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Healthy Eating: Healthy Eating: Healthy Eating: Healthy Eating: Healthy Eating: A Guide For Persons A Guide For Persons A Guide For Persons A Guide For Persons A Guide For Persons With Multiple Sclerosis ith Multiple Sclerosis ith Multiple Sclerosis ith Multiple Sclerosis ith Multiple Sclerosis by Erla Wankling, RD Doreen Abbott, PHEc Multiple Sclerosis Society of Canada Multiple Sclerosis Society of Canada Multiple Sclerosis Society of Canada Multiple Sclerosis Society of Canada Multiple Sclerosis Society of Canada 250 Bloor Street East, Suite 1000 250 Bloor Street East, Suite 1000 250 Bloor Street East, Suite 1000 250 Bloor Street East, Suite 1000 250 Bloor Street East, Suite 1000 Toronto, Ontario M4W 3P9 Toronto, Ontario M4W 3P9 Toronto, Ontario M4W 3P9 Toronto, Ontario M4W 3P9 Toronto, Ontario M4W 3P9

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Page 1: Healthy Eating 2001 - scleroseenplaques.ca · 6 CANADA™S GUIDELINES FOR HEALTHY EATING Ł Enjoy a VARIETY of foods. Ł Emphasize cereals, breads, other grain products, vegetables

Healthy Eating:Healthy Eating:Healthy Eating:Healthy Eating:Healthy Eating:A Guide For PersonsA Guide For PersonsA Guide For PersonsA Guide For PersonsA Guide For PersonsWWWWWith Multiple Sclerosisith Multiple Sclerosisith Multiple Sclerosisith Multiple Sclerosisith Multiple Sclerosis

by Erla Wankling, RDDoreen Abbott, PHEc

Multiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of Canada250 Bloor Street East, Suite 1000250 Bloor Street East, Suite 1000250 Bloor Street East, Suite 1000250 Bloor Street East, Suite 1000250 Bloor Street East, Suite 1000

Toronto, Ontario M4W 3P9Toronto, Ontario M4W 3P9Toronto, Ontario M4W 3P9Toronto, Ontario M4W 3P9Toronto, Ontario M4W 3P9

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Healthy Eating:Healthy Eating:Healthy Eating:Healthy Eating:Healthy Eating:A Guide For Persons With Multiple SclerosisA Guide For Persons With Multiple SclerosisA Guide For Persons With Multiple SclerosisA Guide For Persons With Multiple SclerosisA Guide For Persons With Multiple SclerosisFirst edition, 1991. Revised 1994.

Multiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaThe Multiple Sclerosis Society of Canada is pleasedto be a source of information about multiple sclero-sis. The information in this publication is based onprofessional advice and expert opinion, but doesnot represent therapeutic recommendations or pre-scription. For specific information and advice,please consult your personal physician.

Cover design by Alfred Wong (416) 424-2680

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ContentsContentsContentsContentsContentsCanada�s Guidelines For Healthy EatingCanada�s Guidelines For Healthy EatingCanada�s Guidelines For Healthy EatingCanada�s Guidelines For Healthy EatingCanada�s Guidelines For Healthy EatingA Balanced DietA Balanced DietA Balanced DietA Balanced DietA Balanced DietCanada�s Food GuideCanada�s Food GuideCanada�s Food GuideCanada�s Food GuideCanada�s Food GuideGrain ProductsVegetables and FruitsMilk ProductsMeat and AlternativesOther FoodsNutrients Needed For Good HealthNutrients Needed For Good HealthNutrients Needed For Good HealthNutrients Needed For Good HealthNutrients Needed For Good HealthCarbohydratesProteinFatsVitamin AVitamin BVitamin CVitamin DFolateCalciumIronMineralsSpecial DietsSpecial DietsSpecial DietsSpecial DietsSpecial DietsVitamin Supplementation orMegavitamin TherapyMineral SupplementationLow-Fat Diet (Swank Diet)Polyunsaturated Fatty Acid SupplementsAllergen-Free DietGluten-Free DietMacDougal DietKousmine DietCommon ConcernsCommon ConcernsCommon ConcernsCommon ConcernsCommon ConcernsConstipation

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ContentsContentsContentsContentsContentsUrinary Tract Infections andFormation of Renal StonesWeight GainWeight LossFatigueReferencesReferencesReferencesReferencesReferences

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HEALHEALHEALHEALHEALTHY EATHY EATHY EATHY EATHY EATING:TING:TING:TING:TING:A GUIDE FOR PERSONSA GUIDE FOR PERSONSA GUIDE FOR PERSONSA GUIDE FOR PERSONSA GUIDE FOR PERSONS

WITH MULWITH MULWITH MULWITH MULWITH MULTIPLE SCLEROSISTIPLE SCLEROSISTIPLE SCLEROSISTIPLE SCLEROSISTIPLE SCLEROSIS

Multiple sclerosis is an unpredictable dis-ease, and as a result there are numerousunproven treatments, some of the mostpopular being special diets targeted to-wards the individual with multiple sclerosis.To date, no special diet has been scientifi-cally shown to change the course of mul-tiple sclerosis, despite all the claims.

A well-established medical fact is that properproperproperproperpropernutritionnutritionnutritionnutritionnutrition is the key to good healthgood healthgood healthgood healthgood health. The1990 Health and Welfare Canada NutritionRecommendations give the proper nutri-tion guidelines that should be followed byall Canadians, including people with mul-tiple sclerosis.

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CANADCANADCANADCANADCANADA�S GUIDELINESA�S GUIDELINESA�S GUIDELINESA�S GUIDELINESA�S GUIDELINESFOR HEALFOR HEALFOR HEALFOR HEALFOR HEALTHY EATHY EATHY EATHY EATHY EATINGTINGTINGTINGTING

� Enjoy a VARIETY of foods.

� Emphasize cereals, breads, othergrain products, vegetables and fruits.

� Choose low-fat dairy products, leanmeats and foods prepared with littleor no fat.

� Achieve and maintain a healthy bodyweight by enjoying regular physicalactivity and healthy eating.

� Limit salt, alcohol and caffeine.

The advantage of healthy eating forpeople with multiple sclerosis include:

� fewer complications of poor nutrition,such as anemia, protein deficiency,obesity or inadequate body weight

� ability to fight off infections

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� increased energy level and reducedfatigue

� improved wound healing

� less difficulty with particularsymptoms such as constipation

A balanced diet helps you keep healthy andstrong to make the most of what you have!

A BALANCED DIETA BALANCED DIETA BALANCED DIETA BALANCED DIETA BALANCED DIET

A balanced diet is made up of foods se-lected from each of the food groups inCanada�s Food Guide. A variety of foodsshould be chosen from each of the foodgroups daily. Each food group has certainimportant nutrients needed by the bodythat cannot be supplied by any other foodgroup.

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CANADCANADCANADCANADCANADA�S FOOD GUIDEA�S FOOD GUIDEA�S FOOD GUIDEA�S FOOD GUIDEA�S FOOD GUIDE

Different people need different amountsof food. The amount you need everydayfrom the 4 food groups and other fooddepends on:

- age- activity level- pregnancy or breast feeding- body size- male or female

That is why the Food Guide gives a lowerand higher number of servings for eachfood group. For example, young childrencan choose the lower number, while maleteenagers can go to the higher number.

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Most other people can choose servingssomewhere in between.

Grain ProductsGrain ProductsGrain ProductsGrain ProductsGrain Products

Choose whole grain and enriched productsmore often. 5-125-125-125-125-12 servings each day.

Examples of 1 serving:Bread 1 sliceHot cereal 175 mL (3/4 c.)Cold cereal 30 gramsCooked spaghetti, macaroni,rice or noodles 125 mL (1/2 c.)Hamburger, wiener,bun, pita or bagel 1/2

VVVVVegetables and Fegetables and Fegetables and Fegetables and Fegetables and Fruitsruitsruitsruitsruits

Choose dark green and orange vegetablesand orange fruit more often. 5-105-105-105-105-10 servingseach day.

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Examples of 1 serving:Fruits, vegetables or their juices(fresh, frozen or canned) 125 mL (1/2 c.)1 medium-size potato, carrot,tomato, peach, apple, orangeor bananaSalad 250 mL (1 c.)

Milk ProductsMilk ProductsMilk ProductsMilk ProductsMilk Products

Choose lower-fat milk products more often.

servingsChildren 4-9 years 2-3Youth 10-16 years 3-4Adults 2-4Pregnant or nursing women 3-4

Examples of 1 serving:Fluid milk(whole, 2%, 1% or skim) 250 mL (1 c.)Cheese 50 gramsYogurt 175 mL (3/4 c.)Milk pudding 250 mL (1 c.)Cream soup(made with milk) 375 mL

(1 1/2 c.)

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Meat and AlternativesMeat and AlternativesMeat and AlternativesMeat and AlternativesMeat and Alternatives

Choose leaner meats, poultry and fish, aswell as dried peas, beans and lentils moreoften. 2-3 2-3 2-3 2-3 2-3 servings each day.

Examples of 1 serving:Lean, cooked meat, fish,poultry 50-100 gramsEggs 1-2Peanut butter 30 mL (2 Tbsp.)Cooked dried peas, beansor lentils 125-25 mL

(1/2 - 1 c.)Tofu 100 grams

(1/3 c.)

Other FOther FOther FOther FOther Foodsoodsoodsoodsoods

Taste and enjoyment can also come fromother foods and beverages that are not partof the 4 food groups, but are commonlyused by Canadians. Some of these foodsare higher in fat or Calories, so use thesefoods in moderation. They include:� foods that are mostly fats and oils,

such as butter, margarine, cooking oils,mayonnaise, oil-based salad dressings,

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shortening, lard� foods that are mostly sugar such as

jam, honey, syrup, candy, marshmal-lows, popsicles

� high-fat and/or high-salt snack foodssuch as chips (potato or corn),pretzels

� beverages such as water, coffee, tea,soft drinks, fruit-flavoured drinks,alcohol

� herbs, spices, condiments such aspickles, mustard, ketchup, horserad-ish, soya sauce, steak sauce

These foods can be used in making mealsand snacks and are often eaten with foodsfrom the 4 food groups.

SALTIt is advisable to use less salt in cooking andon the table and to choose highly-saltedsnack foods less often.

ALCOHOLCanadians are advised to reduce their totalalcohol consumption to 1 drink per day andno more than 7 drinks a week. If you arepregnant or breast-feeding, avoid alcohol.

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CAFFEINEIntake should not exceed the equivalent of4 cups of coffee a day, as it acts as a diuretic(increases the need to urinate) and bladderirritant. Caffeine is also obtained from tea,cola drinks, chocolate and some cold rem-edies and head-ache medicines.

FLUIDSDaily intake of fluids (water, juice, tea, cof-fee) should satisfy your thirst. Choose wa-ter often and be sure to drink more in hotweather or when you are very active. Anadequate amount of fluid is needed by thebody to maintain fluid levels and to aid in theremoval of body waste products.

FATSChoose:� low-fat dairy products - skim milk,

low-fat cheese� lean meats, fish, poultry without skin� foods prepared with little or no fat

Remember that doughnuts, croissants,pastries and nuts contain hidden fat.

It is recommended that only 1/3 of your total

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fat intake should be a saturated fat, such asbutter, hard margarine, shortening, animalfats, whole milk and whole milk products(ice cream, cheese, sour cream).

The other portion of your fat intake caninclude oils, most soft margarine, nuts andseeds.

A saturated fat is one that is solid at roomtemperature, a polyunsaturated fat is liquidat room temperature, while a mono-unsat-urated fat is liquid at room temperature butbecomes partly solid when chilled.

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NUTRIENTS NEEDEDNUTRIENTS NEEDEDNUTRIENTS NEEDEDNUTRIENTS NEEDEDNUTRIENTS NEEDEDFOR GOOD HEALFOR GOOD HEALFOR GOOD HEALFOR GOOD HEALFOR GOOD HEALTHTHTHTHTH

Eating a variety of foods from all food groupsprovides the nutrients needed. These are:protein, carbohydrate, fat, vitamin, miner-als, water. Some foods are better sourcesof these nutrients than others.

CarbohydratesCarbohydratesCarbohydratesCarbohydratesCarbohydrates

� chief source of energy

� should be used to replace some ofthe fat in the diet

Excellent Sources Poor ChoicesBread, cereals Syrup andRice, pastas table sugarsPotatoes CandyDried peas and Soft drinksbeans Jams and jelliesFruit (empty calorieMilk foods - energy, but

few nutrients

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ProteinProteinProteinProteinProtein

� the body�s building blocks

� promotes growth and development

� builds muscle tissue which holds thebone structure together

� provides strength to move and work

� forms antibodies that help fightinfection

� aids in making hemoglobin - anoxygen carrier in the blood

Excellent Sources Good SourcesMeat Dried peas andFish beansPoultry Chick peasEggs Peanut butterCheeseMilk and milk productsSoybeans

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FFFFFatsatsatsatsats

� provide energy

� carry fat-soluble vitamins A,D,E andK

� add flavor and variety to the diet

� contribute to maintenance of healthyskin tissue

� form a protective cushion around vitalorgans

Canadians should reduce their fat intake byselecting and preparing foods with smallamounts of fat.

High in High inPolyunsaturated Saturated FatFatCorn oil ButterSafflower, Hard margarinessunflower oil Fat in meatsSalad dressings Cheesewith oils Potato chipsPeanut butter Chocolate

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Walnuts CreamSunflower seeds Palm oilSesame seeds Coconut oil

High in Monounsaturated FatCanola, olive oil

Vitamin AVitamin AVitamin AVitamin AVitamin A

� helps bone and tooth development

� promotes good night vision

� maintains healthy skin and bodymembranes

Excellent Sources Good SourcesLiver BroccoliSweet potatoes PeachesCarrots TomatoesApricotsCantaloupeWinter Squash, pumpkinDark green, leafy vegetablessuch as spinach and beet greens

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Vitamin BVitamin BVitamin BVitamin BVitamin B

B1 (thiamin)� releases energy from carbohydrates

� promotes normal growth and appetite

B2 (riboflavin)� maintain healthy skin

� aid in nerve function

� releases energy to body cells

B3 (niacin)� promotes growth and development

� aid in nerve function

� aid in digestion

B6 (pyridoxine)� promotes production of antibodies

� formation of red blood cells

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Excellent Sources Good SourcesPork (lean) Whole grain orOrgan meats enriched breadsNuts and cereals

FishLegumesEgg yolksMilk

Vitamin CVitamin CVitamin CVitamin CVitamin C

� maintains strong blood vessel walls

� wound healing

� bone and tooth formation

Excellent Sources Good SourcesBroccoli Green peppersCantaloupe Fruit juices withBrussel sprouts Vit.C addedOranges CauliflowerGrapefruitStrawberries

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Vitamin DVitamin DVitamin DVitamin DVitamin D

� The sunshine vitamin

� formed in the body by the directaction of sun light on the skin

� works with calcium to build strongbones and teeth

Excellent Sources Good SourcesMilk and margarines Organ meatsfortified with vitamin D (liver)

Egg yolksSalmon, tuna

FFFFFolateolateolateolateolate

� involved in normal red and whiteblood cell formation

� involved in energy production

Excellent Sources Good SourcesLiver, kidney WalnutsSpinach, asparagus, Oranges, bananasbroccoli Lettuce

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Dried beans SalmonAlmonds Dried peasEggs

CalciumCalciumCalciumCalciumCalcium

� builds and maintains strong bonesand teeth

� helps nerves and muscles functionproperly

� helps blood clot

Excellent Sources Good SourcesMilk- whole, skim Creamed soups,or buttermilk puddings andYogurt custardCheese, hard or Salmon (withprocessed bones)

Mackerel,oystersSoybeans, nuts,tofu

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IronIronIronIronIron

� an essential part of hemoglobin - anoxygen carrier in the blood

� helps body cells release energy fromfood

Excellent Sources Good SourcesLiver, kidney Chicken, lamb,Enriched breads beefand cereals Nuts andDried peas and beans seeds

Dried prunes,apricots

MineralsMineralsMineralsMineralsMinerals

ZINC� helps energy metabolism

� aids in tissue formation

Sources: Meat, shellfish, poultryLiver, egg yolkWhole grains

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SELENIUM� prevents breakdown of fats and other

body chemicals

Sources: Whole grain cerealsMeat, dairy products, poultry

COPPER� aids in formation of red blood cells

Sources: Liver, shellfishWhole grains, nuts

MAGNESIUM� builds and maintains strong bones

and teeth

� helps energy metabolism and tissueformation

Sources: Whole grainsVegetables

IODINE� helps thyroid gland to function

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Sources: Iodized saltSeafood

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SPECIAL DIETSSPECIAL DIETSSPECIAL DIETSSPECIAL DIETSSPECIAL DIETS

No special diet has been scientifically shownto modify the natural course of multiplesclerosis, despite numerous claims.

Fad diets may create false hopes and iffollowed to the extreme, may have detri-mental effects on the well-being of individu-als with multiple sclerosis.

The following are a few of the most publi-cized diets with recommendations by theInternational Federation of Multiple Sclero-sis Societies.

Vitamin SupplementationVitamin SupplementationVitamin SupplementationVitamin SupplementationVitamin Supplementation orMegavitamin TherapyMegavitamin TherapyMegavitamin TherapyMegavitamin TherapyMegavitamin Therapy

(massive doses of vitamins)

� Adequate intake of vitamins isadvised for all individuals with MS,but there appears to be no scientificproof that supplementary doses ofvitamins, alone or in combination,favorably affect the course of thedisease.

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� Excessive doses of some vitamins,especially A and D, may produceharmful effects.

� When pyridoxine (Vitamin B6) is usedin high doses, it sometimes producesweakness and loss of balance.

� High levels of Vitamin C can producestomach problems and kidney stones.

� Vitamins are expensive

Mineral SupplementationMineral SupplementationMineral SupplementationMineral SupplementationMineral Supplementation

� The use of minerals, such as zinc,magnesium and calcium, in a largesingle dose has never been tested in

a properly controlled study.

� Many minerals are harmful whentaken at any level above the tracesfound in normal foods.

Low-FLow-FLow-FLow-FLow-Fat Dietat Dietat Dietat Dietat Diet (Swank Diet)

� This is a diet having a fixed low in-take of animal fats and a low, inter-

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mediate or high level of vegetableoils.

� In the reported studies, no matchedcontrol group was studied at thesame time, and although the diet isnot associated with any significantrisks, it is clear that the diet does notprevent exacerbations (attacks) orprogression.

PPPPPolyunsaturated Folyunsaturated Folyunsaturated Folyunsaturated Folyunsaturated Fatty Acidatty Acidatty Acidatty Acidatty AcidSupplementsSupplementsSupplementsSupplementsSupplements

� Supplementing the diet with linolenicacid, linoleic acid, sunflower seed oil,safflower seed oil or evening prim-rose oil, has shown conflicting results in the studies conducted todate.

� This would add quite a few caloriesto the diet, so would need to becombined with a low fat diet.

� This therapy may have some benefits to a very small percentage ofindividuals with MS.

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Allergen-FAllergen-FAllergen-FAllergen-FAllergen-Free Dietree Dietree Dietree Dietree Diet

� This diet involves avoiding foods thatare known to produce hives, otherskin eruptions, asthma attacks, etc.

� Short term use of this diet has littlerisk, provided food from all foodgroups are eaten.

� It has never been tested in a properlycontrolled trial and there appears tobe no generally accepted scientificbasis for use of this therapy.

Gluten-FGluten-FGluten-FGluten-FGluten-Free Dietree Dietree Dietree Dietree Diet

� This is usually a balanced diet, whichexcludes wheat and rye.

� It may result in inadequate proteinand fibre intake.

� On the basis of available data, thisdiet must be considered ineffective inmultiple sclerosis.

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MacDougal DietMacDougal DietMacDougal DietMacDougal DietMacDougal Diet

� This combines a low-fat diet with agluten-free diet and adds supple-ments of vitamins and minerals.

� It has never been tested in a properlycontrolled trial, and there appears tobe no scientific evidence that thisdiet is effective in multiple sclerosis.

KKKKKousmine Dietousmine Dietousmine Dietousmine Dietousmine Diet

This diet advises the consumption of:

� less fats, particularly animal fats, lessmeats, processedproducts andsugars.

� It involves the consumption of moreraw fruits and vegetables and wholegrain cereals (in order to obtainmaximum vitamins and minerals).

� While these basic dietary principlesare approved by dieticians the dietalso includes information, for themost part, that is unsubstantiated byscientific evidence.

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Always remember to consult with your phy-sician before changing your diet in any way.

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COMMON CONCERNSCOMMON CONCERNSCOMMON CONCERNSCOMMON CONCERNSCOMMON CONCERNS

ConstipationConstipationConstipationConstipationConstipation

� Constipation is very common and iscaused by a �sluggish� bowel and thelack of physical activity.

� To help prevent constipation, the dietshould include fibre from cereals andlegumes.

The following foods are high in fibre:

- Whole grain breads, bran cereals, brownrice- Dried fruits - prunes, raisins, apricots, figs- Legumes and nuts - baked beans,kidney beans, peanuts, peanut butter

Also important is:

- adequate fluid intake (8 cups a day). Thiscan include juices, tea and coffee.- regular activity, whether it be swimming,yoga or wheelchair exercises.

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- emptying the bowel at the same time ofday. The best time is usually 1/2 hourafter a meal, when the emptying reflex isstrongest.

Laxatives, such as Ex-LaxTM, should beavoided as they irritate the intestine andeventually worsen constipation.

Urinary TUrinary TUrinary TUrinary TUrinary Tract Infections andract Infections andract Infections andract Infections andract Infections andFFFFFormation of Renal Stonesormation of Renal Stonesormation of Renal Stonesormation of Renal Stonesormation of Renal Stones

To reduce this risk, it is recommended thatindividuals with multiple sclerosis, who aresensitive to infections and formation ofstones:

- drink lots of fluids- empty the bladder completely- choose cranberry juice rather than otherjuices. Cranberry juice reduces the strongodor of urine and makes it more acidic. Thishelps to prevent the growth of germs.

WWWWWeight Gaineight Gaineight Gaineight Gaineight Gain

� A significant amount of weight gain

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may increase the risk of seriousmedical problems and make walking

more difficult.

� When trying to reduce the calories inyour diet, remember to select foodshigh in essential nutrients and toavoid foods which supply �emptycalories�, such as pop drinks, candy,

chocolates, chips, etc.

� Follow �Canada�s Guidelines forHealthy Eating� by choosing foodslower in fat, higher in fibre and lowerin sugar:

- skim milk products- lean meats- whole wheat or bran- breads and cereals- fresh fruits and vegetables

� Check your portion sizes with thoserecommended in Canada�s FoodGuide.

� Read labels on food products. Theingredients are listed from highest tolowest amount found in that product.If sugar is listed as the first ingredient,

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then there is more sugar than any ofthe other ingredients.

� Choose a regular exercise programthat is suited to you. The best way tolose weight is to combine healthyeating with exercise.

� Fad diets or very low calorie diets arenot advised.

WWWWWeight Losseight Losseight Losseight Losseight Loss

� Occasionally individuals with multiplesclerosis may experience weight lossdue to swallowing problems, fatigueor physical limitations.

� When weight loss is more than 10%of your average weight, and occurs inthe absence of a weight loss pro-gram, it may represent serious mal-nutrition. It then becomes extremelyimportant that you follow the guide-lines for healthy eating and try toincrease your daily energy intake.

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1. Try to have a high energy dessertafter each meal:

- fruit cobbler with ice cream, date squares- milk puddings topped with fresh fruit

2. Choose high energy snacks:

- sandwich or oatmeal cookie with a glassof milk

- milkshakes, eggnogs- commercial dietary supplemental drinks

� Lack of energy and physical limitationmay result in a problem with shoppingand meal preparation. You may needto use community resources such as�Meals on Wheels�.

� Difficulty swallowing can also causeweight loss, and softer foods have tobe chosen.- hamburger dishes- macaroni and cheese- well-cooked vegetables

If these are not suitable, minced or pureedfoods may be required. If a blender or foodprocessor is not available, baby meats can be

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used and gravy or spicy sauces added forflavor. Vegetables can be mashed with apotato masher.

� If swallowing fluids is a problem,instant potatoes can be added tothicken cream soups. Milk or juicecan be thickened to the proper con-sistency by adding pureed fruits,using plain gelatin or a thickeningagent such as �Thickit�, which canbe purchased from some drug stores.

FFFFFatigueatigueatigueatigueatigue

� Fatigue is a major problem forindividuals with multiple sclerosis. Itis important that you do not skipmeals even though you feel too tiredto eat, as this will tend to increaseyour feeling of tiredness.

� It takes a lot of organizing to preparenutritious meals and still have enoughenergy left to eat them.

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Here are a few tips you may find helpful:

1. Preplan your menus and organizeyour work. Try to save as many steps aspossible.

2. If you have to cut, peel or mix ingredi-ents for more than a minute, sit down. It willbe less tiring.

3. Appliances that can help you saveenergy are:

- microwave oven (avoids use of severalpans and is easy to clean)- blender- toaster over- electric can opener

4. Prepare simple, nutritious meals, suchas cottage cheese with fruit and a muffin orscrambled eggs on toast with a slice ofcheese.

5. Prepare meals, such as casseroles,that will cook in the oven while you restbefore dinner.

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6. Prepare meals in large quantities andfreeze extra servings to be used on a daywhen you are feeling too tired to cook.� There may be days when fatigue is

such that you will want to choose pre-prepared meals, such as a TV dinneror a commercial dietary supplementaldrink, for example Resource, Boost orEnsure.

For more information, contact a nutritionist atyour local Dietetic Association, Home Eco-nomics Association or Public Health Unit.

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REFERENCESREFERENCESREFERENCESREFERENCESREFERENCES

1. Action TAction TAction TAction TAction Towards Healthy Eatingowards Healthy Eatingowards Healthy Eatingowards Healthy Eatingowards Healthy Eating -Health and Welfare Canada, 1990

2. Nutrition Recommendations Nutrition Recommendations Nutrition Recommendations Nutrition Recommendations Nutrition Recommendations - Healthand Welfare Canada, 1990

3. Eat BetterEat BetterEat BetterEat BetterEat Better, F, F, F, F, Feel Greateel Greateel Greateel Greateel Great - Manitoba De-partment of Health, Health Promotions,1987

4. Therapeutic Claims in Multiple Sclero-Therapeutic Claims in Multiple Sclero-Therapeutic Claims in Multiple Sclero-Therapeutic Claims in Multiple Sclero-Therapeutic Claims in Multiple Sclero-sississississis - Sibley, W.A., MD, International Fed-eration of MS Societies, 1988

5. PPPPPositive Nutritionositive Nutritionositive Nutritionositive Nutritionositive Nutrition - Barbara Giesser,MD, National Multiple Sclerosis Society,1990

6. A Reference Guide to Nutrition andA Reference Guide to Nutrition andA Reference Guide to Nutrition andA Reference Guide to Nutrition andA Reference Guide to Nutrition andMultiple SclerosisMultiple SclerosisMultiple SclerosisMultiple SclerosisMultiple Sclerosis - Multiple SclerosisSociety of Canada, Quebec Division,1986

7. Know YKnow YKnow YKnow YKnow Your Nutrientsour Nutrientsour Nutrientsour Nutrientsour Nutrients - City of Toronto,Dept. of Public Health, 1989

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8. Nutrition and Multiple SclerosisNutrition and Multiple SclerosisNutrition and Multiple SclerosisNutrition and Multiple SclerosisNutrition and Multiple Sclerosis -Franklin, Gary, MD, Multiple SclerosisSociety of Colorado

9. Using the F Using the F Using the F Using the F Using the Food Guideood Guideood Guideood Guideood Guide - Health andWelfare Canada, 1992

10. FFFFFood Guide Food Guide Food Guide Food Guide Food Guide Factsactsactsactsacts - Health andWelfare Canada, 1992

Erla WErla WErla WErla WErla Wankling, R.Dankling, R.Dankling, R.Dankling, R.Dankling, R.D..... is a community nutri-tionist at the Health Action Centre Clinic,Winnipeg, Manitoba. She is a graduate ofthe University of Manitoba, a member of theCanadian Dietetic Association and theManitoba Association of Registered Dieti-tians. Erla has also been involved with theMS Clinic, Winnipeg as a nutrition counsel-lor.Doreen Abbott, PHEcDoreen Abbott, PHEcDoreen Abbott, PHEcDoreen Abbott, PHEcDoreen Abbott, PHEc is a graduate of theUniversity of Manitoba, and a member ofthe Canadian Home Economics Associa-tion and the Manitoba Association of HomeEconomists. Doreen has worked as anExtension Home Economist for the Mani-toba government, with the Canadian RedCross Society, and is currently ServicesDirector, Multiple Sclerosis Society of Can-ada, Manitoba Division.

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Multiple Sclerosis Society OfficesMultiple Sclerosis Society OfficesMultiple Sclerosis Society OfficesMultiple Sclerosis Society OfficesMultiple Sclerosis Society Offices

Atlantic DivisionAtlantic DivisionAtlantic DivisionAtlantic DivisionAtlantic Division71 Ilsley AvenueUnit 12Dartmouth, N.S.B3B 1L5(902) 468-8230

Quebec DivisionQuebec DivisionQuebec DivisionQuebec DivisionQuebec Division666 Sherbrooke St. W.Suite 1500Montreal, QuebecH3A 1E7(514) 849-7591

Ontario DivisionOntario DivisionOntario DivisionOntario DivisionOntario Division250 Bloor St. E.Suite 1000Toronto, Ont.M4W 3P9(416) 922-6065

Manitoba DivisionManitoba DivisionManitoba DivisionManitoba DivisionManitoba Division141 Bannatyne Ave.Suite 400Winnipeg, Man.R3B 0R3(204) 943-9595

Saskatchewan DivisionSaskatchewan DivisionSaskatchewan DivisionSaskatchewan DivisionSaskatchewan Division150 Albert St.Regina, Sask.S4R 2N2(306) 522-5600

Alberta DivisionAlberta DivisionAlberta DivisionAlberta DivisionAlberta Division10104 - 79th St.Edmonton, Alta.T6A 3G3(780) 463-1190

British Columbia DivisionBritish Columbia DivisionBritish Columbia DivisionBritish Columbia DivisionBritish Columbia Division1130 West Pender St.Suite 1600Vancouver, B.C.V6E 4A4(604) 689-3144

National OfficeNational OfficeNational OfficeNational OfficeNational Office250 Bloor St. E.Suite 1000Toronto, Ont.M4W 3P9(416) 922-6065

Call toll-free in Canada 1-800-268-7582Call toll-free in Canada 1-800-268-7582Call toll-free in Canada 1-800-268-7582Call toll-free in Canada 1-800-268-7582Call toll-free in Canada 1-800-268-7582http://www.mssociety.ca [email protected]://www.mssociety.ca [email protected]://www.mssociety.ca [email protected]://www.mssociety.ca [email protected]://www.mssociety.ca [email protected]

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Multiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of CanadaMultiple Sclerosis Society of Canada250 Bloor St. E., Suite 1000250 Bloor St. E., Suite 1000250 Bloor St. E., Suite 1000250 Bloor St. E., Suite 1000250 Bloor St. E., Suite 1000

TTTTToronto, Ont. M4W 3P9oronto, Ont. M4W 3P9oronto, Ont. M4W 3P9oronto, Ont. M4W 3P9oronto, Ont. M4W 3P9

(Disponible en français)C33E - 06/98

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