How healthy is your lifestyle?

H

Barts-MS rose-tinted-odometer ★★★★★ 

It is a no-brainer. A healthy lifestyle is one of the most effective preventive health interventions available. The study below shows that you can increase your chances, by a factor of over 20, of a life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 by making ensuring you maintain 4 or 5 low-risk lifestyle factors; i.e. not smoking, staying trim, doing moderate to vigorous physical activity, keeping your alcohol intake moderate and eating a quality diet. 

Although this study has implications for the general population the message is applicable to pwMS. All these lifestyle factors have been linked in some studies to MS outcomes. In other words, everyone with MS should assess their lifestyle to see if they can change things to maximise their longterm outcome. 

Another thing you can do is to ask your HCP to score themselves on these five factors. I maintain that HCPs have a responsibility to lead by example and they should be practising what they preach. This is why I am determined this year to max-out on all five of these factors so that I can look my patients in the eye and say “I am with you all the way”. 

What is not discussed in this paper is the fact that what determines your ability to live a ‘healthy life’ is often down to the social determinants of health (SDoH) and these are usually beyond the control of the individual. Education, poverty, inequality, social isolation, a poor environment, lack of self-control, a sense of helplessness, chronic stress, etc. are all factors that make adopting a healthy lifestyle almost impossible. This is why our #ThinkSocial campaign is really a political campaign. Without politicians acknowledging the importance of the SDoH little will change. 

Please let us know if you are managing to adopt and maintain a healthy lifestyle and how you have done it; success stories are more motivating than pontificating from a soap-box.

Li et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 2020;368:l6669

Objective: To examine how a healthy lifestyle is related to life expectancy that is free from major chronic diseases.

Design: Prospective cohort study.

Setting and participants: The Nurses’ Health Study (1980-2014; n=73 196) and the Health Professionals Follow-Up Study (1986-2014; n=38 366).

Main exposures: Five low-risk lifestyle factors: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).

Main outcome: Life expectancy free of diabetes, cardiovascular diseases, and cancer.

Results: The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low-risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low-risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low-risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low-risk lifestyle factors. For current male smokers who smoked heavily (≥15 cigarettes/day) or obese men and women (body mass index ≥30), their disease-free life expectancies accounted for the lowest proportion (≤75%) of total life expectancy at age 50.

Conclusion: Adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases.

CoI: multiple

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

25 comments

  • I do not smoke, I am slim 50kg 1.62m, i do NOT do moderate to vigorous physical activity (permanent on a wheelchair), I don’t drink alcohol at all , I do eat a quality diet ( thank you to my husband who is an amazing cook everything from scratch no sweets no sugars ). No other illnesses yet .

  • I believe my current MS status is largely down to what education has given me -i.e. ability and appetite to assimilate knowledge, the confidence to question HCPs and the reasoning skills to sort out priorities so that I can live as best I can. Specifically, I changed neuro teams, pressed for vitD testing against the judgment of my GP, went in search of a better orthotic than the one on NHS offer and took a difficult DMT decision. None of this would have happened if I’d ‘toed the line’. I think I’d have been even more assertive if I’d fully understood at the outset how important lifestyle factors are to MS outcomes. The impact of brain load caused by co-morbidities wasn’t spelled out at the time of diagnosis and I think it should be. I also like the ‘philosophy of marginal gains’ approach and wonder if this could be unpacked more, perhaps into a self-help monitoring tool – a follow-on from a symptom diary. Lastly, I don’t underestimate the possibilities which open up if PwMS are lucky enough to have financial security: regular physio, holidays, fitness club membership etc. Perhaps the only advice HCPs can offer is for PwMS to think hard about spending priorities. Not at all easy.

  • I follow Overcoming MS. Before my diagnosis just over two years ago I had already been pescetarian or vegetarian for 23 years. I’ve never smoked. Though weight crept on in my late 20s and I had a fairly inactive lifestyle I have never been overweight according to BMI. In my early 30s I took up running. I had always thought I shouldn’t due to my hypermobile joints but my physio, on discharging me after my latest overuse injury, said there was no reason I shouldn’t run. I’ve found it’s actually helped me to manage that condition and now my MS. I run around 50-60km a week, I do yoga and pilates and in the past three years have run 7 marathons and 5 ultras.

    Looking back I think that physio really changed my life. I spent the first 26 years of my life in New Zealand, where my GP referred me to a physio when I was younger, he gave me some exercises which I performed diligently, but my mother didn’t feel it was worth paying for a second appointment. Free of the financial aspect of paying for private care, after moving here I was able to access physiotherapy on the NHS and go to as many appointments as I needed. I was able to recover to a point where I could walk the mile to work and back and then start running. I lost the weight I put on in my 20s, joined a community of runners, made friends, enjoyed benefits to my mental health as well as physical, I could go on and on…

    Now I’m on OMS I follow the diet, though tend to cheat to get enough calories in (which is possible to do without cheating so I need to recommit!). Obviously I check off the exercise and not smoking, taking vitamin D, omega 3. This year I’ve managed to commit to a daily meditation habit as well. There seem to be a lot of other people doing very well on OMS too.

  • There’s a dilemma here. I’m leading the healthiest lifestyle I can (have never smoked or drunk alcohol) in the hope that in the not too distant future there may be therapies that stop progression and perhaps therapies that promote some restoration of lost function. On the other hand, I don’t want to have MS for decades to come given how grim late stage MS is. By keeping my heart etc. healthy I may end up living longer but having to see myself deteriorate over the years. It will be difficult for a doctor to understand this, but if you have MS the fear of reaching EDSS 7, 8, 9 can be pretty overwhelming. I also have to remember that I was very fit and healthy before MS came along, so it appears counter-intuitive to someone like me to say stay as healthy as you can with MS!

    • I have to say I agree with Katey on this . I don’t really want to prolong a disabled life.
      I try to eat healthily..as I always have but I do not obsess over it….if I eventually find it difficult to swallow then I guess food will be limited ..but while I can swallow I enjoy nice food. I have the flu jab and try to avoid infections as they generally make my mobility worse which is interesting …
      My blood pressure is stable and I use a static bike daily…but that is it…. I think the situation is probably different for people with RRMS but I apparently have SPMS and certain,y don’t want to prolong my life!

    • Re: “I don’t intend to prolong my life either = be more disabled”

      An important perspective that HCPs and researchers’ don’t necessarily appreciate; we tend to equate longevity as a medical success. I suspect we should be focusing on the quality of life of pwMS rather than their longevity. Saying that people who live a healthy lifestyle tend to have higher QoL. The issue with the latter is causation vs. association or chicken vs. the egg, which came first QoL or healthy lifestyle?

      • “Look man, you can listen to Jimi but you can’t hear him. There’s a difference man. Just because you’re listening to him doesn’t mean you’re hearing him.”

        “White Men Can’t Jump”
        quote (1992)

      • ‘I suspect we should be focusing on the quality of life of pwMS rather than their longevity.’
        Totally agree. As a 56 year old I’m doing all of the following with the aim to maintain stability for as long as possible, but not wishing to achieve longevity.
        Added to not wanting to prolong my experience of a disabled life, I don’t want to be a burden to my husband in his old age as a healthy wife every which way but for MS disability.
        Exercise when I’m feeling well enough.
        IF – 14/8 and a healthy diet, stay hydrated, + supplements, including Lipoic acid.
        Don’t drink or smoke.
        Meditation and yoga relaxation techniques.
        Routine bedtime.
        Socialising – luckily have friends who can see me during the day, as fatigue means don’t go out in the evenings.
        A number of little things of which I try to do at least one a day that include:
        Stretches, walking up or downstairs with my eyes closed, walking backwards, one leg balance, foot eversion exercises, using my non dominant hand to clean teeth, chop veg etc.
        Reading, including aloud.

        Since Lemtrada and having NEDA in 2017 there’s been no improvement and it can be a struggle to work this hard and not achieve what Kay aptly calls ‘marginal gains’ Equally there’s been no deterioration either so I’m taking the attitude ‘every little helps’… to assist in keeping me ok for awhile longer🤞

  • Intermittent Fasting (18 hour fast, 6 hours to eat your 2000 calories), helps maintain my weight even when I am not well.
    When I am well I exercise as much as I can, I live in Scotland so this means hills (walking) and gym (bike and elliptical trainer for cardio and bodyweight exercises for strength) when the weather isn’t great.
    Like anything the fasting is tough for the first month or so but I find the discipline of this gives me an element of control, even when everything else seems totally out of control.
    Best thing I’ve ever done, happy to answer any questions about it.
    I don’t want to live longer, just better. I’m 39, diagnosed 8 years ago, into my last year of lemtrada monitoring.

  • Doing pretty well I’d say, in the face of / despite “PPMS”. Plant-based diet + fish, staying as active as possible, plenty of interests and hobbies, a second language. Avoiding viruses is key. Good relations with those nearest and dearest and, crucially, a lovely partner. Oh, and I say – never let anybody write you off.

  • I do wonder if posts like this reflect the paucity of real breakthroughs to address the real MS. I can’t brlieve 60 years of global MS research has lead to “don’t smoke, eat your veg, exercise more”.

    The one thing an MSer wants (do a survey to confirm if you wish) is to not become disabled / more disabled. Yet MS research has failed to identify any therapies to achieve this. Disability accrual is inevitable given time. No amount of clean and healthy living will change this. If you have MS you are living on borrowed time – lengthening the life of a disabled MSer adds burn to their family and the state.

    An SPMSer should make the most of their remaining time – enjoy the odd tipple, some nice foi gras, a good cigar now and again, and slump in front of the tv and watch rubbish like love island. Drinking purified water from a Swiss mountain lake, feasting on a quarter of an advocacy, and trying to get up the stairs with two canes to improve your stamina don’t strike me a much fun. MS always wins in the end so why not cut your losses and follow Mouse Doctors approach to booze (a lot) fags (he’s an ex-smoker) and exercise (taking the mouse droppings out to the bins). At least you’ll go out smiling!

    • Yeaa!

      Whatever You eat and unfortunately whatever Medication You Take Will Not Stop this beast. Unfortunately the benefits are so small there’s no point for us SPMS to even consider them . I get really frustrated when I see new drugs on the market that they mean incremental changes. To any RRMS live life to the full , do not worry about now because it could be much worse . And I speak my experience .

      • Whichever approach to living with the evil beast, maybe the one thing we should all have is an ADRT – got mine in the hopes I can make a smooth exit when the sh*t hits the fan.

    • enjoy the odd tipple, some nice foi gras, a good cigar now and again, and slump in front of the tv and watch rubbish like love island.

      Sounds hellish.

      • Re: “..enjoy the odd tipple, some nice foi gras, a good cigar now and again, and slump in front of the tv and watch rubbish like love island.”

        This post is not saying you can’t have your cake and eat it. It is all about moderation and mindful living. Prevention needs a lot of forethought.

    • Re: “I do wonder if posts like this reflect the paucity of real breakthroughs…”

      Our motto is “Good, bad and other research news”. We are just trying to mix things up a bit.

    • lengthening the life of a disabled MSer adds burn to their family and the state.

      People making such statements should really avoid generalisations and stick to speaking for themselves.

  • Yesterday I found a diary from 1992 in which I listed the foods I was eating each day. I was concerned because I had just quit smoking and was packing on the weight. (In retrospect, I would probably be hospitalized for being that skinny today!) Where’s my time machine?!

    The key takeaway is that the changes from Cheetos and fried chicken to salmon and salads took many, many years, with tiny changes all along the way.

    At 58, I am obsessed with taking very good care of myself. Plant based diet, exercise, checkups, vaccines, ocrevus, and lots of intellectual stimulation.

    That said, the rest of the comments in this thread need the rose-colored glasses meter–they’re making it all seem so futile.

  • My diagnosis of RRMS has definitely made me more mindful of my health. I was reasonably healthy, went to the gym and spent my holidays hiking before diagnosis – but did take the ability to do this for granted. I very quickly decided I wanted Lemtrada as a first line DMT and was lucky enough to receive it within months of diagnosis. Having accepted the risks that I have taken in following this course to do everything I can to hold back my MS I’m all the more mindful of the need to looking after myself. What would be the point in taking on all the SE risks if I was going to undermine the benefits by not looking after myself?

    I don’t follow a particular diet, but try to eat more of the good and less of the bad. You’re more likely to get a sardine than a sausage on a BBQ at my house (but I’m not adverse to the odd sausage!). I keep up the gym and supplement that with Pilates and boxing drills with my PT( great for cardio, cognitive and stress work outs!) and relish every hike I’m able to complete (last year we did the Tour de Mont Blanc which was on my bucket list). I’m fortunate to be in a position that these things are available to me.

    One new change I’ve brought in which sits so well with #thinksocial #brainhealth is to start regularly park running. Before MS diagnosis I said I couldn’t run- that I was build for strength not speed, a packhorse rather than a race horse. My diagnosis made me want to increase my cardio and throw off this self limitation. I hated running before parkrun – but my husband convinced me that running with a crowd at these super inclusive, weekly, free, volunteer and community led 5km events which take part across the country would be different. I did my first one 3.5 years ago (two weeks after Lem R1) and haven’t looked back! The events are timed but they aren’t races – and lots of people (including with mobility issues) walk or roll the courses alongside super speedy club runners, children, dogs and mid pack joggers (like me!).

    We have a dedicated FB group if anyone would like to find out more and are still running as a parkrun club under Prof. G’s #Run4MS!
    https://www.facebook.com/groups/parkrun.for.people.with.multiple.sclerosis

    • I’m with Kat though I can’t run. We all have our lives to live and our own priorities but being as fit as possible can help you do them better.

      I’m 74, had ppms for 7 years with some motor disability from outset. Didn’t live healthily when young adult – drank, smoked, ate poorly – better after 40 and I’ve always walked a lot, kept an allotment ate its produce and stayed slim. I now have to watch my diet because I’m celiac. Take Vit D, statins and Om3 (flax seeds) for other conditions so largely by accident my body is now a temple!

      I have a supportive partner, no money problems so I’ve been lucky most of my life. Since walking problems began I started to exercise, eventually effectively and have been pleasantly surprised by the results (particularly as not eligible for Ocrevus). The key thing is I enjoy staying active and it gives me some sense of control in managing the beast.

  • Family history tells me that living to 90+ is quite possible. Family history also tells me that T2 diabetes is very likely, so if I can delay that by a decade or more, I’m on board. I took up exercise a year ago, and am active more days than not. I’m eating more vegetables and less ice cream. My weight is slowly falling, and I feel better even though I do need to modify my diet towards health a bit more and will look into intermittent fasting. I’m in my early 40s and walk unassisted, though looking at my spinal scans that’s its own miracle. I have enough issues, I may as well preserve the systems that function well.

  • The ms diagnosis was delivered nearly 40 years ago, The first 15 years were riddled with exacerbations, A cane was welded to my hand, Absences from work were many, That disoriented feeling one gets after a midway ride was mine, 24/7, the horizon was no longer an absolute stable, A singular pain episode had me writhing like a bug impaled by a pin. Early on I recall collapsing repeatedly next to my hospital bed. MS had declared war and my body was the battlefield. Methylprednisolone was the chosen weapon doctors `used over and over again, with good results, Today I feel as if I’ve won the lottery. The neurologist calls me his lucky man, I’ve gone into a years long remission with an EDSS score of <2. I am delighted. Good luck to everyone!

By Prof G

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