People with MS are not immune to health problems that accompany a sedentary lifestyle. High blood pressure (hypertension) and high cholesterol (hyperlipidemia) are found in more than 10% of people with MS, increasing with age. High cholesterol profiles, particularly high LDL-cholesterol and total cholesterol levels have recently been associated with more disease progression and more activity on MRI in MS.
Canadian investigator, Ruth Ann Marrie, PhD, has reported that MS carries a higher risk of dying from heart disease and that people with MS who have vascular conditions including heart disease are likely to develop reliance on a cane for walking, to develop visual impairments and to develop brain atrophy.
Canadian investigator, Ruth Ann Marrie, PhD, has reported that MS carries a higher risk of dying from heart disease and that people with MS who have vascular conditions including heart disease are likely to develop reliance on a cane for walking, to develop visual impairments and to develop brain atrophy.
Obesity and smoking are two cardiovascular risk factors that may carry additional risks for those with multiple sclerosis. Obesity is reported to affect 24% of people with MS in North America. Recent studies have shown teenage obesity as a MS risk factor and predictor of MS onset at younger age. In one study, females with Body Mass Index (BMI) > 27 were at twice the risk of those with BMI <27. One study found that higher baseline BMI predicted a more progressive MS disease course.
Obesity tends to lower vitamin D levels and vitamin D deficiency is itself a risk for MS. Smoking has been associated with a 2-fold heightened risk for developing MS. Smoking after MS diagnosis has been found to increase the risk for developing progressive MS, as well as risk of more severe brain atrophy and brain lesion load.
The underlying links between obesity and smoking with MS are unknown, but of growing interest. Obesity and other cardiovascular risk factors may affect certain hormones that interact with the immune system in ways that are harmful in MS. Adipose tissue (fat cells) produces hundreds of hormones, peptides, and cytokines, collectively referred to as adipokines. Some are pro-inflammatory, including leptin. Leptin crosses the blood brain barrier.
Mice that are genetically engineered for leptin deficiency are resistant to the experimental version of MS. Calorie restriction also has a benefit on the experimental version of MS in mice. An ongoing study is looking at calorie restriction as a stand-alone treatment for MS. The method being studied is intermittent fasting (2 days per week). Why tobacco smoking is bad for MS is unknown, but the explanation is probably not related to the nicotine content of tobacco.
There is intriguing evidence that Hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) that lower cholesterol levels may have beneficial effects in MS. In secondary progressive MS, a 2-year randomized controlled trial of simvastatin 80mg daily in England found a 43% reduction in brain atrophy and significant differences on measures of disability progression and symptom impact favoring the statin. More work needs to be done to determine the role of statins, if any, in managing MS.
What does all this mean for someone with MS? To put it simply, what is good for your heart is probably good for MS. Having MS is another good reason to quit smoking tobacco. Don’t hesitate to talk to your doctor to get help in quitting smoking. If you are obese or overweight, getting to a lower weight will reduce cardiac risk and may improve your blood pressure and lipid profiles. Many patients report improved sleep and bowel regularity with weight reduction.
Achieving weight reduction requires discipline. Body fat will decrease with an increase in energy utilization (increasing physical activity) or a decrease in energy intake. Combining exercise with dieting is the most effective way to keep the pounds off. Everyone with MS needs regular physical activity. For exercise, the key is keeping a program going over many months or years. That means finding something that is manageable in your lifestyle and it should be enjoyable, too. Physical therapists are a great resource in establishing an exercise program that is right for you, especially in the presence of fatigue, spasticity, reduced balance or weakness.
The National MS Society and the MS Foundation can support exercise by funding personal needs for gym memberships or exercise equipment. At Evergreen, we sponsor physical exercise programs for people with MS, including a neurological exercise group, yoga and laughter therapy. We have a monthly nutritional workshop led by a certified dietician and intended for people with neurological diseases. This summer, we’ll be having our second annual ½ day nutritional seminar for people with MS- mark your calendars for Aug. 1.
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