Although no diet has been proved to change the course of MS, nutritious foods like fresh fruit and low-fat dairy may help you fight fatigue, dietitians say.
Medically Reviewed by Jason Paul Chua, MD, PhD
Find out why dietitians recommend fresh fruit, salmon, and other nutrient-packed foods to fight MS fatigue.
Fatigue caused by multiple sclerosis (MS) is among the most common symptoms of the disease, and one that can take a serious toll on work and home life.
The National Multiple Sclerosis Society (NMSS) estimates that 80 percent of people with MS experience fatigue, and a study published in March 2021 in Multiple Sclerosis Journal revealed similar estimates internationally. After surveying patients with MS in Norway, researchers found that fatigue affected 81 percent of people, and noted a higher prevalence of fatigue in women (83 percent) compared with men (78 percent). Their study also suggested that fatigue was more common in people with greater disability, depression, anxiety, and excessive sleepiness during the day.
Often called “lassitude,” according to the NMSS, fatigue related to MS has unique effects on people with the condition:
- It happens every day and often comes on suddenly.
- It can affect you as you’re starting your day, even if you slept well the night before, and often gets worse as the day goes on.
- Heat and humidity can intensify fatigue.
- It’s often more severe than normal fatigue and can interfere with your ability to function throughout the day.
Lassitude is an effect of demyelination, or damage that happens to the outer covering of your nerves when you have MS, says the certified MS specialist Mona Bostick, RDN, who founded the private practice Food Matters 365 and writes the blog MSBites. Bostick has been living with relapsing-remitting MS since 2008. “Demyelination makes the body work harder throughout the nervous system, thus producing fatigue,” she explains.
And along with lassitude, secondary fatigue can heap another layer of exhaustion onto your daily routine, says Bostick, naming factors like suboptimal eating patterns as possible contributors to secondary fatigue.
So, can sticking to healthy foods help bust MS fatigue? Though no diet has been proven to affect the course of MS, eating the right foods will give you your best shot at managing exhaustion.
“I tell people to think of their body as an engine that MS has rendered less energy-efficient or effective,” explains Bostick. “Folks without MS start out with a tank full of energy every day. People with MS start out with only a gallon or two, and we run out of energy quicker, because MS has made our engine less energy-efficient.”
And when it comes to making the most out of the energy you do have, “putting high-quality fuel in your tank” is key, Bostick adds.
Exactly what should you eat or drink with when you have MS-related fatigue? Here are seven fatigue-fighting ways to fuel your body.
1. Refresh With Water
Dehydration contributes to fatigue, so water is an important tool. “Individuals with MS often have neurogenic bladder, which affects the ability to properly control bladder emptying. As a result, they may refrain from drinking enough water, which can lead to dehydration,” says Nina Eng, RDN, the chief clinical dietitian at Northwell Health Plainview Hospital in Plainview, New York.
According to the Food and Nutrition Board of the National Academies of Sciences, Engineering, and Medicine, men should drink about 3.7 liters of total water a day, and women should drink around 2.7 liters (total water can include drinking water, water-containing beverages, and water-containing foods). And if you are exercising vigorously or if the weather is hot, you may need more than that.
2. Pump Up the Protein
“Protein is a macronutrient that provides the body with fuel,” says Eng. It’s known to have multiple roles in the body, including helping to repair cells and build new ones.
Protein also activates cells that help keep you awake, according to a study done at the University of Cambridge in England that was published in the journal Neuron. Researchers found that energy levels depend on a group of brain-stimulating cells called orexin cells, and that these cells respond better to amino acids in proteins than to other nutrients.
Eng recommends protein-rich options such as nuts, beans, and lean animal proteins.
3. Munch on Nutrient-Packed Snacks
Snacks can help boost and sustain energy throughout the day by keeping your blood sugar from dipping too low.
“Good options include 100 percent whole-grain crackers or bread sticks with low-fat cheese; fresh fruit; plain, low-fat, or fat-free yogurt; low-fat granola; a glass of low-fat or skim milk; and frozen blueberries,” says Elizabeth Somer, RD, the author of several books on nutrition, including Eat Your Way to Happiness.
She recommends steering clear of high-sugar snacks, which cause a spike in energy and then a fast crash, which worsens fatigue.
4. Boost Your Omega-3 Intake
Omega-3 fatty acids, found in high amounts in fatty fish such as salmon, may reduce inflammation in the body and reduce the risk of stroke and heart disease.
So far, studies of omega-3 supplements in people with MS suggest benefits for people with relapsing-remitting MS, according to the NMSS, but the results of those studies have not been statistically significant. Nonetheless, foods containing omega-3s are considered part of a healthy diet, and preventing heart disease is a worthwhile goal for anyone.
“Fish, including wild salmon, mackerel, anchovies, and tuna; ground flaxseed; flax oil; leafy green vegetables; and walnuts are all good sources of omega-3 fats,” Eng says.
5. Begin Your Day With a Good Breakfast
A good breakfast can help improve concentration, strength, and endurance, but what is “good”?
Eng advises, “Look for foods that contain at least three grams of fiber per serving.” Those might include oatmeal, whole-grain breads or pancakes, high-fiber breakfast cereals, and grains such as brown rice or quinoa. Add some fruit or vegetables for more nutrients and fiber.
Include some protein — from foods such as eggs, low-fat dairy products, soy milk, seeds and nuts or nut butters — and a small amount of healthy fats in your meal, too, to feel satiated longer.
6. Bone Up On Calcium and Vitamin D
According to the NMSS, research is increasingly showing that low vitamin D levels in the blood may be a risk factor for developing MS, though more research is needed to find out whether vitamin D has any impact on disease activity in people with the condition.
But experts do know that getting enough vitamin D and calcium is key for bone health among people who already have MS.
“It’s a good idea to incorporate foods high in vitamin D and calcium into your diet, especially if you have been on steroids for a long time,” Eng says, because one side effect of steroids is poor bone health. Low levels of weight-bearing activity, such as walking, can also lead to weak bones and a higher fracture risk.
Steroids are often prescribed only as a short-term, first-line treatment for MS exacerbations — usually for three to five days via IV, and sometimes followed by a tapering oral dose for one to three weeks.
But some comorbid conditions that are common in people with MS, including inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, require long-term steroid use. And per the NMSS, steroid treatment can lead to bone loss if used for prolonged periods of time.
Good food sources of vitamin D include fortified milk and orange juice, cod liver oil, and fatty fish. Small amounts of vitamin D are naturally present in egg yolks and cheese.
To get calcium, Eng suggests eating cheese, yogurt, milk, sardines with bones, dark leafy greens, fortified cereal, and soybeans. And for any calcium-containing foods you choose, Bostick recommends sticking to low-fat options.
7. Consider Taking a Multivitamin
“Since 99 out of 100 Americans don’t meet the standards for a balanced diet, I recommend taking a moderate-dose, broad-range multivitamin every day,” Somer says.
And while B-vitamin supplements are sometimes touted as energy boosters, she says that a multivitamin contains enough B to do the trick for most people.
Vitamin D supplements may also offer some benefits for people with MS, including improved symptoms and quality of life, according to Mayo Clinic. Taking vitamin D is likely safe for people with MS, but doses that are too high could affect your calcium levels, the Mayo Clinic says.
Before taking supplements of individual vitamins or minerals, talk to your doctor about whether you should take them and how much to take. Some supplements can interact with MS medications or other drugs you may be taking.
Additional reporting by Christina Vogt.