Evaluating Nutritional Health and Care for Patients With Multiple Sclerosis

Mona Bostick, RDN, LDN, MSCS

For patients with multiple sclerosis (MS), management of the disease, as well as comorbid conditions, presents distinct challenges. The incorporation of a healthy diet and exercise can be beneficial for this patient population, with the National Multiple Sclerosis Society even establishing a wellness research group in 2014 to further investigate lifestyle factors that may impact disease course and overall quality of life. 

Mona Bostick, RDN, LDN, MSCS, founder, Food Matters 365, commented on the role nutrition can play in the management of MS, noting that dietitians offer unique expertise when it comes to the multidisciplinary care of these patients. Bostick spoke on this topic at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28, clarifying that there have not been any diets proven to contribute directly to the disease process of MS, but there are certain interventions that can aid in treatment of comorbidities and hopefully, health outcomes. 

Bostick further shared her thoughts with NeurologyLive on popular elimination and “fad” diets, cautioning patients to consult their healthcare team if they are looking to make alterations to their current nutritional plan. When asked about the benefits of including dietitians in the holistic approach to MS treatment, she differentiated between dietitians and nutritionists, citing the training and knowledge base that dietitians are equipped to provide. 

NeurologyLive: Generally, what do you feel the role of nutrition is in people with MS, especially in those with other comorbidities?

Mona Bostick, RDN, LDN, MSCS: Nutrition—the role that it plays in keeping people generally healthy—is a very important thing, and that becomes particularly important in people living with multiple sclerosis. At this point, although there is no therapeutic diet that has been shown by science to directly impact the disease process itself, comorbidities are where nutrition can have an enormous impact. My presentation addressed the role of registered dietitians using nutrition interventions to treat and manage comorbid health conditions. There's a lot of evidence that suggests that by managing those conditions well, we can improve the health outcomes of people with multiple sclerosis.

What are your thoughts on popular elimination-type diets, as a registered dietitian? Are there certain diets that may impact symptoms of MS?

They are fad diets, and they're full of buzzwords and trends. There is absolutely no clinical evidence to support the validity of any of these approaches—I won't list them, but I think we can all assume what they are. While there's no clinical evidence to support that they will conclusively impact everyone, there are people who report anecdotally that ‘this or that’ approach does manage symptoms, and I'm certainly not going to poopoo that, but I will say that because your friend Barbara may have had a positive experience on symptom management doing diet or intervention X, that does in no way suggest that you will have a similar response, and there are sometimes some unintended consequences from these approaches. It's really important that you run whatever you're doing by your healthcare team, and if you have questions about whether this would be appropriate for you individually, I would highly recommend you reach out to a registered dietitian.

Within the comprehensive care model, how do you envision the role of dietitians in an MS care facility? How do dietitians interact with clinicians and/or patients in these facilities? 

This is the $6-million question. As a dietitian myself—I wish that registered dietitians were already included in the multidisciplinary care of people with MS. Currently, broadly, I don't believe we are, and I believe we are uniquely qualified, through the nutrition care process that we perform professionally, to be a part of a comorbidity management team. As important as that is, I would encourage people in a hiring position to consider hiring dietitians onto the team, and if not, at least find one in your community, because we are out there. [It is also important to recognize] that we may not all be aware of the role that we can play, simply because we've not been included in the healthcare team thus far, but reaching out and vetting a dietitian in your community to provide the services for the patients you work with, would be an excellent idea.

What is the evolving role of dietitians as people start to move towards a more holistic understanding of the importance of a mind/body approach to wellness in MS? 

Part of my presentation addressed what it is a dietitian is, meaning how our how we obtain our credentials, the education involved, and what it takes to become a registered dietitian. I included that because I have been informed that there are quite a few in the neurology space who are quite unaware of what we provide. I find that that's a very important distinction to make between a registered dietitian and other nutritionists in the world, because all dietitians are nutritionists, but nutritionists are not all dietitians—and that is important because you don't quite know what you're going to get. You do know what you're going to get if you're working with a registered dietitian, in terms of education, training, knowledge base, and background—that is not necessarily the case with nutritionists, so I wanted to get that out there.

The role that a dietitian can play in patient care, working with a vulnerable population, like [the one that] exists in multiple sclerosis, is that right off the bat, we can provide myth-busting to help sort of sort out fact from fiction, from all the internet fluff that's out there that is really overwhelming. Also, we are a valuable asset to a clinical team, because we are trained to provide clinical care. It is my hope that dietitians will be included in the clinical care of people with MS, whether that's in an acute care setting, an outpatient setting, or even in a group program to community type setting. We have a lot to add, I believe.

Transcript edited for clarity. For more coverage of CMSC 2021, click here.