6 Lifestyle Factors That May Affect MS

For patients managing multiple sclerosis—a chronic condition in which the immune system attacks the brain, spine, and optic nerves—adopting longterm, healthy lifestyle behaviors may play an important role in managing symptoms and improving quality of life. We spoke with Kathleen Costello, MS, ANP-BC, MSCN. Costello is Associate Vice President at the Clinical Care Advocacy, Services and Research Department of the National Multiple Sclerosis Society.

6 Factors to Consider

When considering healthful choices, Costello says that there are a number of factors to consider. These include (but are not limited to) diet, exercise, supplements, sleep, smoking cessation, and stress management. Just keep in mind that making small, temporary changes in one or two of your habits probably won’t have a big impact on your condition. Instead, think in terms of adopting healthy habits and being consistent over the long term. Here is what you should know about each of these factors, and the impact they could have on MS:

  1. Diet. Unfortunately, "To date, there is no specific diet that has been determined to be a disease-modifying intervention," Costello says. "However, recent research findings suggest several dietary factors as potential risk factors for the development of MS," including a high sodium [salt] diet. The link seems to be an inflammatory response caused by high-salt foods.

    In addition, maintaining a healthy weight is important since obesity appears to be a risk factor for developing MS. Obesity may also be associated with a poorer prognosis and can put more strain on your body, making your symptoms worse.

    What you can do: "It is very important for people with MS to attend to their overall health. Therefore, a diet that helps reduce the risks of other conditions and diseases (called co-morbidities) is the type that should be followed," Costello says. A healthful diet should be low in refined sugar and processed foods (prepackaged options that are often high in sugar, salt, and sodium), and include:

    • Plenty of fresh fruits and vegetables.
    • Lean protein (found in foods like fish).
    • Healthy fats like omega-3 fatty acids, found in fish; monounsaturated fats, common in some nuts and canola oil, and polyunsaturated fats, which are plentiful in walnuts and flaxseed.
    • Fiber (found in fruits, veggies, whole grain pasta and breads, and brown rice).
    • Water.
  2. Exercise. Exercise is important for everyone to promote cardiovascular (heart and blood vessel) health and to reduce risk of obesity, diabetes, cardiovascular disease, and hypertension (high blood pressure). This is also true for people with MS. "There have been a number of clinical trials of various lifestyle behaviors, particularly exercise, that have demonstrated positive effects on strength, endurance, and fatigue management," Costello says. Exercise also seems to help manage depression, which is a common issue for people grappling with MS.

    What you can do: Costello points out that the best exercise program for someone with MS depends on a number of personal factors; there is no one-size-fits-all approach. Therefore, it’s important to consult with an exercise or rehabilitation professional who is knowledgeable about MS to select the type, frequency, and intensity of exercise that will be best for your specific health status and situation.

  3. Supplements. "There are few supplements that have been found to be important in MS," says Costello. One that may be worth taking is vitamin D, since some preliminary research suggests it may have preventative as well as disease-modifying effects in MS. Though vitamin D is present in fatty fish like salmon and is added to many dairy products, it’s difficult to get enough (the Institute of Medicine of the National Academy recommended 600 International Units a day) from diet alone.

    A simple blood test can determine if you’re vitamin D-deficient; the normal range is generally 30–100 ng/mL (nanometers per milliliter of blood), or 75–250 nmol/L (nanometers per liter). If your vitamin D levels are low, speak with your doctor before taking supplements, since high doses (above 4,000 International Units a day) may be toxic.

    Omega-3 fatty acids or fish oil supplements have also been studied in MS patients, Costello says, but to date they have been looked at only in small trials. "The results are mixed, meaning it is not known if these supplements would be of any help."

    What you can do: It’s always best to consult with your doctor for advice before taking any supplements on your own. Costello also recommends a book called Optimal Health With Multiple Sclerosis: A Guide to Integrating Lifestyle, Alternative, and Conventional Medicine, by Alan Bowling, MD, PhD. "In this book, Dr. Bowling presents the evidence thus far on many supplements and diets as well as other less conventional interventions," she says. This can serve as a good overview to the extensive world of supplements.

  4. Sleep. "Many people with MS experience significant fatigue, and although this may be due directly to multiple sclerosis, there are other factors that can contribute to fatigue and make overall fatigue worse." Sleep issues are a factor; many MS patients don’t sleep well due to neuropathic (nerve) pain, restless legs, bladder urgency and frequency, depression, and mobility restriction, meaning they need help to get into a comfortable sleeping position. Also, some medications can disturb sleep.

    What you can do: Speak to your physician about treatments to manage sleep-disturbing symptoms such as spasticity (spasms or spasm-like movements) or needing to use the bathroom frequently. "Developing healthy sleep habits, such as going to sleep at a regular time each day, relaxing before bed, limiting caffeine intake late in the day, and making sure the bedroom is cool and dark, can also help improve sleep," says Costello.

  5. Stress. Everyone experiences stress. If you have MS, the stress can make symptoms like pain, weakness, and numbness worse. "Stress also has a negative impact on thinking ability or cognition," Costello points out.

    What you can do: "Attention to stress reduction can positively affect quality of life," she says, citing a recent study that looked at a group of people with MS who participated in a stress management program and as a result, had reduced central nervous system inflammation. "Other interventions such as yoga and mindful meditation may be helpful for stress reduction in MS, although the evidence at this time is not as clear," she adds.

  6. Smoking. Smoking has been linked with a higher risk of developing MS and possibly with a poorer prognosis. "Quitting smoking is important for everyone’s health, but may have special significance for people with MS," Costello notes.

    What you can do: Get support to quit smoking. Visit smokefree.gov, where you can find resources, including quit coaches and tips.

Find an Expert to Guide Your Efforts

Before you undergo any dietary changes, start a new exercise routine, or make any significant lifestyle changes, it’s always a good idea to talk to an expert and get some advice. "Wellness professionals who are knowledgeable about MS are unfortunately not on every corner," Costello says. "A first step is to have a conversation with your primary care provider or your MS care provider, who may be helpful in identifying a nutritionist or exercise/rehab specialist." You can also call the National MS Society’s Information Resource Center at (800) 344-4867 and speak with an MS Navigator who can direct you to resources in you area. For more information, visit the National MS Society’s website at nationalmssociety.org.

This article was reviewed by Debra Frankel, M.S., O.T.R., Vice President, Program and Services Team, Advocacy, Services and Research Dept., National Multiple Sclerosis Society.


Kathleen Costello, MS, ANP-BC, MSCN, Associate Vice President, Clinical Care Advocacy, Services and Research Department of the National Multiple Sclerosis Society, Email interview with author.

"Wellness and Lifestyle Research." National Multiple Sclerosis Society. Accessed March 6, 2015.

Farez M.F., M.P. Fiol, M.I. Gaitan, F.J. Quintana, J. Correale. "Sodium Intake Is Associated With Increased Disease Activity in Multiple Sclerosis." J Neurol Neurosurg Psychiatry 2015 86: 26-31. doi: 10.1136/jnnp-2014-307928

Briken S., S.M. Gold, S. Patra, E. Vettorazzi, D. Harbs, A. Tallner, G. Ketels, K.H. Schulz, C. Heesen. "Effects of Exercise on Fitness and Cognition in Progressive MS: A Randomized, Controlled Pilot Trial." Mult Scler 2014 20(3): 382-90.

Latimer-Cheung A.E., L.A. Pilutti, A.L. Hicks, K.A. Martin Ginis, A.M. Fenuta, K.A. MacKibbon, R.W. Motl. "Effects of Exercise Training on Fitness, Mobility, Fatigue, and Health-Related Quality of Life Among Adults With Multiple Sclerosis: A Systematic Review to Inform Guideline Development." Arch Phys Med Rehabil 2013 94(9): 1800-1828.e3. doi: 10.1016/j.apmr.2013.04.020. Epub 2013 May 10.

Bowling, Allen C. "Vitamin D and MS: Implications for Clinical Practice." National Multiple Sclerosis Society Clinical Bulletin Information for Health Professionals. 2009.

Smolders J., et al. "Association of Vitamin D Metabolite Levels With Relapse Rate and Disability in Multiple Sclerosis." Mult Scler 2008a; 14:1220–1224.

Smolders J., et al. "Vitamin D as an Immune Modulator in Multiple Sclerosis, a Review." J Neuroimmunol 2008b 194: 7–17.

"Report at a Glance: DRIs for Calcium and Vitamin D." Institute of Medicine of the National Academies. November 30, 2010.

Artemiadis, A.K., A.A. Vervainioti, E.C. Alexopoulos, A. Rombos, M.C. Anagnostouli, C. Darviri. "Stress Management and Multiple Sclerosis: A Randomized Controlled Trial." Archives of Clinical Neuropsychology i2012 27(4): 406-16. doi: 10.1093/arclin/acs039. Epub 2012 Apr 3.