Sleep disturbances, covering a broad spectrum of issues and diagnoses, are notably common among individuals with Multiple Sclerosis (MS). Disorders such as insomnia, sleep-disordered breathing, restless leg syndrome, and narcolepsy are more frequent in people with MS compared to the general population, with over half of those with MS experiencing sleep disruptions or dissatisfaction. This article will look at how sleep affects MS, and practical ways to help you get some shut-eye.

Can quality of sleep affect MS fatigue?

MS fatigue, thought to be caused by the reduction of energy available for essential functions due to widespread neuroinflammation and oxidative stress, is one of the most prevalent MS symptoms. A 2023 meta-analysis found strong correlations between self-reported measures of insomnia and sleep quality with MS fatigue. Interestingly however, objectively measured total sleep time and delayed sleep onset showed the weakest and non-significant link to MS fatigue.

Insomnia, restless leg syndrome, poor sleep quality, and excessive daytime sleepiness have been shown to be significant predictors of fatigue in people with MS. Frequent night awakenings also have a stronger relationship to fatigue.

How might sleep affect MS outcomes?

A 2019 study of 40 participants with relapsing-remitting MS explored the relationship between sleep quality, relapses and the Expanded Disability Status Scale (EDSS) score over a three-year period. Excluded from the study were those with symptoms likely to interfere with sleep quality, such as bladder dysfunction, severe pain, spasticity, psychiatric symptoms, and cognitive deficits. Participants reporting poor sleep quality as per the Pittsburgh Sleep Quality Index (PSQI) had a significantly higher probability of negative MS progression and increased relapse rates. These results suggest that the course of MS may be influenced by sleep quality, possibly due to impacts on myelin repair. Despite its limitations, including small sample size and reliance on PSQI scores without polysomnographic evaluations (brain wave, oxygen level, heart rate and breathing), the study highlights the need to address sleep issues for potentially better MS outcomes.

Improve sleep with nutrition

Addressing the role of nutrition and adhering to fundamental sleep hygiene principles may significantly enhance sleep quality and overall well-being.

Include:

• A diet high in fibre and vegetables – A healthy gut microbiome has been linked to better sleep. Fibre-rich fruits, vegetables, and whole grains feed the good bacteria in the gut, potentially promoting the production of sleep-supportive neurotransmitters like gamma-aminobutyric acid (GABA). Consider incorporating leafy greens such as spinach, Swiss chard and broccoli, legumes like black beans and lentils, and deep coloured fruit like blueberries into your meals.
• Fatty fish – Omega-3 fatty acids, EPA and DHA, have been linked to improved sleep efficiency. Include 2-3 portions of fatty fish (salmon, mackerel, anchovies, sardines or herring) in your diet each week, or include a quality EPA and DHA supplement.
• Tart cherry juice – Montmorency cherry juice contains naturally occurring melatonin and other antioxidants that may improve sleep duration and quality.
• Supplements (under guidance from a nutritionist) – Deficiencies in magnesium, zinc, or B vitamins may disrupt sleep. Magnesium plays a role in muscle relaxation and neurotransmitter function, while zinc is involved in melatonin metabolism.
• Relaxing herbs – Passionflower and valerian root tea (1-2 tbsp per infusion) an hour before bed may help ease anxiety and promote sleep.
• Probiotics – Certain strains of bacteria may improve sleep quality perception in people experiencing sleep disturbances. Probiotics help maintain a healthy gut microbiome which might contribute to better sleep.
• Tryptophan-rich food – Tryptophan is an amino acid which your body converts into melatonin, the sleep hormone. Include tryptophan-rich foods like salmon, nuts, prunes, soy products, quinoa, oats, and bananas in your diet to support melatonin production naturally.

Avoid:

• Caffeine – While caffeine may be seen as indispensable for many, it can stay in your system for hours, interfering with sleep by blocking the effects of adenosine, a naturally occurring chemical in your body that helps regulate sleep. Avoid caffeine in food and drinks in the afternoon and evening.
• Alcohol – Alcohol may make you drowsy initially, but it disrupts sleep later in the night by suppressing REM sleep, which is crucial for memory consolidation and emotional processing.
• Avoid refined sugars – High sugar intake has been associated with lighter and less restorative sleep. Swaps those cakes and biscuits for sweet treats such as chia puddings with fruit and nuts, or a seasonal fruit crumble topped with rolled oats, nuts, seeds, and spices.
• Acid reflux triggers – If you suffer from heartburn, avoid spicy or fatty foods close to bedtime, as they can worsen symptoms and disrupt your sleep.

Make lifestyle changes

• Epsom salt baths – Magnesium from Epsom salts absorbed through the skin may promote relaxation and better sleep. A warm bath with Epsom salts about an hour before bed can help ease muscle tension and prepare your body for sleep.
• Eat dinner earlier – Aim for dinner at least 2-3 hours before you hit the sack.
• Morning light – Expose yourself to bright natural light soon after waking up. This helps regulate your circadian rhythm, the internal body clock that governs sleep-wake cycles.
• Avoid screens – Power down electronic devices at least an hour before bed. The blue light emitted from phones and tablets can interfere with the production of melatonin, the sleep hormone.
• Consistent routine – Go to bed and wake up at the same time every day, even at the weekend, to help regulate your internal clock.
• Your environment – Make your bedroom conducive to sleep by keeping it cool, dark, and quiet. Consider blackout curtains, a face mask and earplugs.
• Wind down before bed – Incorporate relaxation techniques such as deep breathing, meditation, or gentle yoga before bed to calm the mind and prepare for sleep.

Prioritise sleep

We often overlook the importance of a peaceful slumber. Prioritising good sleep hygiene and addressing underlying nutritional factors could significantly improve your sleep routine and could potentially affect your MS health journey. Here’s to sweet dreams ahead!

Additional resources

• Download my free Sleep Boosting Recipes for MS: 7-day meal planner with easy-to-follow recipes.

Here I explore the connection between weight management and Multiple Sclerosis (MS), providing evidence-based dietary and lifestyle recommendations to support optimal health and well-being.

The impact of weight on MS

What have studies found?

• Obesity has been linked to a higher risk of developing MS and experiencing more frequent relapses.
• People with MS who are obese tend to have greater disability and experience worse long-term health outcomes.
• Excess weight is associated with heightened inflammation, a factor contributing to MS severity.

Why weight management matters

Effective weight management becomes even more crucial for individuals with MS due to the increased risk of co-existing conditions like type 2 diabetes and cardiovascular disease.

Factors affecting weight management

There are various factors influencing weight management, including:

• Basal Metabolic Rate (BMR) – This is your body’s internal calorie-burning furnace. Factors like physical activity, muscle mass, genetics, and thyroid hormones affect your BMR.
• Genetics – While genes don’t predetermine obesity, they may influence susceptibility to weight gain and sugar processing.
• Calories – “Calories in, calories out” is an over simplification. Our bodies are complex, and factors like gut bacteria and hormonal response play a significant role.
• Ultra-processed foods – These convenient, highly palatable options are often loaded with additives, sugar, fat, and salt, leading to overconsumption and weight gain. They may also disrupt the gut microbiome, impacting weight management.
• Gut microbiome – The trillions of microorganisms residing in your gut influence weight through factors like nutrient absorption, appetite regulation, and inflammation.
• Blood sugar regulation – A high-fibre diet promotes gradual blood sugar rise, preventing energy crashes and cravings for sugary snacks.
• Hormones – Leptin, ghrelin, insulin, and cortisol significantly impact appetite, energy expenditure, and fat storage.
• Movement and exercise – Our bodies are incredibly adaptable, and in response to exercise they may increase hunger cues, upping food intake. This doesn’t negate the benefits of exercise for weight management, but it highlights the importance of a holistic approach that considers diet alongside physical activity. Regular physical activity offers numerous benefits beyond weight loss, including improved heart health, immunity, and gut microbiome function.

Developing a sustainable approach

There’s no one-size-fits-all solution for weight management. Here are key principles for a sustainable approach:

• Focus on overall health, not just weight loss.
• Make gradual, long-term dietary and lifestyle changes.
• Prioritise nutrient-dense whole foods over processed options.

Dietary strategies

• Include a good quality protein source with each meal. Protein promotes satiety and helps regulate blood sugar.
• Choose healthy fats over refined sugars and processed carbohydrates. Healthy fats contribute to satiety, hormone regulation, and potentially reduced inflammation.
• Incorporate anti-inflammatory foods and antioxidants. These foods combat inflammation and protect cells from damage, positively impacting gut health, improving insulin sensitivity and overall well-being.
• Increase fibre and plant diversity in your diet. Fibre promotes satiety, regulates blood sugar, and supports a healthy gut microbiome.
• Consider prebiotic and probiotic foods. Prebiotics nourish good gut bacteria, while probiotics directly add beneficial strains to your gut microbiome.

Additional tips

• Explore Intermittent Fasting (IF). IF involves cycling between eating and fasting periods, potentially improving hormonal regulation and weight management.
• Maintain a healthy balance of omega-3 and omega-6 fatty acids. Omega-3s may help reduce inflammation, while excessive omega-6 intake may contribute to weight gain.
• Practise mindful eating. Pay attention to hunger and satiety cues, avoiding distractions like television while eating.
• Prioritise quality sleep for optimal metabolic health and appetite regulation.

Remember, consistency is key!

Additional resources

• Download my free guide on how to support your gut health with probiotic foods.

People with MS have a higher rate of osteoporosis, and increased prevalence of falls and fractures. Great, another challenge on our road to good health.

What is osteoporosis?

Osteoporosis is the imbalance in the rate of osteoclast mediated bone resorption (the process by which the bones are broken down and absorbed by the body) and osteoblast mediated bone formation, leading to a loss of bone mineral density, bone strength and an increase in fractures.

Reduced physical activity

Mechanical stress, including load bearing exercise, stimulates osteoblast activity (cells that build bones) and suppresses osteoclast activity (cells that break down bones). Reduced physical activity due to MS-related disabilities may contribute to decreased mechanical stress on bones, leading to bone loss and higher rates of osteoporosis.

Medications

Glucocorticoids which can be used for the management of acute relapses in MS, increase bone turnover, and are a subsequent risk for osteoporosis and osteopenia.

Vitamin D

Vitamin D deficiency, a risk factor for the development of MS, may also play a role in increased rates of osteoporosis. Vitamin D plays a crucial role in bone health by regulating the intestinal absorption of calcium and phosphorus, and promoting osteoblasts (those bone builders).

The autonomic nervous system (ANS)

Dysfunction in the autonomic nervous system (ANS) is increasingly recognised in MS, and it may contribute to reduced bone mineral density and an increased risk of osteoporosis. The ANS modulates bone metabolism through its sympathetic and parasympathetic branches. Dysfunction in either branch can impact bone health, with an overactive sympathetic nervous system leading to excessive bone breakdown and an underactive parasympathetic nervous system hindering bone formation.

While the exact mechanisms are still under investigation, several factors contribute to ANS dysfunction in MS:

• Inflammation – The chronic inflammatory process characteristic of MS can directly damage autonomic nerve pathways, leading to functional impairment.
• Demyelination – Damage to the protective myelin sheath surrounding nerve fibres disrupts signal transmission within the ANS.
• Brain lesions – Lesions in specific brain regions responsible for autonomic control can disrupt communication and feedback loops within the nervous system.

Women’s health, oestrogen, menopause, and MS

In women with MS, the decline in oestrogen during perimenopause and menopause further heightens the risk of osteoporosis. Oestrogen plays a crucial role in bone health by stimulating bone formation, inhibiting bone breakdown, and regulating calcium absorption. The shift during perimenopause and menopause disrupts this delicate balance, leading to increased bone breakdown and slower formation. Postmenopausal women with MS are at an elevated risk of osteoporosis, compounded by other factors such as low calcium intake, family history, and reduced exercise. This interplay of hormonal changes, MS, and osteoporosis underscores the need for tailored interventions and heightened awareness in women’s health care.

Nutritional therapy

While osteoporosis, osteopenia, and MS bring unique challenges, nutritional therapy offers a valuable tool to support bone health and overall well-being in individuals facing these conditions. By working with me, a registered nutritional therapist, you will receive a personalised plan that addresses your specific needs and risk factors.

If you would like support on your health journey, take a look at the range of nutritional therapy programmes which I offer. Please contact me for a free discovery call for more information. I look forward to working with you soon.

Introduction

Multiple Sclerosis (MS) is a complex neurological disorder that not only affects the central nervous system but has also been associated with an increased risk of cardiovascular issues. Studies have shown a higher prevalence of ischemic heart disease, congestive heart failure, and abnormalities in blood pressure, heart rate, and dyslipidaemia (imbalance in levels of fats in the blood) among individuals with MS compared to the general population. In this blog, I’ll look into the relationship between MS and cardiovascular risk, exploring the various factors that contribute to this association.

Risk factors in people with MS

• Macrovascular Disease (MVD) and atherosclerosis

Individuals with MS face an elevated risk of MVD, affecting large blood vessels like coronary arteries, the aorta, and major arteries in the brain and limbs. Atherosclerosis, characterised by the build-up of plaque on vessel walls, is a key contributor to MVD. Chronic inflammation, which is seen in MS, may damage blood vessel walls, making them more susceptible to plaque formation. Studies have shown that women with MS may be at a greater risk of macrovascular disease and myocardial infarction compared to men (as if we didn’t already have enough to deal with).

• Diabetes and cardiovascular risk

People with MS are more likely to have diabetes at the time of diagnosis than the general population. Diabetes is a known cardiovascular risk factor, and its coexistence with MS may contribute to an increased susceptibility to cardiovascular complications.

• Autonomic cardiovascular dysfunction

Correlations have been observed between autonomic cardiovascular dysfunction (the autonomic nervous system is involved in all the stuff that happens without our conscious control) and secondary progressive MS. Plaques in the spinal cord and brain disrupt autonomic pathways, potentially leading to altered blood pressure and heart rate responses. Lesions in reflex pathways within the brainstem further contribute to cardiovascular irregularities.

• Heart rate variability (HRV)

HRV, an indicator of autonomic nervous system activity, is crucial for adaptability to stress and overall health. Individuals with MS often exhibit decreased HRV, suggesting reduced adaptability to stress, impaired cardiovascular regulation, and potential links to disease progression, fatigue, and pain.

Understanding the mechanisms

The precise mechanisms linking MS and cardiovascular risk are still under investigation. Chronic inflammation, autoimmune responses affecting cholesterol metabolism, lifestyle factors (such as physical inactivity, an unhealthy diet, and smoking), and certain medications used to treat MS, particularly corticosteroids, are considered contributing factors.

• Higher levels of LDL cholesterol (often referred to as “bad cholesterol”), total cholesterol, and triglycerides are associated with worsening disability, with increased total cholesterol linked to more MRI brain lesions in clinically isolated syndrome patients. This may be due to altered mechanisms in the blood-brain barrier vascular endothelium from an increased recruitment of immune cells.
• Chronic inflammation in MS may play a role. Inflammation damages blood vessel walls, making them more susceptible to plaque buildup and atherosclerosis, the underlying cause of MVD. Additionally, inflammatory cells might directly contribute to cholesterol dysregulation.
• The immune system dysfunction underlying MS might directly affect cholesterol metabolism and its regulation. Some studies suggest autoantibodies targeting specific proteins involved in cholesterol transport and processing may be at play.
• Individuals with MS might be more prone to certain lifestyle factors associated with MVD, including physical inactivity, an unhealthy diet, and smoking. These factors can further exacerbate the risk associated with MS itself.
• Some medications used to treat MS, particularly corticosteroids, can raise LDL cholesterol levels as a side effect. This highlights the need for regular monitoring and potential adjustments to manage both MS and cardiovascular risks.
• Vitamin D deficiency, common in people with MS, has been linked to an increased risk of MVD. Additionally, genetic susceptibility might play a role in some individuals.

Conclusion

As individuals with MS face an increased vascular burden compared to the general population, vascular management should be an integral part of their overall care. Regular screening for risk factors, including cholesterol levels, blood pressure, and smoking habits, is essential. Lifestyle modifications, such as maintaining a healthy diet and weight management, play a vital role in reducing cardiovascular risk.

It is important to recognise that not all individuals with MS experience elevated LDL cholesterol or develop cardiovascular diseases, however, understanding and addressing cardiovascular risk factors early on can contribute to better overall health outcomes for those living with MS. Additionally, as some disease-modifying therapies may have side effects, close monitoring and potential adjustments are necessary to manage both MS and cardiovascular risks. Overall, a holistic approach to healthcare, considering both neurological and cardiovascular aspects, and the effect of nutrition, is important for individuals with MS.

If you would like support on your MS health journey, take a look at the range of nutritional therapy programmes which I offer. Please contact me for a free discovery call for more information. I look forward to working with you soon.