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The Influence of Lifestyle Factors on MS (CMSC 2016)
While not traditionally thought of as a ‘lifestyle disease’, lifestyle factors can have an effect on MS according to a presentation at the 2016 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), held June 1-4 in National Harbor, MD.
The term “lifestyle medicine’ was coined in 1999, and is a branch of medicine that includes prevention strategies that address lifestyle habits, such as diet and exercise. According to data from the National Health and Nutrition Examination Survey (NHANES) found that only 2.7% of Americans satisfy crucial lifestyle areas diet, physical activity, tobacco, and body fat percentage stated Allen Bowling, MD, PhD, from the Colorado Neurological Institute, Englewood, CO. MS is not typically thought of as a lifestyle disease, but there is emerging evidence that ‘westernization,’ including diet, physical inactivity, high stress, and hygienic conditions, contributes to MS as well as other autoimmune diseases.
“If you think about MS and lifestyle factors there can be direct effects, for example obesity,” stated Bowling. Other contributors include Vitamin D, tobacco and alcohol. “There can be indirect effects were an unhealthy lifestyle leads to comorbidities, that then have a direct negative effect on MS.”
Bowling reminded clinicians to take the time to talk to patients about modifiable lifestyle factors such as diet, exercise, and tobacco use during each visit. Clinicians should promote a generally ‘healthful diet’ to their patients that includes limiting salt intake, adequate intake of vitamin D and fiber. Many MS patients are prone to constipation, which can be helped with fiber. Although many patients do not eat enough fiber in their diet. Emerging evidence suggests that dietary fiber can influence comorbidities associated with MS. Bowling mentioned that starting a patient early on a healthful diet, even patients in their 20’s, can have positive effects over the course of a lifetime, and greatly impact quality of life.
The average American consumes 4,000 mg of salt per day, despite recommendations of about 1,500 t0 2,300 mg per day. “High salt intake increases the diseases risk of many processes including high blood pressure, heart disease, stroke, and kidney disease.” Recent data suggests that high salt intake impacts MS comorbidities.
Weight management is an additional factor that may play a role in the disease course of MS. Childhood obesity may increase the risk of disease, and obesity in MS patients may worsen symptoms of fatigue and depression. Many diets that patients ask about, such as anti-inflammatory diets, are based on murky literature, and lack evidence of effectiveness. In general, there is a lack of evidence for the association between specific foods and MS comorbidities. When patients ask about these kinds of issues, the best advice is to promote a generally healthful diet. This means a mostly plant based diet, with limited intake of sugar and refined carbohydrates.
The use of medical marijuana is rising in MS patients. At this time the evidence does not support the use of medical marijuana for MS. One of the biggest problems with studying this issue is product formulations. There is no standard research-grade preparation that can be used for clinical studies in the US. In addition, the potency and purity of available products is not regulated, and labeling may be inconsistent with what is actually contained in the product. There are also well-documented side-effects associated with medical marijuana use in MS patients, and these include cognitive deficits and evidence of neurotoxicity on MRI.
In conclusion, Dr. Bowling mentioned that asking patients about lifestyle factors at every visit can provide better care for each patient.