Every MS patient’s triggers are going to be different. Understanding what can cause your MS to worsen will help you and your health care provider devise strategies to avoid setting off a flare-up.

Published: March 14, 2022 | Updated: August 25, 2022

Multiple sclerosis (MS) triggers that worsen symptoms or cause a relapse can include stress, heart disease and smoking. While some are easier to avoid than others, maintaining a healthy lifestyle and overall health and wellness can have outsized benefits for MS patients.

Every MS patient’s triggers are going to be different. Understanding what can cause your MS to worsen will help you and your health care provider devise strategies to avoid setting off a flare-up.

“Multiple sclerosis can be an overwhelming disease to live with. Taking care of your whole self can help you live your best life,” said Jocelyn H. McGuire, APRN, a nurse practitioner at the Norton Neuroscience Institute Hussung Family Multiple Sclerosis Center.

The top five things not to neglect if you have MS are:

• Heart disease
• Obesity
• Smoking
• Age-appropriate cancer and other screenings
• Mental health

Cardiovascular risk, which includes high blood pressure, high cholesterol, diabetes and obesity, is linked to higher risks of relapse and disability progression. There also may be a link between cardiovascular risk and brain function.

Obesity itself can contribute to worsening MS symptoms and disability. One study found that excessive weight can contribute to worsening inflammation, fitness, and increase fatigue and depression.

Smoking can increase neuroinflammation and demyelination. It also can increase the likelihood of developing secondary progressive MS, a shorter time to transitioning to secondary progressive MS, and a higher disability score and disability progression. Finally, some MS treatments may not work as well in smokers, compared with nonsmokers.

For patients with MS, it’s important to continue to see a primary care provider at least once a year to make sure you have completed age-appropriate screenings for diabetes, hypertension, cancer and other health conditions, according to Jocelyn.

Your primary care provider can oversee the management of other diseases and health conditions, such as heart disease, diabetes, high blood pressure, thyroid disorder, depression and anxiety.

People with MS are more likely to experience depression and anxiety. Symptoms of depression, such as fatigue, decreased activity and mental changes, can overlap with symptoms of MS, which can make it hard to tell the difference between the two, according to Jocelyn.

Jocelyn lists five key components to wellness:

• Healthy food choices
• Exercise
• Not smoking
• Attending to mental, emotional and spiritual health
• Addressing other health conditions

Small changes can reduce MS triggers and have a significant impact on your overall health, according to Jocelyn.

For example, to improve your diet you could swap one sugary drink a day with water, or choose whole wheat bread or pasta, or brown rice, or eat a sweet potato rather than a regular baked potato.

To improve your physical activity, you could walk a little each day, gradually adding more as you are able. You could attend a yoga, tai chi or aquatics class offered through the Norton Neuroscience Institute Resource Center, or you can meet with a physical therapist to learn a strengthening or stretching program.

If you’re ready to quit smoking, you can discuss methods of quitting with your primary care provider or MS specialist. Norton Prevention & Wellness offers a free smoking cessation course.

Addressing mental, emotional or spiritual health can relieve MS triggers. Deep breathing exercises, meeting with a clinical psychologist or talking with a spiritual or religious leader can help.

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