Platform Therapy for MS: 5 Essential Steps

I am often asked to provide advice on diets, vitamin supplementation or other complimentary approaches to the management of MS.  While there may or may not be a role for some alternative approaches to MS management, I find that patients are often putting the proverbial ’ Cart ahead of the horse’, when they ask these questions. The question that should be asked is, how do I remain active, independent, socially engaged, and overall mentally and physically healthy with this disease? This is no small task given the barriers and challenges faced by MS patients. Some in the neurological community believe these goals can only be achieved with so called disease modifying therapies of which the older injectable therapies are usually regarded as the platform therapy on which all other treatments are built. While it is true that these pharmacologic disease modifying therapies have a significant role to play in MS disease management, I have a different idea of what represents a platform therapy. To me platform therapies represent those management strategies, often adjustments in lifestyle and health behavior, that will prevent the development of or modify those other medical conditions (known as co-morbid conditions) known to have a detrimental physical and mental effect on MS patients. So what are these health behaviors and co-morbid medical conditions? I think you know the answer but I will list them anyway (in no particular order):

1. Smoking
2. Obesity
3. Type II Diabetes Mellitus
4. Hypertension
5. Osteoporosis
6. Low vitamin D levels
7. Depression, anxiety and chronic daily stressors

Every one of these health behaviors or conditions has been shown to have a detrimental effect on MS outcomes . More importantly, some of these risk factors interact with one another in a synergist manner, meaning that their combined effects are worse than their individual effects. So what is my platform therapy prescription? It involves 5 crucial steps:

First, focus on improving your mental health; without modification of chronic symptoms of depression and anxiety, modification of common chronic stressors harmful to your MS and your health, and continued social interaction and participation, other therapies will fall short in achieving their goal. This can be a tall order. You will lay the foundation for this goal by stopping unhealthy behaviors, exercising regularly, eating well and taking care of other health concerns (see below). But this is often just the starting point. Now is the time to consider a closer examination of lifestyles, relationships, and career or work issues. While it can be difficult to find a therapist, either group or individual, that works for you, it is well worth the effort. Often online support groups now form the basis of support for many patients. Some patients will require medications as well but rarely in isolation. Most importantly, it is time to consider what is important and what is not important in your life in order to help in this process. But remember this is a lifelong process; do no be discouraged and always keep working to achieve peace and happiness.

Second, stop harmful health behaviors, notably smoking. Although alcohol consumption in moderate amounts has not been linked to more rapid progression of MS, alcohol abuse and other illicit forms of drug use, particularly cocaine and narcotics, are in my experience associated with worse outcomes..

Third, build a pattern of behaviors that is likely to achieve ideal body weight and maintain activity levels. This is extraordinarily difficult for many and often a lifelong struggle. I am not a big advocate of a particular diet; in fact it seems that the best results occur with increased activity level associated with a reduction in calories and a change in diet. Over the years, many of my patients have reported feeling better and losing more weight after switching to gluten free or gluten light diets. While there is no evidence that this diet specifically alters the course of MS, it certainly seems to have indirect benefits. In those patients morbidly obese (usually defined as 100 lbs over ideal body weight) despite efforts to reduce their weight, I am a strong advocate of bariatric surgery, although the safest and most appropriate bariatric procedure will require consultation with your physician and a qualified bariatric center. Increased activity levels are possible in everyone although some patients experience more barriers in achieving this goal, whether as a result of disability, lack of resources or social isolation. Ideally, I want all of my patients to perform aerobic exercise a minimum of 20 minutes a day, 5 days a week. I advise patients to start slow and low and increase gradually, if necessary. A personal fitness instructor or a physical therapist can help you design a program that meets your needs and your physician can advice you on any particular restrictions you may need to follow. Additional strategies must include progressive resistance training (basically weight lifting) to improve and maximize muscle function. Again a personal fitness instructor or a physical therapist can help you design an appropriate and safe program. Lastly, many patients report benefits in flexibility, strength and physical and mental well being as a result of group or individual yoga programs.

Fourth, supplement your diet with vitamin D3; the evidence is clear that low vitamin D3 levels are associated with the risk of developing MS and MS disease activity after onset. Whether vitamin D supplementation modifies the course of the disease remains unclear until larger studies are completed. Supplementation with 5,000 to 10,000 IU a day is safe in the vast majority of patients and should achieve your goal of obtaining a 25 hydroxyvitamin D level over 50, if not closer to 100.

Fifth, focus on modifying co-morbid health states like hypertension, osteoporosis and diabetes if these conditions are present. All too often patients neglect their other physical and mental health concerns after a diagnosis of MS, either as a result of feeling overwhelmed or helpless to achieve the desire results of therapy because of the barriers imposed by their combined conditions. This is a mistake. Hypertension, osteoporosis and diabetes are all associated with a more rapid rate of MS progression. Diabetes in particular creates a number of management issues in MS patients and makes the disease more difficult to treat.