Lifestyle Changes:

People with multiple sclerosis should make every effort to preserve their general health. A healthy diet, sufficient rest, establishing priorities to conserve energy, and developing emotional support networks can all be very helpful.

Rehabilitation Therapies

Patients with MS can benefit from various rehabilitation services to help them cope with the physical and emotional symptoms of their condition.

Physical Therapy. Physical therapists can provide professional guidance on exercise programs. Patients with MS should engage in a variety of exercises including stretching, muscle strengthening, and range-of-motion. Exercise can help reduce fatigue and relieve muscle spasticity. Physical therapists can also provide advice on how to best use mobility aids (canes, crutches, scooters) and other assistive devices.

Occupational Therapy. Occupational therapists help patients learn how to improve their functioning and independence within their home and workplace environments. They can provide professional advice on what sort of adaptive tools, such as grab bars, should be used in the bathroom, bedroom, and kitchen. Occupational therapists may also be able to evaluate and treat problems with thinking and memory.

Vocational Therapy. Vocational therapists provide guidance on how patients can best manage in the workplace.

Speech / Language Therapy. Speech/language therapists treat problems with speech and communication, and can also help address problems with swallowing.

Dietary Factors

Some dietary suggestions for patients with MS include:

• Drink 2 quarts of water a day, and avoid caffeine-containing beverages, which are actually dehydrating. Drinking water helps avoid constipation (although it may cause difficulties in patients who also have urge incontinence).
• Eat a diet rich in fiber, particularly from whole grains (especially bran, oats, or flax), fruits (particularly prunes), and vegetables.
• Low-fat diets have not proven to have much effect on MS but are, in any case, generally healthy.
• Omega-3 fatty acids, found in oily fish and fish oil supplements, have been associated with protection against inflammation and some reduction in symptoms in people with various autoimmune conditions. Such fatty acids are also available in supplements as docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids. Standards for optimal amounts and forms of omega-3 fatty acids have not yet been established, however. Some doctors recommend that people with MS eat three fish meals a week.

Special diets, such as those that are gluten- or yeast-free, do not have any direct effect on the symptoms or course of MS.

Cooling Methods

Body overheating causes demyelinated nerves to function less efficiently than usual. Although this effect is resolved within a few hours of regaining normal body temperature, active cooling can help reduce fatigue and improve stability. As a result, researchers are studying the effectiveness of cooling suits.

The following measures may help:

• Use air conditioners in the summer.
• Keep the home slightly cool in winter.
• Avoid swimming in heated pools. However, swimming is an excellent exercise as water supports the body and cool water dissipates heat.

Prevention of Influenza

MS symptoms worsen during a cold or the flu, probably because of increased immune system activity. Doctors recommend that patients with MS receive a flu shot in the fall. However, patients should not take the nasal spray version of the flu vaccine (FluMist Intranasal). Unlike the flu injection vaccine, which uses an inactivated virus, FluMist contains a live virus. Live virus vaccinations may be harmful for people with MS, especially those who take immune-suppressing drugs.

Complementary and Alternative Medicine

Many patients with MS try some form of nontraditional remedies. Research on any benefits is slim, and there may be some danger with certain herbal remedies. Alternative therapies used to treat MS include:

Relaxation and Meditation Techniques. Patients may try relaxation, meditation, biofeedback, music therapy, yoga, tai chi, and massage therapy. They are generally harmless, and possibly helpful.

Acupuncture. Some patients report benefit from acupuncture.

Herbs and Supplements

Generally, manufacturers of herbal remedies and dietary supplements do not need FDA approval to sell their products. Just like a drug, herbs and supplements can affect the body's chemistry, and therefore have the potential to produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from herbal products. Patients should check with their doctor before using any herbal remedies or dietary supplements

The following warnings are of particular importance for people with multiple sclerosis:

Antioxidants. Some patients use antioxidant vitamins or supplements, since the destruction in the MS disease process may be partly due to oxidation (chemical damage from particles called oxygen-free radicals). Theoretically, however, antioxidants can trigger T cells and macrophages (inflammatory components of the immune system) and, therefore, may pose some danger to patients. Small studies to date have not found any worsening of the disease from taking vitamin supplements, but patients should be cautious. No vitamins studied for MS, including carotenoids, vitamin C, vitamin E, B12 injections, or vitamin D, have been proven to be beneficial.

Gingko. Although the risks for gingko appear to be low, there is an increased risk for bleeding at high doses. Ginkgo can also interact with high doses of vitamin E, anti-clotting medications, aspirin, and NSAIDs. Large doses have also been known to cause convulsion. Randomized trials have failed to show any benefit.

Bee Venom. For years, anecdotal reports have claimed that bee stings relieve some MS symptoms, although a study on mice indicated that it may worsen MS. Bee venom contains many chemicals, some of which can cause severe and sometimes deadly allergic reactions in some people.

Linoleic Acid. Linoleic acid, commonly known as evening primrose oil, is a polyunsaturated fatty acid believed by some people to be helpful because myelin is composed of fatty acids. No study has proven that it is beneficial, but supplements sold in health food stores do not appear to be harmful.