Evidence based diet and MS: looking at the Mediterranean diet

MS Plus acknowledges the traditional custodians of Country throughout Australia and their connections to land, sea and community. And we pay our respects to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

Jess: So, this is Mariam, who is our presenter today. Mariam is an accredited practicing dietitian and fertility certified fertility dietitian and founder of Tayyib Nutrition. She is passionate about helping women gain relief from women's health conditions like PCOS and supporting women and couples to optimise their diet and lifestyle to support their fertility and preconception health.

She's also passionate about MS and using diet and lifestyle to help improve quality of life, particularly for women of the periconception period. And she also runs her virtual practice, Tayyib Nutrition, where she supports clients one on one, as well as delivering a variety of support to educate and inform the community at large through webinars and her social media.

And Mariam has also very kindly been involved in some of our women's health projects in the past. So very warm welcome to Mariam who's presenting today.

Mariam: Fantastic. All right let's get stuck right into it. So as Jess introduced today's webinar, we'll be discussing all about diet for MS, looking particularly at the Mediterranean style diet as well as the gut microbiome.

And the few objectives we wanted to unpack diet for MS, Mediterranean diet and MS, the gut microbiome and MS, and we'll also have some question time at the end if we get some time for that. So, first things first, if you're here today, it's because you're likely interested in diet for MS and most people who are diagnosed with MS, whether it's a new diagnosis or, you know, it's been a long time coming, people are really interested in diet because it's a modifiable risk factor. And there is a lot of overwhelm and confusion when it comes to MS and diet. So if you've done even just a brief Google search, you will have come across a whole variety of different diets for MS, whether it's the Swank diet, the OMS diet, Paleo and Wahl's protocol, intermittent fasting, the McGoul diet, as well as a variety of free diets, so gluten free, dairy free, saturated, and then also thinking about minimizing things like your red meat and saturated fats.

So, it can be quite overwhelming, especially if you're newly diagnosed and all these diets tend to have, you know, different things that they encourage to either include in the diet or to cut out altogether. So, it can definitely be very confusing and overwhelming. So as we've discussed, diet is a modifiable risk factor for the risk of developing MS, as well as a risk of lapse and progression of MS. So, at the moment, as we currently speak, there is inclusive or limited evidence on the different dietary strategies and dietary patterns which increase or reduce the risk of rate lapses. So, there isn't enough evidence to recommend a specific MS diet. So unfortunately, all of those diets I've previously mentioned, what you tend to find is there might be a few small studies with their own kind of limitations, which is why I guess, evidence based medicine and science based research, one study is not enough to generalize to applying to a whole population of people. And often with these studies, you know, the population, might be a bit of a unique population. We can't generalize to all people with MS. And there tends to be limitations to small study numbers bias in literature, etc. So currently the recommendations for people with living with MS is to follow general healthy eating dietary principles, which supports overall health.

However, you know, there is a lot of current MS specific research being conducted as we speak but as we know in the research world, it just takes a bit of time to translate that across to guidelines. In terms of what we know can be harmful for MS, we do know that diets high in saturated fats, trans fats and sodium or salt can worsen MS progression or outcomes. And then healthier dietary patterns, which are rich in things like your whole grains, fish and low unsaturated fats tend to be protective for MS. But again, we do need stronger evidence on the whole. In terms of, you know, following these MS diets, a lot of people will think, okay, well, what's the harm, the best case scenario is it might help me, it might not, but I often like to encourage us thinking about risk versus benefit on the whole. Because if we are cutting out certain food groups, which is common in all of these MS diets, so whether it's cutting out dairy, cutting out animal products, or cutting out grains, this can increase our risk of nutrient deficiencies, so it can actually have some harms.

But they can also be quite challenging to implement. So, whether we're speaking about costs, so they're quite financially challenging to implement, time factors, so having to spend all day in the kitchen cooking these special meals, or stress as well. So even, social isolation, if you're not able to enjoy a meal with family if you're out of the house because you're following a strict dietary guideline.

So, this leads me to the Mediterranean diet and MS and I will speak a little bit about why I've chosen to speak about the Mediterranean diet in today's webinar in particular. So firstly, what is the Mediterranean diet? The Mediterranean diet is a traditional eating pattern based on the healthy eating choices of people living across the Mediterranean. So, this is countries such as Greece, Italy, Portugal and Spain. And the Mediterranean diet includes large intakes of your vegetables, fruits, fish, olive oil and their lower intakes of things like dairy, red meat and sugars.

Now, the Mediterranean diet is one of the most well researched diets internationally, which has shown very strong evidence for a whole host of conditions, such as supporting brain health. So, it's got really strong evidence for things like reducing the risk of Alzheimer's disease, heart health, again, reduction of the risk of cardiovascular disease it has anti-inflammatory benefits as well, just due to the foods included, so really high plant foods in there, as well as managing and preventing things such as conditions such as diabetes. So, it's a really strongly evidence research anxiety pattern.

Now, in terms of the benefits of the Mediterranean diet, in particular for MS, we know, again, like we discussed earlier, there's no one set dietary pattern that's recommended for MS. But we have, again, limited but promising and growing evidence in terms of the role of the Mediterranean diet in MS to reduce symptoms of MS, such as fatigue, as well as reduce disability. In terms of, I guess, the evidence in particular to MS, again, we've got some, you know, quite better-quality studies, so things like, you know, systematic reviews, which take into account, multiple different studies and tends to grade the evidence. And we have, studies published as of, this year or late last year. So, there is quite a lot of research happening in this space at the moment. In terms of, sorry, we mentioned the evidence is limiting, but promising.

But in terms of the benefits for MS in particular, one reason I wanted to really hone in on the Mediterranean diet is because the Mediterranean diet has so much evidence to support chronic diseases which are clinically relevant to MS. So we know with MS it's very important that we manage our risk of things such as your heart health and keeping your cholesterol in check, reducing the risk of again, other comorbidities such as diabetes and then other things like mental health such as anxiety and depression. And we know that as well as, you know, managing your gut health and symptoms. So constipation can be quite chronic in MS and the Mediterranean diet can help with all of these. So it is again, very clinically relevant and promising in terms of MS in particular.

So how can you implement the Mediterranean style diet? Now I always bring up this kind of food pyramid which is a bit of a rough guide to the Mediterranean diet and it's worth knowing there are different types of Mediterranean diets, but this is what you call more of the classic or traditional Mediterranean diet. So, at the base we want to be having lots of plant-based foods in the day including your whole grains, breads and cereals, beans and legumes, nuts and seeds, fruits and vegetables, olive oil. And then less frequently things like fish and seafood, your dairy, eggs and cheese and poultry products. And then again, less frequently, again, meat and seafood.

So, if we break this down, I like to, again, this kind of gives us a rough guide of daily, weekly, et cetera. I like to break it down further just so you can get a really clear guide of what your meal should be looking like on a daily basis. Firstly, like I mentioned, the main focus is really all of the plant-based foods. So, your meals should ideally be based on lots of fruits and vegetables, so it could be having things like salads or stir fries or casseroles with lots of vegetables in there. You might be having fruits as dessert or as snacks, whole grain breads and cereals. Now, this is really trying to choose, you know, less refined carbohydrate types. So rather than having, you know, white toast, white bread, white rice, we're choosing the more multi grain or whole grain alternative. So, it could be brown rice, multi grain bread, wholemeal pasta, etc. Using beans and legumes. Now this is one thing that I guess in the Australian diet, it's maybe not quite as common as an occurrence.

I know in my practice, at least when I ask people how often they have beans and legumes, it tends to be once a fortnight or once a week at the max for most people. So, this is probably one of the biggest changes. Which is again one of the bigger changes to be making compared to, you know, standard Australian style diet. I'm trying to include beans on a daily basis, or if not daily, you know, weekly. Now this could be having things like baked beans for breakfast or other kind of beans. It could be including tinned beans or legumes in a salad for lunch or dinner, or adding beans to, again, bakes casseroles or dishes.

And then nuts and seeds, so nuts and seeds, having them daily, they're really rich in those healthy fats and fiber, and they've been shown to actually, it's great for our brain health, but it's also been shown to reduce the risk of those comorbidities that we spoke about. So, things like type 2 diabetes and heart disease. And one of the biggest players in the Mediterranean diet is olive oil. So again, it's the main oil that's produced in the Mediterranean and well consumed. And again, in Australia, it’s obviously becoming a lot more widespread and common. But I guess the main difference in terms of the Mediterranean style diet versus Australian style diet is, you know, we might tend to, in Australia, people use it as a salad dressing, but they might not use it as the main go to oil or fat. So, they might still use, you know, butter on toast, or they might use canola or other vegetables for cooking. With the Mediterranean diet, we do encourage using olive oil as your main fat and oil, and it actually is safe to cook with as well. So, me personally, I love olive oil and everything, and I do have a Mediterranean background, so it's something that taste wise, you know, I'm accustomed to as well. But you know on bread, it's actually quite delicious, so it just takes a bit of getting used to, if you're not used to having olive oil as your main fat but it has really profound benefits. And we know that having, you know, up to three, around three tablespoons of olive oil per day, sounds like quite a bit, has been shown to have really strong benefits for your health in terms of things like heart health, diabetes inflammation, et cetera. And when you use it as your main fat, it's pretty easy to reach that target as well.

So, looking at weekly service, we're looking more about these protein type foods. So, we're looking, and again more animal based. So, we're looking at fish and seafood. A Mediterranean style diet tends to recommend having oily fish like salmon, sardines, trout, etc. about two to three times a week. And these are really rich in what we call those omega 3 fatty acids, which are strongly anti inflammatory and very good for brain health. So, these are really good to be including. And look, I would say it's ideal. Most people struggle to reach their Fish servings, but you know, it's something that it's, we can work towards that target if you do include, or you enjoy fish products.

We need to have a, you know, chicken and other white meat, and that can be featured as breakfast food. Or you might make a frittata or an omelette as a, as a lunch or a dinner. And things like, again, your dairy product. In the Mediterranean style diet what we tend to find is they tend to encourage more fermented dairy as a, you know, things like your cheese and yogurt versus milk products. But again, this is a slight difference between the Australian style diet where we tend to have a lot of milk, whether it's as a breakfast cereal or in coffees and smoothies. But they can all be included, but again, we know that there's some benefits to including things like yogurt, which has, you know, probiotics, which we'll discuss later as well.

And finally, looking at the foods to be including in small amounts or occasionally. So that's looking at red and processed meats and then things like your sweets and fried foods. And that's because these are rich in saturated fats, which we discussed can be, you know, not ideal for MS as well as they can increase things like inflammation in the body.

One thing I wanted to highlight or pause on for discussing red meat is, like I mentioned, there's different types of Mediterranean style diets. The very traditional style diet, I would almost like you to encourage thinking about it as a peasant style diet where red meat wasn't traditionally available. So, people would make do with, you know, beans as they are quite cheap and readily accessible proteins. But as we know in Australia, we're very used to having red meat and actually all of our meats a lot more frequently. So the good news is we have data coming out of Australia looking at what we call the modified Mediterranean style diet and this has allowed an inclusion of unprocessed and low fat also kind of you know leaner red meat up to four times a week and we've got research using this style diet has still been shown to be beneficial, against the risk of developing MS as well as, you know, benefits for mood. So, the gut and brain. There's a lot of research on the Mediterranean style diet and preventing things of type or treatment of depression and other mental health conditions. So, it's worth noting, you know, that yes, the traditional Mediterranean style diet limits red meat. It doesn't mean that you have to completely restrict it and there is scope for including it more frequently. But what I'd like to encourage with the Mediterranean style diet is, again, compared to traditional Australian diet, is we're thinking about trying to use a variety of different proteins. So, we're not just reliant on simply red meat, we're using our beans, we're using maybe things like you know, tofu, eggs, etc.

And we still can include these other animal based proteins. So, what does this look like as a sample day of eating? So, breakfast might be something like avocado toast with some vegetables like spinach, tomato, some feta cheese, and eggs cooked in olive oil, or it could just be boiled eggs. Lunch might be a tuna salad with a salad mix, canned tuna a tinned four bean mix as well. And then whole grain crackers as a carbohydrate and some olive oil for the dressing. Could also turn that into a sandwich. It could just be a tuna and salad sandwich, similar concept as well. And dinner might be grilled chicken with a Greek salad. It doesn't have to be Greek salad. This is just going with the Mediterranean theme. And the key thing is it doesn't actually have to be Mediterranean style foods. So, it could be any type of salad. And you might have that with whole grain pitas or whole grain bread or baked potatoes as well. And snacks, you might want to have some dark chocolate and nuts you know, handful of nuts. And you might also have your two pieces of fresh fruit with some Greek yogurt. So, it could be as a snack or as a supper.

So, a lot of people tend to have some misconceptions around the Mediterranean diet and thinking what if it's too challenging for me to apply is like, or there's a lot of misconceptions. So I'm going to break these down to show that we can actually implement it fairly easily. Firstly, a big misconception is people thinking it's a strict diet and you have to follow it to the T. Now, the Mediterranean diet is not a strict diet. It's rather a suggested guideline for healthy eating, and not just healthy eating, but healthy living.

So, I probably should have discussed this sooner, but the Mediterranean diet also looks at the lifestyle. So, people are engaged in activity that's, that's purposeful. People are having meals as a, you know shared meals, whether that's with family or with friends, or if you're at work, having that with your colleagues. And we're also thinking about things like stress management. So, it is a whole lifestyle as well. And the diet is a key feature of it as well. But the principles of the diet can be adapted to, like I mentioned, to any style of or pattern of eating, including different cultural backgrounds and cooking abilities.

So, someone from, you don't necessarily have to follow, again, that very Mediterranean style of eating, whether it's Italian or Greek or Middle Eastern style, where a lot of these foods are used, you can also adapt it to, again, like an Australian style diet an Asian style diet, anything.

Again, it's more so thinking about, okay, how can we have these key foods in there? So, whether that's the vegetables, beans, the legumes, et cetera, and the olive oil. And it also allows all foods to fit in moderation. So, there's you know, we said there's the sometimes foods, there's the daily or weekly foods. You still can include foods that you really enjoy. It's just more so thinking about how we're balancing it out across the week with our other foods, which have more benefits I guess nutritionally. Another misconception or question that came through is people saying it's expensive to follow the Mediterranean diet. And while, yes, at the moment, obviously with the cost of living being this can be challenging for a lot of people to keep up with their, you know, their grocery shop. So, while the Mediterranean style diet can have ingredients which are a bit more expensive, so I'm thinking here like salmon, if we're trying to include that two to three times a week, or you know, lots of fresh produce, that can be expensive, but there are swaps and tweaks that you can make to make the Mediterranean style diet more affordable.

So, this can include using, rather than using, you know, all the produce being fresh, you might choose things such as seasonal produce, which is cheaper. So again, we're trying to find what's in season, tends to be a lot cheaper versus things that have been shipped out. And then also using things like your frozen and tinned produce. So, these are just as nutritious and they can often be more affordable. But again, if you're using tinned produce, I'd encourage you to look for sodium or salt reduced products so you're not having excess salt in those foods. As we said, seafood, fresh seafood can be expensive. So, you can look at using things like your tinned fish or even frozen fish and stock up on that when it's on sale. So again, it could be a tinned salmon or tinned sardines or tuna, for example. And then you also might want to look into buying and cooking in bulk because That can often be a good way to save on some money as well and rather than, you know, buying in small quantities and infrequently.

Now another misconception is that you have to be, you know, a master chef to be able to follow the Mediterranean diet, or you need to spend hours cooking. So, this figure I've put in here is coming from a study which basically shows how we can follow the Mediterranean style diet with very minimal cooking or what we might call a no cook Mediterranean diet. So, what it shows is that you can still follow these principles without cooking really fancy or gourmet meals. So, you can use as a vegetable element, you know, prepackaged salad mixes. You can use frozen vegetables or if you're using fresh produce, you know, really simple things like cucumber, tomato, carrot, which can be chopped up in a few minutes and with minimal effort or like shredded cabbage and coleslaws.

So again, I'd encourage if you're short on time or you don't, you're not a great cook, to really think about using these shortcuts. And when speaking about a carbohydrate element, you can use, you know, rather than cooking all of your grains, you can use prepackaged things like whole grain crackers or whole grain bread. Microwavable brown rice versus cooking brown rice, which can take quite a bit of time. Potatoes as a carbohydrate can be really easily cooked in the microwave or boiled or couscous, and you can choose, you can find wholemeal couscous as well, which can cook in three minutes with just a bit of boiling water rather than having to boil it. Full of proteins as well. Without cooking we can use, lean heavily onto these tins or prepackaged proteins. So, tin chickpeas or lentils or legumes. You can use again in salads or in soups. Canned chicken or you can buy kind of rotisserie, like prepackaged precooked chicken and you know use that rather than having to cook, chicken yourself. You can use canned fish. So, like I mentioned, the tinned tuna, sardines, etc. Boiled eggs can be cooked in, you know, quite easily with minimal skill. Bit of YouTube or Googling can help you if you're not too sure what to start here. They can take about five to ten minutes, depending on your preference.

And then also things nut and nut butters can contribute here. And they're basically, there's no prep involved here. And obviously for your flavouring and condiments, you know, your spices, your olive oil, lemon and vinegar. Again, as long as you have this stocked in your pantry, it can be quite easy to use. So again, using these pre prepped options or, you know, really minimally prepared, minimal effort ingredients, what an example can look like this.

So, this could be like a lunch style meal. You can choose your protein, choose your carbohydrate, and choose your vegetable. So, you might, again, do a tuna as a very, you know, really quick. If you get your chicken, you might have it precooked, or you prepare it at the start of the week. And again, the beans, as I mentioned, you can use tin because they're easier. And then with the carbohydrate, you can choose. Something like a grainy bread, no prep involved quinoa or brown rice. You can actually use the prepackaged ones as well, or the, from the shops or a pasta at the carbohydrate. Again, fairly easy to cook. And vegetables, again, if you might use the frozen and microwavable steamed vegetables, which will take you three minutes in the microwave.

Or if you're using these fresh produce capsicum, baby spinach, tomato. Again, these are fairly low prep options. And again if you use your healthy fat, use your olive oil, avocado or nuts. And then flavoring, so any herbs and spices. Another tip to help cut down on time, and again cost as well actually, is to spend a bit of time planning your meals.

So meal planning, again I like to say, whether it's at the end of the week or the start of the week, or if you have, again, any time that's convenient for you, is to, you know, firstly, take stock of what you have in the pantry, take out things from your fridge use what needs to be used up and throw anything that's gone old. And then use that to build a few meals and then also add on your shopping list. So, you can say, okay, I already have this in the fridge. What do I need to turn that into a meal? So that can be really helpful to do. And then once you have a few meals in mind and you do your grocery shop, it will save you a lot of time across the week because you've already done a lot of that mental energy of going to the shopping center or thinking about what to cook. If you spend like just one hour, two hours at the start of the week, that can save you loads of time in the long run. And money as well you're just preventing going to, number one the shops multiple times per week, or even just relying on takeaway, or when you finish work and you're too tired to think about what to cook.

And yeah, you can also, I guess, if you're someone who doesn't want to cook, you don't have the time for it, and you're using things like prepackaged meals or, you know, meal preps, you can try to find meals that have more of a Mediterranean style principle to it. So, choosing meals that have lots of vegetables, low in saturated fat, choosing, you know, a variety of those proteins that we've discussed, the plant protein, the fish, and then moderating red meat and chicken as well they can be quite helpful as well.

And another, I guess, question that came through multiple times is, you know, can I follow the Mediterranean diet if I'm vegetarian or vegan? Or people assuming that they have to include animal foods if they don't want to. Now, again, like I said, the Mediterranean diet is not a strict or a hard and fast kind of rule based diet. So, you can still apply many of the principles of the Mediterranean style diet if you're vegetarian or vegan. And really the, the core focus of this diet is actually plant based. Plenty of vegetables, beans, legumes, tofu, whole grains, nuts and seeds. So, you know, I always say there's a way to do a vegetarian diet, you know, really healthfully or not, depending on what you're basing your meals off. So, it's really about trying to focus on these core foods. And I guess, obviously with a vegetarian or vegan style diet.

If you're restricting certain foods, so you know, your dairy foods, animal foods there might be some nutrients which might be worth considering supplementation if you are, you know, at risk of deficiency. So, always best to discuss that with a health professional. So that's B12, vitamin D and omega 3s. So always, yeah, always best to chat with a health professional before starting any supplements.

And another question was, does diet or the Mediterranean style diet, will that still help me if I have advanced MS?

Now this one is very much individualized based on the person. So, we know most of the studies conducted in diet and MS have been conducted in people with relapsing permitting MS. But regardless of the disease cause, or you know, what type of MS you have, we know that diet can help to improve your quality of life, such as energy, manage those gut health symptoms and then also managing those health risks, which can worsen MS progression. So, things like keeping your diabetes risk in check, or if you already have diabetes, keeping your diabetes well managed, and your cardiovascular disease risk as well. So, it's always important to know that diet is a key, is an important part to the MS management puzzle, but it's only one part, and it's important to have advice tailored for all aspects. Again, outside of diet, we also want to look at things like your disease modifying therapies, exercise, sleep hygiene, stress management, and etc. So, again, always best to work with a team, so your neurologist, potential dietitian, exercise physiologist, etc. to make sure your MS is well looked after.

Now, let's touch on the gut microbiome for MS. Now, firstly, what is the gut microbiome? The gut microbiome is a collection of bacteria, yeast and fungi found in the large intestine. And we have, you know, lots of emerging evidence now showing, linking this gut bacteria or microbiome to many different illnesses and disease, including the risk and the progression. So, for example, we have the gut brain axis, which is looking at the link between our gut health and our mood. So again, things of depression and anxiety. We also have research looking at, you know, the gut kidney microbiome, a whole host, and even things like women's health. So, endometriosis and PCOS as well.

As for MS, we do also have some emerging evidence linking the gut microbiome disturbances to MS. And look again, a lot of this evidence is still very emerging. So, some animal studies, not very high quality here, is linking suggesting alteration in the gut microbiome. are associated with the disease incidence and severity in MS. So again, early days and a lot of people again are looking at this in adults as well or in humans. So now again, going back to the Mediterranean diet, another strong benefit of this of this diet is that it's been shown to have a positive impact on the gut microbiome because it's so rich in these plant based foods. And this has been shown to have a positive impact on cognitive function and inflammation as well. So, having an anti inflammatory effects and these are very key and pertinent for MS as well because you know, wanting to have optimal cognitive function and lowering inflammation is very important in MS.

So, how can we focus, what are the foods we want to be looking at to build a healthy gut microbiome? So again, Basically, you don't need to stress about this too much if you're having lots of these plant based foods across the week. But these are some key foods which can be, can help to support a gut, healthy gut microbiome. First we have again, foods rich in prebiotic fiber. So, this prebiotic fiber actually feeds the good bacteria in the gut. So, this is found in a lot about, you know, high fiber, whole grain cereals, legumes, so yeah, beans and chickpeas. If we're having these daily, fantastic food for a gut microbiome and nuts and seeds as well. Cooked and cooled starches. So, these have something that we call resistant starches. So, if you're cooking, you know, pasta or rice or potato and having it the next day or, you know, as leftovers, whether it's cooked, I'm sorry, whether it's cool or reheated, that has a very positive effect for helping with that good bacteria growth.

And then again, a high intake of plant based foods are fruits and veggies, especially there's really high prebiotic rich fruits and veggies such as the onion, garlic, cabbage, broccoli, etc. The other thing to look at or to be thinking about as well, as I mentioned, we spoke about the fermented food in the Mediterranean diet. So, things like your yogurts and cheese. So, probiotic rich foods can help to provide, again, supply this good gut bacteria. Now we know that it's, you know, we don't really know how much of these good bacteria actually survive in our intestines, but they have been shown to be positive. So, usually I like to say focus on getting both the probiotic fiber is probably more important, but getting some probiotic rich foods can also be helpful. So, again, this can be, again, your Greek style yogurts or a traditional yogurt, as long as it has the strain in there and like a kefi, which is really strong in probiotics or other kind of probiotic drinks, like Yakult, and then fermented. foods like your kefi or kimchi or sauerkraut et cetera, or kombucha even.

There are also supplements, so the probiotic supplements you can consider but to have, I guess, the optimal benefit, it is always best to have this as a strain specific, and I always recommend to speak to your health professional before starting any they may not be essential, but it's, it's more of a nice to have, as I like to think about, and it's also, again, depending on your unique situation. So, for example, there's some certain strains in between, it might be helpful if you have IBS, for example, versus you know, other kind of health conditions. So that's kind of the end of my the slides for today and I'm now opening the floor up to any questions. So, Jess, I might pass over to you here.

Jess: Great. So, we did have a question, is there evidence that uncooked olive oil has more positive impact than using it in cooking?

Mariam: Yeah, look, really great question. So, I guess, I love the reason why people traditionally thought you can't cook with olive oil is because it's full of these really rich like antioxidant compounds. Now that's the same reason, so basically the newer research is showing the reason it's safe to cook is because it has these antioxidants, it protects it against heat damage. And yes, so some of these good compounds might be essentially destroyed in cooking. It doesn't make it harmful, but I would say yes, there's having, you know, having a variety is important.

So, having it, you know, uncooked on a salad was, is likely to have more of these antioxidant benefits versus uncooked.

Jess: Great. Thank you, Mariam. And I think that, that covered a lot of our pre submitted questions as well.

Mariam: Awesome anything else I guess, yeah, actually, you know quickly on that note, just on the pre submitted ones, I guess I didn't really touch on specific questions like, is dairy bad for my MS or gluten?

And I guess, yeah, the key kind of takeaway was covered in the earlier slides around diets, but basically from these, there might be some very small research to link, you know, changes in, cutting out dairy or gluten. But like we said, we can't really generalize that because it's just not enough evidence. And I always would encourage if you are someone who's wanting to try these different diets, it's always best to start with a health professional, such as a dietitian, to make sure you're not putting yourself at risk of having nutrient deficiencies as well.

Jess: Great. Thank you, Mariam. And we've had a few questions about getting a copy of the slides, so we will certainly send those through after today's webinar.

And we have actually had just another question. So, if you're struggling with, you know, eating meat, digesting meat, how would you incorporate beans as a protein source if there's maybe people are new to starting their diet?

Mariam: Sure. Great question. So, first thing I would say is, yeah, I guess when we think about beans, like even Australian guys who are healthy eating, when we talk about our protein foods, it can be any type of protein. It can be meat, fish, chicken, eggs, or beans or legumes. But the key thing is the quantity. So, for us to be getting enough of, I guess, the protein, we want to be having enough in the meal. And we, a serving size of beans is actually one full cup, not just like a little kind of a couple of spoons into your meal.

So, it's important to know that if you're having it to replace meat, you want to be having enough of it in the first place. The second would be thinking about, I guess digestibility. So, I guess like I mentioned, many people don't actually eat much beans and we know that it can cause a lot of people, some gassiness. So, I would say if you are new to eating beans, my suggestion would to be, will be to start slowly. So, your gut back through has time to get used to it essentially, and you'll be better able to tolerate it. So, what you might want to do is start with small amounts and maybe just. you know, use some well rinsed, tinned chickpeas or lentils in a salad in a small amount and then work your way up.

And also, it's helpful to not do it every day because it does take a longer time for it to be fermented in the gut or digested. So, I'd say, you know, have it maybe start once a week, work up to every second day would be ideal. And then once you can then go straight for daily. And in terms of how to include them, so like I said, it can be, you know, if, for example, if you don't eat meat, you can simply, in a lot of meals that have meat, you can replace it. So, for example, like a minced meat in a spaghetti bolognese or another kind of minced meat dish, like a tacos, or you can simply use beans to replace the meat component. If you're someone who still eats meat, you can actually just do a bit of both. So, it's something that's easier to do that rather than to include it as a, on its own. So, you might do, you know, some spaghetti bolognese, for example, half meat, half tin lentils or you know, yellow lentils, split lentils. So, that's a really easy way to include them. And then the other thing is to kind of get inventive. So, googling some recipes that use beans and legumes.

So some, you know, cultures are really great at using beans and legumes, whether it's like a chili con carne, so more of like a, I know we're in summer at the moment, so not so summer friendly, but it could be again, like I said, there's salads, it could be different dishes that use things like, you know, your rice and lentils and then often the easier ones can be simply adding it to a salad is tends to be quite easy.

So, I'd say go easy start slow and then just do some, you know, find some safe kind of recipes that you really enjoy, your family enjoys, and then you can start to add more of those into your diet.

Jess: Great, Thank you Mariam. And we did, we have you know, dairy is a very contentious topic, but we did have a question come through around, you know, what's your view on what sort of milk is the best?

So, things like, you know, almond milk, oat milk, like, do you have any sort of views on those?

Mariam: Yeah, well, that's a really good question. Sorry, I guess if, firstly, I would say, like I said in terms of nutritionally, dairy milk is actually one of the most, it's probably the most nutritious milk option available on the market because it has, it's full of calcium, protein B vitamins, like I said, sorry, B12, riboflavin, et cetera.

So, it's a really nutritious kind of food group, right? If you're someone who prefers to avoid dairy or for one reason or the other, what I tend to recommend is choosing a milk that is essentially as similar as possible to Dairy milk. So, the next best I would say nutritionally is soy milk because again, the protein is very comparable to dairy milk. Very similar I would choose one that's fortified with calcium, because if you're doing one that doesn't have calcium, you're missing out on the benefits for your bone health. So, calcium fortified, and especially if you're vegan or vegetarian, I would choose one that's got some fortified in B12 or other B vitamins, which can be hard to find in plant based foods.

Other than that, a lot of it is taste preference. So, for example, you know, people often like to do almond milk and it's just about pros and cons. So almond milk, again, I would always say no matter what you do, I would always make sure its calcium fortified if it's a dairy alternative. But for example, almond milk is very low in protein, so I wouldn't say it's comparable, but if you have it in a smoothie and you're adding a protein powder, then that would be okay. If you're having any coffee and you just enjoy the taste and that's fine as well, but it's just mostly thinking about what nutrients am I missing and is it comparable?

I guess another one I will touch on that's related to MS is coconut milk. Probably that's one I would recommend not to be using frequently because it's quite high in saturated fat and nutritionally it's not very comparable to dairy, so very low in protein as well. And yeah, like we said, we want to limit saturated fat in MS.

So, I'd say probably, you know, dairy is fine. If you prefer to avoid dairy, a soy, maybe an almond, but you just want to be conscious of the protein as well.

Jess: Great thank you for that. So, I really want to thank Mariam from Tayyib Nutrition for her time today and all of her expertise. And so just following on from that, you know, we've got a whole host of other supports and services through MS Plus that you can engage with.

And just an update on our resources. So, we've got, you know, the usual resource hub. We actually have a new podcast series launching February 13th, the MS Boost. And there are some links there. there where you can scan, you know, if you use Apple or Spotify so you can access those there. The first episode will actually be on medical gaslighting.

So, it would be really interesting. We'll have some good speakers lined up for that. And if you have any further questions. You know, about anything else that's come up today, you can get in touch with MS Plus

Connect with all of their details there. And again, thank you so much, Mariam that was really informative and we really appreciate your time today.

Mariam: Absolutely. Thank you for having me, Jess.