Allen Bowling: What We Know About Lifestyle Factors and MS

Lifestyle factors and multiple sclerosis is a two-way street; but what does that mean for practicing physicians? Allen Bowling, MD, PhD, explains at the 2016 Annual Meeting of the Consortium of Multiple Sclerosis Center (CMSC) in National Harbor, Maryland.

The term “lifestyle medicine” was first coined in 1999, and it covers daily habits and practices, such as diet and exercise. These modifiable factors are important in nearly every health condition. Allen Bowling, MD, PhD, a practicing multiple sclerosis specialist in Colorado, explained how the factors apply to this condition at the 2016 Annual Meeting of the Consortium of Multiple Sclerosis Center (CMSC) in National Harbor, Maryland.

It’s true that multiple sclerosis isn’t considered a typical lifestyle disease, like obesity and high blood pressure. Bowling said, however, that he would call it an atypical lifestyle disease. Evidence continues to emerge pointing to “westernization” — consisting of diet, physical activity, hygienic conditions, and high stress – as playing a role in the central nervous system disease.

“Lifestyle factors can have an effect on MS,” Bowling said during the talk at CMSC 2016. But it’s not a one-way street; multiple sclerosis can impact lifestyle choices as well.

A study conducted by the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2006 found that only 2.7% of Americans satisfy four crucial lifestyle areas — diet, physical activity, tobacco, and body fat percentage. Now think about the number of people living with multiple sclerosis, who may need to satisfy these areas more than others, and how most of them most likely don’t.

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It’s been well-established that these lifestyle factors impact health conditions, but it’s still being investigated how they directly influence multiple sclerosis. However, with the emerging evidence saying that they do connect, knowledge is power, right? “That’s not true,” Bowling said. It’s not enough to just know that there is a link, it’s really about learning how to address lifestyle issues and how to improve them.

Bowling, who interacted with his first patient with multiple sclerosis 30 years ago, explained that using multiple sclerosis as a lifestyle motivator is frequently a missed opportunity. Clinicians can optimize the patient’s suffering to encourage lifestyle changes.

The missing piece in this multiple sclerosis-lifestyle puzzle is comorbidities. Many patients experience pain, psychological issues, and gastrointestinal problems — just to name a few. So lifestyle decisions can influence the likelihood of having additional health conditions.

Bowling mentioned that people with multiple sclerosis are prone to constipation — an issue that can be eased with fiber. Fiber also helps prevent non-neurological diseases, such as diabetes and heart disease. So managing fiber intake in patients with multiple sclerosis, especially in their 20’s so that they can have positive effects over a lifetime, can have great impact on quality of life.

Salt intake is one of the greatest dietary harms to health. The average American consumes 4,000 mg of salt per day, even though the recommendation is 1,500 to 2,3000 mg/day, and this intake increase the risk of disease. Previous research has shown that high sodium intake increases production of pro-inflammatory Th17 cells and causes more severe experimental autoimmune encephalomyelitis (EAE) — an area used to develop multiple sclerosis therapeutics. “We should have been talking about dietary salt five years ago,” Bowling said.

So when a patient comes in the office asking about the best diet for someone with multiple sclerosis, what do you say? Well, as Bowling described, the literature on diets is murky — including anti-inflammatory diets that many people ask about. Some good data has supported Paleolithic and Mediterranean diets, but the understanding on how food is relative to multiple sclerosis is “extremely limited.” Yes, inflammation affects organs and tissues, but direct data linking to multiple sclerosis is another story. Until better research is gathered, a generally healthy diet is what physicians tend to shoot for with their patients. This means more fruits and vegetables, and less sugar and refined carbs. It doesn’t look like there’s a magic diet awaiting patients with multiple sclerosis, not yet anyway.

Needless to say, there’s a lot that we don’t know about how lifestyle factors, specifically diet, impacts multiple sclerosis and its comorbidities. But based off of recent research, it’s fair to say that the two do impact one another. Now it’s just a matter of answering the lingering question… how?

Also on MD Magazine >>> More News from the CMSC 2016 Annual Meeting