Multiple Sclerosis (MS) is a chronic disease that affects the central nervous system, disrupting the flow of information between the brain and the body. While MS pathology does not directly cause an increase in body fat, weight gain is a common concern. The connection is indirect, arising from secondary effects related to MS symptoms and the medications used to manage them. Understanding these links is important for maintaining a balanced weight and overall health.
How MS Symptoms Affect Calorie Expenditure
The most significant indirect cause of weight gain stems from MS neurological symptoms that limit physical activity and alter the body’s energy balance. Severe fatigue, which affects most individuals with MS, often leads to an extreme reduction in daily movement and promotes a sedentary lifestyle. This pervasive exhaustion interferes with the motivation and ability to exercise, directly lowering the total calories burned each day.
Mobility impairments, such as spasticity, muscle weakness, and balance issues, make sustained physical activity difficult or unsafe. When walking is challenging due to gait problems or pain, the ability to engage in calorie-expending activities decreases. Individuals with MS often engage in significantly more sedentary behaviors, which is linked to adverse health outcomes like obesity.
This reduction in movement also impacts the body’s energy-burning machinery. Sustained inactivity leads to a loss of muscle mass, which is metabolically active tissue. A lower amount of muscle mass results in a decreased basal metabolic rate (BMR), meaning the body burns fewer calories at rest. This combination of reduced activity and a lower BMR creates an energy imbalance, contributing to weight gain.
Medication-Related Causes of Weight Change
Weight gain can be a direct side effect of pharmacological treatments for MS or its related symptoms. High-dose corticosteroids, such as methylprednisolone, are commonly used in short courses to manage acute relapses by rapidly reducing inflammation. These steroids cause weight gain through multiple mechanisms, even in short-term use.
The primary effects include stimulating appetite, leading to increased caloric intake, and promoting fluid retention. Steroid use can also cause fat redistribution toward the abdominal area. While weight increase from fluid retention is temporary, increased appetite can contribute to lasting weight changes.
Certain medications prescribed to manage MS-related symptoms, such as neuropathic pain or depression, may also list weight gain as a known side effect. For example, some anticonvulsants and specific classes of antidepressants can influence metabolism or appetite. Most modern disease-modifying therapies (DMTs) used for long-term management of MS are not associated with significant weight fluctuations.
Strategies for Maintaining Weight Balance with MS
Maintaining a balanced weight requires an approach customized to accommodate the unique physical challenges of MS.
Adaptive Exercise
Adaptive exercise is a foundational strategy, focusing on movement that mitigates symptoms like heat sensitivity and fatigue. Low-impact activities are encouraged, such as water aerobics or swimming. The water’s buoyancy supports the body, and the cool temperature helps prevent the temporary symptom worsening that can occur with overheating.
Pacing activity is an important tactic to manage MS fatigue, often involving short bursts of movement followed by rest periods. Using cooling vests or neck wraps during exercise helps regulate core body temperature, allowing for longer or more comfortable workouts. Functional movements that mimic daily tasks, like chair squats or step-ups, can be incorporated to build strength and maintain independence.
Nutrition
Nutritional considerations must address general health and specific treatment side effects. When taking corticosteroids, focusing on nutrient-dense foods and managing portion sizes can counteract the steroid-induced increase in appetite. A balanced diet rich in fresh fruits, vegetables, lean proteins, and healthy fats is recommended to support overall energy levels and neurological health.
Professional Support
An interdisciplinary care team is an invaluable resource for creating a safe and sustainable plan. A physical therapist can design an individualized exercise program that accounts for specific mobility limitations and spasticity issues. Consulting with a registered dietitian who understands the metabolic and fatigue challenges of MS can help tailor a meal plan that manages weight without compromising energy or nutritional needs.