In most countries the Government publishes a framework for healthy eating in order to promote optimal dietary intake to the population to help prevent diseases such as heart disease and osteoporosis (see 'Diet to reduce risk of further diseases' page). In the UK the Food Standards Agency (FSA) published the 'Eatwell Plate' in 1997, based on much research into the optimal proportion of food groups recommended for health; this was updated in 2016 to provide the 'Eatwell guide'. The Guide provides a visual representation of what constitutes a healthy proportion of the main food groups for each meal.
The guide is appropriate for most adults regardless of height, weight, dietary restrictions, preferences or ethnic origin. The guide is a broad recommendation. If you are in any doubt about how it applies to you please consult a registered dietitian (RD) for further clarification.
The guide is appropriate for most adults regardless of height, weight, dietary restrictions, preferences or ethnic origin. The guide is a broad recommendation. If you are in any doubt about how it applies to you please consult a registered dietitian (RD) for further clarification.
How does it work?
The Guide splits food and drinks that we eat into five main groups. You should try to choose a variety of different foods from each of the groups every day to help your body stay healthy and work most effectively.
While it is important to include fat in your diet, foods high in fat, salt and sugar are placed outside of the model as these are not essential to the diet and are therefore accessory items. Healthier types of fats to substitute are fats from plant sources (eg avocado) and vegetable or olive oils. It is worth remembering however that although these are healthier alternatives, all types of fat are high in energy (calories) so should only be eaten in small amounts. It is also important to remember that we eat 'meals' not individual food items alone so many of our meals will fall into a number of different sections on the guide.
A closer look at the food groups
1. Fruits and vegetables
May people know that they could include more fruits and vegetables in their diet and have heard the advice on eating at least 5 portions each day but may be unsure of how much is in a portion (we can help here) or are stuck for ideas of how to include more options for different meals (we can also help here too!). Fruit and vegetables are excellent sources of fibre (particularly if you eat the skins of options like potatoes or parsnips) which can be a help in managing symptoms such as constipation. They also provide a good source of many vitamins and minerals that we need; they are also a great way to bulk out your meals without adding many more calories if you are trying to lose weight.
All fruits and vegetables count towards your five-a-day including tinned, frozen, canned, dried and juiced - however by breaking down fruit into a smoothie/juice you are breaking down the item's structure, removing the fibre and releasing simple sugars which raise blood sugar in a way that consuming the whole fruit doesn't: for this reason it is recommended that you limit juices/smoothies to 150ml per day and counts as one portion, however much you choose to consume.
Nutrients provided:
Fruits: Good source of minerals, water-soluble vitamins, fibre, water and sugars
Vegetables: good source of minerals, water-soluble vitamins, fibre, water and complex carbohydrates
2. Potatoes, bread, rice, pasta and other starchy carbohydrates
Starchy food is an important part of your diet and should make up around 30% of the food you eat to provide you with adequate amounts of energy. Wholegrain varieties should be chosen where possible to provide fibre to help with symptoms of constipation and provide slower release of energy than more processed whites varieties, which give a quick, sharp increase in energy followed by a sharp drop. Selecting wholegrain varieties will provide a more consistent level of energy for longer which can help to manage symptoms of fatigue. To maintain consistent levels of energy starchy carbohydrates should be included as part of each meal, for example: choose a wholegrain breakfast cereal (with no added sugar) for breakfast, a sandwich make with wholegrain bread or soup with a wholegrain roll for lunch, and include potatoes, rice or pasta as part of your evening meal.
Many people avoid eating starchy carbohydrates in the mistaken belief that they are the cause of weight gain; however gram for gram carbohydrates provide the same amount of energy as protein (4 calories per gram) and less than half the calories of one gram of fat (9 calories per gram). Starchy carbohydrates have received bad press over the years! If you are concerned about managing your weight (see here too) be mindful of what you are putting on your bread: butter, nut butters and chocolate spreads for example are all high in fat, vastly increasing the calories in your meal.
Nutrients provided: primarily starchy carbohydrates. Wholegrain options also provide fibre, water-soluble vitamins and minerals.
3. Dairy and alternatives
Milk, yogurt and cheese are good sources of protein and vitamins, plus important sources of calcium which helps to maintain bone strength; strong bones are important to help prevent osteoporosis; the weakening of bones as you age making them vulnerable to breaks through everyday activities. PwMS maybe susceptible to weaker bones due to immobility and side effects of some medications; balance problems and fatigue may lead to trips and falls and subsequent broken bones.
Some dairy options can be high in saturated fats, like cheese and full-fat milk, but lower-fat alternatives can be selected such as reduced fat cheeses and skimmed milk. Be mindful that reduced-fat products or those with the fat removed (such as 0% fat yogurts) often have sweeteners added to enhance the flavour - check the labels before jumping towards 'low fat' options, particularly for milk drinks and yogurts,. When buying dairy alternatives such as nut milks choose unsweetened varieties which are fortified with calcium.
Another option is to have a smaller portion of the full-fat options like cheese; although reduced fat options, particularly of stronger-flavour cheeses are difficult to distinguish from their full-fat cousins. Visit our 'What exactly is a portion?' page to see more about recommended portion sizes.
Nutrients provided: Protein, fat, milk sugar are all present in varying proportions depending on the item selected. Also fat soluble vitamins including magnesium and calcium.
Milk, yogurt and cheese are good sources of protein and vitamins, plus important sources of calcium which helps to maintain bone strength; strong bones are important to help prevent osteoporosis; the weakening of bones as you age making them vulnerable to breaks through everyday activities. PwMS maybe susceptible to weaker bones due to immobility and side effects of some medications; balance problems and fatigue may lead to trips and falls and subsequent broken bones.
Some dairy options can be high in saturated fats, like cheese and full-fat milk, but lower-fat alternatives can be selected such as reduced fat cheeses and skimmed milk. Be mindful that reduced-fat products or those with the fat removed (such as 0% fat yogurts) often have sweeteners added to enhance the flavour - check the labels before jumping towards 'low fat' options, particularly for milk drinks and yogurts,. When buying dairy alternatives such as nut milks choose unsweetened varieties which are fortified with calcium.
Another option is to have a smaller portion of the full-fat options like cheese; although reduced fat options, particularly of stronger-flavour cheeses are difficult to distinguish from their full-fat cousins. Visit our 'What exactly is a portion?' page to see more about recommended portion sizes.
Nutrients provided: Protein, fat, milk sugar are all present in varying proportions depending on the item selected. Also fat soluble vitamins including magnesium and calcium.
4. Beans, pulses, fish, eggs, meat and other proteins
These foods are sources of protein which is vital for growth and repair of body tissues. Protein is not generally used for energy unless the body is starving or completely depleted of energy, for example during a very strenuous sporting event such as a marathon.
Protein should make up around 15-20% of the diet; protein deficiency is uncommon in Western populations even through a vegetarian diet. Proteins are make up of 'building blocks' of amino acids - there are 20 amino acids which the body needs in order to function correctly: 9 are considered 'essential' as the body cannot synthesise them itself so they must be taken in through the diet; the remaining 11 amino acids are non-essential as the body is able to synthesise itself. Animal sources of protein including meat, eggs, poultry and dairy are considered 'complete' proteins as they contain all 9 essential amino acids in sufficient quantities. Conversely plant-based protein sources such as vegetables, cereals, pulses, lentils and nuts are lacking adequate quantities of one or more essential amino acids and are termed 'incomplete' proteins. Some non-animal sources of protein including quinoa, buckwheat and soy foods are complete proteins.
The guide recommends adults eat at least two portions of fish per week (140g each), one of which should be oily (eg tuna steaks, salmon or sardines).
Some meats are high in saturated fat, particularly if the skin is eaten too; it is recommended that lean cuts of meat are selected or you cut off the visible fat before cooking. Care should be taken in the way meat is prepared: frying in oil dramatically increases the fat content, grilling or baking is a healthier option. Similarly with eggs - a poached or boiled egg contains less fat than an egg fried in oil. Red meat should be limited to around 70g per day as it often contains fat 'marbled' into the meat, increasing the fat and calorie content. Processed meat such as sausages, burgers, bacon and reformed meat products should be limited and the processing often adds extra salt for flavour which should be avoided.
Protein is interesting in relation to PwMS as proteins help to mediate cell responses to an external stimulus (eg rhodopsin is a protein in the eye which is used for vision) antibody proteins are needed for immune protection.
Nutrients provided: Primarily protein but fat, fat-soluble vitamins and minerals (eg iron and sulphur) may also be present.
5. Oils and spreads (fat)
Some fat in our diet is essential to provide energy, insulation, storage of fat-soluble vitamins and protection for our organs, however some types of fat are better for us than others. One gram of fat contains more than double the amount of calories (kcal) provided from protein or carbohydrate (9 kcal per gram compared with 4 kcal per gram), so all fats - whether they are 'healthier' (unsaturated) versions or not - should be consumed in moderation. Fats are generally solid at room temperature (eg butter) and oils are generally liquid at room temperature although there are some exceptions such as coconut oil which is solid at room temperature. Fat is an interesting and current topic within the MS community and where much of the 'diet debate' in MS focusses; fat makes up much of the central nervous system (CNS) and spinal cord; it makes up the myelin sheath around the nerves and transmits messages from sensory receptors around the body to the brain, and from the brain to parts of the body required to respond. As you likely already know the fatty myelin sheath is what is destroyed through MS activity (lesions) which makes nerve impulses (messages) more difficult for the CNS to interpret and respond to; the 'faulty brain wiring' analogy in MS. It would make sense therefore to somehow use dietary fat to repair the myelin damage caused by MS - easy huh? Thankfully there is much ongoing research around theories of myelin repair and how we can stop our immune system eating away at itself causing this damage however it is unlikely to be as easy as dietary supplementation.
Fats are made up of chains of fatty acids; their biochemical structure dictates whether they are saturated or unsaturated. saturated fats are generally found in animal products (eg meat, cheese and butter) although some plant sources - such as coconut oil - are very high in saturated fat so moderation is key. Saturated fat is considered more unhealthy because it has been shown to be laid down as fatty deposits in the arteries which can impede blood flow around the body; increase the amount of cholesterol in the blood which can lead to coronary heart disease and can cause heart attacks. Reducing your saturated fat consumption is recommended to keep the heart and blood healthy. The average adult male in the UK should not consume more than 30g of saturated fat per day, while adult women should not consume more than 20g per day.
Trans fats are saturated fats which have been highly processed using heat to change their chemical composition to behave more like unsaturated fats. These are found in items such as margarine, crisps, chocolate, take-away foods, chips and processed meats; trans fast have been shown to affect the levels of 'bad' cholesterol in the blood (LDL cholesterol) which can lead to many other diseases including some cancers, diabetes, immune system dysfunction and atherosclerosis (hardening and narrowing of the arteries). These items - as shown in the Eatwell Guide are not part of a healthy diet so should be avoided as much as possible.
Better choices of fats are unsaturated fats which are further divided into monounsaturated fats (found in avocado, nuts, seeds and olives) and polyunsaturated fats. Polyunsaturated fats are where much of the research into diet in relation to MS has centred; they are further divided into omega 3 and omega 6 fatty acids (FA). This may seem a little like a chemistry lesson but some explanation is important to understand more about how fat in our diet may be related to our MS. Omega 3 FA are found in oily fish, walnut oil, flax oil and pasture-reared eggs and have been shown to lower levels of fat in the blood and raise levels of 'good' cholesterol (HDL cholesterol). More recent popular advice to avoid saturates and the widespread use of vegetable oils in commonly-consumed processed foods has lead to a widespread imbalance of omega 6 FA vs omega 3 FA as omega 6 FA are commonly found in vegetable oils. This in interesting to PwMS as overconsumption of omega 6 FA compared to omega 3 FA has been shown to ignite inflammatory pathways within the body. The demyelination damage evident in MS is considered an inflammatory response hence the interest in this hypothesis.
Nutrients provided: Fats
6. Foods high in fats, salt and sugar (convenience foods)
These foods - such cakes, biscuits, chocolate, full-sugar soft drinks and ice-cream are not needed in the diet so should be eaten infrequently and in small amounts. Many of these type of products contain trans fats so should be avoided.
Nutrients provided: High is fats salt and sugar. Little nutritional value.
Sources:
Active IQ (2016) Nutrition for exercise and health; Personal Training Manual
British Heart Foundation (2017) Fats Explained
Public Health England (2016) The Eatwell Guide: helping you to eat a healthy, balanced diet
MS Trust (2004) Diet Factsheet
Active IQ (2016) Nutrition for exercise and health; Personal Training Manual
British Heart Foundation (2017) Fats Explained
Public Health England (2016) The Eatwell Guide: helping you to eat a healthy, balanced diet
MS Trust (2004) Diet Factsheet
