There's no person alive for whom brain health isn't important. But if you're living with multiple sclerosis (MS), protecting this organ is doubly important. Following your treatment plan is step 1, and committing to healthy-brain habits is step 1(a).
“The brain, like any organ, can be maintained,” says Daniel Ontaneda, M.D., a Cleveland Clinic neurologist who specializes in MS. “There are all these things that you can do in day-to-day life that will probably have as much of an impact as the medications,” he says. “If you do everything you can for brain health, the impact can be substantial.”
About 1 million people in the United States have multiple sclerosis, an autoimmune disease that affects the brain and spinal cord. It happens when the immune system attacks something called myelin, the sheath that surrounds nerve fibers like the protective coating on an electrical cord. When myelin gets damaged, communication errors happen. Messages may take longer to reach the brain or get lost or distorted.
Sometimes this damage, known as lesions, goes unnoticed. But other times, it leads to days- or weeks-long relapses or attacks, causing symptoms like numbness, tingling, blurred vision, weakness, and fatigue.
Cognitive symptoms are also surprisingly common, says Rhonda Voskuhl, M.D., a neurologist and director of the multiple-sclerosis program at UCLA. According to the National Multiple Sclerosis Society, 65% of MS patients report changes in cognitive functioning, like slowed processing as well as memory and attention problems.
Medication, such as steroids, can help speed recovery from these attacks, Dr. Ontaneda says. But the cumulative damage that can build over time is another story.
Lesions leave behind small scars, triggering a neurodegenerative response that causes the brain to shrink. Everyone’s brain shrinks naturally with age, but for those with MS, this occurs earlier and faster, Dr. Ontaneda explains. This is what can eventually lead to permanent disability. Starting disease-modifying medications early can help prevent lesions from building up.
Here’s the good news: The human brain is not static. It can change and adapt. By reorganizing itself to form new connections, it can compensate for lost function, Dr. Ontaneda says. And by repairing some of the damage, it can restore function, too.
It does this by drawing on its cognitive reserve, extra resources that are usually kept out of action but are available in case of emergency.
But at some point, even the reserve gets depleted. Again, this is true for everyone, not just those with MS. When the reserve falls below a certain threshold, that’s when your cognitive function—your ability to think—starts to slow, and symptoms may become more severe.
You can delay that as long as possible by adopting healthy-brain habits to help maintain or even build up your reserve. We've got 10 to get you started.
1. Move Your Body
For people with MS, exercise is key for overall health and well-being. It promotes vascular health, and some evidence suggests it may even stimulate the regrowth of myelin, Dr. Ontaneda says. Yet 40 percent of MS patients do not exercise on the regular.
Find an activity you enjoy that’s tailored to your level of ability, Dr. Ontaneda advises.
For those with mobility and balance issues, the elliptical machine and stationary bike are good options. Others with more severe disability may consider water therapy—it can help ease spasticity (muscle spasms and contractions), Dr. Ontaneda says, and some research suggests it can improve quality of life.
Aim to exercise three to four times per week for 20 to 30 minutes, Dr. Ontaneda recommends. And don’t worry if your symptoms worsen afterward—heat can temporarily make symptoms more noticeable, but that should go away as your body cools.
“I have one patient who’s a marathoner,” Dr. Ontaneda says. “After his runs, he notices some numbness and tingling, and sometimes worsened vision. But it’s not to a point where it affects his quality of life, so he continues to do it. And there’s absolutely no problem with that.”
Like walking? Try listening to upbeat music. People tend to sync their steps to the beat, and a new study in the journal Multiple Sclerosis and Related Disorders suggests that for those with multiple sclerosis, this synchronization may increase motivation and reduce cognitive fatigue.
2. Exercise Your Brain, Too
We all use our brains every day—to plan, organize, remember, and perform our jobs. But the more you exercise your brain, and the more purposeful you are about it, the more cognitive reserve you can create, Dr. Ontaneda says.
Science backs this up: In one Neurology study, the more MS patients engaged in cognitively stimulating leisure activities—creating artwork, writing, participating in hobbies—the less they experienced disease-related cognitive decline.
Engage your brain whenever possible: Balance your checkbook in your head. Be proactive about solving problems. Practice memory games or puzzles. Learn an instrument or a new language.
Like TV shows? Don’t just watch mindlessly, Dr. Voskuhl says. Analyze characters and plotlines, then engage in intellectual conversations about it afterward.
3. Read—and Read Often
Science has shown reading stimulates many parts of the brain, and one study from Emory University suggests it may increase connectivity in the brain, improving brain function for at least a few days.
“It doesn’t have to be Tolstoy,” Dr. Voskuhl says. “Read what you like—the sports page or cartoons, even. Reading involves a lot of different cognitive skills, so it’s a fantastic thing to do.”
4. Be a Social Butterfly
Many parts of the brain are active during social interaction, says Dr. Ontaneda—areas responsible for attention, working memory, and language comprehension. All this helps build cognitive reserve.
But don’t dismiss the Internet. Even engaging with people online, through text or video chat, may also stimulate your brain and improve your cognitive reserve, Dr. Ontaneda says.
5. Eat a Heart-Healthy Diet
One of the easiest ways to fight the effects of aging on the brain is through diet, Dr. Ontaneda says. While there’s no miracle food that will eliminate symptoms, he recommends trying the Mediterranean diet, which is rich in fish, fruits, vegetables, whole grains, and healthy fats.
According to research in the Archives of Neurology, following this diet may help protect small brain vessels, areas that can be damaged by MS. A Mediterranean-style diet promotes vascular health, improving oxygen supply and blood flow to the brain.
6. Make Mental Health a Priority
MS patients are more likely to suffer clinical depression than those in the general population, according to the National Multiple Sclerosis Society. Left untreated, depression can make other symptoms, like fatigue and cognitive changes, feel worse.
“Depression and fatigue often align with cognitive decline,” Dr. Voskuhl says. “Being happy could make you less fatigued, and even improve cognition because they do overlap to some degree.”
In fact, one Multiple Sclerosis Journal study suggests successfully treating depression in MS patients may encourage a more active lifestyle, thereby aiding brain health.
If you’re experiencing depression or anxiety, talk to your doctor—a neuropsychological evaluation may be warranted, and therapy may help, says Carrie Sammarco, D.N.P., a nurse practitioner at the Multiple Sclerosis Comprehensive Care Center at NYU Langone Health.
7. Monitor Your Vascular Health
Keeping vascular risk factors—like blood sugar, blood pressure, and cholesterol—under control is important for managing brain health, Dr. Ontaneda says.
“If you look at patients who have high cholesterol, high blood pressure, or uncontrolled diabetes, their brains are shrinking much more rapidly,” Dr. Ontaneda says. “Compound that with MS, and it becomes a huge problem.”
Talk to your doctor about having your vascular risk factors checked, including blood pressure, cholesterol, and blood sugar. If your numbers are high, medication may help.
8. Don’t Skimp on Sleep
Sleep has a huge impact on brain health, Dr. Ontaneda says. While you sleep, your brain clears waste and restores pathways, so you can wake refreshed and think more clearly the next day.
Standard sleep hygiene applies: Create a calming environment, relax before bed, and turn off your phone already, would ya?
Still, some MS symptoms can make sleep hard, namely pain, depression, and frequent nighttime urination.
Again, working with the right medical professional—a nurse, physical therapist, or sleep specialist—may help. Treating MS tends to be a team effort, Sammarco says.
For bladder problems, a few easy tips can go a long way: Avoid acidic foods, caffeine, and alcohol—all can irritate the bladder, Sammarco says. And be sure to stay well hydrated during the day.
“People with MS who have to urinate frequently might have the impulse to restrict fluids,” Sammarco says. “But if you restrict fluid too much, your urine can become more acidic. The bladder doesn’t like that, so you’ll actually urinate more frequently.”
Try to front-load your drinking earlier in the day, Sammarco suggests. “Parse it out when you know a bathroom will be available.” Then cut yourself off about three hours before bed.
9. Train Your Response to Stress
We all know stress can impact cognitive function, and in people with MS, it can make cognitive symptoms more obvious, Sammarco says. Some research even links chronic stress with worsening neurological symptoms and increased brain lesions in people with MS, the Mayo Clinic reports.
Try to focus on your response to stress, advises Sammarco, who often integrates mindfulness techniques into her practice. By learning to respond to stress in a healthier, more productive way, you can mitigate its harmful effect on your system.
Stress level rising? Try this: Hit the pause button, Sammarco says. Stop what you’re doing, take slow, deep breaths, and observe what’s happening. Then decide how to proceed.
This helps slow down the process, giving you time to make a considered decision rather than reacting without thought.
10. Check Your Vitamin D Levels—and Supplement if Needed
Research suggests vitamin D may help ease symptoms and improve quality of life for those with MS. Vitamin D aids immune function, and it's also been shown to boost brain health.
What’s more, some evidence links low D to MS, Dr. Ontaneda says. (In fact, the risk of MS increases the farther away from the equator you live—significant because sunlight is the most efficient source of vitamin D.)
Before you consider a supplement, talk to your doctor about having your levels checked. If you’re deficient, ask your doctor what supplement dose you should take. It may be anywhere from 1,000 IU to 5,000 IU per day, Dr. Ontaneda says. Look for D3, the most easily absorbed kind.
See more helpful articles:
Six Ways Exercise Helps People With MS
Why Don't My Lesions Match My MS Symptoms?
10 Best Strength Exercises for MS