Lifestyle Choices Associated With Less MS Disability and Fewer Relapses

Patient Expert

How do lifestyle, medication, and demographics affect people with multiple sclerosis? Answers to this question are the focus of international, internet-based research conducted by George Jelinek, M.D., and his team from the University of Melbourne, Australia.

In 2012, the research team collected baseline data for the Health Outcomes and Lifestyle Interventions in a Sample of people with Multiple Sclerosis (HOLISM) study. Participants from 57 countries were recruited through social media leveraging MS blogs, forums, Facebook, Twitter, international MS societies, and the primary researcher’s website, The HOLISM study provides a snapshot of current lifestyle and risk-modifying behaviors of a large international group of people with MS, as well as an ongoing platform for analyzing the association between these factors and disease progression.

Researchers have been analyzing the data collected in 2012 from approximately 3,000 people living with MS and publishing the results in individual articles. Those published to date are listed below. The original research plan includes a 5-year follow-up survey which would allow for comparison of longitudinal data. Updates on the status of that survey are unavailable. This latest article focuses on the associations of lifestyle, medication, and socio-demographic factors with disability in 2,469 people with any form of MS.

In general, the people who participated in the study were primarily female, well-educated, and led unusually healthy lifestyles, according to authors. Most participants ate healthy diets, supplemented with omega 3 fatty acids and vitamin D, didn’t smoke or drink heavily, meditated regularly, and were physically active. Sixty percent had relapsing-remitting MS, 55 percent had low disability (scoring 0-2 on the Patient Determined Disease Steps scale), and only 10 percent had major disability (scoring 6-8 PDDS). The PDDS scale correlates well with the 10-point Expanded Disability Status Scale (EDSS).

Researchers found more disability among older individuals with MS and those who lived farther from the equator. They also found that each additional year since diagnosis was associated with higher risk of moderate or major disability by 66 percent and 268 percent, respectively, compared to low disability.

Factors associated with moderate vs. low disability

Researchers found that positive lifestyle factors, such as better diet, not smoking, more exercise, omega 3 supplementation, and use of disease-modifying therapy, are associated with lower disability. The likelihood of a person with MS being in the moderate disability group compared to the low disability group increased with the number of comorbidities (43-56 percent), smoking (32 percent), and moderate versus low alcohol consumption (55 percent).

Better diet consumption was associated with lower disability and a modest reduction in relapse rates. For people eating a poor diet, researchers noted that a 30-point improvement on the 100-point Dietary Habits Questionnaire (DHQ) scale was associated with 28 percent lower risk of being in the moderate versus low disability group and a 33 percent lower risk of relapse over the prior year.

Factors associated with major vs. low disability

Several modifiable lifestyle factors were found to reduce the risk of major disability compared to low disability by significant amounts. Increasing amounts of moderate/high physical activity were associated with 65 percent and 93 percent reduced risk of being in the moderate or major disability groups, respectively, compared to the low disability group. However, the fact that people have low disability may make them more likely to be more physically active.

Participants taking plant-based (not fish-based) omega 3 supplements had 61 percent lower risk of being in the major disability group. Participants using disease-modifying therapy for longer than 12 months were 55 percent less likely to be in the major versus low disability category.

Factors associated with relapses

Among the 1,493 study participants with relapsing-remitting MS (RRMS), researchers found few associations of lifestyle factors with relapses in the last year. Odds of experiencing relapses increased with moderate versus low disability (80 percent), having two comorbidities (68 percent), or having three or more comorbidities (138 percent).

Likelihood of recent relapse in people with RRMS was reduced with use of disease-modifying therapy over the previous 12 months (55 percent), taking plant-based omega 3 supplements (44 percent), and each additional year since diagnosis (42 percent). Researchers found that for every 30-point improvement in diet on the DHQ, there were 33 percent lower odds of relapse in the previous 12 months.

More results from the HOLISM study:

Co-morbidities and MS (2016)

Depression and MS (2014)

Dietary factors and MS (2014)

Disability, relapses and MS (2016)

Exercise and MS (2014)

Fatigue and MS (2015)

Medications and MS (2015)

Meditation and MS (2014)

Omega 3 and fish consumption and MS (2013)

Smoking and alcohol and MS (2013)

Sunlight, vitamin D, latitude and MS (2015)

See more helpful articles:

MS Diet and Nutritional Approaches to Treatment

Which Type of Exercise is Better for People with MS?

MS and Cholesterol: MS Diets and Therapeutic Lifestyle Changes


Jelinek GA, De Livera AM, Marck CH, et al. Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study. PLoS One. 2016; 11(8): e0161701. Published online 2016 Aug 25. doi:  10.1371/journal.pone.0161701