Multiple Sclerosis Management: 6 Lifestyle Recommendations for Living Well
For those living with multiple sclerosis (MS), disease management takes a three-pronged approach and emphasizes the importance of six lifestyle choices as a key to brain health and living well.
The Holistic Approach to Managing Multiple Sclerosis
Lifestyle choices are important for all of us, and for people with multiple sclerosis this is especially true as they are part of the three pillars of managing the disease and living well with MS.
The three pillars are:
- Disease modifying therapies (DMTs) help to decrease future nerve damage.
- Symptom management helps people with MS feel and function better.
- Evidence-based healthy lifestyle recommendations.
6 Lifestyle Recommendations for Managing MS
Here we discuss the six pillars of brain health, and how these can help people with MS feel and function their best.
The six pillars of brain health are:
- Diet & nutrition
- Exercise
- Sleep
- Stress management
- Social connection
- Avoiding harmful substances
Diet & Nutrition
We know that there is plenty of information about diet and MS and unfortunately there are some misconceptions.
There is no one MS diet, and there is no one food group that has been definitively shown to help or hurt MS. We also know that no diet has been shown to have disease modifying effects for MS, so MS cannot be managed with diet alone. However, as is the case for everybody, a healthy diet can certainly help you feel and function your best, and it may impact other medical conditions such as diabetes, high cholesterol or heart disease. Aim for a plant forward diet with lean proteins, whole grains, good fats, and avoid ultra-processed food and saturated fat.
Fruits & Vegetables: We generally advise people with MS to emphasize a plant-forward diet— meaning a diet that is heavy in colorful fruits and vegetables, whole grains, lean proteins, and good fats. There are some studies that suggest that people who eat a healthier diet may have less disability. We also know that a healthy diet may modify some other medical conditions such as diabetes and high cholesterol. We also know that when people with MS have these other medical conditions, they tend to do a little worse, so a healthy diet may indirectly benefit people with MS by managing these other medical conditions.
Good Fats: We encourage the use of good fats. These are liquid at room temperature and examples include olive oil and avocado oil. By contrast, a bad fat is what we call a saturated fat which is solid at room temperature. So that includes butter, lard, and even some plant-based fats such as coconut oil. We suggest that people avoid saturated fats as they are thought to promote inflammation.
Avoid Ultra-processed Foods: The main type of food that we ask people to limit are what we call ultra-processed foods. Apart from raw foods, all the food we eat is processed in some way. It’s either cooked or physically changed. An ultra-processed food however is generally a food that has significant amounts of chemical additives, salt and sugar. It doesn’t mean that you can never have an ultra-processed food item but do try to limit them.
Exercise
Not only can people with MS tolerate and benefit from exercise, we now know that it is very, good for them. Data suggest that exercise may be anti-inflammatory. In addition, we have many decades of data showing that exercise and physical activity can:
- Improve strength and mobility
- Decrease fatigue
- Improve mood and decrease spasticity
When we say exercise, we also include physical activity. What’s the difference?
- Exercise is generally defined as a structured, repetitive motion such as, walking, jogging or hand cycling if you’re not mobile.
- Physical activity is any movement that involves large muscle groups. It includes things such as housekeeping, walking the dog, or chasing after a 2-year-old!
We encourage all kinds of exercise. General guidelines which apply to most people, are at least 150 minutes a week of exercise and/or physical activity.
Ideally, we like to talk about incorporating different types of exercise and physical activity. We encourage people to try to achieve a mix.
- Aerobic activity increases your heart rate.
- Resistance training a few days a week could include weightlifting or resistance bands.
- Stretching is important. Nobody stretches enough, including me, and we should all stretch at least once a day.
- Neuromotor engagement or dual tasking engages your mind and your muscles at the same time. Good examples of this includes certain forms of dancing and tai chi.
So, exercise really is the magic bullet addressing a wide range of problems.
Sleep
Sleep disorders are more common among people with multiple sclerosis than the general population. General recommendations for most people are approximately seven to eight hours of restful sleep per night. Primary sleep disorders, which are sleep problems that are not due to another cause disproportionately affect people with MS. These include:
- Insomnia: Affects at least 40% of people with MS, making it one of the most frequent complaints.
- Restless Legs Syndrome (RLS): Individuals with MS are at least three times more likely to experience RLS compared to the general population.
- Obstructive Sleep Apnea (OSA): Estimated to impact 20% to 50% of people with MS.
The contributing factors particular to people with MS include:
- Brain and spinal cord lesions: Damage to specific areas like the brainstem or spinal cord can directly disrupt the body’s sleep-wake cycles and respiratory control during sleep.
- Secondary symptoms: Chronic issues like pain, muscle spasticity, bladder dysfunction, depression, and anxiety frequently wake patients or prevent restful sleep.
- Medication side effects: Certain symptom-management drugs may interfere with normal sleep patterns.
We try to address the underlying causes to encourage a good night’s sleep.
Stress Management
Unfortunately, we are all too stressed. We all have multiple personal and professional life stresses which can take their toll. There are no conclusive data suggesting that if a person with MS gets stressed it causes more nerve damage. But we certainly have seen people with MS have some symptom flare up when they get stressed. So, in line with living well, we encourage stress management including deep breathing techniques and meditation practices.
Social Connection
The National MS Society likes to say, “When MS short circuits you, the society helps you connect.” And we think that’s an apt saying. We know that people with MS may tend to become isolated and may not have as much social connection as they need.
Social connection is important for all of us, so it’s important to have a support system including family, friends or religious groups or organizations. We certainly encourage people to have social connection which can be through exercise, engaging in a hobby, talking to a friend, and sometimes including professional counseling.
Avoiding Harmful Substances
The most harmful thing that a person with MS can do is smoke. We know that smoking anything causes inflammation in the lungs, and this includes vaping.
Smoking is one of the very few things that we tell people with MS has an absolute zero tolerance policy. Additionally, smoking is linked to other medical conditions such as lung cancer, emphysema, and heart disease.
High amounts of alcohol are not good for anybody. And in people with MS, alcohol can certainly cause incoordination and balance problems and exacerbate other symptoms. Low alcohol consumption, which is approximately 4 drinks or less/week for women, and 7 drinks or less per week for men may be acceptable for most persons with MS.
While some cannabis extracts, e.g. CBD or THC taken orally or topically may be useful for treating some MS symptoms such as spasticity, smoking cannabis is discouraged. Additionally, heavy cannabis use has been linked to cognitive impairment in some studies.
Incorporating Brain Wellness & Lifestyle Interventions
Now more than ever, people with MS can live well. The three pillars of managing MS and living well with MS are disease modifying therapy, symptom management, and lifestyle choices.
The Brain Wellness & Lifestyle Program at Pacific Neuroscience Institute offers ongoing support through individual and small group sessions, providing individualized lifestyle intervention recommendations.
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