Your Complete Guide to Maintaining (and Maximizing) Brain Health with Multiple Sclerosis

A multiple sclerosis diagnosis can make people wonder why they got it and what causes it. Here’s what the experts say about the causes of MS.

Why Do I Have MS?

MS symptoms like pain, fatigue, and muscle stiffness can be a strain on quality of life, but staying active can help. Here are nine science-backed ways exercise can ease symptoms in people with MS, plus how to safely start a new fitness routine. 

Exercise to Manage MS

young woman using resistance band outdoors

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Staying active can start a positive-feedback loop: Fewer symptoms of multiple sclerosis mean more opportunity to do all the things you love to do. 

9 Proven Ways Exercise Can Help Manage MS

MS and Exercise: 9 Research-backed Ways Staying Active Reduces Symptoms

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A multiple sclerosis diagnosis can come as a total shock—and leave you wondering whether you did anything to cause it.

Why Did I Get MS?

- __MS Causes Research:__ National MS Society. (2020). “What Causes MS?” [nationalmssociety.org/What-is-MS/What-Causes-MS](https://www.nationalmssociety.org/What-is-MS/What-Causes-MS)

- __Obesity and MS Study:__ *JAMA Neurology*. (2019). “Association of Obesity with Multiple Sclerosis Risk and Response to First-line Disease Modifying Drugs in Children.” [jamanetwork.com/journals/jamaneurology/article-abstract/2737283](https://jamanetwork.com/journals/jamaneurology/article-abstract/2737283)

- __Smoking and Health Risks:__ Centers for Disease Control and Prevention. (2020). “Health Effects.” [cdc.gov/tobacco/basic_information/health_effects/index.htm](https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm)

- __Vitamin D Deficiency Information:__ Cleveland Clinic. (2019). “Vitamin D Deficiency.” [my.clevelandclinic.org/health/articles/15050-vitamin-d--vitamin-d-deficiency](https://my.clevelandclinic.org/health/articles/15050-vitamin-d--vitamin-d-deficiency)


What Causes MS?

There’s No Single Known Cause of MS

It’s a Combination Effect

Risk Factor: Your Genes

Risk Factor: Certain Infections

Risk Factor: Vitamin D Deficiency

Risk Factor: Obesity

Risk Factor: Smoking

Risk Factor: Where You Live

Debunked Myths About MS Causes

Remember: It’s Not Your Fault

Jackie Zimmerman testing out the Alinker

Learn about the many ways you can keep your brain healthy with MS, from diet and exercise to starting medicines once MRI scans show certain changes.

Now What? A Beginner's Guide to MS

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One million people in the U.S. have multiple sclerosis, but there is still confusion over the disease. We clear things up.

Your Top RRMS Questions, Answered

- __MS Facts:__ National MS Society. (n.d.). “What Is MS?” [nationalmssociety.org/What-is-MS](https://www.nationalmssociety.org/What-is-MS)

- __MS Prevalence:__ *Neurology*. (2016.) “Multiple sclerosis prevalence in the United States commercially insured population.” [ncbi.nlm.nih.gov/pubmed/26888980](https://www.ncbi.nlm.nih.gov/pubmed/26888980)

- __MS Epidemiology:__ John Hopkins Medicine. (n.d.). “The Multiple Sclerosis Center.” [hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/multiple_sclerosis/index.html](https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/multiple_sclerosis/index.html)

- __MS Treatment and Management (1):__ Cleveland Clinic. (2018). “Multiple Sclerosis: Disease Management.” [clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/multiple_sclerosis/](http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/multiple_sclerosis/)


Guillaume Lamotte, M.D.

Medical Reviewer

Your Top Questions About MS

Who Is a Typical MS Patient?

What Are Early Signs of RRMS?

What Causes RRMS?

Why Did My MS Happen Suddenly?

What Type of MS Do I Have?

How Is MS Diagnosed?

Am I Going to Die from MS?

Is There a Cure for My MS?

Will I Need a Wheelchair?

Your Top RRMS Questions, Answered!

Out of the blue, in November 2019, Byron Hall’s wife Sabrina, 52, began having strange symptoms. She suddenly suffered from extreme fatigue and weakness in her legs. After a couple of falls, they headed to the ER. There she was diagnosed with relapsing-remitting multiple sclerosis, a chronic neurological disorder that affects the central nervous system.

“It definitely came as a shock,” says Hall, 55, an actor from Newport News, VA. “We weren’t expecting that. We both had so many questions about what the future would look like: Would she be able to go back to work as a teacher? What was the long-term prognosis? What did it mean for our 12-year-old son? It was scary and a lot to take in.”

Hall knew that as his wife’s care provider, he needed to get answers to many of his questions about life with MS. One of the first people he turned to was a good friend and former high-school classmate from the Bronx whom he knew had been living with MS for 15 years. 

She gave him the gritty details about life with the disease. Another friend introduced him to the resources offered by the Multiple Sclerosis Society, including support groups and educational brochures. One addressed how to speak to their son about his mom’s condition.

Understanding the disease and what it means to be a care provider are both important first steps in any MS journey, says Julie Fiol, director of information and resources for the MS Society.  “Many people have heard of MS, but the general population doesn’t know exactly what it is.”

[Multiple sclerosis](https://www.healthcentral.com/condition/multiple-sclerosis) is a disease that affects everyone differently. Many patients, like Sabrina, begin by showing symptoms such as weakness, fatigue, balance issues, and difficulty walking. Some symptoms may come and go and can last anywhere from 24 hours to several weeks. Others can appear once and never return. In the extreme, some patients may be unable to walk or care for themselves. 

One of the first questions the newly diagnosed and their caregivers usually have is about long-term lifestyle changes, mobility, and the ability to work. If they are diagnosed as a young adult, they want to know whether the patient can have children and if they’ll pass the disease along.

Plus, she says, “We have 18 different therapies to consider. That’s wonderful, but also very confusing.” And caregivers are suddenly thrust into a whole new world as well as a healthcare partner for the one they love. This advice can help you both navigate this new world.

## Identify Your Strengths

The role of caregiver is a big responsibility. Fiol suggests that the newly diagnosed and their partners work together to find the answers to their questions. One may be better at research and another at talking to family and friends. “It’s important for couples to stay on the same page by communicating and letting the person with MS be the guide.”

Hall’s advice: “Don’t panic. Do your homework and be there for your partner to support them.” But, he says, let them call the shots. Don’t tell them what to do because they may resent it. Instead, offer suggestions based on what you’ve learned through research, but in the end, he says, let them take the lead and make their own decisions.

## Share Facts and Figures in Bits and Pieces

If you go on a fact-finding mission, don’t hit them over the head with all you’ve learned without asking if they're ready to hear it, says Fiol. “They may not be receptive to receiving all that information too quickly.” Remember there is a grieving process with a lot of feelings and emotions that can be different from person to person and that can change throughout the day. You could be watching someone’s Instagram page and something frightens you so you go from empowered to frightened.

“Ask: What are you thinking?” she suggests. Hall notes that even when his wife says nothing is bothering her, he knows better by watching her body language. Stay in tune with your partner and ask if they want to talk about how they are feeling or if they want help. Bottom line, he says, is to listen and show them they are not alone. Sometimes, as a caregiver, that’s all you can do.

## Take Care of You, Too

Care partners are a vital source of support and assistance to those living with MS. But don’t let self-care fall off because burnout and exhaustion can result, says Fiol. “Caregivers need to remember to take care of themselves.”

Hall says that though his primary goal is taking care of his wife, he tries to meditate, exercise, and eat a clean diet. “Those things all help me to stay grounded and keep levels of stress down.”
When he needs to vent or talk about his worries, he calls one of his friends who has experience with MS. There are also many hotlines and support groups to help not only the patient, but the caregiver as well.

## Work as a Team

When faced with a scary medical diagnosis, some partners hit the road. Others truly believe their vows of “for better or worse.”

An unpredictable future didn’t stop Nick Smith, 35, from marrying his fiancé Morgan, 29, one week after her diagnosis. The Seattle couple was engaged in the summer of 2017 and planned a June 2018 wedding. But during that time, Morgan began having symptoms including fatigue, weight loss, and problems walking. 

When she finally got diagnosed in April 2018, she wondered if they should put the wedding on hold, Smith recalls. But he wanted to marry her right away. “I believe we are step-by-step going to fight this disease as a couple. I wanted to cement that with our marriage.’

While researching the disease, he learned that there was an upcoming local MS walk to raise funds for research. So, in a week, the couple raised a whopping $14,000 from family and friends and had team T-shirts made. On the day of the walk, they stood in front of an inflatable arch festooned with orange balloons at the finish line to take their vows.

“The unknown of what was happening to her before we knew was harder than getting the actual diagnosis,” he says. Once they had a diagnosis in hand, he felt “we could move forward to find a cure and help relieve some of her symptoms. I was confident that the two of us together would get through whatever challenges there were.”

## Be Vocal

Communication is key to coping as a couple. The best thing you can do as a partner is to ask, ‘How can I share in this road” and make sure you navigate it as a team, says Smith.  

“In a lot of ways, MS is an invisible disease and it’s hard to know the daily struggles that your partner may be experiencing,” he says. “I’m not a mind reader so we consistently work at overly communicating and dealing with little irritations or frustrations before they become big breakdowns.”

Learn how your partner thinks, he suggests. To lighten the mood over the disease that has become such a constant in their life, Morgan named her MS symptoms “Becky.” She’ll say: “Becky is kicking my ass today,” says Smith. Referring to her daily struggles in the third person, “makes it a little more manageable. 

## Get to Know Your Partner’s MS

Everyone copes with the disease in a different way. “Some want connections to other people living with this disease for reassurance and validation. Others don’t want to think about it, says Fiol.
If you need support but your partner doesn’t, find a group for caregivers. If your partner is into it, go to a group for couples. 

Learn when to offer help. When the person with MS is having symptoms, they may need more help than at other times, she says. Don’t just step in to help; instead, ask the person if they want help. “That gives them more control.” 

## Celebrate Life Going Forward

It’s natural to mourn the future you imagined, but it just takes some readjustment to your new normal. “It’s ok to be sad, but that’s no place to stay,” advises Hall. “It is what it is and it’s all how you look through the lens.” He tries not to “get too high or too low. Those feelings block you from actually caring for your person properly. I come from a place of confidence and that is empowering.”

Morgan and Nick know their future will look different in many ways. It will affect where they live, having children and other issues affected by MS. 

But they take it in stride. One of the first changes, he notes, is how they vacation. “She used to want to go somewhere warm and lie on the beach but now the heat heightens her symptoms. So, instead, we take winter vacations with a more moderate climate. She doesn’t drive at night any more either. It’s a learning process,” says Smith. “Every day is different; an adventure, but we are in it together.” And who knows what medical advancements will make life easier in the future. 

## Stay Connected

Research, treatment, medications and more on the horizon will likely bring advances in how people deal with their MS and its complications, notes Fiol. To find support and stay updated on what’s new, contact the resources below:

[__Can Do Multiple Sclerosis__](https://www.cando-ms.org/multiple-sclerosis-programs) delivers health and wellness education through webinars, wellness weekends and other programs for people with MS and their support partners.

Check out their [webinars](https://www.cando-ms.org/online-resources/support-partners) aimed at support partners that tackle issues including care for the caregiver, communicating about tough subjects and building satisfying partnerships. 

[__National Multiple Sclerosis Society__](https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Documents/Relationship-Matters_Final-Single-Pages.pdf) offers lots of educational material, programs and services for patients and family members online and in your community. 

- Check out their “8 Hours to a Lifetime of Relationship Satisfaction,” an enrichment course for couples living with MS. 
- Download “[A Guide for Support Partners](https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Brochure-A-Guide-for-Caregivers.pdf).” 

[__Multiple Sclerosis Association of America__](https://mymsaa.org/) (MSAA) offers a range of services, including a toll-free helpline, community forum and blog. 

- Join their community [online forum](https://mymsaa.org/msaa-community/my-msaa-community-forum) to talk to other care partners to share information and experiences with MS.
- The organization publishes numerous publications for those with MS, their care partners and family members. See their magazine, the [*Motivator*](https://mymsaa.org/ms-information/publications/), with many articles aimed at caregivers.

[__MyMSTeam__](https://www.mymsteam.com/) is a free social network and online support group for people who are living with MS and their care partners. Connect with a community of others who understand what you are going through. 


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Real couples share how they supported each other through a multiple sclerosis diagnosis.

When Your Partner Has MS

Hearing that your love has multiple sclerosis is scary. We've got tips on how to help your partner (and yourself) through.

Your Partner Was Just Diagnosed With MS, Now What?

__Resource for Kids/Teens:__ National MS Society. “For Children and Families.”
[nationalmssociety.org/Resources-Support/Library-Education-Programs/Brochures/For-Children-Teenagers](https://www.nationalmssociety.org/Resources-Support/Library-Education-Programs/Brochures/For-Children-Teenagers)

Hind Kettani, M.D.

Helping Your Partner Cope With an MS Diagnosis

Magnetic resonance imaging (MRI) — a specific technique used in radiology to create very detailed images of internal parts of the body — is an important tool in the diagnosis and monitoring of multiple sclerosis (MS). Once diagnosed, people with MS will typically undergo annual MRI scans. Some may have more frequent scans, some less frequent.

MRI scanners use strong magnetic fields to generate images. The standard imaging protocol in MS suggests use of a minimum 3 Tesla (3T) "closed machine" for best results. The imaging sequences focus on the white matter and grey matter of the brain and/or spinal cord before and after venous administration of a contrast agent, gadolinium, to enhance certain anatomical features.

Here are some things you need to know to make your MRI experience less stressful and more successful.

### Before the MRI

Dress comfortably. Because the MRI scanner is basically a large magnet, you must not wear clothing with lots of metal rivets, buttons, or zippers. To avoid the need to disrobe and put on a hospital gown, I prefer to go to my MRI appointment wearing sweatpants and a comfortable T-shirt. That way, the only clothing I have to remember to take off in the dressing room is my underwire bra. Don’t worry, the technician will double-check that you aren’t wearing anything that would interfere with the MRI.

Remove body jewelry, watch, and wallet. Consider leaving your jewelry at home for safe keeping. You will be asked about metal in the body — such as a [pacemaker](http://www.mayoclinic.org/medical-professionals/clinical-updates/cardiovascular/new-protocols-allow-mri-selected-pacemaker-patients), cochlear implants, joint replacements, or metal fragments — because in certain circumstances, an MRI can cause damage to the equipment itself or to body tissue when metal is involved. Some metals, such as titanium clips from a breast biopsy, do not pose a problem.

Tell the MRI technician about all medications you take. You will be asked specifically about chemotherapy. If you have used chemotherapy, it is important to take results of your most recent blood work with you because they want to make sure that your kidneys are healthy enough to process the gadolinium contrast agent.

Describe your current symptoms. This information will be included in the notes that the radiologist will have access to while examining your scans. Although [lesions](https://www.healthcentral.com/article/beginners-guide-to-ms-what-is-multiple-sclerosis) and symptoms do not always correlate, sometimes they do and the radiologist may take an extra close look at certain areas of the images based on a history of symptoms.

Go to the bathroom one last time. Once you get on the MRI table, you will be immobile for 1.5 to 2.5 hours. At my local MRI center, 45 minutes is allotted to complete the scanning of each area typically imaged in MS — brain, cervical spine, thoracic spine. Individual scanning sequences may take as little as 30 seconds and as much as five minutes. But once you start, you really should not get up unless absolutely necessary.

### During the MRI

Protect your hearing. You will be provided with foam earplugs to protect your hearing because the MRI scanner is extremely loud and noisy. Be sure to roll the earplug firmly between your fingers to shape it into a narrow cylinder that you place in your outer ear canal. Hold the foam earplug in place as it expands to get the best fit.

Tell the technician if you are claustrophobic or nervous. If you have trouble with MRI scans, your doctor may prescribe an anti-anxiety medication to help you relax. You can use the time in the MRI to practice meditation and slow breathing. Or you might fall asleep. I actually enjoy "listening" to my favorite music in my head while the exam is going on.

Get cozy. When you are on the MRI table, request that a cushion be placed under your knees to take the pressure off your back and a blanket to reduce the chill of the fans inside the machine. I recommend you also ask for extra foam be placed inside the “cage” that goes over your head to help block some of the noise and to make it easier to keep your head still. As you are rolled into the machine, fold your arms slightly across your chest and slowly allow them to relax to your sides once you are in place. I usually keep my eyes closed during the exam because I can’t see without my glasses or contacts anyway.

Stay still. It’s very important not to move during the active scanning. The technician will tell you how long each sequence will take so that you can anticipate when it is okay to swallow or cough. If you move during active scanning, the sequence may need to be repeated to get better images. If you have an uncontrollable itch, tell the technician, who can come help you out.

### After the MRI

Stick around. Once the scanning is complete, many MRI centers will save the images to a disc for you to keep for your records. These may be helpful if you ever move and need to establish care in a different hospital system. Although I’m no expert on what the brain looks like inside, it’s fun to view the images at home.

Lisa's MRI scan from October 25, 2016 from the Sagittal T2 FLAIR sequence. No lesions can be seen here.

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Magnetic resonance imaging (MRI) — a specific technique used in radiology to create very detailed images of internal parts of the body — is an important tool in the diagnosis and monitoring of multiple sclerosis (MS). Once diagnosed, people with MS w…

Magnetic resonance imaging (MRI) — a specific technique used in radiology to create very detailed images of internal parts of the body — is an important tool in the diagnosis and monitoring of multiple sclerosis (MS). Once diagnosed, people with MS w...

What It's Like to Have an MRI Test for MS

What It's Like to Have an MRI Test for MS - Testing for MS - Multiple Sclerosis

Jackie Zimmerman 

Patient Advocate

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](https://www.nationalmssociety.org/Living-Well-With-MS/Cognitive-Health), 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](https://www.healthcentral.com/article/slowing-down-the-longterm-progression-of-multiple-sclerosis-by-using-diseasemodifying-therapies-dmts) 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](https://www.health.harvard.edu/mind-and-mood/what-is-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](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706216/) 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](https://www.ncbi.nlm.nih.gov/pubmed/28215060) 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*](https://www.ncbi.nlm.nih.gov/pubmed/31357124) 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](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3721094/), the more MS patients engaged in cognitively stimulating leisure activities—creating artwork, writing, [participating in hobbies](https://www.healthcentral.com/slideshow/how-hobbies-can-reduce-stress-in-ms)—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](http://esciencecommons.blogspot.com/2013/12/a-novel-look-at-how-stories-may-change.html) 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](https://www.ncbi.nlm.nih.gov/pubmed/22332193) 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](https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Depression) than those in the general population, according to the [National Multiple Sclerosis Society](https://www.nationalmssociety.org). 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](https://journals.sagepub.com/doi/abs/10.1177/1352458517692887?journalCode=msja) 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](https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/mindfulness-practice-can-it-reduce-symptoms-of-ms/faq-20111459) 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](https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/vitamin-d-and-ms/faq-20058258) 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](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132681/).
 
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.



anthony-tran-3TCrqSnSHeU-unsplash

Brain health is important for anyone, but for those living with multiple sclerosis (MS), it’s essential for managing the disease. In addition to medical treatments, adopting these everyday habits can go a long way in protecting and even restoring cognitive function in people with MS. 

Boost Your Brain

Simple, everyday strategies can make a huge difference in how multiple sclerosis affects your brain and cognitive function. 

10 Totally Doable Ways to Boost Your Brain Health With MS

Shaheen Lakhan, M.D.

10 Ways to Improve Brain Health and Fight Multiple Sclerosis

Strength training is a powerful tool in managing MS symptoms. We asked experts to share the 10 exercises they recommend most for people with MS to improve muscle strength and function. You can do most of them from the comfort of your own home, with little to no equipment. 

Strength Exercises

4 MS exercise illustrations - Bird Dog, Clamshell, Glute Bridge, and Sit-to-Stand

Ready to work it?! Adding a few strength-training moves to your daily routine gives you a powerful way to help manage the physical symptoms of multiple sclerosis.

10 Best Strength Exercises for MS

Strength Training for MS Symptoms: Top 10 Exercises to Try

You’ll Preserve Brain Function

You’ll Build Muscle Strength and Function

You’ll Improve Balance and Coordination

You’ll Have More Energy

You’ll Protect Your Bones

It Promotes a Healthy Weight

You’ll Boost Your Mood

You’ll Have Better Bowel and Bladder Control

You’ll Move Better and Feel Less Stiff

Before You Begin an Exercise Program

Take It Slow

Multiple sclerosis can interfere with memory, attention, and word recall. The brain-stimulating games on these mobile apps can help you keep your mind sharp.

Best MS Apps

google-nexus-4-lg-smartphone-technology-12829

Many people with MS have trouble with memory, attention, and word recall. These games will help you stay one step ahead of the disease.

Best Brain-Boosting Apps for MS

- __MS and BrainHQ study:__ *PLOS One*. (2017). “Cognitive Function in Multiple Sclerosis Improves with Telerehabilitation: Results from a Randomized Controlled Trial.” [journals.plos.org/plosone/article?id=10.1371/journal.pone.0177177](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0177177)

- __MS and Lumosity study:__ *PLOS One*. (2015). “Enhancing Cognitive Abilities with Comprehensive Training: A Large, Online, Randomized, Active-Controlled Trial.” [journals.plos.org/plosone/article?id=10.1371/journal.pone.0134467](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0134467)

- __MS and Cognifit study:__ *NeuroRehabilitation*. (2010). “Home-Based Personalized Cognitive Training in MS Patients: A Study of Adherence and Cognitive Performance.” [content.iospress.com/articles/neurorehabilitation/nre00546?resultNumber=0&totalResults=6&start=0&q=cognifit&resultsPageSize=10&rows=10](https://content.iospress.com/articles/neurorehabilitation/nre00546?resultNumber=0&totalResults=6&start=0&q=cognifit&resultsPageSize=10&rows=10)

- __MS and Constant Therapy study:__ *Frontiers in Neurology*. (2019). “Comparison of Therapy Practice at Home and in the Clinic: A Retrospective Analysis of the Constant Therapy Platform Data Set.” [frontiersin.org/articles/10.3389/fneur.2019.00140/full](https://www.frontiersin.org/articles/10.3389/fneur.2019.00140/full)

- __MS and Decoder study:__ *Frontiers in Behavioral Neuroscience*. (2019). “Improvements in Attention Following Cognitive Training With the Novel “Decoder” Game on an iPad.” [frontiersin.org/articles/10.3389/fnbeh.2019.00002/full#h8](https://www.frontiersin.org/articles/10.3389/fnbeh.2019.00002/full#h8)

- __MS and Elevate study:__ California State University. (2015). “Elevate Effectiveness Study.” [elevateapp.com/assets/docs/elevate_effectiveness_october2015.pdf](https://www.elevateapp.com/assets/docs/elevate_effectiveness_october2015.pdf)

- __MS and HighIqPro study:__ *Intelligence*. (2018). “Multi-Modal Fitness and Cognitive Training to Enhance Fluid Intelligence.” [sciencedirect.com/science/article/abs/pii/S0160289617300818#bb0465](https://www.sciencedirect.com/science/article/abs/pii/S0160289617300818#bb0465)  

- __MS and Memorado study:__ *Proceedings of the National Academy of Sciences*. (2008). “Improving Fluid Intelligence with Training on Working Memory.” [pnas.org/content/105/19/6829](https://www.pnas.org/content/105/19/6829)
 


How to Keep Your Mind Sharp With MS

The app: <a href="https://www.brainhq.com/?v4=true&fr=y" target="_blank">BrainHQ</a>

The app: <a href="https://www.lumosity.com/en/" target="_blank">Lumosity</a>

The app: <a href="https://www.cognifit.com/" target="_blank">Cognifit</a>

 The app: <a href="https://thelearningcorp.com/constant-therapy/" target="_blank">Constant Therapy</a> 

 The app: <a href="https://play.google.com/store/apps/details?id=org.ccpes.free.games.decoderbraintraining&hl=en_US" target="_blank">Decoder</a> 

The app: <a href="https://www.elevateapp.com/" target="_blank">Elevate</a> 

The app: <a href="https://www.iqincrease.com/" target="_blank">HighIQPro</a>

The app: <a href="http://memorado.com/" target="_blank">Memorado</a>

The app: <a href="https://play.google.com/store/apps/details?id=mobi.redstonegames.crossword.en&hl=en_US" target="_blank">Crossword Puzzle</a>

There’s no magic food that will immediately eliminate MS symptoms, but certain eating patterns are proven to help reduce the inflammation associated with MS and make you feel better day to day. Here’s what to add to your plate and what to avoid for an ideal MS diet.

Healthy Eating Tips

close up of hands picking up summer roll containing vegetables

brenna-huff-InBE7uk3X0I-unsplash

When you eat to beat the inflammation associated with MS, you’ll not only start to feel better day to day but you’ll get some bonus health benefits, too.  

10 Healthy Eating Tips for MS

MS Diet: The Best and Worst Foods for Managing MS Symptoms

How to Use This List

Exercise #1: Bird Dog

How to: Bird Dog

Exercise #2: Sit-to-Stand

How to: Sit-to-Stand

Exercise #3: Glute Bridge

How to: Glute Bridge

Exercise #4: Single-Leg Stand

How to: Single-Leg Stand

Exercise #5: Stationary Lunge

How to: Stationary Lunge

Exercise #6: Clamshell

How to: Clamshell

Exercise #7: Resistance-Band Row

How to: Resistance-Band Row

Exercise #8: Standing Leg Lift

How to: Standing Leg Lift

Exercise #9: Resistance-Band Shoulder Press

How to: Resistance-Band Shoulder Press

Exercise #10: Standing Wood Chop

How to: Standing Wood Chop

My MS diagnosis came as a complete shock. At 21, I’d never even had stitches, let alone any major medical issues. But that all changed in a millisecond when, in September 2006, a neurologist looked at me and said, “Multiple sclerosis.” It turns out, there was a reason I was experiencing numbness from the waist down.

On the drive home with my mom, as she steered our white Jeep through the Detroit suburbs, I felt speechless and dazed—like we were just going through the motions of existing. That was how my journey with MS began. Soon, it would involve navigating a whole new world: the healthcare system. And I quickly discovered that it was ﬁlled with twists, turns, and dead ends.

I’m 34 now and busy with my work as a writer, nonproﬁt founder, and graphic designer. But there are so many things I wish I had known on that drive home under the overcast Michigan sky—things that could have made the years so much easier, or at least less stressful. 
Some I just needed to learn over time, the way a teenager gets better at making life decisions after living a bit. I also needed to get to know my MS, and how we would work together—or against each other. This was going to be a lifelong relationship, after all. It was an insight no one could have taught me

Here are some of the things I wish I’d known from the start.

## For Best Results, Advocate for Yourself

The ﬁrst lesson I learned was a pretty painful one: Except for me and my family, no one really cares about my health. As someone who had never really been sick, I thought the medical system would have my best interests in mind at all times. Not so. I quickly learned that I would have to be my own (and most determined!) advocate—every step of the way.

Sometimes this meant making uncomfortable decisions, like getting a second opinion. Sometimes it even meant disagreeing with medical advice. I think I’ve needed to advocate for myself most with regard to medications, and I’ve been on a lot. But when a doctor suggested I start cyclophosphamide to deter recurrence, I knew to take a stand. That particular drug was just too aggressive for my MS (though it may be right for others). I am the boss of my own body.

## Be Kind to Yourself

Having MS can feel like a full-time job, especially when you’re ﬁghting to be heard. And it can be exhausting! I now know to give myself permission to put down whatever I may have on deck for the day, if needed, and just revisit it later. Sometimes, even if it’s urgent, you have to take time and space for yourself. In 2018, I had my ﬁrst relapse in eight years. So I cut back on a bunch of stressors in my life and let myself recharge.

## Keep Asking Questions!

This goes hand in hand with being your own advocate, especially in the beginning. So often, doctors and nurses would say something that went over my head, but I wouldn’t ask them to explain what they meant because I thought I’d look stupid for not knowing. In the beginning, I didn’t understand what myelin was, or what it meant to be lacking myelin with MS. (It’s a protective sheath around nerve ﬁbers.)

I also didn’t understand what they were looking for with biannual MRI scans. Now I know to ask doctors, nurses, the MRI tech, the insurance company, the home nurses... everyone! What is this? Why are we doing this? Questions not only give me power but help make me smarter. When I asked my neurologist to actually show me my MRI and share what he saw and what it meant, things changed. 

## Stay Smart Online

In the six months after my diagnosis, I spent hours online. I found scary story after scary story about people losing their mobility or their ability to talk. Some became bedbound. Was this what I was supposed to expect for the future? I was devastated.

What I didn’t realize then was that every individual’s experience with MS is unique; the level of disease severity and other aspects of the illness vary from person to person. Plenty of people with MS stay active and mobile for years.

If I’d known this, I wouldn’t have limited myself so much to only what I thought I could do in those ﬁrst few years. I turned down bike rides because I was afraid my legs would be too weak. I refused festival tickets because I’d convinced myself I’d hold everyone back if lots of walking were involved. I know now that I should have been soaking up every moment that I was able to enjoy life on my own two feet!

## MS Can Drain Your Bank Account, But There’s Help

It wasn’t until I was recovering from my ﬁrst relapse and got billed for loads of tests that I learned about patient-assistance programs. Many hospitals and healthcare providers offer discounts and grants to people experiencing ﬁnancial hardship.

Six months after my ﬁrst relapse, I got charged $8,000 for an MRI—and that was after insurance had kicked in. I called the hospital assistance department and the bill dropped to $10. Assistance isn’t available to everyone, but it can’t hurt to make the call. And most pharmaceutical companies offer help for MS medications. I’ve deﬁnitely taken advantage of this over the years.

## Anticipate the Hiccups—Practical and Emotional

Despite living in America, with a well-established healthcare system, a lot of things can go askew. With me, the wrong insurance was billed, a doctor wouldn’t see me because I initially saw a different doctor in his practice, and so on. The system is hardly hiccup-free, and I’ve spent hours on the phone trying to ﬁx errors or answer questions to receive the care I need. It’s part of the “MS job.”

## I’ll Be OK

Mostly, things work out. I now know that the setbacks are temporary. Whether it’s a physical or emotional issue, things are OK in the end. 
Once, I opened my eyes in the morning and my vision was shaded. It was optic neuritis. But my vision came back. Leg numbness didn’t persist; I got feeling and balance back. Now I know that MS doesn’t have to prevent me from doing what most healthy people enjoy, like falling in love and heading to the roller derby track with my skates!



Jackie Zimmerman

A writer and designer with multiple sclerosis details the practical, emotional, and financial survival strategies she wish she’d had when first diagnosed.

One woman’s take on staying strong, sane, and solvent despite multiple sclerosis.

What I Wish I'd Known I'd Known About Multiple Sclerosis

Multiple Sclerosis: What I Wish I’d Known

One woman’s take on staying strong, sane, and solvent.

When I first saw Selma Blair posting about the Alinker walking bike on Instagram, I thought: That’s really cool…but not for me. I have multiple sclerosis, too, but my walking is fine. My legs are fine. I don’t use any other devices to get around. Why would I need one of these? But Selma kept talking about it, and I kept thinking about it. Could I do more or go farther if I did have assistance? 

So I reached out to Alinker to see if there was somewhere I could try one. Barbara Alink, the owner and inventor, got me in touch with a lovely local woman who let me borrow hers, and after that, my wheels were definitely turning (pun 100% intended).  

With all this research coming out about how staying active can help [preserve brain health](https://www.healthcentral.com/article/brain-preservation-key-with-multiple-sclerosis) in people with MS, I wondered if the Alinker might be the missing link for people who straddle that line between being able-bodied and disabled. Selma’s Alinker was the first walking bike I saw, and I was curious to find out if there were others out there. Who was using them? Why hadn’t I heard more about them until now? And in that moment, I started a mission to learn more about walking assistance devices and to see how they could help my community.
 
Turns out, there’s only one other option I could find that’s comparable: The Van Raam Walking Support Bike. I reached out to the company, and they were kind enough to send me one to test for this review. Here’s my take on both:

## The Alinker



### The Design

The Alinker has three wheels, two in the front and one in the back, which makes it an excellent choice for anyone who may have balance difficulties. The width of the front wheels is the same as standard-sized wheelchair, so it fits through doors with ease. The Alinker also comes in three sizes, which means almost anyone can find one that will fit their body. The bike is uniquely designed, and its bright yellow frame draws lots of attention, which could be a pro or a con depending on your preference. While I didn’t run into any issues with access to public places like stores, it’s possible that you could be stopped and need to explain the purpose of this mobility device. One drawback: The three-wheel design may make it tricky to take into small stores or restaurants.

### Usability

The Alinker is great on paved paths, gravel, and even mud thanks to its big, thick-treaded tires, which by the way, pop off for transport with the push of a button.  I was able to keep pace very easily with those around me, and though my legs were doing the work, I didn’t feel tired like I do after a long walk. If you find yourself picking up some speed, you can rest your feet on the front axle and coast, or just pull the hand brake to slow down. Because you can rest your feet on the front axle, a friend could easily push or pull you if you ever needed a little help getting up a hill or if you were stuck.

### Portability



The Alinker folded up

The Alinker folds down, and the seat and tires can be removed for transport, making it fit in almost any trunk or back-seat area. That said, there are no designated handles for holding it while folded, and I found that carrying its 26-pound frame through my front door to be a little awkward. But once I did get it outside, it was only a matter of seconds before I had it put together and ready to ride.

### Cost

The Alinker retails at $1,977, which makes this walking bike a large investment. Currently health-insurance providers will not share the cost on this one so the Alinker company does provide a rent-to-own program and even helps customers set up their own crowdfunding campaigns. Check out their [site](https://www.thealinker.com/) for details and to order.

### What I loved about it:

- Easy to assemble and ride
- The three-wheel design leaves no fear of losing your balance
- It stands upright when in its folded position

### What I wish it had:

- An easier way to carry it

## The Van Raam Walking Support Bike



Jackie Zimmerman using the Van Raam Walking Support Bike

### The Design

Van Raam’s Walking Support Bike looks like a traditional bicycle with two wheels minus the pedals. The bike has low support bars on the frame, which makes getting on easy. There’s no need to lift your legs to get settled. You can adjust the seat and handlebars to your height. I found that it took some time to get the handlebars and seat adjusted properly, but once I did it was quite a comfortable ride. The bike is very compact, making it an ideal tool to take with you many places; however, because it looks like a regular bicycle, you’ll probably have to explain why you’re using it to cruise into public places.  

### Usability

The Van Raam is really fun to ride, and when I was on my own, I’d fly down sidewalks with ease. But because you do need a certain amount of speed to maintain your balance (just like you do on a standard bike), walks with my husband were harder. Riding with a friend who jogs would probably work better if you want some company. Like the Alinker, this bike was also great on paved paths, gravel and mud, and I found it very easy to maneuver going up and down hills. The more I ride this bike the more I like it. With its slim profile, it’s great for sidewalks or in busy areas. That said, if you’ve got balance issues, the two-wheeled design is going to be tough.

### Portability



The Van Raam Walking Support Bike folded up for portability

At 19 pounds, the bike is easy to maneuver, especially when the back wheel is folded in, cutting the length almost in half and making it incredibly portable. I had no problem picking it up and taking it in and out of my house or car, but in its folded state it doesn’t stand up very well on its own, making it a bit cumbersome to store.

### Cost

The Walking Support Bike retails at $735 and is not covered under health insurance plans at this time. You have to order it through one of the company’s US dealers. Find them [here](https://www.vanraam.com/en-gb/dealers?country=271&radius=10&DealerType=partner#DealerLocator_dealers).   

### What I loved about it:

- It was very fun to ride
- Very compact
- It comes with an adorable bell


### What I wish it had:

- A more stable standing position when folded
- A guide to help you find the best handlebar/seat height

After using both the Alinker and the Van Raam Walking Support Bike, I realized that these are both definitely for me—or anyone else living with MS who still has use of their legs but may need a bit more support than a cane or walker can offer. It felt so good to be able to keep up with those around me, and honestly, both bikes look so cool. People are curious about them and ask questions, which helps open up the conversation about mobility aids in general and blast through those stereotypes. If you find yourself a little tired after a long walk, or sitting out of activities in the sun, either of these bikes would be a great way to keep you out and about interacting with the world.



The Alinker and the Van Raam Walking Support Bike on a path

The Alinker and Van Raam Walking Support Bike are cool mobility devices that can be excellent options for people with earlier forms of multiple sclerosis, helping you do more and go farther.

Walking Bikes

These cool mobility devices can be an excellent option for people with earlier forms of multiple sclerosis, helping you do more and go farther.

Do You Need a Walking Bike in Your Life?

Product Review: Walking Bikes for MS

Eat More Low-Fat Dairy

Eat More Fruits and Vegetables

Eat More Fatty Fish

Eat More Fermented Foods

Eat More Nuts and Seeds

Eat More Whole Grains

Drink Less Caffeine

Eat Less Salt

Eat Less Saturated Fat

Eat (and Drink) Less Sugar

Managing multiple sclerosis (MS) isn’t a one-size-fits-all situation. The disease is complex, and it comes with chronic, often painful symptoms that change over time.
 
No wonder many people feel overwhelmed trying to get a handle on the unpredictable nature of their symptoms, says Kathy Costello, C.R.N.P., associate vice president of healthcare access with the [National MS Society](https://www.nationalmssociety.org).
 
Part of what makes MS so confusing is that the cause of the disease is still unknown, and each patient will progress and experience symptoms differently, adds Eoin Flanagan, M.B., B.Ch., a neurologist with the Mayo Clinic who specializes in MS.
 
We do know that MS is an autoimmune disease that occurs when the body mistakenly attacks myelin, the protective layer that surround the nerves in the brain and spinal cord. The damaged areas are called plaques or lesions.
 
“Patients may grapple with different issues at different stages of their life and their disease,” Dr. Flanagan says. But many of the most common questions remain the same. We’ve got answers for six that doctors hear over and over. 
 
## Question #1: My MRI shows new lesions, but I’m not having as many symptoms. How can this be?
 
All patients with MS develop lesions on the spinal cord and brain. These lesions can happen with varying severity, and doctors monitor the disease progression through magnetic resonance imaging (MRI), Dr. Flanagan explains.
 
It’s fairly common for someone with MS to have a lot of active lesions on their brain MRI but not have new symptoms. This may have to do with where the lesion develops, Dr. Flanagan says. There are three areas of your central nervous system that are impacted by MS: the spinal cord, the brain, and the optic nerve.
 
The nerves in the brain are more spread out compared to the nerves in the spinal cord or in the eye, where they’re more compacted. When a lesion develops in the brain, you may not have symptoms right away. However, you’re more likely to have symptoms from lesions on the spinal cord, Dr. Flanagan says. 
 
“Similarly, if you have a lesion along the optic nerve in the eye, it’s more likely to cause a problem with your vision,” he says.
 
## Question #2: Why am I having new symptoms, but not seeing any new lesions on my MRI?
 
This situation is called [pseudo-relapse](https://msfocusmagazine.org/Magazine/Magazine-Items/13-Truths-About-Pseudo-Exacerbations.aspx), Dr. Flanagan says. Pseudo-relapse symptoms may include optic neuritis, or inflammation of the optic nerve that impairs vision, problems with balance, weakness in the legs or arms, pain, or severe fatigue.
 
A pseudo-relapse may be caused by a virus or other infection that is taxing the person’s neurological system. It could even be caused by an increase in body temperature following exercise or a new medication. 
 
“For people with MS, their neurological system is a weak point for them,” Dr. Flanagan says. “A viral illness or a urinary tract infection, for example, can re-trigger symptoms that they had in a previous MS episode.”
 
However, these pseudo-relapse symptoms are not from new active MS inflammation; instead some other outside factor has exacerbated an older lesion, Dr. Flanagan explains. When the underlying trigger is recognized and treated, you can get back to baseline.
 
The takeaway: If a patient who has had MS for many years and hasn’t had many symptoms for a while suddenly starts developing new or worsening symptoms, he or she should see their doctor to check for an underlying virus or infection, Dr. Flanagan says.
 
“They should make sure they don’t have pneumonia, a urine infection, or a flu-like illness, as any of these may be mimicking an MS attack,” he says. 
 
## Question #3: Everyone says I look so great, but I feel awful. What’s going on?
 
MS is a disease with many invisible symptoms, Costello says. This can be very frustrating to the person living with MS because it’s hard for those around them to understand what they’re going through.
 
While no two people will experience MS the same way, fatigue, pain, and bladder issues are among the most common unseen symptoms, Costello explains. Up to 90% of people with MS experience a type of severe fatigue, known as [lassitude](https://www.healthcentral.com/article/lassitude-fatigue-and-ms).
 
“Lassitude is described as not being able to move another muscle or think another thought without rest,” Costello says. “This is different than the kind of fatigue we all experience, where we didn’t get a lot of sleep and we’ve been running around all day.”
 
It’s important to let those around you know what you’re going through. It’s also important for friends and family to understand that just because a person with MS looks fine, it doesn’t mean they aren’t experiencing symptoms, Costello explains.
 
## Question #4: What’s the difference between nerve pain and musculoskeletal pain?
 
Pain affects at least 65 percent of people with MS, Costello says. There are two main [types](https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Pain) that patients experience:
 
1.    __Neuropathic pain__, or nerve pain, is caused by damage to the nerves in the brain and spinal cord. This includes burning, throbbing, or searing pain, but it can also include numbness or a pins-and-needles sensation. Examples of MS-related nerve pain include uncomfortable sensations in the side of the face, called [trigeminal neuralgia](https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet), and a tight feeling, often around the chest, called the MS hug. Pain in the limbs is also very common.

2.    __Musculoskeletal pain__, or nociceptive pain, is caused by weakness and damage to muscles, tendons, ligaments, and other soft tissues. Muscle stiffness and spasm are called [spasticity](https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Spasticity).
 
“Pain, especially nerve pain, can be miserable to live with,” Costello says. “Someone may have pain that they would rank as an eight to 10 in severity, sometimes worse at night. This means they’re not sleeping well, which only compounds the fatigue they may feel during the day.”
 
Pain has been a constant for [Trevis Gleason](https://www.healthcentral.com/author/trevis-gleason) since he was diagnosed with MS in 2001. Gleason grew so frustrated with excruciating nerve pain in his foot that he once asked his doctor if the pain would go away if he amputated it.
 
“My doctor told me, ‘The pain isn’t in your foot,'" he says. Instead, he explained that there's damage to a nerve somewhere *between* his brain and his foot, and that lesion is scrambling the signal. 
 
The doctor’s explanation didn’t make the pain go away, but it did help him understand what was going on, says Gleason, has written a book about his experiences with MS called [*Chef Interrupted*](https://www.amazon.com/Chef-Interrupted-Discovering-Multiple-Sclerosis/dp/1603813012).
 
## Question #5: Why does MS so commonly cause bladder dysfunction? And what can I do to control it?
 
Bladder issues are very common in people with MS—[up to 80%](https://www.nationalmssociety.org/Symptoms-Diagnosis/MS-Symptoms/Bladder-Dysfunction) deal with some form of bladder dysfunction, according to the [National MS Society](https://www.nationalmssociety.org). This happens when nerves that control the bladder and urinary sphincters are damaged by MS lesions, possibly leading to an overactive bladder that’s unable to hold the normal amount of urine, Costello explains.
 
Urinary problems may cause feelings of urgency to urinate or needing to urinate frequently. Some people may have wetting accidents or be unable to empty their bladder completely, which can increase the risk for [urinary tract infections](https://www.healthcentral.com/article/what-to-know-about-urinary-tract-infections). You may also have to get up multiple times per night to use the bathroom, which isn’t great when you’re already exhausted, Costello says.
 
Bladder dysfunction can be embarrassing, but there are several medications and interventions that can help, Costello says. Some medication-free strategies include:

- __Percutaneous tibial nerve stimulation (PTNS).__ This is a type of electroacupuncture. A small needle electrode is inserted into the ankle, and it transmits a signal to the sacral plexus, a network of nerves that controls the bladder and pelvic floor muscles. Patients usually have 12 weekly 30-minute treatments, which can help relieve overactive bladder symptoms.
- __Injections of botulinum toxin, or Botox__, into the bladder muscle, which causes partial paralysis and targets the nerves that control the sensation of urgency.
- __Lifestyle changes__, such as limiting or avoiding caffeinated beverages or alcohol, which can irritate the bladder or increase the urgency to urinate, Costello explains. But don’t shun *all* fluids, as it’s important to maintain proper hydration. “Not drinking any fluids is more irritating to the bladder than maintaining good hydration,” Costello says. “Limiting fluids in general—not specifically caffeinated beverages or alcohol—can significantly make bladder symptoms worse.”
 
## Question #6: Why does MS affect more women than men? And how does pregnancy or menopause affect MS?
 
It’s unknown exactly why MS affects more women than men, but medical professionals have long noted that in general, women are more likely to have autoimmune diseases of all kinds, Dr. Flannagan says.
 
Women are two to three times as likely to get MS as men, according to [research from the National Multiple Sclerosis Society](https://www.nationalmssociety.org/Research/Research-We-Fund/Past-Research-Efforts#section-1). This may be because MS has some link to fluctuations of hormones, such as testosterone and estrogen—a theory supported by the fact that many women find they don’t have as many symptoms during pregnancy, Dr. Flannagan says. However, women may be at risk for a relapse, where symptoms become more acute, in the months after giving birth.
 
That’s not always the case, says Holly Hill, 51, who has lived with MS for more than 30 years and has a 16-year-old daughter.
 
“When I was pregnant, my experience was that it was the best I ever felt,” says Hill, who lives in the Seattle area. “I was really afraid that after I gave birth, I would have an attack. But that didn’t happen for me.”
 
However, Hill notes that her MS progressed more rapidly after she went through [menopause](https://www.healthcentral.com/slideshow/ten-things-you-should-know-about-menopause), something that may affect as many as half of women with MS, according to [one survey](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031240/#R2).  
 
“I don’t have attacks anymore, but I’m definitely declining and losing functionality and mobility,” Hill says. “That seemed to correspond with menopause. I’m very heat sensitive, and when the hot flashes started and my body temperature was changing all the time, my MS started getting worse.”
 
If you can relate to this or any of the potentially confusing symptoms above, call your primary care provider to schedule an appointment. He or she can answer your questions and suggest further treatment if needed.





A pseudo-colored image of high-resolution gradient-echo MRI scan of a fixed cerebral hemisphere from a person with multiple sclerosis

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Multiple sclerosis can be confusing and overwhelming. Patients may experience different MS symptoms at different stages of life and their disease, but they often have similar questions. Here are the answers you need to help put your mind at ease.

MS Questions & Answers

Why don’t my lesions match my symptoms? Are my bladder problems normal? Get the answer to these and more common conundrums about multiple sclerosis.

Understanding MS: Your Top 6 Questions Answered!

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Disease-modifying medications are a key component of comprehensive care in people with relapsing-remitting multiple sclerosi s(RRMS), but the options can be overwhelming. Check out this guide to learn how to choose the right DMT for you. 

DMT Guide

The great news about multiple sclerosis treatments? You’ve got options! The potentially stressful news? You’ve got A LOT of options. We break down the basics.  

The MS Guide to DMTs

Multiple Sclerosis: Which Disease-Modifying Medication Is Right for You?

The great news about multiple sclerosis treatments? You’ve got options! The potentially stressful news? You’ve got A LOT of options. We break down the basics.

If you’ve been diagnosed with multiple sclerosis (MS), there’s no doubt you put a lot of thought, time, and energy into managing your symptoms, slowing down their progression, and protecting your brain function, too. So what about the food you eat? Is there a special “MS diet” you should follow?

The short answer is no. There’s not *one* diet plan proven to be effective in treating MS, but there are general guidelines that can make a difference in your overall health, energy level, and risk for developing other conditions associated with MS, including heart disease, bladder issues, and bowel problems.

“More rigorous research is needed, but what does exist points to focusing on a healthy, plant-based diet that’s rich in fruits, vegetables, and healthy fats, and low in saturated fat,” says Ilana Katz Sand, M.D., associate medical director of the Corinne Goldsmith Dickinson Center for Multiple Sclerosis in New York City. More specifically, you can keep these six recommendations in mind.

## 1. Eat Like the Greeks

A Mediterranean diet has long been known to help with heart health. After all, it's typically packed with all the good stuff--fruits, vegetables, whole grains, nuts and seeds, fish, and healthy fats like olive oil and avocado--and low on the less healthy stuff like red meat, full-fat dairy, and processed foods. But [new research](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132382/) suggests it may also be helpful for people with MS.

A study of 36 patients with MS at the Mount Sinai School of Medicine in New York City found those who followed a Mediterranean-style eating plan for six months reported improvements in day-to-day symptoms like numbness, limb weakness, dizziness, and fatigue.
 
“The Mediterranean way of eating is an anti-inflammatory diet, which in turn may reduce some of the inflammation that occurs in MS due to the body’s immune cells attacking its own nerve fibers,” explains Dr. Katz Sand, who was the lead study author.

Another reason it’s worth trying: Unlike most diet plans, this way of eating favors general guidelines and recommendations over strict rules. “It’s more a lifestyle,” says Keri Gans, R.D.N., author of *The Small Change Diet*. “It’s what we should all refer to as well-balanced, healthy eating.”
 
## 2. Cut Your Sodium Intake

Science points to sodium as a potential factor in MS flare-ups.  One observational study published in the [*Journal of Neurology, Neurosurgery, and Psychology*](hthttps://www.ncbi.nlm.nih.gov/pubmed/25168393) found that people who consumed a moderate or high amount of sodium experienced more relapses and had a greater risk of developing new lesions compared to people who consumed a low amount.

How much is too much? The [American Heart Association](https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sodium/how-much-sodium-should-i-eat-per-day) recommends no more than 2,300 milligrams of sodium per day, with an ideal limit of 1,500 mg. That means not only removing your salt shaker from the table, but also watching your intake from sneaky sodium sources, like processed and fast foods.
 
## 3. Go Fish

Fish is already a key component of the heart-healthy Mediterranean diet, but there’s even more reason to support putting it on your plate once or twice per week. Fish is rich in omega-3 fatty acids, which may help improve MS symptoms by reducing inflammation that can impact nerve function, Dr. Katz Sand says.

“I encourage my patients to try to eat fatty fish such as salmon, sardines, and tuna instead of red meat as much as possible,” she says. “They not only get the health benefits from the fish, but they also reduce their consumption of saturated fat, which may also have a role in MS symptoms.” 

## 4. Steer Clear of Strict Fad Diets (Unless One's Recommended by Your Doctor) 

Three diet plans are often touted to help with MS symptoms, including:

- The Paleolithic or “paleo” diet, which is high in protein and plant-based foods (except cereals) and low in dairy, eggs, and gluten
- The McDougall diet, a low-fat, high-carbohydrate, moderate-sodium, vegan diet
- The Swank diet, a low-fat diet that focuses on reducing both saturated and unsaturated fats 

But a [review](http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Documents/Diet-and-Multiple-Sclerosis-Bhargava-06-26-15.pdf) by the [National Multiple Sclerosis Society](https://www.nationalmssociety.org) found there is insufficient evidence that any of these diets are effective in reducing MS symptoms. What’s more, following certain strict diets may do more harm than good if they skimp on crucial nutrients such as folic acid, thiamine, and vitamin B6 (due to reduced intake of cereals); calcium and vitamin D (due to lack of dairy intake); and iron.

“These diets are also very restrictive, making them tough to stick to long term,” says Julie Fiol, B.S.N., R.N., senior manager of MS information and resources at the [National MS Society](https://www.nationalmssociety.org). And if you can’t stick to something, you’ll never reap the benefits it promises.
 
## 5. Bone Up on Vitamin D

[Research](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5990512/) in the journal *Neurology Review* points to a reduced level of vitamin D in the blood as a risk factor for developing MS. And [more studies](https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/expert-answers/vitamin-d-and-ms/faq-20058258) suggest vitamin D may help ease symptoms and improve quality of life for those living with MS.

Known as the “sunshine vitamin,” vitamin D aids immune function and has also been shown to boost [brain health](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132681/). Plus, it’s crucial for bone health, which is important for people with MS since they’re at higher risk of osteoporosis, Fiol says.

Start by incorporating vitamin D-rich foods into your diet, including fatty fish and foods fortified with D, like low-fat dairy products or orange juice. You may also want to get your blood levels of vitamin D tested to make sure you’re not deficient. If you are, ask your doctor what supplement dose you should take. The National MS Society [recommends](http://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Clinical-Bulletin-Vitamin-D-and-MS_-Implications-for-Clinical-Practice.pdf) about 1,000 IU per day, but you may need more depending on your current levels and health status. 

## 6. Go Easy on the Alcohol and Caffeine

Booze affects your central nervous system, which means it can impact your balance and coordination—two things you may already struggle with when you have MS, Fiol says. And too much caffeine can aggravate symptoms like muscle spasms and hand tremors.

Alcohol and caffeine are also both diuretics. That means they make you pee more, which is often already a problem if you have MS.

You don’t have to completely abstain from either but stick to 300 milligrams of caffeine or less per day—that’s about two cups of coffee—and one drink or less per day. One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor (one shot glass). Be careful: People usually pour more than these amounts when they serve one up.



woman chopping chives, preparing meal of salmon and vegetables on cutting board

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There's no magic MS diet proven to treat your symptoms, but that doesn’t mean the food you eat can’t make a big difference in how you feel and your risk for developing other conditions associated with MS. Here are six simple eating rules people with MS should follow. 

Best MS Diets

The short answer: a healthy one! We've got doctor-approved advice can improve your overall health and your quality of life, too. 

What's the Best Diet for People With MS?

What's the Best Diet for People with MS?

Mindy Eisenberg was just a child when her mother was diagnosed with multiple sclerosis (MS), an autoimmune disease that affects the brain and spinal cord. But she remembers like it was yesterday.
 
“The philosophy was very different at the time,” Eisenberg, 55, says. “My mother was told not to move, to stay as sedentary as possible.”
 
Over the next 25 years, Eisenberg watched her mother’s condition slowly deteriorate, until she was largely limited to using a wheelchair or staying in bed. She eventually resorted to a nursing home.
 
A lot has changed in the decades since Eisenberg’s mother was diagnosed. Not only has modern medicine improved the treatments available for MS, but there's also a much more holistic approach. “Now doctors tell you that you absolutely should move and do whatever you can to stay active,” says Eisenberg, who lives in Franklin, MI. We now know that in addition to improving overall health and quality of life, [exercise can directly combat the symptoms of MS](https://www.healthcentral.com/slideshow/six-ways-exercise-helps-people-ms).
 
There’s also a growing awareness of how mind-body therapies can also help people living with MS, says Eisenberg, who runs a nonprofit group called [Yoga Moves MS](https://www.yogamovesms.org/), which offers MS patients yoga and other complementary therapies like [mindfulness meditation](https://www.healthcentral.com/slideshow/8-reasons-try-mindfulness-meditation) to help manage their symptoms and reduce stress.
 
## How Exactly Can Mind-Body Therapy Help?

The term “mind-body therapy” refers to a group of healing techniques that can induce relaxation and improve overall health and well-being.

“Mind-body interventions may be an incredibly helpful, low-cost, and low-risk way to help cope with stress and anxiety,” says Kathy Zackowski, Ph.D., an occupational therapist and scientist who serves as senior director of patient management, care, and rehabilitation research for the [National MS Society](https://nationalmssociety.org).
 
[Numerous studies](https://report.nih.gov/nihfactsheets/viewfactsheet.aspx?csid=102) have shown the mind can have a big impact on a person’s physical symptoms, Zackowski explains. Stress and anxiety in particular can play a role in increasing MS symptoms, and many people may have a flare-up during especially trying times, she says.
 
“That’s why mindfulness and resilience training may be really important, because if we can develop strategies to harness the strength of the mind, maybe we can improve our ability to function or temper how our body reacts,” Zackowski explains. “More research is needed in this area, but one goal of such studies would be to see if mind-body therapy may help slow the progress of MS, in addition to improving symptoms.”
 
Still, even if new science reveals promising results from mind-body therapies, it won’t be a one-size-fits-all solution, Zackowski says. You may need to try several different techniques to see what works for you.
 
## Want to Give Mind-Body Therapy a Try? Start Here

“We don’t know that there’s one mind-body strategy that works better than all the others, so it’s important that people figure out what feels good to them,” Zackowski says.
 
Options include:

- Yoga
- Meditation
- Acupuncture
- Hypnosis
- Music therapy
- Tai chi or qi gong, which are both forms of moving meditation
- Guided imagery, in which you’re guided in imagining a relaxing scene or series of experiences
- Aromatherapy, which uses the scent of concentrated plant oils, known as essential oils, to improve feelings of well-being
- Mindfulness techniques, which may simply involve being present in the moment or focusing on your breath

“We’re all different, and it may be that meditation doesn’t speak to you,” Zackowski says. “You may need something different, like yoga, where you move your body. Or some people may like being quiet and listening to music or having someone talk them through a meditation session.”
 
After seeing her mother’s experience with MS and realizing how yoga may have helped her, Eisenberg was drawn to a practice called [adaptive yoga](https://www.yogamovesms.org/about/what-is-adaptive-yoga/). This style of yoga uses props such as blocks, wraps, bolsters, and chairs to help people with balance problems, limited flexibility, or those who become easily fatigued. It can accommodate nearly any skill level, Eisenberg says.
 
“The idea is to do what fits your body on any particular day,” she says. “One day you may feel more tired, so we may be doing things slower and working on more restorative poses. Another day you may feel more energetic and be able to do some traditional poses or some adaptive poses with more energy. But you benefit from both.”
 
Trevis Gleason, 53, who was diagnosed with MS in 2001, is a big believer in daily mind-body practices. For him, it may take the form of a contemplative walk with his dog or gardening in the shade. He also enjoys doing yoga and practices mindfulness and breathing techniques.
 
On days when Gleason is feeling particularly fatigued or struggling with other MS symptoms, simply sitting somewhere with a view, practicing mindfulness by being in the moment, and observing the world around him helps him feel more relaxed and at ease.
 
“Anything that takes my mind to a calm place is enjoyable and beneficial,” says Gleason, who splits his time between Ireland and Seattle. “For me, it’s about finding quality of life. I often say, ‘On my worst MS days, the best thing is a good window,’ so I can stay connected and see that life is going on around me.”
 
## Think of Mind-Body Therapies as Complementary (not Alternative) Medicine

Healthcare providers specializing in MS prefer to consider these therapies as strategies to be used in conjunction with traditional medicine, such as [disease-modifying therapies](https://www.healthcentral.com/article/slowing-down-the-longterm-progression-of-multiple-sclerosis-by-using-diseasemodifying-therapies-dmts), which may help slow the progression of MS, and other medication that can help treat acute MS symptoms, says Kathy Costello, C.R.N.P., associate vice president of healthcare access with the [National MS Society](https://www.nationalmssociety.org).
 
“We don’t like to think of these as alternative treatments that you would use *instead of* something else,” she says. “We want to use interventions and therapies that work in concert together. So you can use lifestyle changes (like [eating a healthy diet](https://www.healthcentral.com/slideshow/best-food-choices-multiple-sclerosis) and maintaining an [exercise routine](https://www.healthcentral.com/article/7-best-exercises-for-living-better-with-multiple-sclerosis-infographic)), complementary interventions (like yoga or meditation), and medications for symptom management.”
 
Most mind-body therapies are relatively inexpensive with no known side effects, so there’s minimal risk in seeing how they work for you, Zackowski says:  “It doesn’t replace modern medicine, but mind-body therapies can prompt people to be more involved in taking charge of their health, rather than simply relying on a physician for treatment.”
 
Anything that helps you stay in touch with what’s going on with your body and the symptoms or sensations you’re feeling is valuable, Eisenberg adds. That’s true even if it simply helps you learn to be present with the pain, instead of anticipating it’s going to get worse. Yoga and mindfulness meditation are among the most popular and common mind-body therapies that have been found to help people with MS, Costello says. But don’t feel limited to those.  If you’d rather try something else, go for it!



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Mind-body techniques like yoga and meditation, can be a powerful tool in managing multiple sclerosis symptoms. Here’s how to get started and find the approach that reduces stress and boosts your well-being the most.

Mind-Body Basics

Learning how to get a handle on stress (so it doesn’t manhandle you!) not only helps you manage multiple sclerosis symptoms, it may help you prevent them too.

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