MS Research Australia has just released a lifestyle guide for people with MS that honestly would benefit more than just those of us with the disease. By improving our overall health we decrease the chances of developing various illnesses and diseases that can be avoided or controlled, such as heart disease, type 2 diabetes, and to some extent a range of mental health conditions such as depression and anxiety. The guide is free, and I’ve summarised the key points in this post.
When you get diagnosed with multiple sclerosis your first thoughts turn to “what can I do now to control a disease I have no control over?”. If you are like me you started reading. You ordered books, you searched scientific journals, you Googled, read blogs and forums, even asked your treating doctors “what can I do now to control the uncontrollable?”. Turns out there are a few things that you can do to help control the trajectory of your MS that are backed by scientific research, and I would argue a few more things you can do that will contribute to a more positive outcome by increasing other aspects of your health. These particular aspects are called modifiable lifestlye factors, they are the things you can control such as your behaviour and environment, unlike your genetics or age.
- gut health
- vitamin d and sun exposure
- weight and obesity
- other medical conditions
If I asked you if smoking was healthy I am pretty confident you would answer no. It’s not surprise then that this makes the list of modifiable lifestyle factors with some very solid evidence behind it that it increases your risk of developing MS as well as faster progression (55% faster than those with MS who don’t smoke), worse symptoms, and the development of other medical conditions such as lung cancer, anxiety and depression. This isn’t simply cigarette smoking either, it includes marijuana, opium, cigars, pipes, hookah etc. Simply put, no smoking is good for you.
Importantly this includes passive smoking, if you have MS and are around smokers but don’t smoke yourself, you are putting yourself at greater risk.
But, there is hope, quitting as soon as possible is beneficial; for every 10 years that people didn’t smoke there was a 30% decrease in the risk of further MS disability. Quitting smoking is important for any smoker, the sooner you quit the sooner your body begins to repair and you can reduce your risk of cancer, lung disease, stroke and heart attack. There is no reason to smoke in the age of education and scientific understanding that we are in now, if you are struggling to give up smoking, talk to your local GP as a first step and know that no matter how hard the journey is the pay off is a longer and healthier life.
Unfortunately many people who are diagnosed with MS tend to have lower activity levels than most people. This stems from a number of reasons, partly it is because of the crippling fatigue people with MS feel due to the damage done in their brain and spinal cords, some of it is due to depression and a feeling of helplessness. Low levels of physical activity leads to a reduced quality of life, increased rates of depression, and a much greater risk of developing heart disease and obesity. This is true of anyone – exercise is essential for overall health and can benefit everyone regardless of their baseline health status.
In particular for people with MS regular exercise has been shown to help with fatigue, balance, sleep quality as well as movement patterns, important for those with spasticity or issues with general movement and limb control. Exercise also helps with cognition, often a huge hurdle for those with MS, and with improving mood and decreasing rates of depression. Exercise has also been linked with reduced rate of relapses and slow disability progression so if all I have to do to achieve those things is aerobic workouts 2-3 times a week and strength workouts 2-3 times a week then I’m in.
Diet is a tricky one, there are a number of diets on the market for people with MS and they can directly contradict each other and claim the same benefits (for example the Wahls protocol and the OMS diet). However, if I were to ask you what foods were good for you and what were bad I think we could come up with a pretty simple list. Good: fruits and veggies, grains, legumes, leafy greens, unprocessed items; Bad: high sugar, highly processed foods, high salt, lots of alcohol, saturated fat. The Guide goes through a few diets and concludes that there is no real evidence for any of them. Instead, it suggests you follow a balanced diet as laid out in the Australian Dietary Guidelines which call for limited consumption of foods containing saturated fats, added salt, sugars and alcohol. Only about 4% of the population actually adhere to these guidelines! Limiting your consumption of these kinds of items and following a balanced diet will help keep your body weight in a healthy range, allow your body to function effectively, and will reduce your risk of developing (or worsening) MS, diabetes, cardiovascular disease, depression, and various cancers. If you look at what you eat and think you could do a bit better, start there, every little change can make a huge difference.
This is a new and very exciting area of research and warrants a blog post all on it’s own. Our gut health is essential not only for our general physical health, but also our psychological health; more and more are we seeing connections between gut health and brain health. For people with MS there is evidence to suggest significant differences in the composition of our gut bacteria when compared to people without MS. Whilst there is no strong evidence for any treatments to improve our gut health there are things we can do, the biggest thing is to look to our diet. We can improve our gut health by improving our diet. By eating lots of fruits, vegetables and legumes and avoiding foods high in saturated fat, salt and sugar the microbiota of our gut will get healthier and healthier. We can also improve our gut bacteria with regular exercise, and by avoiding smoking and drinking alcohol, things we also know will help our MS. It is becoming exceedingly clear that all these areas are tightly intertwined and by improving one area we can help improve other areas.
There are many supplements on the market and whilst there is evidence to support the use of some in people with MS, there are plenty that are marketed at people with MS but have no evidence to back up those claims. This can lead to dangerous outcomes and unwanted side effects, for example alpha lipoic acid, inosine and green tea extract have caused kidney problems, high levels of serum urea and abnormal liver function, respectively, so it pays to research the science behind a supplement that has been touted as beneficial for MS. According to the guide your best bet is to get the range of vitamins and minerals essential for healthy bodily functions from a diverse and balanced diet, again linking our outcome across the modifiable lifestyle factors.
Vitamin D and sun exposure
Vitamin D is essential for calcium absorption and maintaining our bone health, but it is also involved in reducing inflammatory immune responses which is relevant to the disease process of MS. People with low levels of vitamin D in the blood serum are more likely to develop MS than those who have healthy levels, and there are higher rates of MS in areas further away from the equator (where they receive lower exposure to sunlight which is how we naturally produce vitamin D). Whilst there is no strong consensus on whether or not to supplement with excess vitamin D for people with MS, when you are diagnosed it is more than likely that you neurologist will recommend you take a supplement. The recommendations from this guide are to test your baseline vitamin D levels and then supplement if necessary to reach the levels appropriate for your age and gender.
With regards to sunlight exposure is it important that we receive regular exposure to ensure we are able to naturally produce vitamin D. This only occurs when the UV index is above 3 which often does not happen during winter months which would require supplementation in order to maintain good vitamin D levels. Of course you must balance your sun exposure with skin cancer risk, but by avoiding dangerously high UV days or time of day (i.e. midday) you can produce vitamin D for your body rather than relying on a supplement.
Weight and obesity
All of these modifiable lifestyle factors seem like general knowledge to me. If I were to ask you what was a healthy weight I am sure many of you would have somewhat of a good idea of what that is. If I were to ask you what were the risks of being overweight and obese you would probably list the obvious risks like high cholesterol, diabetes and cardiovascular disease, though you probably wouldn’t mention MS. For multiple sclerosis, obesity can increase your chances of developing it, can hasten your disease progression, can increase your risk of relapse, can make your symptom experience worse and lead to depression. In Australia, over 60% of people with MS are overweight or obese. Not only is this making their experience and life with MS worse, it is putting them at greater risk of developing other health conditions to manage on top of their MS.
This is another example of a modifiable lifestyle factor that is relevant to everyone. For a long and healthy life we must maintain a healthy weight. In order to do this you need to eat right and exercise and when you do this you are able to reduce your risk of numerous chronic health conditions, including MS. An easy way to determine a healthy weight for you is to use the BMI. Whilst it is often claimed to be a flawed tool as it has some limitations, it does give you a good guide as to where you healthy weight range would be. Alternatively, you can get body scans and determine directly your percentage body fat and muscle mass and use that to help guide you to a healthy weight.
Other medical conditions
As you read through the list it becomes clear that often those who have MS may have another medical condition as well, known as a comorbidity, at rates higher than the general public. The most common comorbidities are anxiety, depression, and high blood pressure. This is a problem as adding another health condition on top of the stress and strain of one you already have can make both of them worse. People with MS and other medical conditions report a reduced quality of life, an increase in relapse rate compared to those with only MS, an increased rate of disease and disability progression, they also experience worst symptoms, are hospitalised more often and have a higher rate of loss of work. For some people this doesn’t have to be the case, for example you don’t simply have to live with depression because you assume it’s normal for someone with MS to feel that way. As with the other sections above, by improving your lifestyle, improving your diet, exercising, and be seeing your doctor regularly and being open and honest about your experience you may be able to reduce the risk of, or prevent some conditions from developing. This will reduce the burden on you and again this applies to everyone, allowing you to live a longer, healthier life.
The myelin sheaths that our immune system attacks when you have multiple sclerosis is made up on lipids. Whilst they are essential to our body functioning they become a problem when our lipid levels are abnormal or high which is actually very common not only in people with MS but in the general population and can cause cardiovascular disease. For people with MS, high lipid levels can contribute to worse disability outcomes and can increase the number of lesions on your brain and spinal cord which directly relates to relapse rate and symptom severity. It is important for everyone to monitor their lipid levels to ensure they are within healthy ranges and that they aren’t putting themselves unnecessarily at risk. The best way to do this, and you guessed it, is through a healthy lifestyle; eating well, exercising regularly, these are the things you can do to help prevent abnormal lipid levels.
All in all, there is no magic bullet. Changing your lifestyle is hard, changing your diet, your exercise patterns, your mindset, it’s all hard, but that doesn’t mean it isn’t worth it. Multiple sclerosis is a disease that is unpredictable and ostensibly out of our control however, there are a number of aspects of our lives that are completely within our control and will directly impact our outcome. Our doctors can only help us so much if we aren’t willing to help ourselves. It is upon us to be the best we can be, to give ourselves the best chance. I will be giving myself my absolute best chance, I want a long, healthy and happy life with my family and friends so I will control what I can control for a future I can’t.