Multiple Sclerosis (MS)
Pathophysiology
Signs/symptoms/diagnostic
criteria
Causes/risk factors5
Goals for MNT
Multiple Sclerosis (MS) is an autoimmune disorder of unknown etiology characterized by the
destruction of the myelin sheath surrounding nerves of the central nervous system. When the
nerve covering is damaged (caused by inflammation), nerve signals slow down or stop. MS
occurs in women more than men and is most commonly diagnosed between the ages of 20-50
years old.
Signs/symptoms:
 Weakness and numbness; Tingling in legs and arms; stiffness in legs
 Urinary urgency, retention; Constipation
 Incontinence and recurrent infections
 Sexual dysfunction
 Blurred vision and blindness; Double vision
 Imbalance; Tremor of arms
 Impaired memory and concentration; Fatigue
 Heat sensitivity
 Depression and other mood disorders
 Primary Progressive MS is characterized by steady onset, with few lesions in the brain,
but there is spinal cord and neurological damage.
 Relapsing/Remitting MS is characterized by periods when a symptom appears or
reappears for at least 24 hours.
Diagnostic Criteria:
 MS is considered when a patient presents with a neurologic deficit of gradual onset
 Diagnosis rests on the basis of knowledgeable physician taking history, performing a
neurological examination, and conducting various tests.
 Objective diagnosis on two or more areas of demyelination in the CNS that have occurred
at more than one time point.
 McDonald Diagnostic Criteria
 MRI of the brain and/or spinal cord will provide findings supporting the diagnosis in more
than 90% of patients.
Causes:
 The causes of MS are not completely understood
 An autoimmune attack on CNS myelin is the central pathogenetic event
 Vitamin D deficiency
Risk factors:
 Some evidence suggests a role for viral infection in early life as a predisposing factor;
minor viral infections frequently precipitate relapses
 Polygenic influences are an important contributing factor
 Trauma is a controversial factor that likely only increases the relapse rate to a small
degree, if at all
 The relapse rate increases by approximately one third in the immediate postpartum period,
although the rate decreases to a similar degree during the last two trimesters of pregnancy
 Maximize nutritional intake
 Coordination of Care for swallowing evaluation to assess for dysphagia
 Assess UTI frequency and fluid intake
 Assess for neurogenic bowel
 Assess vitamin D status
Kilocalorie calculation
formulas and notations
Mifflin-St. Jeor Equation:
Males: kcal/day = [10 x wt (kg) + 6.25 x ht (cm) – 5 x age +5] x activity factor x stress factor
Females: [10 x wt (kg) + 6.25 x ht (cm) – 5 x age -161] x activity factor x stress factor
Protein calculation
formulas and notations
Fluid calculation formulas
and notation
Fiber recommendations
Monitored - Labs and
1.0-1.2 g/kg/day
35ml/kg
25 g
Monitor/diagnosis labs5:
Jessica Seppala and Teresa Harrat
Multiple Sclerosis (MS)
Altered - Labs
Treatments and
Medications and DNIs
Supplements, herbs or
botanicals.
Vitamin and Minerals
Diet therapies typically
prescribed for this disease
state.
Medical Nutrition Therapy.
MRI of the brain and/or spine
Analysis of the cerebrospinal fluid (CSF)
Complete blood count (CBC) and comprehensive metabolic panel to detect metabolic and
electrolyte abnormalities
 Antinuclear antibody (ANA) testing and erythrocyte sedimentation rate (ESR) to look for
vasculitis and other autoimmune diseases
 Vitamin B12 measurement to determine if a deficiency is present
Altered Labs:
 Low vitamin D
Non-drug Tx5:
 Intermittent catheterization to help prevent recurrent UTIs
 Physical and occupational therapy for maintaining mobility and helping pts with MS
maintain their independence.
 Dietary modification (Swank diet)
 Exercise
 Counseling
Medication Tx3:
 Interferon β 1a and β 1b:Reduces number and severity of exacerbations: May cause
anorexia, wt loss, dry mouth, taste changes, abdominal pain, N/V/D. Mayserum glucose,
cause bone marrow suppression and affect the function of the liver, kidneys and bones.
Caution with supplements that thin the blood and those that have immune modulating
effects.
 Copaxone:Stimulates myelin basic protein: May cause fever, chills, dizziness, D,
tachycardia,  urinary frequency and sores in the mouth. Most people report significant
pain at the injection site.
 Novantrone→ Antineoplastic suppresses T cells, B cells and Macrophages: Need for 
fluids due to  uric acid excretion. May cause stomatitis, mucositis, N/V/D, bone marrow
suppression, elevated serum glucose, impairments in liver and kidney function. Caution
with supplements that thin the blood & those that have immune modulating effects.
 Tysabri: Monoclonal Antibody: May cause low BP, dizziness, hives, chest pain, nausea,
chills & difficulty breathing.
 Glucocorticoids: Used for acute exacerbations: May  appetite, wt, blood sugar, bp and
TG.  need for calcium, PRO, Vitamin A, D & C, & zinc.
 Cod Liver Oil (1 tsp. or equivalent capsules)
 Ginkgo biloba
 Vitamins B6, B12, Folate
 Vitamin D
 Vitamin C and E
 Magnesium
 Selenium
Swank Diet4
 Saturated fat intake of no more than 15g/day
 Unsaturated fat intake between 20g – 50g/day
 No red meat consumption for the first year; following first year only 3 oz per week
 White meat poultry, fish, and shellfish are permissible in any amounts as long as they
contain low saturated fats
 Elimination of dairy products containing 1% butterfat or more
 Ensure adequate Antioxidants and EFA’s
 Optimize Vitamin B6, D, B12, Folate and magnesium status
 Evaluate overall health status and changing physical abilities / Symptoms
 Manage constipation
 Distribute fluids throughout waking hours, limit before bed
 Monitor for dysphagia and neuralgia in face
 Manage DNI’s
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Jessica Seppala and Teresa Harrat
Multiple Sclerosis (MS)
References:
1. Krause’s Food and the Nutrition Care Process, 13th Ed. by L. Mahan, S. Escott-Stump, J. Raymond
2. Swank MS Foundation. http://www.swankmsdiet.org . Accessed May 3, 2012
3. Nutrition Interventions for Multiple Sclerosis by K. Morrow
4. Pizzorno J, and Murray M. Textbook of Natural Medicine. 3rd. St. Louis: Churchill Livingstone Elsevier, 2006. 19251935.
5. Rensel M, Misulis K, and Harper W. "Multiple Sclerosis ." MDConsult.com. N.p., 26 Jan 2011. Web. 18 May 2012.
<http://www.mdconsult.com>.
Jessica Seppala and Teresa Harrat