got in this time. excerpts:
"Health implications of unbalanced diet
Nutritional imbalances might justify widespread vitamin deficiencies,101 reduced control of body weight,102,103 prevalence of atherosclerosis,104 hypertension,
hyperlipidemia, diabetes, and an increased risk of vascular comorbidities, observed in MS patients as compared to the general population.105 Emerging evidence of an increased risk of disease progression in MS patients with vascular and metabolic comorbidities makes it reasonable to assume the existence of a dangerous vicious circle
Malnutrition can be defined as a pathological state resulting from inadequate nutrition, including undernutrition, over-nutrition (overweight and obesity), and deficiency of one or more specific nutrients (such as vitamins or minerals)
. To date, its exact prevalence in MS patients is unknown, but some studies have demonstrated that malnutrition may occur more frequently in MS than in other chronic diseases
, being more relevant in severely disabled patients. The detrimental consequences on functional abilities, mental activity, immune system, and muscle strength may contribute to worsen pre-existing MS symptoms,impacting negatively on patients’ quality of life
Pressure ulcers and malnutrition
Pressure ulcers – which represent a major cause of hospitalization – occur more often in MS than in the general population, especially in the presence of mobility
decline (in advanced stages of the disease), older age, male sex, lower socio-economic status. Decreased albumin and hemoglobin levels, but also a low mid-arm circumference, seem to be related with pressure sores. An inadequate nutritional status characterized by a low intake of calories, iron, folate, vitamin D, zinc, arginine, and anti-oxidants,120 in combination with the use of medications, such as glucocorticoids, may contribute to delaying the healing process of pressure ulcers in MS patients, increasing costs for medical care and hospitalization
Evaluation of nutritional status in MS
The evaluation of nutritional status in MS is a stepwise, time-consuming procedure, often neglected in clinical practice
*cough* YA DON'T SAY!! *cough*
... although the early identification of patients at risk of developing malnutrition or nutritional imbalances has important health implications. Many nutritional screening questionnaires are available: ... As suggested by Pasquinelli et al., the following steps should be observed:
• Evaluation of nutritional status through some key points. Nutrition ‘history’ (through diet diaries etc) assessing lifestyle and types/quantities of consumed food; ...
• Calculation of nutritional needs; ...
• Evaluation of dysphagia and potential interfering conditions with nutrition (through a multidisciplinary approach).
• Schedule of nutritional intake.
• Plan for the eventual occurrence of complications.
Dietary recommendation and specific nutrients in MS Until now, a specific dietary model has not been established for MS patients; therefore, balanced and healthy nutrition – as advised to the general population – is recommended
In MS subjects, respecting the proportions between macro- (lipids, proteins, and carbohydrates) and micronutrients (vitamins and minerals), the diet
should increase plasma levels of essential fatty acids, unrefined carbohydrates
(to alleviate symptoms such as fatigue and weakness), anti-oxidants, vitamin D and B12
; it would also be appropriate to ensure an adequate supply of proteins, zinc (for tissue trophism), fibers, and fluids
(to maintain regular gut function).
... in case of demonstrated deficiency
– a very common occurrence in MS population – oral supplements of vitamin D are strongly and unanimously recommended. ... a cumulative dose of 300 000–1 000 000 IU, over 1–4 weeks, is recommended, followed by a maintenance dose of 800–2000 IU/day
(or weekly equivalent).
Some authors have speculated about the relationship between the dysregulation of certain minerals and MS.176–178 It has been reported that selenium deficiency
(contained in cereals, beef, white bread, pork, chicken, fish, and eggs), and that of zinc
(in oysters, sardines, meat turkey, beef, lamb, poultry, pumpkin seeds, eggs, cereals, nuts, legumes, dark chocolate), magnesium
(in green leafy vegetables, dried fruit, legumes, cereals, and bananas), and iron
(in beef, pig, horse, poultry, and fish), probably associated with malnutrition and/or to an increased demand, may worsen some aspects of the disease
(especially pressure sores and fatigue).109,179 Given their multiple biological roles
and the lack of association between serum concentrations and homeostasis at tissue level, in the nutritional assessment of MS patients, it seems appropriate to evaluate the individual risk factors of mineral dysregulation and deficiencies, in order to promptly correct them according to the RDA
Conclusions and future perspectives
...Furthermore, because diet-related comorbidities, such as malnutrition, metabolic syndrome, and cardiovascular disease, seem to be related to a decline in physical condition and quality of life in MS patients, an accurate nutritional counseling should be encouraged in clinical practice
. Future studies, exploring the role of a healthy and specific diet on MS onset and/or evolution, should be strongly encouraged in order to move toward a holistic management of MS."
common sense FTW