The Connection Between MS and Your Weight

Maintaining a healthy weight isn’t a cakewalk for anyone, but it can be even more challenging when you’re one of the approximately 2.3 million folks who deal with the disabling symptoms of multiple sclerosis (MS), a chronic neurological disease.

To help make sense of the connection, it's important to understand the basics of the disease. “It’s believed that genetic factors make a person with MS susceptible to an unidentified trigger in the environment that causes their immune system to attack the central nervous system," says clinical psychologist Rosalind Kalb, Ph.D., Vice President of Clinical Care at the National Multiple Sclerosis Society and lead author of Multiple Sclerosis for Dummies. "That system includes the brain, spinal cord and optic nerves.”

The immune system attack damages myelin, the coating around the nerve fibers in the central nervous system, as well as the nerve fibers themselves. This makes it difficult for messages to travel between the brain and the rest of the body. Everything we do, from thinking to walking, relies on the smooth transport of these signals. Delayed or blocked messages cause the life-altering symptoms of MS, including debilitating fatigue, which can make the task of staying in shape downright daunting. Weight gain isn’t inevitable though, and avoiding extra body weight can actually help you lead the most active, independent lifestyle possible.

Why weight gain?
“Unlike most neurological diseases that typically affect specific parts of a person’s brain, MS can cause damage, or lesions, throughout the central nervous system,” says neurologist Allen Bowling, M.D., Ph.D., medical director of the Multiple Sclerosis Program and Director of the Complementary and Alternative Medicine Service at the Colorado Neurological Institute. “Each person with MS has a different constellation of lesions and therefore, a unique collection of symptoms.”

Severity varies, but there are certain problems that overlap among MS patients — the majority of whom are women diagnosed between the ages of 20 and 50. Fatigue, the kind that can leave you feeling like you’re trudging through cement, is one of the most common symptoms. According to the National Multiple Sclerosis Society, other frequent symptoms include numbness, bladder and bowel dysfunction, dizziness, muscle stiffness, vision problems and trouble with walking, balance and coordination.

Any of these can bar you from regular exercise — and the mobility necessary for everyday tasks, such as food shopping. Once you decrease activity, the pounds can add up. With an increasingly sedentary lifestyle, your body may become progressively deconditioned (i.e. aerobic ability dips and muscles can atrophy and lose strength and flexibility), making it even harder to exercise.

Changing moods can dictate weight shifts too. “Depression, whether from the disease itself, a reaction to its challenges or a side effect of MS-managing medications, is more widespread in MS patients than in the general population,” says Kalb. “If you’re depressed, your motivation to exercise can wane and you may overeat for comfort — or in some cases lose your appetite and drop weight.” It can zap the energy it takes to plan and prepare healthy meals, making high-fat convenience foods the go-to.

Compounding the issue, antidepressants can cause weight gain. Another medication pitfall: About 85% of people with MS are diagnosed with “relapsing-remitting MS.” Patients can experience disease flare-ups, wherein new symptoms develop or old symptoms worsen for weeks or months. Remission periods follow these attacks, when symptoms disappear or improve some (a smaller percentage of MS patients have a steadily progressive course of the disease without the attacks). Doctors may treat severe attacks with short-rounds of corticosteroids, medications that can increase appetite and fluid retention. While excess weight doesn’t worsen MS, it can intensify symptoms such as fatigue and speed the deconditioning process, says Bowling.

Setting up a strategy
To keep the scale at a happy number, people with MS should adjust their diets with smart food choices and controlled portion sizes to reflect changes in their activity level. “There’s no specific MS diet or foods that are off-limits,” says Kalb, who explains that dietary recommendations often echo those given to the average person: a low-fat, high-fiber diet and plenty of water. The latter helps manage bowel and bladder symptoms of MS. Outside of debilitating attacks (when exercise can be impossible), a well-designed fitness program can help with managing weight, improving muscle tone, endurance, and range of motion, lifting mood and decreasing fatigue. There’s no one-exercise-fits-all approach, since abilities among MS patients run the gamut. “Physical therapists create individualized programs that usually include a combination of flexibility, strength training, aerobic and balance activities,” says Mandy Rohrig, PT, DPT, a physical therapist who specializes in the treatment of MS at Horizon Rehabilitation Centers in Omaha, Nebraska.

Many MS patients may find it easier to accomplish exercise in the morning — when people often report less fatigue — and in cool environments or while wearing special cooling garments, since heat can temporarily exacerbate symptoms. An occupational therapist (OT) can offer energy-conserving strategies — from preparing meals in bulk one morning to sitting while showering — that’ll help you wisely “budget” your energy to make exercise, healthy food prep and other daily tasks doable. Rohrig says, “Adjusting to the ‘new normal’ is tricky, but staying focused on abilities, not disabilities, will help improve weight loss success.”