Professor Andrew Chan, from the University of Bern in Switzerland, discusses his recommendations for lifestyle management for patients with MS.
Whenever I discuss lifestyle management with my patients, I try to differentiate whether he wants to know or she wants to know, because he wants to drop or not start the disease modifying treatment, or whether the patient really wants to do something on top. These are entirely different situations and one has to discuss that, because the first situation really indicates that something like adherence could be too low, or that there’s still something, you know, some unsolved questions about potential disease modifying treatments or about the disease which need to be discussed. So when it comes to the second sort of situation, the patient wants to know “is there anything, Doctor, which I can do on top of my medication?” I tell him, mostly, you know, you should behave like before and try to have a healthy lifestyle.
We see a lot of data where specific like alcohol consumption or other environmental factors, smoking, negatively affect MS, or we have been talking about sodium chloride some aspects, of course, deal with the microbiome and whether by specific diets we can somehow alter the bacteria in the gut in order to somehow modify also the MS treatment, however, I think it’s not there yet that we can really recommend a specific procedure or a specific diet in order to modify these aspects. In general, what I recommend is like what I would recommend to you or my children, like a healthy diet which is generally described as the Mediterranean diet. So just think about it. What we’ve recently learned is that prognosis obviously in MS is improving, so we will see a lot of elderly patients with MS hopefully well controlled but they are probably at higher risk also for cardiovascular disease and it appears that especially in these patients like, you know, preventing other secondary diseases or diseases which can ensue in later life like strokes or myocardial infarctions is really – would really have a big impact and diets like Mediterranean diet would play a major role in this.
I would recommend to my patients to stop smoking. However for many patients who are severely disabled that is like a lifestyle, something that is really quality of life. The one cigarette after dinner, or something, I try to find a balance there. When it comes to alcohol, I’m a bit less strict. However, I would try to recommend to my patients to avoid like an exaggerated intake of alcohol. Alcohol, the effect on MS is controversially discussed one has to say but then in the end what we see regularly is that like these issues, the patient has an increase of liver function tests and we just don’t know what it comes from, either from the disease modifying treatment or from intake of alcohol or something, so also to limit the alcohol intake would be the other dietary suggestion.
There is good data around that. In general, the prognosis of MS is negatively affected by smoking and then additionally, certain specific functions such as cognition or motor function may also be negatively affected. However, if you put that into a larger context like because smoking very often does not come alone but maybe you know these people have other rather vascular risk factors like increased body mass index, high sugar intake, lack of fruits and vegetables in their diet, stuff like that then you can observe that these sort of aspects could for example be associated with brain atrophy. So, the more sort of these risk factors you have it appears that the stronger the brain atrophy is, that is data from the groups in the States right now.
So structured and formalised exercise is certainly important but mainly in order to show the efficacy to, for example, payors or people who don’t believe in these kinds of interventions. In daily clinical routine I tried to have the threshold that the patient takes up physical exercise as low as possible. If I tell him you need to do this and that at least for this or that time or so and have it controlled by someone or by a wearable that raises the threshold and the likelihood the patient will not do anything. So I’m very happy with whatever the patient does.