Multiple sclerosis (MS) is an autoimmune condition affecting the central nervous system where the body may mistakenly target the myelin sheaths covering nerves. This can lead to demyelination and potential damage to axons of nerves, which help to transmit electrical signals, possibly resulting in progressive neurologic challenges.
Digestive issues and gastrointestinal symptoms are common in people with MS and can significantly impact their quality of life. In one survey, nearly two-thirds (65.6%) of patients with MS report at least one persistent gastrointestinal symptom. The most common digestive issues in those with MS are constipation (36.6%), dysphagia (21.1%), and fecal incontinence (15.1%). Functional gastrointestinal disorders like irritable bowel syndrome (IBS) are also very common in this patient population and may contribute to reduced health-related quality of life, increased utilization of health care, and impaired work productivity.
Functional medicine for digestive health in MS offers comprehensive strategies based on understanding the connection between digestive health, the nervous system, and MS. Functional medicine utilizes specialized testing to guide personalized management plans that can support gut health and quality of life.
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Understanding the Link Between MS and Digestive Health
The immune and mitochondrial imbalances that may contribute to MS result in a range of symptoms, including various digestive problems. An autoimmune response on the myelin sheath around nerves and impaired energy production due to oxidative stress and mitochondrial dysfunction may interrupt the transmission of nerve signals between the central nervous system and the rest of the body. This can lead to common symptoms of MS such as fatigue, a loss of control over movement and muscle function, vision problems, balance issues, and an inability to feel various sensations.
MS can therefore impact the gastrointestinal system in various ways that may significantly affect quality of life. Impairment of nerve signals to muscles along the gastrointestinal tract may contribute to digestive problems such as constipation, difficulty swallowing (dysphagia), and fecal incontinence.
Difficulty swallowing can make eating, drinking, and taking oral medications challenging. Dysphagia is common in MS, with at least a quarter of patients affected by this symptom. It can lead to further complications such as malnutrition, dehydration, and aspiration pneumonia if food or liquid enters the airway instead of the esophagus.
Constipation is even more common in people with MS, impacting over half of patients. This condition often develops due to impaired nerve communication with muscles of the gastrointestinal tract combined with inadequate fiber and water intake secondary to dysphagia. The resulting infrequent bowel movements are difficult to pass and may contribute to significant bowel discomfort and bloating.
Impaired communication between the nervous system and muscles of the gastrointestinal tract along with difficulty passing stool can contribute to fecal or bowel incontinence. While not very common in the general population, up to 50% of those with MS experience bowel incontinence at some point with 25% experiencing it on an ongoing basis.
The Role of Gut Microbiota in MS
The trillions of microorganisms that inhabit your digestive tract make up your gut microbiome. While studies are still exploring the relationship between brain-gut inflammation seen in MS, it is understood that the gut and microbiota residing there may play a role in the development of MS.
Multiple sclerosis is influenced by a combination of intersecting factors that may trigger an autoimmune response in genetically susceptible individuals. Environmental, infectious, lifestyle, and nutritional factors may impact the gut microbiome and gut health and contribute to the body’s normal immune defenses functioning abnormally and affecting the nervous system instead of the normal targets of pathogens or toxins.
Microbes in your gastrointestinal system communicate with and influence the brain and nervous system in complex ways via the gut-brain axis. This network facilitates bi-directional interactions that may play a role in the development of neurological conditions like MS.
When the microbes that inhabit your gut become out of balance (dysbiosis), increased inflammation, an impaired intestinal barrier, and dysregulation of the immune system can occur. Your gastrointestinal tract houses gut-associated lymphoid tissue (GALT) that helps to protect the body against harmful microbes and also plays a role in regulating the gut’s normal flora.
When the gut becomes more “leaky” in the setting of dysbiosis, exogenous molecules such as bacterial products and metabolites can get into the bloodstream and trigger inflammation along with local GALT and systemic immune responses. This may set the stage for autoimmunity to develop, which could lead to conditions like MS.
Research suggests that the gut environment may influence the progression of MS. Inflammation in the gastrointestinal tract can develop due to factors like dysbiosis and diet, which can in turn impact both the number and the diversity of microbiota species. This increased inflammation may lead to the activation of immune cells (T cells) in the gut that play a role in the initiation of autoimmunity in the central nervous system.
Functional Medicine Lab Testing for Gut Health
Functional medicine laboratory testing for gut health in MS may be valuable for uncovering imbalances and distinguishing the root causes of inflammation and immune dysregulation that may contribute to nervous system challenges. Performing a stool analysis, microbiome testing, and assessment of micronutrients can pinpoint areas to address as part of a personalized plan to help manage the progression of the condition, reduce the frequency and severity of relapses, and support symptom management.
The GI-MAP + Zonulin from Diagnostic Solutions is a comprehensive stool test that provides an analysis of the relative amounts of healthy and unbalanced gut bacteria, inflammation, and leaky gut markers. Together this information can point to dysbiosis and intestinal permeability that may be associated with autoimmunity and perpetuating the cycle of inflammation and damage. This type of testing helps guide a personalized protocol to support the gut microbiome, address any identified dysbiosis or imbalances, and support gut function. Testing can be repeated after several months to monitor progress and adjust the plan as needed.
Gut health and intestinal permeability may also be impacted by food sensitivities. Testing to identify any foods to which an individual is sensitive can be used to guide a personalized nutrition plan designed to support overall well-being. The LRA Food Block 96 By ELISA / ACT Biotechnologies measures delayed hypersensitivities to 96 commonly consumed foods to identify foods that may be avoided to support overall health.
When the gut is inflamed and leaky, nutrient deficiencies can occur. Progression and worsening of nerve function can occur in MS when deficiencies in vitamin A, B vitamins, vitamin D3, and omega-3 fatty acids are present. Micronutrient testing from SpectraCell Laboratories can be used to detect any deficiencies that can then be targeted using diet and supplementation.
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Nutritional Strategies for Gut Health in MS
Diet can play a significant role in modulating the gut microflora and thereby potentially influencing the progression and outcomes of MS. Nutritional strategies can help people with MS maintain a healthier gut, balance their weight, support a healthy inflammatory response, and balance dietary metabolites that impact the immune system and nervous system.
Overall, an individualized anti-inflammatory diet that removes common food allergens like gluten and dairy and any foods to which an individual is sensitive may help support overall health in patients with MS.
Diet plays an essential role in shaping the balance of gut bacteria. Anti-inflammatory whole foods-focused diets for MS may help to improve the composition of the gut microbiome, support gut health, and modulate immune responses. Eating plenty of plant-based foods like vegetables and legumes provides natural fiber and phytonutrients that support a balanced microbiome, decrease inflammation, and support overall well-being in MS.
Enhancing an anti-inflammatory diet with probiotic-rich fermented foods like miso, kimchi, and sauerkraut may help support a healthy variety of beneficial bacteria. In addition, prebiotic foods including leeks, artichokes, garlic, and beans help to nourish healthy bacteria. Together, these foods may help nourish a healthy gut, support a healthy inflammatory response, and allow for the repair of the intestinal lining to support overall health.
Depending on an individual’s needs and testing results, there are specific dietary plans that have been developed to help support gut health and improve symptoms in patients with multiple sclerosis. For example, The Wahls Protocol is a modified Paleo diet that focuses on vegetables, grass-fed meat, and wild fish. This protocol proposes that excluding grains including gluten, dairy, and starches may help support gut health by avoiding triggering excess inflammation.
Addressing Common Digestive Symptoms in MS
Managing digestive symptoms in MS requires a personalized holistic approach. Functional strategies for MS-related IBS and other digestive issues like constipation and diarrhea integrate dietary changes, lifestyle modifications, and targeted supplementation.
While a functional medicine approach is tailored to each individual’s needs, some general guidelines often help with common digestive symptoms in MS. For bowel dysfunction like constipation, it may be helpful to drink adequate amounts of water with balanced electrolytes. Many people also find improvement in bowel function when they incorporate fiber from fresh fruits and vegetables, whole grains, and/or supplements like powdered psyllium fiber into the diet. Diet and supplementation should be tailored to your individual needs and testing results under the guidance of a knowledgeable professional.
Maintaining a regular routine and setting aside time for emptying the bowels is sometimes helpful for retraining the bowels with issues like chronic constipation. It is also helpful for bowel regularity to exercise and stay physically active as part of your routine.
Targeted supplementation may also help support gut function and motility in people with MS. In addition to the nutritional changes mentioned above, herbal remedies and nutritional supplements may help relieve constipation as part of an individualized approach depending on the identified underlying contributing factors.
Magnesium oxide acts as an osmotic laxative to increase the amount of water in the stool and stimulate intestinal contractions to make bowel movements easier. 400-800 mg of magnesium oxide taken before bed may help improve bowel function.
Aloe vera pulp is rich in mucilage to soothe inflammation in the digestive tract and contains anthraquinones which may enhance intestinal motility to act as natural laxatives.
The Impact of Lifestyle Factors
Lifestyle factors such as stress, physical activity, and sleep may impact the microbiome, digestive health, and MS symptoms. Lifestyle changes for MS and digestion include meaningful stress management, regular physical activity, and adequate restorative sleep.
Stress can contribute to digestive health issues and also trigger and worsen symptoms of MS. Stress hormones like cortisol can directly act on the digestive tract, altering motility and contributing to inflammation. Stress also significantly affects the microbiome and can contribute to increased intestinal permeability, contributing to autoimmunity.
Incorporating mind-body practices like yoga and meditation into your life regularly may help reduce chronic stress. These stress management techniques help to shift the body into a parasympathetic state that may allow for greater support of gut health and improved digestion.
Appropriate physical activity is also a great way to manage stress and support the fatigue and other symptoms that occur in MS. Personalized physical therapy and mindful movements such as yoga and tai chi may help people with MS reduce fatigue, increase strength, and improve muscle tone, balance, and coordination.
Balanced exercise not only helps to manage stress and supports symptoms of MS, but it also positively impacts the gut and digestive health. Exercise may increase the diversity of the microbiome and can increase the production of short-chain fatty acids (SCFAs) that act as prebiotics to nourish beneficial bacteria.
Restorative sleep is crucial for a healthy microbiome and nervous system, and the balance of your gut microbiome can impact your sleep. These microbes influence your circadian rhythm, so when their balance is disrupted (dysbiosis) circadian alignment and sleep can be thrown off. In turn, sleep is very important for neurological health and keeping the microbiome balanced. Make your bedroom a quiet, dark, cool, and comfortable place to sleep for 7-9 hours each night.
Integrative and Complementary Therapies
Since gut health is so impactful in MS, a variety of integrative and complementary therapies have been studied to support and balance the gastrointestinal tract. Integrative approaches such as acupuncture, meditation, reflexology, massage therapy, yoga, diet, reiki, and Tai Chi may help improve fatigue, quality of life, and discomfort in people with MS.
To support gut health and improve overall well-being, complementary therapies for MS gut health may be beneficial. As mentioned above, foods containing prebiotics like bananas, greens, onions, garlic, soybeans, and artichokes and naturally-occurring probiotics like yogurt, kefir, sauerkraut, tempeh, and kimchi can be incorporated into the diet to support the diversity of the gut microbiome and support beneficial gut microbiota.
Probiotics can also be taken as supplements. One study suggested that supplementing with the probiotic yeast Saccharomyces boulardii resulted in a decrease in inflammation and improvements in discomfort, fatigue, and overall quality of life in patients with MS.
Supplementation with the SCFA propionate has also been studied in people with MS. Propionate may help to support the immune system. Supplementation with 1 gram of propionate daily was associated with restored levels, reduced the annual relapse rate, and slowed progression in people with MS.
Another emerging strategy for modulating the microbiome is fecal microbiota transplantation (FMT). In this approach, feces is taken from healthy donors without a personal or family history of autoimmune conditions and implanted into a patient with MS. Studies suggest lower intestinal permeability, a more anti-inflammatory state, and enhanced composition of the gut microbiota in patients with MS who have received a FMT.
Antioxidants consumed via the diet and/or supplementation may help to support the immune system, decrease inflammation, and mitigate oxidative stress, potentially supporting the nervous system in MS. These include vitamin D, vitamin A, curcumin, and omega-3 fatty acids.
In particular, vitamin D has been extensively studied for its role in supporting the immune system. Lower levels of vitamin D are associated with a greater risk of multiple sclerosis and supplementation of this nutrient may help support overall health.
Studies also suggest that increasing consumption of foods rich in omega-3s such as fish, nuts, and seeds and/or supplementation with these fatty acids may support quality of life and help support gut health in patients with relapsing-remitting MS as well as helping to support neurological health. A systematic review found that omega-3 and fish oil supplements may benefit patients with MS by supporting overall health, decreasing inflammatory markers, and supporting quality of life.
Challenges in Managing Digestive Health in MS
MS is a complex condition with a wide range of symptoms that impact the whole body and quality of life. The accompanying fatigue, discomfort, mobility challenges, and digestive symptoms can take a toll on the body and mind.
A multidisciplinary patient-centered approach to care is needed to address the challenges in managing digestive health in MS patients and the overall complexity of the condition. Tailoring a personalized management plan to an individual’s needs, testing, preferences, and symptoms can help bring greater balance.
A functional medicine approach to digestive health in MS patients looks at the contributing underlying factors that may lead to symptoms. Environmental factors, dysbiosis, immune system dysregulation, and intestinal permeability all may contribute to gut health imbalances in MS via the gut-brain axis.
Medications used to manage MS can impact the microbiome. Some may contribute to dysbiosis while others can have a favorable impact. For example, dimethyl fumarate (DMF) is an oral medication used to manage relapsing-remitting MS. It has anti-inflammatory and neuroprotective antioxidant effects and may impact the gut–brain axis by supporting beneficial bacteria that produce SCFAs, supporting the permeability of the intestinal barrier, and having an antimicrobial effect.
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Digestive Health in Patients with Multiple Sclerosis: Key Takeaways
Gastrointestinal symptoms are extremely common among people with multiple sclerosis and the health of the gut may play a key role in the development of immune dysregulation and inflammation underlying this autoimmune condition.
Gut health and the balance of microbes inhabiting the intestinal tract may have significant impacts on the immune system and nervous systems via bi-directional communication along the gut-brain axis. Dysbiosis of the gut microbiome is associated with immune dysregulation and progression of MS.
Therefore, a comprehensive individualized approach to digestive wellness is needed to address the unique needs of MS patients. Functional medicine provides a holistic approach to digestive health in MS using specialized testing to assess the health of the gut. A personalized management plan utilizing lifestyle, diet, supplements, and integrative approaches can then be put into place to help support the gut, support a healthy inflammatory response, and improve quality of life.
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