December 12, 2013 | News | Living with MS

Lifestyle choices: the good and bad news

As we enter the holiday period, it’s worthwhile looking at how all those seasonal temptations can affect multiple sclerosis.

Smoking is near the top of everyone’s hit list, as you might expect. Surveys have shown that a majority of people with MS have smoked at one time or another (Marrie and colleagues. Neuroepidemiology 2009;32:72-79), although many people try to quit after they’re diagnosed. The current estimate is that about 1 in 6 people with MS continue to smoke (Healy and colleagues. Arch Neurol 2009;66:858-864), a slightly lower rate than what’s seen in the non-MS population.

It’s well established that smoking increases the risk of developing MS (Handel and colleagues. PLoS One 2011;6:e16149). This has prompted some to speculate that the increasing prevalence of MS (especially among women) in society is linked to the increasing prevalence of smoking, a phenomenon that peaked in 1965 (as fans of Mad Men will appreciate) (Palacios and colleagues. Ann Epidemiol 2011;21:536-542). It’s an interesting idea, but one that’s difficult to prove.

Does continuing to smoke after you’re diagnosed make MS worse? Here the results are a little more mixed. One study found that smoking is associated with larger brain lesions on MRI (Zivadinov and colleagues. Neurology 2009;73:504-510). Other studies have suggested that smokers are at risk of developing disability earlier (Manouchehrinia and colleagues. Brain 2013;136(Pt 7):2298-2304), although this has been disputed (Handel 2011). One group of researchers found that smokers were somewhat less likely to have a relapse, but had a higher risk of progression (Pittas and colleagues. J Neurol 2009;256:577-585). And others have reported that smoking doesn’t appear to make other MS symptoms worse (Shirani & Tremlett. J Inflamm Res 2010;3:115-126).

Smoking may also indirectly affect MS because it’s been shown to increase the likelihood of having a poor response to some MS therapies, such as the interferons (Avonex, Betaseron/Extavia, Rebif) and Tysabri (Hedstrom AK and colleagues. Mult Scler 2013; epublished August 7, 2013; Hedstrom and colleagues. Mult Scler 2013; epublished December 5, 2013). In both cases, smoking promotes the development of antibodies to these drugs, so the treatments become less effective.

Of course a smoker’s list of New Year’s resolutions isn’t complete without a mention of quitting. To add to the incentive, a study at the Karolinska Institute in Sweden recently reported that nicotine may lower the risk of developing MS because of its anti-inflammatory effects (Hedstrom and colleagues. Mult Scler 2013;19:1009-1013). So nicotine patches or gum may help you quit – and could provide some added benefit to your MS.

The news is a little better when it comes to alcohol. A large study recently found that people who consumed moderate amounts of alcohol had a better quality of life and a lower risk of disability compared to alcohol abstainers (Weiland and colleagues. J Neurol Sci 2013; epublished November 8, 2013). Similarly, a Belgian study found that people who enjoyed a glass of wine with dinner or the occasional beer were less likely to develop significant disability (D’hooghe and colleagues. Eur J Neurol 2012;19:616-624).

So if you plan to toast the New Year, you can do it guilt-free. A little alcohol won’t have an impact on your MS.

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