AskMe: We Asked an Expert Your Questions About Multiple Sclerosis

Multiple sclerosis is a complex condition that can be debilitating and unpredictable. There’s a lot of confusing and conflicting information out there about MS, which can make it difficult for patients to know who to trust and how to best manage multiple sclerosis symptoms. So we asked an expert: Elena Grebenciucova, MD. Dr. Grebenciucova is Assistant Professor of Neurology in the Division of Multiple Sclerosis and Clinical Immunology, Davee Department of Neurology at Northwestern University Feinberg School of Medicine. Here are answers to some of your most pressing multiple sclerosis health questions.

Responses have been lightly edited for clarity.

What advancements have been made with multiple sclerosis medications in recent years?

Over the past several years, several new medications became FDA approved for the treatment of RRMS and one for the treatment of PPMS. Both Ocrelizumab (Ocrevus) and Ofatumumab (Kesimpta) are B cell depleting therapies that challenged prior approaches to treating multiple sclerosis and proved to be highly effective both in clinical trials and in real life.

Do medications wane in their ability to treat multiple sclerosis as patients age?

As people with multiple sclerosis get older, some of them transition into secondary progressive MS without activity, meaning their MRIs are stable, with no new lesions for a number of years. In these patients, these medications do not have as much proven efficacy, as they have for people with relapsing forms of the disease (RRMS) and SPMS with activity (meaning patients who still have new lesions on MRIs).

Is increased fatigue a symptom of multiple sclerosis? How can someone feel more rested?

Fatigue is a common symptom that many patients with multiple sclerosis experience. In order to battle fatigue, we have to focus on diet, quality of your sleep, pain management, and exercise, as well as help with any underlying mood concerns. One of the common symptoms of depression, for example, is fatigue. People with anxiety often have trouble sleeping, which leads to chronic fatigue. People with depression can either have trouble sleeping or feel like they need to sleep all the time and never feel rested. Addressing these concerns early can help improve fatigue.

Other things to consider if you are fatigued are vitamin D level and B12. Deficiency in both can lead to fatigue. Thyroid disorders, which are not uncommon in people as we age and in people with MS, also can lead to severe fatigue. Many medications used in symptom management also can cause fatigue, so it’s important to discuss with your physician if some of your medications may be making you extra tired.

Are there certain exercises that can help someone manage their multiple sclerosis?

Exercise is very important for all people living with multiple sclerosis. However, creating an exercise plan is best done initially with a physical therapist to ensure that the type of exercise you are doing is ultimately safe for you, in case you have some level of trouble with balance or weakness. Exercising 3-4 times a week for 30-45 weeks is ideal, but many patients new to the exercise regimen or still recovering from their recent attack need to ease into exercising very slowly and gradually increasing their time. For example, if you are very fatigued, you may find it very difficult to exercise, but if you try and set a goal of just 10-15 minutes 3-4 times a week, and then gradually over time increase it to 20-30 min and finally 30-45 min, the process may be easier.

For those people who experience spasticity/muscle spasms, stretching before exercise is critical. Also, you have to make sure that you are not overheating during the exercise. In order to avoid overheating, make sure you hydrate plenty prior to exercise and during exercise, wear appropriate clothing, and take frequent breaks, as well exercise in a well-ventilated, cool area. If you still feel that exercising causes you more muscle spasms or heaviness in the legs or more tingling, try to reduce the intensity of the exercise and take more frequent breaks.

Aerobic/cardio exercise is important for all patients with multiple sclerosis. Exercise helps to reduce fatigue levels, improve mood and sleep, and maintain muscle mass in those people who may have some level of weakness.

Can specific diets or foods reduce multiple sclerosis symptoms?

There are many diets that claim to be anti-inflammatory, but inflammation is a complex term, and not all inflammation is bad. Some inflammation is good as it clears damaged cells, fights infections, etc. Overall, you may focus on a diet that reduces pro-inflammatory response and has some neurodegenerative properties. The diet with the best reputation for managing neurological conditions is the Mediterranean diet, which focuses on foods rich in antioxidants, low in processed foods, low in sugary foods and red meats. The basis of the Mediterranean diet is fruits, vegetables, olive oil, nuts, and seeds, fish and poultry, and less red meat. The Mediterranean diet is easy to adhere to for most people.

Recently, diets such as Wahl’s diet and Swank’s diet have gone through clinical trials to show clear benefit in reducing fatigue and improving quality of life in patients with MS. Wahl’s diet, for example, is a version of the paleo diet, taking you back to the way our ancestors ate. This diet focuses on vegetables, especially green, leafy ones, brightly colored fruit, like berries, fats high in omega-3 fatty acids, meat, and fish.

It is important to know that there is not such a thing as the best diet for MS. The best diet for you when managing multiple sclerosis is one that is balanced in nutrients, sustains your energy levels, and that you can easily adhere to without it causing undue stress and financial burden.

Get support on your journey with multiple sclerosis

If you’re living with multiple sclerosis, finding people who understand can make life less lonely. Join Multiple Sclerosis Connections, our support group in partnership with the National MS Society.