I would say the number one thing is lifestyle and nutrition. There isn’t necessarily definitive evidence for a specific diet in MS. However, people who are healthier overall tend to do better.
I have a patient who has quite advanced multiple sclerosis and has a lot of weakness in the legs, but she’s still able to walk because she’s really healthy and fit overall and very strict with her diet, really avoids processed foods, and doesn’t have a lot of other medical conditions. And I’m certain she wouldn’t be able to walk if she were less healthy overall.
There are certain medications where the risk of side effects is greater for people who have certain medical conditions. For instance, the S1P receptor modulators: If you have diabetes, the risk of a certain side effect—macular edema, swelling in the back of the eyes—is more likely. That’s just one example. There are many other examples. People taking immunosuppressants, if they’re less healthy overall, they’re more likely to get a serious infection.
So, having good nutrition, having a good exercise regimen, and avoiding smoking is very important. There’s specific evidence that smoking worsens multiple sclerosis on the average.
Now, in terms of diet, I can’t recommend a definitively proven diet. There’s some epidemiologic evidence that MS is more common in areas where people consume more dairy and saturated fat. So it may be better to have a diet composed mostly of whole fruits and vegetables. There may also be a link between salt, between sodium, which is present in processed foods, and multiple sclerosis.
Of course, there are actually some good studies on, say, the Paleo diet. People may have heard of Dr. Terry Wahls, who has done some randomized trials on a Paleo diet, which isn’t necessarily very plant-based, showing some good results. So probably the most important thing is avoiding processed foods and eating abundant whole foods, and having a good exercise regimen.
The other thing I would say is having good social support. Some people are very private; they don’t want to tell people they have MS, which is certainly OK, but it’s good to have at least a few close family members and friends you can confide in and get some advice.
And in general, I think it’s important to have a meaning and purpose in life. Even if you lose some things because of the disease, maybe you can refocus your energies on other things. So you know where you want to be and what you want to do, even if you do have some disabilities from the disease.