In consultation discussions about MS, patients often ask me what they can do in addition to taking prophylactic medication. In this context, questions about special diets or specific behaviors in everyday life are often asked. This is understandable, as the internet is full of many more or less sensible tips on this topic. Most of the time my patients are then surprised that my answer usually is, that from my point of view there is nothing that needs to be done beyond the basic principles of a “healthy” lifestyle. What does that mean? Everyone has their own ideas about a healthy life. Of course, you can’t avoid the topic of nutrition when talking about healthy living. The principles here are relatively simple and apply to everyone – not just for patients with MS. You should reduce the consumption of animal fats and focus on unsaturated fats. Limit meat consumption to twice a week, prefer whole grain products and ensure adequate intake of fruit, vegetables and fluids. The diet should be balanced and adapted to energy needs – in other words, if you consume more calories than you burn, you will gain weight, which is ultimately unhealthy. You shouldn’t actually have to say anything more about this topic.
Many of my patients find this too trivial. I often hear the question “Can’t you really do more?” as a response to my explanations. The idea of some restriction diet, which often comes with more or less pronounced “promises of salvation”, is usually at the back of the mind, trusting. In this context, I am often surprised by an observation: I get the answer “Yes” to the question “Do you smoke?” from quite a few patients who ask me about concepts of a healthy lifestyle and want to discuss the meaning of certain diets and behavioral prescriptions – or perhaps have already committed to a particular concept and want me to confirm the sense of their actions. I don’t want to be misunderstood now, I’m far from bashing smokers. They usually know quite well that smoking is harmful to health on various levels. But it’s not that easy to quit either. On the one hand because nicotine is addictive, on the other hand because the motivation is lacking. However, you would expect this motivation in an MS patient who is virtually in search of the Holy Grail of healthy life and is convinced that you should do more than “just take medication”. After all, wouldn’t it be more obvious to first eliminate the things that have demonstrably negative effects before trusting concepts whose significance is completely unclear.
According to current studies, smoking is associated with more severe symptoms at the onset of the disease, a higher risk of conversion into a progressive course of the disease, a higher lesion load in the MRI and faster brain atrophy. In addition, smokers have a higher risk of developing primary chronic progressive MS and have twice the risk of developing further bouts of the disease after the first bout compared to non-smokers. These study data have been published in renowned medical journals and are well substantiated experimentally. All studies have also shown that the effects are more pronounced the earlier nicotine consumption began. So there are some strong arguments for MS patients to quit smoking. This is definitely healthier than many other measures. That’s why I answer the question “can’t I do more than just take medication” in such cases “yes, you can do something else: stop smoking and exercise!”
