I have MS, what do I eat? With Associate Professor Yasmine Probst

MS Plus acknowledges the traditional custodians of the land this podcast is recorded on, the Wurundjeri people of the Kulin Nation. We pay our respects to their Elders past and present.

Nicola: Welcome to the MS Podcast Series. I'm Nicola Graham and this episode is called I Have MS, What's Great to Eat? And today I'm talking with Associate Professor Yasmine Probst. And Yasmine is a dietitian, she's a MS researcher, and a person living with MS. So, if anyone's in a position to give us a wonderful, informed direction on what to eat when you've got a diagnosis of MS, then I really feel that Yasmine is in that position.

So please stay listening. If you want to find out, well, what does Yasmine need and what does she recommend? I know I'm fascinated because there is so much conflicting information out there. It's very confusing. There's lots of myths that can be busted. And I think it's going to be really interesting to cut through all that information and really find out the nitty gritty.

So very warm welcome, Yasmine.

Yasmine: Thank you, Nicola. Lovely to be here and having a chat with you today. Apologies if you can hear my puppy in the background. He's decided to take now as the time to start being noisy.

Nicola: It's always the way. Okay, so Yasmine, do you mind just starting with telling our listeners a little bit about yourself?

Yasmine: So, I wear a number of different hats in my day to day life. I guess as Nicola mentioned, I've had MS for a number of years now, so I think it were about 17 years in, but it's not normally the first thing I say to someone. I don't say, hi, I'm so and so and I have MS. I think I see myself more in terms of my role, my wider role.

So, you know, I'm a mom, I'm a wife, I'm a sister, I'm a granddaughter. I have three little kids. Well, they're not so little anymore, but three within three years was definitely fun for us, but also, I'm a dietitian and that really, for me, is my fascination. I've loved food ever since I was little and I think I'll love it forever.

So, anything I can do with food, whether I'm cooking it or growing it or anything in that space, it was really what I do.

Nicola: It's a lovely passion to have Yasmine, isn't it?

Yasmine: Oh, it is. And now having a little bit of time during the lockdown as well, I can go outside and potter in my backyard a little bit and play with my veggie gardens, which were a bit neglected when I had to drive to work every day.

Nicola: Oh, well, that's an upside of lockdown, I guess. So, Yasmine, what do you include in your diet? I know that's what all our listeners will be keen to know. What are you eating?

Yasmine: Well, I'm, I guess, your traditional dietitian. I have a healthy, balanced diet. No, no. So, I eat a range of different things. I'm not a particularly picky person.

You know, there are only a handful of foods that I'd say I really avoid. And that's usually just because I'm not particularly fond of the taste. So, I tend to go quality over quantity. That's definitely a preface that I have. So as part of that, I'm a bit of a self confessed chocoholic. And when it comes to chocolate, though, I decide, you know, for me, dark is best, the darker the better.

But for some people, they prefer other, you know, forms of chocolate. So really, go for the best quality and the best taste that works for you. I used to be vegetarian for 15 years, so I was a pesco vegetarian, so I did still eat fish, and I decided after I had my children that I would actively go back to consuming other forms of meat as well, mainly because I was trying to set the example.

I wanted them to learn what a balanced diet looks like, and then they can make their own decisions as they're older. So now I don't really exclude anything. I love all my food types. I particularly love my chocolate, but mango is definitely my absolute favourite.

Nicola: I love your suggestion, Yasmine, about quality over quantity.

I must take that a little bit to heart. And being a chocoholic too, I also really like the good dark chocolates. So what foods are you passionate about? You've said chocoholic and mangoes. Anything else you'd recommend?

Yasmine: Oh, lots of different things. I mean, the tricky thing is when you do go shopping as a dietitian, it happens that everyone looks straight down into your trolley.

No matter what you're doing, boom, into the trolley. That's where they look.

Nicola: And I mean, that's really what we're trying to do on this podcast, isn't it? It's like if we bumped into you in the supermarket, we'd be looking down, what? What have you got in your trolley?

Yasmine: The eye contact disappears completely, everyone's staring at the food.

But no, no, I do tend to have a trolley full of fresh veggies and fruits. Thankfully my children do love their fruits and veggies, so that was a bit of a blessing and maybe, you know, from some good influences, I suppose. But definitely, very, very keen on my fruits, veggies. I'm a regular maker of salads and, you know, I have no one rule about salad.

Anything that goes in the bowl works for me. I'm of European background, so I love, love, love my grainy breads. The grainier the better in my opinion and you know, when I find a beautiful grainy bread, that's for me just the icing on the cake almost. I'm working through my food groups here, you might notice.

And also, I mean, the same thing, I'm a bit of a seafood fan, so any forms of seafood, I absolutely love them. And I don't mean just seeing food with that the pun, but literally seafood from the ocean. So, you know, crustaceans, shellfish, crayfish, any forms of oily fish, whitefish, the lot. I love them because you can do so many things with them.

And particularly here in Australia, we are so lucky. We've got access to a number of beautiful coastal regions where we can get these. you know, fresh from almost the source. And I think there's nothing better than trying to obtain, your local supply of food for your area in particular. Yeah, it's a hard one because I really do eat almost everything.

So, I don't really have one favorite foods per se but I definitely go for the balance. I would definitely have a strong focus on lots of fruits and veggies. That's just naturally been the way I've grown up, but I would say that's probably my one piece of advice for people out there as well. Make sure you do have a balance of fruits and veggies on your plate.

So, look and see how much of your plate is filled with your vegetables, for example, and could it maybe be a little bit more on the plate by comparison to other things on the plate.

Nicola: Yeah, I think, Yasmine, that I love your approach, which is, you know, good quality and, really not restricted. It feels really liberating and appetizing.

Can you explain to our listeners a little bit about fats? Because I know for people with MS, there seems from a dietary point of view, to be quite a focus on that and people get really confused. So, which to enjoy, which to limit. bit of information about that would be really great.

Yasmine: Yeah. I mean, that's a nice segue from, from seafood because your oily fish and so forth one of the best sources of our, what we call omega 3 fatty acids.

And in terms of general health, omega 3 fatty acids, there are what we call polyunsaturated fatty acids. So, they are one of the better forms of fats that we can eat. And they help us with a range of different things. So, for general health, you know, our skin, our eyes, our ability to think, our cognitive functions.

So, it's useful not only for people in the general population, but for us with MS as well. Those healthy fats that come from not only your oily fish sauces, but other products like nuts and eggs and avocado and so on. They're really, really useful and They can help with some of the symptom management, I believe in terms of MS.

And there are some early-stage studies coming through showing that there are some links in terms of the types of fats and what MS is actually doing for us. So, are we having a lot of symptoms? Are we progressing in our disease? And so forth. And sometimes it might be a case of having a bit of a think about, hmm, what am I actually eating here?

Could it be that I could swap some of my sources the less suitable fats with more appropriate fats. So, swapping those, I guess, colloquially bad fats and good fats or swapping out the bad fats for good ones. And even things like cooking with, you know, the right types of oils. So, an olive oil, for example, is a really, really nice choice.

And It's funny because as a dietitian, this is the usual spiel that most people would hear from a dietitian. But I think it still comes back to making sure that you're enjoying what you're eating but being aware again of what you're eating. So, if you do have a few, a few foods that you eat that maybe do have more of those bad fats in them, maybe try to reduce the frequency that you're having those.

So, if you're a big fan of, you know, pies and pastries and biscuits and so forth. Think, do I need to eat this right now or could I have something else instead? And maybe that something else is swapping it out for some, for a handful of nuts or something like that.

Nicola: And I definitely find, Yasmine, in terms of trying to manage what I eat, is not having it in my house in the first place is a really big help.

I'm just surrounding myself with the stuff that I'm happy to eat. The only way that I can manage really, because rest assured if a biscuit is there, I will eat it.

Yasmine: Another thing I've also learned, I tend to follow a similar pattern, but having children in the house means that you are less likely to get a chance to even reach those foods, because they will consume them before you do.

Nicola: Like magic. Yeah. Do you make any particular effort, Yasmine, to increase your omega 3s?

Yasmine: Yeah, for me, I actively think to include fish in our meals throughout the week. And that's not necessarily just at dinner time, but also, you know, in my lunches and so forth.

So, the aim would be to have at least two fish meals per week. If you can have more, that's fabulous. And if they're oily fish meals, that's even better because then you're definitely getting those omega 3 fatty acids. Some people, for them, they're not fans of fish and there definitely are other sources out there that do have omega 3 in them.

So, I think I mentioned before eggs. There are certain types of eggs that are actually now produced to include omega 3 fatty acids in them as well. Certain types of nuts have the early variants of the omega 3s in them that are converted in the body. So those, those fatty acids are really quite good for us as well.

And I would say for some people if they're really not fans of, of all these, I guess, food sources of Omega 3, worst comes to worst, supplementation is okay. But I think it should be a last resort for, in terms of Omega 3s, because we have lots and lots of available food sources out there now that contain Omega 3 and have varied taste profiles.

Nicola: Yeah, so there's some options out there.

Yasmine: Yeah, there are definitely a lot more options.

Nicola: People can include I know a lot of people I speak to include flaxseed oil as well in their diet, which is a source of omega 3.

Yasmine: Yeah, exactly. Definitely.

Nicola: But I have to ask you, do you enjoy mackerel?

Yasmine: I'm European, so yes, I do.

Nicola: You do? Oh, well done. I keep trying to go there, but, even even on toast with tomato sauce, I'm struggling. Anyway, I'll keep trying. So I'd love to ask your thoughts Yasmine on some of the more contentious areas of nutrition such as meat, dairy, eggs, wheat, gluten with regards to an MS diet.

Yasmine: And I hear this a lot.

I guess it's a pretty common thing that when you're diagnosed, you try to take control of the disease somehow. And food is something that a lot of us can try to control. You know, we can fill our own trolleys, we can fill our own baskets at the shops, and we can cook our own meals largely. So, I guess that control factor of changing the food choices that you put into your body gives that sense of control.

And I've heard a lot about you know, eliminating meat from the diet and eliminating dairy in particular as well. They're probably the two most popular food groups that are referred to when I'm talking to people who have MS or people who are caring for someone with MS. And To be honest, I mean, as you've heard me say already, I don't exclude anything from my diet.

I eat everything. And in terms of what we found in our research that we've been doing, we found a similar type of pattern. So certain types of studies, we've actually found that less and less people are now excluding these food groups. It's increasingly difficult, I think, to keep excluding something.

Whereas if you're quite open and inclusive, and you're open to different types and different options, it's less of a challenge. And it makes, I think, eating a little bit more fun. But no, there's definitely a bit of I guess, disconnect there between people's clear beliefs in it must be this way or it must be the other way and I don't feel we need to be that way.

So maybe if you are a big meat eater, you know, cutting back a little bit to more in line with recommendations. So, you know, about the palms, the size of your palm would be about the size of a piece of meat. And you should have that about at least three times a week for a nice lean cut of meat. The same thing with dairy.

If we choose some options and there are so many options for dairy out there. You know, we should at least have a three serves per day for dairy. And that can be milk, that can be yogurt, that can even include some cheeses. But remember that cheeses do also include some of those bad fats.

So, they're probably not the ones to bulk up on too much. I mean, yeah, you mentioned also eggs as another, another food group that tends to be cut out and eggs are actually a little funny little one. They've jumped in and out of the, the good and bad press for a number of years in the nutrition space.

And I guess as dieticians, we've always believed eggs are good for us. You know, I enjoy eggs regularly as well and one thing actually in recent research has been coming through about eggs that there's a component in them called choline, and choline is linked specifically to cognitive health. So, while we're not saying that you should go out and only eat eggs, including them is definitely not a bad thing there used to be a really negative spiel in terms of eggs and cholesterol that's all been dispelled.

And we can. Quite readily and healthily eat eggs, on a daily and even weekly basis without too many concerns there. And I think the other one that comes up a fair bit probably would be the avoidance of gluten. And this has been hanging around for quite a while now. I mean, gluten is found in many wheat based products.

So, you'll find them in a few breads and cereals. And there was a trend occurring for quite a while where people were just excluding gluten because they thought it was having various effects on people. I mean it's, for many, it's a personal preference. We looked into the research in relation to MS and there are so few studies out there in relation to gluten and MS and they all say different things. So, I think unless you have celiac disease, which is then obviously a reason to exclude gluten, I think, it can be eaten safely and shouldn't be something that needs to be avoided if you do like to eat breads and cereals, for example.

There are always options, but I do tend to find that it's a little bit harder to eat gluten free by comparison to eating a general balanced diet if you don't need to be gluten free.

Nicola: Yeah, I get you. And again, Yasmine, I really love your inclusive, joyful way of eating. It's really empowering, I think, for our listeners.

What about supplements, Yasmine? Is there any basis to take supplements? That old chestnut.

Yasmine: You might have guessed I prefer my vitamins and minerals to come from food. I'm definitely one for a whole food approach and if I think that, I'm feeling a bit down or if something might be missing, obviously with my dietician hat on, I start to analyze my intake internally and think what might I have been missing?

But I just think through, have I had a balanced diet in the last while? You know what have I been eating today and during the week and what is it a bit out of the norm. So, I don't supplement with anything, I haven't supplemented my intake since I guess I was pregnant. During pregnancy, I did folic acid.

But other than pregnancy supplementation I, I don't. And I think it is an option for people if they have some limitations. So, for example, if you are unable to eat properly or you're unable to eat a balanced diet for various reasons, be it symptom related or other, then it's definitely worth considering the idea of supplementation.

But also, be really careful because some supplements can interact with each other and to be honest, sometimes people are buying so many supplements and consuming pill after pill that it ends up being quite expensive urine.

And I think it's best to always speak with your healthcare team. So, don't make your own decisions on that one. Talk to preferably a dietician, but if you can't find a dietician or can't access a dietician, Talk to your GP. I mean, vitamin D is probably the most common one that I've heard about in the MS space followed by omega 3 fatty acids. And out of all the different types of supplementation studies that we looked at in our research for MS in particular, they probably have the strongest support behind them.

So, if you were to be supplementing, they're probably the two areas where there would be some. It's a beneficial impact for your MS, but of course I wouldn't do that in isolation. I would chat to your healthcare team.

Nicola: And Yasmine, for you keeping your vitamin D levels at a healthy point, how do you do that then without supplements?

And I know we don't need to have supplements, but people do, with MS, do tend to keep an eye on their blood levels.

Yasmine: They do. Yes, I get regular blood tests as many people probably would also do but I'm out and about a fair bit, so I'm out in my garden you know, tending to my veggies when I'm home.

I'm out playing games with my kids, so I enjoy the sunshine quite a lot, so the recommendations in terms of exposure to some sunshine each day, I definitely meet those.

Nicola: The gut microbiome and bacteria, there's a lot of noise and positive commentary at the moment in this space. It sounds, yeah, it is a hot topic and it sounds so interesting.

I had no idea that we make neurotransmitters in our gut. It's, it all sounds really fascinating. What are your thoughts and comments in this area, Yasmine?

Yasmine: Yeah, the gut microbiome, it's fascinating. I mean, only recently did I find out that we have microbiomes in a number of other places in our body.

So, I thought that was really interesting as well.

Nicola: Where else are they?

Yasmine: They're in the brain as well. Yeah, and I think there are probably a number of other regions, but if I state them, I'll probably end up making a mistake.

Nicola: We've definitely learnt that we are a lot of bacteria, that there's more bacteria than our own cells, which is kind of almost impossible, quite grasp, isn't.

Yasmine: It's amazing? Yeah, so the gut microbiome in particular, so basically the bacteria that are living in your gut or you want them to be living in your gut there's a really, really strong interaction there between what happens in your gut and what happens in your brain. So, it's called the gut brain axis and the research in that space is increasing substantially at the moment.

It's, like I said, the hot topic of, at the moment and in the MS space, I think we're still quite early stage for a lot of that. So other fields of chronic disease have really jumped on board and have been able to do a lot in terms of what the microbiome is doing. But we're still a little bit earlier in terms of progress there because I think we have a few additional considerations in terms of inflammatory markers to consider. But also I guess a majority of people who are diagnosed with MS are likely to be on some form of disease modifying therapy probably in the early stages of their disease.

And those therapies have an effect on the microbiome straight away, so it'll make some changes. Other things like antibiotics, for example, also make changes to your microbiome, so you're constantly needing to almost care for this little bacterial community that's sitting there in your gut to make sure it's giving you the most benefit that you can possibly get.

The fascinating thing is that Every person is different. I don't think anyone's microbiome is going to be the same as the next person. And I guess from a nutrition perspective, what we can do there is to help keep our microbiome healthy, is to eat based on foods that are going to benefit. So, like I mentioned before, I love my grainy breads, and grainy breads are often comprised of whole grains, and those whole grains are definitely good for our gut.

Other things, like you might have heard of prebiotics they're found in, you know, you've got yakult and all of those little shop options, but just your dairy products like yogurt include a probiotic option as well. So, it's basically the way of increasing the bacteria in your gut and then feeding that bacteria in your gut at the same time with the pre and the probiotics.

And I think that's one thing that we can all you know, keep in the back of our minds that the more we feed our bodies correctly. The more our body will be able to do beneficial things for us. And I wouldn't be surprised in the future when we start to really dig into the MS and microbiome research that we'll find some nice connections there and that we'll find that there'll be some maybe impact on our symptoms in a positive way with, you know, positive microbiome profiles.

So, it's a fascinating area but we've got lots of animal studies at the moment. Not very much happening in the human space. I've actually got a student working on this right now, so it was very, very topical, this question.

Nicola: And so, you're eating grainy breads and prebiotics like a good quality yogurt.

Would you also include something like sauerkraut in your diet being European Yasmine? Would that, would that make its way in? Or are there any other foods that you would positively encourage people to eat to help keep their microbiome healthy?

Yasmine: Yes so, I guess for me I'm a regular eater of you know, every morning, say for breakfast, I'm a whole grain eater.

I eat porridge. I love my porridge. I'll have some banana in my porridge, which is also beneficial. And I'll have some yogurt included as well. So, I've already knocked off pre and probiotics just in that one meal. But funnily enough, you mentioned sauerkraut. I'm actually German, so I love it. I love it.

But my problem is my husband doesn't.

Nicola: You haven't got competition for it.

Yasmine: Well, that's the one good thing. Yes, yes. Except for my son. He eats everything too. So, I did grow a little competition there when he was born. Think about preference of taste as well. So don't make yourself eat something just because you know, it's meant to be good.

Food should be there to be enjoyed as well. You know, there are a whole bunch of products out there in the pre and the probiotic space that can do really good things for our guts. But I think if you don't like the taste of it, don't force yourself to consume it. There'll be other options that you can try that will possibly have a similar effect.

Nicola: And I love the fact that you're kicking the day off really well with, you know, with your porridge and yoghurt and banana and having a wonderful gut friendly breakfast to start with, which is great. Can you also speak briefly about fasting? That's something that we get quite a few questions on here at MS.

Yasmine: Yeah, I mean, fasting, it's been around for a long time. It's probably more common in relation to weight loss approaches. And that's not to say that, you know, people with MS don't have a little bit of extra weight to lose. That's probably not a bad thing. So, if you do know that you're overweight, losing some weight can actually be beneficial for symptom management in MS as well.

But I guess the fasting approach is something that is definitely very challenging. It's emerging more and more as we get longer term research studies coming through. And I think the main thing that comes through is It will definitely result in weight loss, from that perspective. There are very few studies that say that it won't.

But there are now also some studies coming through to say that it actually helps in terms of things like neuroplasticity. So, how your brain is wired and how it keeps doing what it's supposed to be doing. So, there's still early stage and I'm not, not necessarily saying that we're recommending that fasting is the way to go.

But I guess if fasting is an approach that works for you to keep your weight down it's something that in the short term could help you to get to a stable and a healthy weight range. And I don't, I can't say it would do you any harm if it's done safely.

Nicola: Of course, it's not for everybody, obviously, pregnant, diabetic, etc.

Yasmine: Oh, no.

Nicola: Or underweight people, but it's an interesting area as well, I think. Lots of really beautiful information from you, Yasmine, and I really feel that if I met you in a supermarket, your trolley would be absolutely loaded with food and I find very appetizing. Can you provide a brief summary of key points that you'd love our listeners to take away from this podcast, please?

Yasmine: Yeah, sure. I mean, you probably have picked up on those already. I mean, I think the idea of keep, keep what you eat varied and, you know, keep your body excited about the food that you're consuming. So, focus on the taste of the foods. learn to listen to what your body is saying. So, I know there are a few people out there that think, oh, I must follow this particular diet.

I must follow, I don't know, the keto diet, for example. They're really hard. And I think they use a lot of extra energy in terms of having to think about what am I going to cut out? So, you might've noticed, I'm suggesting, try not to cut out, try to include. And Keep things in mind of, you know, we're not saying no to any particular food, but if we do know that something isn't necessarily the best option, then just remind yourself that it's a food to be consumed in moderation.

So maybe don't eat it five times a day and every single day. Cut back and swap it for something different, something that's maybe a little bit fresher from the garden or fresh from the local greengrocer or other. But another thing that people tend to forget about, and it’s probably part of modern society, is just slowing down a little bit.

So, enjoy your food, not only the taste, but taste and smell are really closely related. And another thing, if you did see me in the supermarket, you'd see me sniffing everything. My daughter hates it, but she now does it herself. But I sit there and I smell all of my fruits and veggies. And It's just, it's a habit, but it's just something I do.

Nicola: We sound like a great Italian woman. I think that's what they'd be doing too. They'd be checking the quality of the produce.

Yasmine: I enjoy it. I love going to the shops and going shopping for you know, fruit and veg when I've got the time. So, a quick duck in, is never quite the same as having that, you know, a long chunk of time, which at the moment we're not allowed to do.

But when it goes back to the norm, eventually I'll be back in my supermarket in my greengrocer, wandering around the aisles and looking at new and exciting produce that's available to us. So yeah, try something different. Try something you haven't tried before. Challenge yourself. but also try to include as much color and as much variety.

So, if you think fruits and veggies, think maybe a rainbow of fruits and veggies. So, have I had a few different colors today or am I missing a few? And maybe tomorrow I should have a few different colors added to what I would normally have. But most importantly, just learn to love food because it can be part of what you do with your family.

It can be part of what you do to relax. It can actually help a fair bit with stress management, and it can be really, really tasty at the same time. So, I think that's probably the most important message, unless of course you have some concerns, in which case it would obviously be referred to a dietitian.

Nicola: Thank you so much Yasmine. I've had a big smile on my face through the whole of this podcast. I've loved chatting with you today and I love the joy and the inclusive and you know Get out there and stretch your boundaries with food and enjoy a wide variety approach. And I'm, I'm really going to take that on board.

I really love it. Thank you.

So yeah, it's a really lovely, healthy approach. It's, it's very empowering. So thanks again, Yasmine, for joining us today and, and obviously wish you really well with your research and your health and your, your family. And thanks for sharing your wisdom.

Yasmine: Oh, thank you for having me.

Nicola: My pleasure, and thanks to our listeners for joining us today, and we do have a lovely nutrition tool on our website as well So if you head to ms.org.au and type Nutrition tool in the search bar, then you'll find that and of course, we'd love to hear from you can subscribe to the podcasts and you can email us any topics you'd like covered or send us feedback by emailing [email protected] or please just get in touch with us, we'd love to hear from you. You can call MS Connect on 1800 042 138. Thanks for your company.