BrainHealth & ClinicSpeak: chicken or egg?

How healthy is your lifestyle? Have you optimised your brain health? #BrainHealth #ClinicSpeak

“The cross-sectional study below suggests moderate-to-high exercise, moderate alcohol consumption, plant-based omega 3 supplementation and disease-modifying medication are all associated with less disability in MSers. Chicken or egg? A knee jerk response would be that it is obvious that all these lifestyle factors must be affecting the natural history of MS. However, with the exception of DMTs we don’t have class one evidence that this is the; by class 1 evidence I mean randomised blinded intervention studies. These observations can all be due to reverse causation, i.e. mild MS, or less disabling MS, may simply be associated with better lifestyle choices. It is unlikely that we are going to see Class 1 evidence anytime soon for these lifestyle factors, so it will need to be a judgement call you personally will need to take about whether or not to adopt them or not. Outside of MS there are strong scientific arguments to support a healthy lifestyle, which is why these factors are one of the pillars of our Brain Health campaign. The decision in my opinion, whether or not you have MS, is when are you going to take control of your own life and live the lifestyle that will optimise your long-term brain health? Your GP, neurologist or MS clinical nurse specialist can’t do it for you.”

Jelinek et al. Associations of Lifestyle, Medication, and Socio-Demographic Factors with Disability in People with Multiple Sclerosis: An International Cross-Sectional Study. PLoS One. 2016 Aug 25;11(8):e0161701. doi: 10.1371/journal.pone.0161701. eCollection 2016.

OBJECTIVE: Emerging evidence links modifiable lifestyle risk factors to disease progression in multiple sclerosis (MS). We sought further evidence around this hypothesis through detailed analysis of the association with disability of lifestyle behaviours of a large international sample of people with MS.

MATERIALS AND METHODS: A total of 2469 people with MS from 57 countries provided self-reported data via cross-sectional online survey on lifestyle (mostly with validated tools) and the primary outcome measure, disability (Patient Determined Disease Steps), categorised from 8 steps into 3 categories, mild, moderate and major disability. Multinomial logistic regression modelling derived relative risk ratios (RRRs) for disability categories.

RESULTS: RRRs of having moderate vs mild disability were: diet (per 30 points on 100 point scale) 0.72 (95%CI 0.52-0.98), ever smoking 1.32 (1.06-1.65), exercise (moderate/high vs low) 0.35 (0.28-0.44), latitude (per degree from the equator) 1.02 (1.01-1.04), and number of comorbidities (2 vs none) 1.43 (1.04-1.95), (3 vs none) 1.56 (1.13-2.16). RRRs of having major vs mild disability were: exercise (moderate/high vs low) 0.07 (0.04-0.11), alcohol consumption (moderate vs low) 0.45 (0.30-0.68), plant-based omega 3 supplementation 0.39 (0.18-0.86), and disease-modifying medication use 0.45 (0.29-0.70).

CONCLUSIONS: Healthier lifestyle has strong associations with disability in our large international sample of people with MS, supporting further investigation into the role of lifestyle risk factors in MS disease progression.

One thought on “BrainHealth & ClinicSpeak: chicken or egg?”

  1. Being diagnosed in 1986 with no DMT's means I missed a lot of years with no medications. Now at 57 I'm concerned about my MS future even though I remain RRMS. Great information stated here for the entire MS community. Many thanks.

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