Multiple sclerosis (MS) is a disease that affects the brain and/or the spinal cord. All patients with MS are given drug treatment. However, experts are trying to find out whether a patient’s lifestyle affect MS disease. They have looked into the effect of vitamin D, tobacco smoking, and factors that increase the risk of cardiovascular disease (i.e. diseases that affect the heart or blood vessels).1,2
This article also features video interviews with Nicole Sconzo, an MS Clinical Nutritionist, and Noel, an MS patient who is affiliated with the Multiple Sclerosis Association of America (MSAA). The first video talks about getting busy, and how our habits affect the way we feel when living with MS. Ms Sconzo and Noel also look at the way our habits can affect MS symptoms and the level of disability patients suffer with the disease. People who live with MS are becoming more interested in improving their well-being. Changing lifestyle is not meant to replace drug treatment, but to boost its effects. People with MS can improve their lives by eating a healthy diet, exercising regularly, keeping vitamin D levels up, not using tobacco, coping with stress, being active, and sticking to healthy habits. To stick to a healthy lifestyle, patients need information they can rely on. Ms. Sconzo says that we should check out so-called ‘experts’ to be sure that the information they give is correct.
As well as its effect on well-being, living with MS is expensive. Patients may not be able to work, and MS drugs are not cheap.3 However, healthy living does not cost much and can improve the lives of people with MS.4 Preventing disability lets patients stay in work and keep active.1 We must remember that patients and professionals may have different ideas on healthy living. Patients and professionals need to talk to each other to make sure they are getting the right advice.
The second video talks about the use of vitamin D supplements. We know that vitamin D is useful for patients with MS,5 but scientists are still trying to work out the best levels of vitamin D to take. At the moment, experts say that patients with MS should take 2,000–5,000 IU of vitamin D3 a day. They should get their blood levels of vitamin D checked in 3 months and each year, as MS patients sometimes do not reach the recommended blood levels.6 We do not know the best foods and amount of fat in the meal to help the vitamin D to be absorbed.7
Noel and Ms Sconzo also talked about fish oils and plant-based oils like flax seed. We do not know the best dose of these oils. We also do not know how important the oils in our diet are. Some studies have found that patients who take plant-based omega 3 oils, such as flax seed oil, are less disabled than those who take fish oils.8,9 The way the fish oils are stored, for example in the fridge, may affect their quality. This might explain why studies have found that fish oils are less effective in MS.10
Medicinal plants have traditionally been used to treat diseases. Curcumin may be a useful treatment for MS. It may act on cells that are involved with MS but we don’t know whether it has any effect on the disease symptoms.11
Diet is also important. A small study looked at a special diet that involved reducing calories, being semi-vegetarian and taking supplements of vitamin D, fish oil, lipoic acid, omega 3 poly unsaturated fatty acids, reservatrol and multivitamin complex. When patients were examined after 6 months, their symptoms had not changed, but blood tests showed changes in substances causing inflammation. This means that this supplement may be helpful for patients with MS.12 However, the American Academy of Neurology looked at studies of using supplements and alternative medicine in MS. They decided that fish oils did not reduce the rate of relapses in MS, and no other supplements affected MS.13
The video also talks about selenium. One study measured the levels of selenium and other metals in blood, and found that there was no difference between patients with and without MS. Another study found that patients with MS had lower selenium levels than those without MS. At the moment, we do not know whether selenium is important in MS.13,14
The third video focuses on the exciting topic of gut bacteria in patients with MS. Bacteria in our gut affect our immune system, particularly in the brain and spinal cord. Many studies have tried to see whether altering the gut bacteria can help patients with MS. The type of bacteria in the guts of people with MS is different compared to those without MS. There are fewer bacteria that help control the immune system, and more bacteria that make the immune system more active. This might affect the brain and spinal cord.15 We can alter the gut bacteria in patients with MS using vitamin D supplements, probiotics (i.e. live bacteria and yeasts that are good for your digestive system) and changing the diet.15 Studies on animals have found that changing diet and/or taking probiotics may change the way MS progresses16,17 but we do not know yet whether this occurs in humans. Eating more fibre may also alter gut bacteria. In a small study, MS patients who ate a diet high in vegetables and low in protein for a year became less disabled, as well as having fewer relapses, compared with patients who ate a typical “Western diet”. The diet also altered their gut bacteria.18
Factors that increase the risk of cardiovascular disease also seem to affect the risk of having MS, as well as shrinking of the brain and the damage in the brain and spinal cord.19,20 Reducing these risks can improve overall health, reduce disability and avoid developing other diseases. Patients with other diseases as well as MS may take longer to be diagnosed as well as being more disabled.21 Diets aimed at healthy hearts may also be good for people with MS. One study found that patients with MS less fruits, vegetables and pulses compared to those without MS. People who ate healthy food were also less likely to smoke, less likely to be obese and more likely to be active.20 People were less likely to be disabled if they ate more fruits, vegetables, pulses and whole grains, and fewer desserts, sweetened drinks, red and processed meats. People who were a healthy weight, regularly exercised, didn’t smoke and ate a healthy diet were less likely to suffer from tiredness, depression, pain and trouble learning, concentrating or remembering things.20
To sum up, making healthy changes is likely to help our patients with MS.
- Marrie RA. Comorbidity in multiple sclerosis: implications for patient care. Nat Rev Neurol. 2017;13:375–82.
- Berrigan LI, Fisk JD, Patten SB, et al. Health-related quality of life in multiple sclerosis: direct and indirect effects of comorbidity. Neurology. 2016; 86:1417–24.
- Giovannoni G, Butzkueven H, Dhib-Jalbut S, et al. Brain health: time matters in multiple sclerosis. 2015. Available at: https://msbrainhealth.org/perch/resources/brain-health-time-matters-in-multiple-sclerosis-sep-17-1.pdf(accessed March 13, 2018).
- Ysrraelit MC, Fiol MP, Gaitán MI, Correale J. Quality of life assessment in multiple sclerosis: different perception between patients and neurologists. Front Neurol. 2018;8:729.
- Shoemaker TJ, Mowry EM. A review of vitamin D supplementation as disease-modifying therapy. Mult Scler J. 2018;24:6–11.
- Bhargava P, Steele SU, Waubant E, et al. Multiple sclerosis patients have a diminished serologic response to vitamin D supplementation compared to healthy controls. Mult Scler. 2016;22:753–60.
- Borel P, Caillaud D, Cano NJ. Vitamin D bioavailability: state of the art. Crit Rev Food Sci Nutr. 2015;55:1193–205.
- Jelinek GA, De Livera AM, Marck CH, et al. Associations of lifestyle, medication, and socio-demographic factors with disability in people with multiple sclerosis: an international cross-sectional study. PLoS One. 2016;11:e0161701.
- Jelinek GA, Hadgkiss EJ, Weiland TJ, et al. Association of fish consumption and Ω 3 supplementation with quality of life, disability and disease activity in an international cohort of people with multiple sclerosis. Int J Neurosci. 2013;123:792–800.
- Jiménez-Martín E, Antequera Rojas T, Gharsallaoui A, et al. Fatty acid composition in double and multilayered microcapsules of ω-3 as affected by storage conditions and type of emulsions. Food Chem. 2016;194:476–86.
- Xie L, Li XK, Takahara S. Curcumin has bright prospects for the treatment of multiple sclerosis. Int Immunopharmacol. 2011;11:323–30.
- Riccio P, Rossano R, Larocca M, et al. Anti-inflammatory nutritional intervention in patients with relapsing-remitting and primary-progressive multiple sclerosis: a pilot study. Exp Biol Med (Maywood). 2016;241:620–35.
- Yadav V, Narayanaswami P. Complementary and alternative medical therapies in multiple sclerosis–the American Academy of Neurology guidelines: a commentary. Clin Ther. 2014;36:1972–78.
- Alizadeh A, Mehrpour O, Nikkhah K, et al. Comparison of serum concentration of Se, Pb, Mg, Cu, Zn, between MS patients and healthy controls. Electron Physician. 2016;8:2759–64.
- Mowry EM, Glenn JD. The dynamics of the gut microbiome in multiple sclerosis in relation to disease. Neurol Clin. 2018;36:185–96.
- Libbey JE, Sanchez JM, Doty DJ, et al. Variations in diet cause alterations in microbiota and metabolites that follow changes in disease severity in a multiple sclerosis model. Benef Microbes. 2018:1–20. doi: 10.3920/BM2017.0116. [Epub ahead of print]
- Calvo-Barreiro L, Eixarch H, Montalban X, Espejo C. Combined therapies to treat complex diseases: the role of the gut microbiota in multiple sclerosis. Autoimmun Rev. 2018;17:165–74.
- Saresella M, Mendozzi L, Rossi V, et al. Immunological and clinical effect of diet modulation of the gut microbiome in multiple sclerosis patients: a pilot study. Front Immunol. 2017;8:1391.
- Kappus N, Weinstock-Guttman B, Hagemeier J, et al. Cardiovascular risk factors are associated with increased lesion burden and brain atrophy in multiple sclerosis. J Neurol Neurosurg Psychiatry. 2016;87:181–7.
- Fitzgerald KC, Tyry T, Salter A, et al. A survey of dietary characteristics in a large population of people with multiple sclerosis. Mult Scler Relat Disord. 2018;22:12–8.
- Yamamoto E, Ginsberg M, Rensel M, Moodley M. Pediatric-onset multiple sclerosis: a single center study. J Child Neurol. 2018;33:98–105.