioxidant. Contained in green tea.
Inosine – 2g. This supplement increases uric acid levels, which neutralize perioxynitrite. Note: Gout may occur if uric acid levels are too high. It is necessary to raise uric acid levels as high as possible without triggering gout.

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Foods to Avoid

Although an MS-friendly diet allows you to eat a variety of healthy and delicious foods, there are still some food groups that you should limit to help manage your MS symptoms.

Most of these foods are associated with chronic inflammation. These include processed meats, refined carbohydrates, trans fats, and sugar-sweetened drinks, to name a few (, ,).

Here is a list of foods to avoid if you have MS:

Processed meats : such as sausages, bacon, canned meats, and salted, smoked or cured meats.
Refined carbohydrates : such as white bread, pasta, cookies and flour tortillas.
Fried foods : such as french fries, fried chicken, mozzarella sticks and donuts.
Junk food : such as fast food, potato chips, processed foods and frozen meals.
Trans fats : such as margarine, shortening and partially hydrogenated vegetable oils.
Sugar-sweetened drinks : energy drinks, sports drinks, sodas, and sweet tea.
Alcohol : Limit all alcoholic beverages if possible.

As mentioned above, some people with multiple sclerosis may have celiac disease. If you have celiac disease, try to avoid all gluten-based foods, such as those containing wheat, barley and rye.

Conclusion:
An MS-friendly diet is similar to a general healthy diet. She limits her intake of unhealthy foods such as processed meats, refined carbohydrates, soda and trans fats. These foods do not help manage the symptoms of multiple sclerosis and may make inflammation worse.

Other Diet Recommendations to Help with MS

In addition to the dietary recommendations above, people with multiple sclerosis may want to consider the following tips to help manage their symptoms.

Make sure you eat enough food . Not eating enough calories can cause fatigue.
Prepare food in advance . If you have time, preparing meals ahead of time will help you save energy later. If you are often tired, this may be especially helpful.
Remodel your kitchen . Place food, dishes and other equipment in areas that are easy for you to clean. This will help you save energy.
Try "ready-to-eat" foods . Buying pre-cut fruits and vegetables can shave a few minutes off your prep time and make the preparation process easier.
Make thicker drinks . If you have difficulty swallowing, making thicker drinks, such as a healthy smoothie, will make it easier for you to swallow.
Soft foods may help . If a lot of chewing makes you tired, try choosing softer foods, such as baked fish, bananas, avocados and cooked vegetables.
Limit your consumption of crumbly foods . If you have difficulty swallowing or often choke on food, consider limiting crumbly foods such as toast and crackers.
Ask for help . Even if you don't like asking for help, helping other family members with small tasks like cooking, cleaning, or just setting the table can help reduce your fatigue.
Stay physically active . Although exercise can make a person with MS feel tired, it is especially important for managing weight and staying healthy. Physical activity is also important to prevent osteoporosis, which is more common in people with MS.

If you have other problems related to multiple sclerosis not discussed above, it is important to notify your doctor. He or she can make personalized recommendations to help you better manage your symptoms.

Conclusion:
The tips listed above can help improve your quality of life with MS by helping you maintain a healthy weight and manage symptoms such as fatigue and problems swallowing.

Discussion

The need and possibility of correcting cellular energy deficiency in inhibiting neurodegeneration in MS

The most promising from the point of view of inhibiting neurodegeneration are considered therapeutic strategies aimed at improving metabolism, in particular ensuring a sufficient supply of energy, neurons and glial cells. Adenosine triphosphate (ATP), as the main source of energy, is necessary in the central nervous system (CNS) to maintain membrane potential, synapse function, and the functioning of neurons and glial cells. The bulk of energy reserves is spent on maintaining the membrane potential of Na+/K+ ATPases [11], which can be disrupted due to inflammation and demyelination [12]. Insufficient energy production or excess energy consumption leads to hypoxia, which can cause neuronal and axonal dysfunction and degeneration [4]. The emergence of metabolic drugs with proven clinical effects in MS allows us to be optimistic about the prospects for this new direction in the treatment of MS.

Biotin is the first in a series of such metabolic drugs. Long-term high-dose biotin reduced EDSS disability and/or improved walking distance of 25 feet in 12.6% of patients with progressive MS [5], although these results require further confirmation and refinement. The metabolic mechanism of action of biotin is manifested primarily in the fact that the drug enhances the synthesis of fatty acids by increasing the activity of carboxylases, which stimulates energy production in neurons, thereby reducing hypoxia and promoting remyelination [13].

Another important metabolic therapeutic agent that has predominantly immunomodulatory and anti-inflammatory effects in MS is vitamin D [6]. Its effects have been studied in a number of clinical studies, mainly in RMS and clinically isolated syndrome; it is also planned in patients with progressive MS [14], especially in terms of the effect on remyelination and inhibition of CNS damage. It has been established that vitamin D deficiency correlates with an increased risk of developing MS, and its level may be inversely related to the activity and progression of RRMS [15].

Thus, metabolic therapy is now increasingly not only considered as a promising direction in the treatment of MS, but also receives objective confirmation of this.

Metabolic effects of cytoflavin

One of the metabolic drugs that has been used for many years in practical healthcare for various diseases accompanied by energy deficiency is cytoflavin. The drug consists of four active metabolic components (succinic acid, riboxin, riboflavin, nicotinamide) that can influence the functioning of the Krebs cycle of mitochondria, which is accompanied by an increase in the production of high-energy compounds, in particular ATP. The components of cytoflavin simultaneously act on various parts of the Krebs cycle, which causes an antihypoxic and antioxidant effect, activates the intracellular synthesis of protein and nucleic acids, promotes the utilization of glucose, the synthesis and intracellular accumulation of ATP. Each of these components of cytoflavin individually is widely used in clinical practice for various forms of pathology. Using them together in combination can provide additional synergistic (additive) metabolic effects under ischemic conditions.

Thus, it has been established that riboxin (inosine, a purine nucleoside) is a precursor of ATP and realizes its metabolic effects on the myocardium, being an agonist of purinergic receptors, with the participation of which activation of glycolysis occurs - the most important process for maintaining the energy pool in the myocardium under hypoxic conditions. In animal studies, inosine not only improved memory and learning in rats, but also had a strong antioxidant effect and increased the survival of hippocampal neurons [16].

The next component, riboflavin mononucleotide, provides high activity of a number of enzymes involved in antioxidant protection and maintaining normal glutathione levels. In addition, riboflavin plays a critical role as a coenzyme for succinate dehydrogenase in complex II of the mitochondrial respiratory chain, which generates intracellular ATP [17].

Nicotinamide, being a precursor of dehydrogenase coenzymes (NAD+ and NADP+), has antihypoxic properties [18]. In addition, nicotinamide inhibits the development of an experimental model of MS, autoimmune encephalomyelitis, by blocking T-cell differentiation [19] and has a neuroprotective effect on axons in autoimmune encephalomyelitis [20].

The fourth component of cytoflavin, succinic acid, is an intracellular metabolite that acts as a substrate for oxidative phosphorylation in the mitochondrial cycle of tricarboxylic acids, improves tissue respiration by enhancing electron transport in mitochondria and thereby enhances the energy supply of the cell [21], reduces the concentration of lactate, pyruvate and citrate, which increase during hypoxia. Oxidized by succinate dehydrogenase, succinic acid in the respiratory chain ensures rapid resynthesis of ATP by cells [22] and, more pronounced than other Krebs cycle substrates, increases the amount of reduced mitochondrial nicotinamide dinucleotides (NAD+) [23]. Administration of succinic acid in some experimental models of neurodegenerative diseases leads to a rapid decrease in mitochondrial dysfunction and a decrease in neurological defect [24].

Among other drugs with metabolic effects, pentoxifylline should be noted. In addition to the well-known antiplatelet drug, this drug also has an anti-inflammatory effect, which is probably due to inhibition of the production of the important pro-inflammatory cytokine TNFa by macrophages [25]. Pentoxifylline showed in studies on a model of MS autoimmune encephalomyelitis in rats a significant reduction in symptoms of the disease and a decrease in inflammation in the brain, according to histological studies, compared with the control. However, in a clinical study for RMS, the effectiveness of pentoxifylline was not confirmed [26]. Nevertheless, the known antiplatelet and potential metabolic properties, along with the availability of the drug, ensure its widespread use in clinical practice.

Thus, metabolic therapy for MS may have as its goal both the correction of energy deficiency and hypoxia, as well as immunomodulatory, anti-inflammatory and antiplatelet effects, which allows us to consider this therapy as an important, separate, additional direction in the treatment of MS, capable in a number of aspects (safety, availability, inhibition of progression) to compete with PMTRS.