Diet and Nutrition for NMO

The foods you eat have an impact on your health today and later in life. Fad diets are popular, but most people do not need restrictive rules for eating in order to have a healthy diet.

While some studies have shown that what you eat can impact your brain health, no diet has ever been systematically studied in neuromyelitis optica spectrum disorder (NMOSD). This does not mean that diet and nutrition are not important. Many approaches may not have trial evidence, but they may still benefit those with NMOSD.¹

General nutrition tips

Every person is different, but there are some general guidelines about what you should eat when you have NMOSD. In general, most doctors believe that:²

• Half of your plate should be filled with non-starchy vegetables, one quarter with a low-fat protein, and one quarter with carbohydrate-rich foods.
• Reduce the amount of foods you eat that are high in saturated fat, salt, and sugars or other carbohydrates.
• Drink plenty of water and other no-calorie beverages.
• Eat vegetables, fruits, whole grains, fat-free or low-fat dairy products, fish and seafood, lean meats, eggs, beans, peas, and nuts and seeds. These foods are dense with the nutrition you need.
• Avoid highly processed, packaged foods as much as possible. These foods tend to be light on nutrition but high in calories, salt, and fat.
• Pay attention to fiber. Fiber helps your body process carbohydrates and fat.

Vitamin D

Vitamin D supplements are potentially important for people with NMOSD from both the perspective of symptom management and disease-modifying effects. Vitamin D is recognized as an important factor in maintaining bone density. People with AQP4-IgG positive NMOSD are at increased risk for decreased bone mineral density. There are different reasons for this, including:^3-5

• Steroid use
• Loss of mobility

Other factors, such as increased age or decreased body weight, can also lead to decreased bone density. Having a decreased bone density can lead to an increased risk for fractures. In those with NMOSD, falls are also linked to an increased risk for fractures.⁵

Results from several studies suggest that low vitamin D levels may play a role in the development of some neurologic (brain and spine) conditions. More studies are needed to determine a clear relationship between vitamin D and NMOSD.

Also, more studies need to be done to prove that vitamin D has disease-modifying effects. If you would like to use vitamin D supplements, talk to your doctor first. Your doctor can give you a blood test to find out your blood level of vitamin D. If your level is low, your doctor may suggest a daily supplement to bring your levels up to normal.³

Fatty acids

Fat has a bad reputation. It is true that eating too much fat is unhealthy. However, it is also true that the body needs a certain amount of fat to fuel the body.

There are 2 basic groups of fats in foods: saturated fats and unsaturated fats.
Saturated fatty acids come mostly from animal products, such as red meat, bacon, and cheese. They are considered “bad fats.”²

Other “bad fats” include trans fats, a type of saturated fat that occurs naturally in some foods, such as animal products. Some trans fats are made in a process called hydrogenation. Trans fats are found in many processed foods.²

Polyunsaturated and monounsaturated fats are considered “good fats.” Omega-3 fatty acids are 1 type of polyunsaturated fat found in fatty fish, nuts, seeds, and vegetable oils. In some studies, fatty acids have been shown to decrease inflammation, which may be helpful in those with NMOSD. However, this has not been proven, and fatty acids have not been shown to change outcomes in NMOSD.^1,6

Herbs

Herbal supplements come from plants, and like drugs, they may produce changes in the body. However, there is a lack of research evidence to support the use of herbal supplements in NMOSD. There are safety concerns since there are no quality control measures in place to monitor supplements. As with any complementary therapy, people who are considering taking herbal supplements should talk to their doctor before starting them since supplements may interfere with medicines.^1,7

Antioxidants

With NMOSD, the area between the blood and the brain can weaken. This area is known as the blood-brain barrier. The blood-brain barrier has several jobs, including:⁸

• Protect the brain from substances in the blood that could injure it (“foreign” substances)
• Allow some healthy substances to reach the brain
• Maintain a constant environment for the brain

Harmful proteins and molecules can enter the brain in NMOSD, due to a weak or leaky blood-brain barrier. This can sometimes result in oxidative stress. This is a specific kind of damage resulting from injurious molecules called reactive oxygen species. Oxidative stress could possibly play a role in NMOSD, though this is not well known. Taking antioxidants may be of interest because of this link. Antioxidant nutrients may include:⁹

• Omega-3 fatty acids
• Vitamin C
• Resveratrol

Some supplements and herbs may interact with the medicines you take for NMOSD. Also, some herbs and supplements may not be safe because they interact or interfere with your immune system. Always talk to your doctor about any supplements or herbs you take.¹