Modifiable risk factors in MS – help yourself


Modifiable Risk Factors in the Progression of Multiple Sclerosis: A Systematic Review of the Epidemiology and Treatment [Internet].


Hempel S, Fu N, Estrada E, Chen A, Miake-Lye I, Beroes J, Miles J, Shanman R, Shekelle P.


Washington (DC): Department of Veterans Affairs (US); 2015 Dec.
VA Evidence-based Synthesis Program Reports.


Multiple sclerosis (MS) is the most common progressive disease of the central nervous system in young adults and the cause of serious physical disability in adults of working age. Epidemiologic data suggest that rates of MS vary with demographic and environmental factors. The disease presentation is very heterogeneous with diverse clinical manifestations. Progression of MS may vary with modifiable risk factors. This systematic review focused on modifiable risk factors and exposures that are associated with MS progression, and interventions that are directed at modifiable risk factors to delay progression.

I keep a close eye out for research publications looking into improving outcomes in MS, it is not all about disease modifying treatments 😉 We keep our blog readers appraised of this on a regular basis and I know many of you embrace the freedom it provides to choose.

Here, Hempel and colleagues identified 8,594 articles but only 94 met their criteria (quality not quantity!).

So what were the modifiable risk factors?
1) VITAMIN D – lower vitamin D levels were associated with higher EDSS (disability) scores.
2) SMOKING – increased risk of faster progression in smokers than non-smokers.

What about risk modification treatments?
1) EXERCISE – although the pooled effect of exercise interventions was not significant from control groups, but when using a sensitivity analysis (a way of determining if specific values of an independent variable, i.e. exercise, impact on a dependent variable, i.e. EDSS) the results favored the exercise arm.
2) VITAMIN D – vitamin D supplementation showed a trend for EDSS improvement.

Overall, the evidence for modifiable based on this meta-analysis is moderate at best, as it is difficult to analyze environmental risk factors. The interactions between environmental risk factors are manifold and direct causal inferences cannot be made. That said, they are out there, easy to do and all with minimal side effects.

Today you are You, that is truer than true.
There is no one alive who is Youer than You
– Dr Seuss.

About the author

Neuro Doc Gnanapavan


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  • Thanks for this post. In my view it compliments the science/focus on DMTs.
    It seems to me there's a whole heap of nonsense, or dubious, claims of MS cures accessible on the internet. It is more reassuring to be informed therefore of pertinent aspects concerning life-style from the Bart's team!

  • I'm surprised that there's no mention of the avoidance of co-morbidities.Also, the fact that diet is not in there confirms my belief that diet matters in the broad sense of keeping healthy – not to do with avoidance of specific foods. Interesting.

  • They did look at diet but couldn't find any good studies. "Studies addressing fat consumption did not report on the same outcome measure…the only identified prospective study reported on the Swank diet for MS patients and showed that for poor dieters, operationalized as participants with an intake of more than 20g fat per day, the average worsening significantly exceeded those of good dieters, but the size effect was not reported. The quality of the evidence base was judged to be insufficient overall".

  • My sister have followed a tipycal paleo diet, took vitD, been nonsmoker and anti-alcoholic. In spite of this lifestyle she progressed countinously with ponto-cerebellar lesions and atrophy (took copaxone aka snake oil and tecfidera 15 mnths and 6 mnths) Finally (one year ago) she have started fingo witch put her into remission and thank God her neurological symptoms have improved. I hope it can continue for long-long time!
    I think the key using highly effective drugs! Lifestyle might help to avoid another diseases and exercise might help MSer to regain functions without acute and subacute inflammation. Brain got a chance to regenerate itself!

    • Active disease needs to be controlled – that has been our team mantra like forever…there is also room for improving inherent plasticity which is where modification of risk factors come into play.

  • Started training for the Marathon on Sunday, almost had to post to the unrelated section asking for a ringer to run for me. But feeling better now 🙂



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