Beyond the essential role of disease-modifying therapies (DMTs) in managing MS, there’s a growing interest in strategies that support brain health. While DMTs are critical in reducing relapses and slowing progression, they aren’t the only tools in our arsenal.
By focusing on holistic wellness — encompassing things like diet, sleep, stress management, exercise, and social engagement — we can bolster the brain’s resilience and enhance quality of life.
But first, let’s dig into the science with a quick refresher on the basics of MS.
Understanding the Brain and MS
Not long ago, MS was classified into rigid categories or “types” of MS:
- Clinically Isolated Syndrome (CIS) and Radiologically Isolated Syndrome (RIS)
- Relapsing-Remitting MS (RRMS)
- Primary Progressive MS (PPMS)
- Secondary Progressive MS (SPMS)
These classifications suggested a fixed path, from less severe forms like CIS and RRMS to more debilitating progressive forms like PPMS and SPMS. It was generally accepted that if your MS progressed, it would follow a similar path toward the more severe forms, and often new MS patients were told to prepare for the worst.
Today, we understand that MS doesn’t fit so nicely into those fixed definitions. Every individual person’s experience with MS is different, and while many people share lots of common symptoms, there’s no single defining way that MS presents itself, and no singular path that MS takes.
Partly, that’s due to where MS is physically impacting a person’s central nervous system – where MS lesions develop will impact the symptoms that affect your life. But it also has to do with the interventions we’re able to apply, from early and effective use of modern MS medicines, to lifestyle adjustments and what we each can do to most effectively adapt and thrive while managing the disease.
Advancements in Understanding
Years ago treatment options were limited, and the advice to patients often centered around avoiding stress and exercise, based on the belief that these could exacerbate symptoms. The recommendation to “take it easy” left many feeling powerless in their management of the disease.
The development of MRI technology in the 1980s marked a pivotal shift in our understanding of MS. With the ability to visualize lesions and monitor disease progression, doctors and researchers gained new insights into how MS affects the brain, and new perspectives on how to track and treat it over time. This technological leap, paired with developments and rapid advancements in medicines, transformed MS from a largely untreatable condition into one where long-term management is not only possible, but now considered quite routine.
Over the years, many common myths about the brain have also been debunked. Contrary to what was once popular belief, we use all parts of our brains, not just 10 percent, and the adult brain retains its ability to change throughout life. This concept, known as neuroplasticity, is vital for people with MS. It means that even in the presence of damage, the brain can adapt — as we’ll talk about later.
Maximizing Brain Health: Brain Volume and Cognitive Reserve
The brain has remarkable capacity for resilience, much of which hinges on two key concepts: brain volume and cognitive reserve. Brain volume refers to the physical aspects of the brain, such as its size and overall neuron count.
Some people are naturally endowed with larger brain volumes, which may offer some protection against damage. You can think of brain volume as the brain you’re born with – or at least, the brain’s innate characteristics that we don’t have much control over.
It’s also important to note here that roughly around the age of 30, ALL of our brains begin to shrink. This is a natural part of the human aging process, and therefore it’s not particularly alarming — but it’s important for people living with MS to understand that the normal course of aging is also impacting their brain volume.
Cognitive reserve, on the other hand, is developed over time and reflects how effectively the brain utilizes its resources. Unlike brain volume, cognitive reserve is shaped by things like exercise, mental engagement, and life experiences. The way we live, learn, interact with the world, and take care of ourselves can all have direct impacts on cognitive reserve.
And that’s vitally important – cognitive reserve is the brain’s ability to adapt and compensate for damage by rerouting neural pathways. Think of it like having a versatile toolkit — when one tool breaks, cognitive reserve provides us with another tool to handle the job.
Most importantly, and distinctly different from brain volume, we know that there’s an encouraging element at play when it comes to cognitive reserve.
“There are many aspects of MS that you can’t control, but it’s important to know that there are many, many things that you can influence to help you feel your best. There are no silver bullets, but each area of brain health is something that you can influence.”
DR. ENRIQUE ALVAREZ,
Medical Director, Rocky Mountain MS Center
Encouraging News About Cognitive Reserve
Having a robust brain and cognitive reserve means the brain is better equipped to handle and adapt to damage caused by MS. Just like keeping a savings account helps weather a personal financial crisis, a strong cognitive reserve acts as a neurological safety net, allowing the brain to reroute signals, compensate for damage, and maintain function even in the face of disease progression.
This concept partly explains why two people with similar MS lesion loads can experience vastly different symptoms. One person may have numerous lesions visible on an MRI but show minimal cognitive difficulties, while another may have fewer lesions but struggle with memory, processing speed, or multitasking. It’s not just about how much damage occurs—it’s about how effectively the brain can work around it.
So, what’s the encouraging part? Cognitive reserve is not a fixed trait — it’s something that can be built and strengthened, over time and throughout our lives.
While MS can present challenges, the brain has an incredible ability to adapt and reorganize itself in response to those challenges. This is neuroplasticity, the process mentioned earlier, that allows the brain to form new pathways, reinforce existing connections, or even shift brain functions to less-affected areas.
This means that even though MS may cause damage to certain parts of the brain, the ability to think, learn, move, problem-solve, and function isn’t necessarily lost — it can be rerouted and preserved with the right support. Just as regular deposits grow that financial reserve in your savings account, continually engaging and challenging the brain helps reinforce its ability to function, even under the stress of living with MS.
Building cognitive reserve is an ongoing process, one that doesn’t happen overnight but accumulates over a lifetime. And while MS can make certain tasks more difficult, taking steps to support brain health and adaptability can help ensure that the mind remains as strong and resilient as possible.
While no single lifestyle change can cure MS, adopting a combination of healthy habits can optimize brain function and reduce the burden of symptoms.
Diet: Nourishing the Brain
There’s no definitive diet that can stop MS in its tracks, but growing evidence suggests that nutrition plays a vital role in brain health, lowers the risk of many other diseases and disorders, and promotes overall wellness. While diet alone cannot alter the course of the disease, making thoughtful food choices can support the body’s natural resilience, helping to manage symptoms and promote long term brain function.
Diets that emphasize whole, unprocessed foods—such as fresh produce, lean proteins, and healthy fats—are widely considered beneficial for overall health and have been linked to improvements in cardiovascular health and cognitive function, and can support weight management.
Among the diets studied for brain health, the Mediterranean diet stands out. Its focus on fruits, vegetables, whole grains, nuts, olive oil, and lean proteins like fish and poultry, has been associated with reduced cognitive decline and improved long-term health outcomes. Unlike many restrictive diets, the Mediterranean approach is flexible, sustainable, and easily adaptable to different tastes and cultural preferences, making it a practical option for many people.
Another nutritional philosophy to consider for brain health is the MIND diet. MIND stands for “Mediterranean-DASH Intervention for Neurodegenerative Delay.” It is a combination of the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. The MIND diet emphasizes eating more of nine categories of food (green leafy vegetables, all other vegetables, berries, nuts, olive oil, whole grains, fish, beans, and poultry) and less of 5 categories (butter and margarine, cheese, red meat, fried food, and pastries and sweets). These recommendations focus specifically on nutrition that promotes better cognitive function and prevents dementia.
Ultimately, no single dietary approach has been proven to be the “best” for MS. Rather than focusing on rigid dietary rules, the best approach to nutrition in MS is to prioritize balanced, nutrient-dense eating habits that support both brain and body function. And remember that small, sustainable changes are better than none — and we’re also much more likely to stick to interventions that don’t completely disrupt our routines. Take changes step by step, and make more changes when you’re ready.
For more information, see “Food for Thought” from InforMS Magazine (Fall 2020) and past webinars from our education library.
“It’s a lot of little choices made throughout a day or week that really add up. You want to give your MS a good one-two punch: start with an effective disease modifying therapy, and make lifestyle choices that support overall brain health.”
DR. ENRIQUE ALVAREZ,
Medical Director, Rocky Mountain MS Center
Sleep: The Foundation of Health
Quality sleep is essential for brain function, immune regulation, and overall well-being, yet it remains one of the most overlooked aspects of MS management. Sleep disturbances are not just common in MS—they are often multifaceted and persistent, affecting both physical and cognitive function. People with MS frequently experience disrupted sleep due to a combination of factors, including pain, spasticity, frequent nighttime urination, and anxiety. Over time, these issues can contribute to chronic sleep deprivation, which can worsen fatigue, weaken cognitive function, and heighten sensitivity to stress, among other things.
The relationship between MS and sleep is complex. While MS-related symptoms can make it harder to fall and stay asleep, poor sleep itself may also worsen MS symptoms, creating a self-perpetuating cycle of exhaustion and neurological strain. When sleep quality declines, cognitive fog tends to increase, emotional regulation becomes more difficult, and the ability to cope with ordinary daily life can be impacted.
While sleep challenges in MS can be frustrating, targeted strategies can make a meaningful difference. By prioritizing restful sleep and taking steps to address disruptions, people with MS can support not just their energy levels, but also their cognitive resilience, emotional well-being, and long-term brain health.
For more information, consult resources like “Sleep” from InforMS Magazine (Fall 2017) and review past presentations from our education library.
Stress: The Double-Edged Sword
Stress is often portrayed as a villain in the narrative of health, but it’s not always harmful. In manageable doses, stress can be a powerful motivator, stimulating growth, adaptation, and resilience. It can push us to meet deadlines, stay alert in difficult situations, and adapt to challenges. However, when stress becomes chronic and unrelenting, its effects shift from beneficial to harmful, leading to a prolonged state of physiological strain that can worsen MS symptoms and impair overall brain function.
For people living with MS, chronic stress can elevate cortisol levels, which in turn may increase inflammation, heighten fatigue, and contribute to cognitive difficulties. Over time, persistent stress can wear down both mental and physical health, making it harder to manage symptoms and reducing the brain’s ability to recover from disease-related changes. Many people with MS report that stress worsens fatigue, triggers symptoms, and makes pain more difficult to tolerate.
For more information, consult resources like “Exploring Stress” from InforMS Magazine (Fall 2023) and review past presentations from our education library.
Exercise: Building a Resilient Brain
Exercise is often associated with physical fitness, but it is just as important for brain function. Movement increases blood flow, oxygenation, and the release of neurotrophic factors, which support neuron growth and connectivity.
Research has shown that regular physical activity enhances cognitive function, improves mood, and even stimulates the production of new neural connections. For people with MS, the benefits extend even further. Exercise has been linked to better mobility, reduced fatigue, and improved overall function.
There is no single “best” form of exercise for MS — it’s about finding what works for your body. Some people thrive with structured workouts like swimming or yoga, while others prefer outdoor activities like walking or cycling. Strength training and balance exercises can also be beneficial, helping to prevent falls and maintain coordination.
For those who experience heat sensitivity, activities like water aerobics or exercising in a cool environment can help avoid triggering symptoms. The key is to stay consistent. Even small amounts of movement—stretching in the morning, standing periodically throughout the day, or taking short walks—can make a meaningful difference in how the brain and body function over time.
Despite misconceptions, exercise is not harmful to people with MS. In fact, it can be a lifeline, helping maintain mobility and independence. Whether through hydrotherapy, online exercise classes, or structured routines, the goal is to incorporate movement into daily life.
For more on exercise, have a look at “Get Moving” from InforMS Magazine (Summer 2024) and review past presentations from our education library.
Social Connections: Engaging the Mind and Heart
Maintaining social connections is essential for emotional and cognitive well-being. Interacting with others stimulates the brain, improves mood, and combats feelings of isolation—a common challenge for those with chronic illnesses. Programs like KADEP (King Adult Day Enrichment Program) and MSYPN (Multiple Sclerosis Young Professionals Network) provide invaluable opportunities for connection, education, and support.
Lifelong learning also plays a role in strengthening cognitive reserve. Engaging in community activities, attending workshops, or participating in recreational groups can keep the mind active and resilient.
Conclusion
Building a brain-healthy lifestyle is a journey, not a destination. It’s about adopting small, manageable changes that collectively enhance resilience and well-being. By focusing on diet, exercise, stress management, sleep, and social connections, individuals with MS can bolster their brain health and improve quality of life.
Every effort counts, and starting where you can is the key. Just as these strategies benefit those with MS, they also support the well-being of families, friends, and communities. By prioritizing brain health, you not only improve your own resilience but also model healthy habits for others.
The path to maximizing brain health is accessible to all. Changes you can make, no matter how small, are victories for your brain and a testament to your strength in the face of MS.
