Healthcare Beyond MS
By Susan Wells Courtney
Taking Good Care of Yourself
All too often, someone living with a long-term illness, and those caring for a loved one, focus primarily on treating the disorder. As a result, many other vital aspects of one's health and well-being may be neglected. Individuals with any chronic condition, as well as those caring for them, need to look beyond their diagnosis and care for themselves so they may feel their very best.
MS, its symptoms, and the nerves it affects, are just a portion of one's overall health. It does not preclude one from developing oher health conditions... nor does it keep someone from reaping the benefits of a healthy regimen. With or without a chronic illness, people need to take care of their physical health. This may only be accomplished through proper diet, exercise, regularly scheduled halth exams and screenings, good oral care, not smoking, and avoiding substance abuse.
Diet and Exercise
The importance of diet and exercise cannot be understated. Controlling weight, preventing certain illnesses, enabling proper body function, and living a longer, more comfortable life, are just some of the many potential benefits derived from a balanced diet and regular exercise.
Dietary Guidelines for Americans 2005
On January 12th, the government released its latest edition of the Dietary Guidelines for Americans 2005. This report is published every five years by the Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA). This report, along with many other diet and exercise publications, may be viewed and downloaded by going to www.healthierus.gov/dietaryguidelines. Printed copies of this 80-page report may be purchased by calling the United States Government Printing Office's toll-free number at (866) 512-1800. A smaller, 12-page brochure based on the report may also be found at the same website, or ordered by calling the Federal Citizen Information Center's toll-free number at (888) 878-3256.
Here is an overview of the key recommendations for the general population:
- Eat and drink a variety of foods and beverages that are rich in nutrients within the basic food groups (described later). Limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.
- To maintain a healthy body weight, balance the number of calories taken in with the amount of calories used in physical activity.
- To prevent gradual weight gain over time, gradually increase physical activity while making small reductions in the amount of food and beverages consumed. [Editor's note: recommended water intake, which is eight, eight-ounce glasses daily, should not be reduced. Those experiencing urinary frequency may limit fluid intake an hour or two before going out or going to bed, but should make up any missed glasses at other times of the day.
- Participate in physical activity regularly to promote health, psychological well-being, and a healthy body weight.
- Physical fitness may be achieved through cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance.
Recommended food groups:
- Fruit and vegetables - on average, two cups of fruit and two-and-a-half cups of vegetables per day; select a variety, including those with deep colors, to eat several times per week.
- Whole-grain products — three or more ounce-equivalents daily, with whole-grains making up at least half of the total grains consumed.
- Dairy — fat-free or low-fat milk or milk products; three cups per day are recommended.
- Fats — less than 10 percent of calories should come from saturated fatty acids; less than 300 mg/day cholesterol; avoid trans fatty acid as much as possible (found in foods such as chips, fried foods, cookies and cakes); keep total fat intake between 20 and 35 percent of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, found in fish, nuts, and vegetable oils; choose lean and low-fat or fat-free meat, poultry, dry beans, and low-fat milk products.
- Carbohydrates — choose fiber-rich fruits, vegetables, and whole grains frequently; choose and prepare foods and beverages with little added sugars or caloric sweeteners; reduce dental problems by practicing good oral hygiene and eating fewer foods with sugar and starch.
- Sodium and potassium — use less than 2300 mg of salt daily, which is approximately one teaspoon; consume potassium-rich foods, such as fruits and vegetables.
Other Recommendations:
Alcoholic beverages should be used in moderation, up to one drink daily for women and two drinks daily for men. These should not be consumed by: individuals who cannot restrict their alcohol intake; women who may be pregnant or lactating; children and adolescents; individuals taking medications that can interact with alcohol; and those with specific medical conditions.
For safe handling of food and to avoid microbial foodborne illness: clean hands, clean surfaces that food comes in contact with, and wash fruits and vegetables; meat and poultry should not be washed or rinsed; separate raw, cooked, and ready-to-eat foods while shopping, preparing, and storing foods; cook foods at a safe temperature to kill microorganisms; refrigerate perishable food promptly and defrost foods properly; avoid raw or unpasteurized milk, eggs, meats, juices, and sprouts, as well as food that might contain them.
The Food Guide Pyramid
According to the Associated Press, even though the food pyramid was developed 12 years ago, not everyone is following the recommendations, as two-thirds of this nation's population is overweight. Agriculture Secretary Ann Veneman states that an estimated 42 billion dollars is spent each year on diet books and products.
The U.S. Department of Agricuture's Food Guide Pyramid may be found by going to www.nal.usda.gov/fnic. The pyramid will soon be revised for the first time. The changes will reflect healthier food choices to maintain proper weight and help prevent health problems relating to diet.
Additional Diet Information
Dr. Walter Willett, MD, is the chairman of the Department of Nutrition at the Harvard School of Public Health. He has directed the Nurses' Health Study since 1976, which presently studies the diet, lifestyle, and health of more than a quarter million participants. In an article that appeared in the October 2004 issue of MORE Magazine, he noted several findings about diet and its relation to health and illness. To follow are some key conclusions from the study so far.
- Trans fat (the solid, partially hydrogenated fat found in fried foods, some margarines, and baked goods), along with eating too much refined carbohydrates and sugar, is a big risk factor for heart disease. Eating plenty of fruits, vegetables, as well as omega-6 and omega-3 polyunsaturated fats, can greatly reduce this risk. Polyunsaturated fats also help reduce the risk of type 2 diabetes. Cutting back on refined carbohydrates, reduces the risk of heart disease and type 2 diabetes, while helping to control weight as well.
- Consuming large amounts of red meat and processed meat may increase one's risk of colon cancer. A deficiency in folic acid may contribute to colon cancer too, and especially for women who drink alcohol, lacking this nutrient may increase the risk of breast cancer. In addition, the risk and death rates of breast cancer would be 50 percent less if women avoided middle-age weight gain.
- Regarding supplements, Dr. Willett advises taking a multivitamin if someone does not eat foods fortified with vitamins. Studies suggest that many Americans would benefit by taking vitamin D (Dr. Willett suggests up to 1,000 IUs per day for individuals over 40). He also notes the importance of calcium, but explains that the ideal amount is not known. He suggests about 700 mgs per day as having the most benefit, and many can get this from a diet that includes dairy products, or a supplement to add 500 to 1,000 mgs.
- Dr. Willett mentions active studies to see if high dairy consumption may have adverse effects, citing possible elevated ovarian cancer and prostate cancer risks. Additionally, studies have yet to confirm that increased calcium has any effect on bone fractures. For reducing the rate of bone fractures, vitamin D is recommended (because it helps the body absorb and use calcium), along with regular exercise (cardio and strength training) to build and maintain strong bones.
Some individuals may be interested in vegetarian diets (only to be done under the advice and supervision of a doctor). The Physicians' Committee for Responsible Medicine has a "Vegetarian Starter Kit" to assist individuals wishing to become vegetarians and to help ensure proper nutrition. This may be found at www.pcrm.org. Under "Vegetarian Foods," various health conditions which potentially may benefit from a vegetarian diet are listed (these include a healthier heart, lower blood pressure, controlling diabetes, and possibly preventing certain types of cancer). The importance of calcium, vegetables, whole grains, fruit, and legumes are all discussed.
The Cancer Project (a charitable organization whose website can be found at www.cancerproject.org) lists the importance of the same four foods often mentioned: vegetables, whole grains, fruit, and legumes. In their writing, "Foods for Cancer Prevention," they sum-up their findings in two sections titled, "Fiber Fights Cancer," and "Fat Raises Cancer Risk."
Specific Dietary Notes for Individuals with MS
With a cause and a cure still yet to be identified, no concrete scientific evidence (coming from large, multi-center, clinical trials) is available on diet and its effects on MS. Many heories do exist, however, noting data that suggest the involvement of diet.
As some readers may remember, MSAA published three articles by Dr. Ashton Embry in its Health and Wellness section. In these articles, he explains the theories that nutritional factors may play an important role in MS. He believes the "prime suspects" in the cause and worsening of MS include dairy products, gluten grains (wheat, rye, and barley), and legumes (beans, peas, and lentils). Other prime suspects include chronic deficiencies in vitamin D, fish oil, and anti-oxidant vitamins, minerals, and phytochemicals. Please contact MSAA at (800) 532-7667 to request copies of these articles, or log onto MSAA's website (at www.msaa.com) to view or download copies of these articles which appeared in the Winter, Summer, and Fall 2004 issues of The Motivator.
In the Consortium of MS Centers (CMSC) publication, The International Journal of MS Care, an article titled "Nutritional Management of Multiple Sclerosis" by N. Caldis-Coutris, M. Namaka, and M. Melanson (June 2002), talks about the different dietary elements that may affect MS. This article may be found by going to www.mscare.org, then going to past issues, and doing a search for "CPJ/RPC."
In this writing, the authors note that individuals with MS seeking a possible alternative treatment may make decisions that are not always based on sound nutritional recommendations, and some may be putting themselves at risk of adverse secondary conditions and malnutrition. High doses of certain macronutrients (fats, carbohydrates, and proteins) or vitamins may put patients at a risk of toxicity as well as deficiencies. For these reasons, individuals with MS should always consult their physician to ensure they are making good decisions with their food and supplement selections. To follow are a few interesting points from the article.
Saturated fatty acids (SFA) are solid at room temperature and are found in meats, coconut and palm kernel oils, and butterfat. They should be limited to seven to 10 percent of calories per day (roughly 14 to 20 grams). Excess saturated fat has been proposed be involved in the course of MS, possibly altering the stability of the myelin sheath. Studies suggest that lower consumption of SFAs may be related to "significantly fewer exacerbations, slower deterioration, and lower death rates." Higher SFA intake "was associated with increased disability and three times the death rate." And finally, according to the article, "MS patients who adopt a diet low in saturated fat, are likely to show improvements in energy and fatigue profiles."
Monounsaturated fatty acids (MUFA) are found in soft margarine and canola, olive, and peanut oils; MUFAs may be up to 10 percent of one's total daily calories.
The article goes on to note the potential positive affects of polyunsaturated fatty acids (PUFA), described as omega-6 (found in certain vegetable oils) and omega-3 fatty acids (found in cod liver oil, fish oil, and ocean fish). These fatty acids are "essential," because they cannot be made in the body and must come from the diet. Omega-6 fatty acids can be related to immunosuppression, while Omega-3 fatty acids are involved with anti-inflammatory functions.
Controlling Weight
Losing weight and maintaining weight loss is a challenge for most adults, particularly in mid-life. For individuals with MS, the problem may be compounded by the fact that symptoms may prevent them from participating in moderate to vigorous daily exercise.
The Weight-control Information Network (WIN) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health. Readers may contact WIN at (877) 946-4627, and they may also visit WIN's website at www.win.niddk.nih.gov. This organization has a good deal of helpful information and publications. One publication, Better Health and You, Tips for Adults, provides advice for healthy eating and physical activity for all ages.
According to WIN, individuals who are overweight are at a much higher risk for: type 2 diabetes, high blood pressure, heart disease and stroke, certain types of cancer, sleep apnea (when breathing stops for short periods during sleep), osteoarthritis (wearing away of the joints), gallbladder disease, irregular periods, and problems with pregnancy. Individuals may determine if they are at a healthy weight, overweight, or obese by calculating their body mass index (BMI). The publication Better Health and You includes a chart with height, weight, and BMI figures, with shaded areas showing what determines healthy weight, overweight, and obesity.
Factors that contribute to one's weight gain include poor habits (such as watching TV versus physical exercise), genes, illness, certain medications, one's environment (being tempted by fattening foods at work, home, shopping, social events, etc.), and emotions (people often eat when they are bored, sad, gry, or stressed — even when they are not hungry).
The keys to weight maintenance and loss include:
- Select healthy foods, emphasizing fresh or canned fruits, a variety of colorful vegetables, and whole grains, while avoiding foods containing high amounts of saturated fats and/or sugar.
- Read labels to know how much fat, sugar, and calories are being consumed.
- Eat smaller portions at mealtime, and eat healthy snacks (low-fat, low-sugar) between meals.
- Don't skip breakfast; the best breakfast consists of whole-grain foods (such as oatmeal and cereal); studies show this to be the most beneficial in terms of weight loss and good health.
- Increase physical activity (if able); walking continues to be an excellent activity for losing weight, lowering blood pressure, and lowering blood sugar levels.
- Get plenty of sleep (researchers at the Eastern Virginia Medical School found that individuals getting adequate sleep each and every night have a far greater likelihood of staying thin).
If overweight, losing as little as five to 15 percent of one's body weight (over six months or longer) will do much to improve health. Other helpful tips include: keeping a food diary, shopping from a list and when not hungry, storing foods out of sight, eating at the table with the TV off, setting realistic weight-loss goals, seeking support of family and friends, and participating in regular physical activity (if able).
The United States Food and Drug Administration (FDA) has an article titled "Losing Weight: Start By Counting Calories." Appearing in the FDA Consumer magazine in January/February 2002, this article offers a great deal of information about dieting, exercise, weight-loss drugs, and fad diets. A copy may be found at www.fda.gov/fdac/features/2002/102_fat.html.
Exercise with MS
Those who cope with the symptoms of MS need to be particularly careful with the activities they choose. Fatigue and weakness are common symptoms of MS, and walking a flight of stairs or parking farther from the store could well use up valuable energy needed for other, more important functions — such as housework, caring for the children, or working a full day at the office.
Individuals with MS should not begin an exercise program of any kind on their own. Given the nature of MS, each person is unique in his or her needs and capabilities, so a custom exercise plan should be prescribed. Attempting an exercise program on one's own can cause problems — including overworking weak muscles, over-exercising to the point of fatigue, overheating and bringing on a pseudo-exacerbation (a temporary flare-up of symptoms, not relating to new myelin damage), and increasing muscle tightness — possibly causing an increase in spasticity, just to give a few examples.
An individual with MS needs to see his or her doctor, and in most cases, be referred to a physical therapist (PT). A PT can develop a safe and successful exercise program designed specifically for that individual. Depending on the progress made by the individual, and possibly new disease activity, the patient should be re-evaluated regularly to be sure the exercise program is still appropriate.
MSAA's cover story in the Winter 2004 issue of The Motivator discussed the many benefits of rehabilitation, including physical, occupational, and speech therapy. For a copy of this issue, readers may call MSAA at (800) 532-7667, or go to MSAA's website at www.msaa.com.
Another publication that may be of interest is WIN's Active at Any Size, which provides exercise instruction for individuals who are very large. Individuals with MS should consult their physician before participating in any exercise program, however, with a doctor's approval, individuals may find that this publication provides many valuable tips for starting slow and minimizing the risk of injury. Active at Any Size may be found at www.win.niddk.nih.gov/publications/active.htm or by calling (877) 946-4627.
"No Boundaries" has Pilates exercises for individuals with limited mobility. These may be found at ww.noboundaries.tv/pilates.htm. Again, individuals with MS should get a doctors approval for any exercise program.
While some may feel disheartened that they can no longer perform vigorous exercise as they may have in the past, moderate exercise still offers great benefits. According to the FDA, "Exercise does not have to be strenuous to be beneficial. Some studies show that short sessions of exercise several times a day are just as effective at burning calories and improving health as one long session."
Advisory:
Please note that any change to one's diet and exercise should only be made under the supervision of his or her physician. Some of the recommendations may not apply to individuals with MS, particularly the amount of recommended exercise — individuals with MS should see their physician and a physical therapist for an exercise plan. Additionally, some people may require special diets, which is why everyone should consult his or her physician about the best diet specifically for him or herself.
Preventive Services
The Agency for Healthcare Research and Quality (AHRQ) is an agency of the HHS; readers may visit their website at www.ahrq.gov. Their United States Preventive Services Task Force developed a list of recommended clinical preventive services for normal-risk adults. (Children's recommended services may also be found by going to the website.) To follow is an overview of their recommendations for adults.
Periodic screenings
- For blood pressure, height and weight, obesity, and alcohol use, with individuals 18 years and older
- For cholesterol, every five years beginning at age 35 for men and age 45 for women
- For Chlamydia, with individuals between 18 and 25 years of age
- For colorectal cancer, with individuals 50 years and older
- For osteoporosis, with women, routinely after 65 years of age, or after 60 years for those at an increased risk
- For vision and hearing, for those 65 years and older
- A pap smear is recommended every one to three years for women ages 18 to 65, and a mammogram every one to two years for women 40 and older
Immunizations
- Tetanus-Diphtheria (Td), every 10 years for individuals 18 and older
- Measles, mumps, rubella (MMR), one dose for women of childbearing age
- Pneumococcal pneumonia, one dose for those 65 years and older
- Influenza, yearly for those 50 years and older (except for those with allergies to eggs)
- Varicella (VZV), two doses for those 18 years and older who are susceptible
Chemoprevention (using a medication to help prevent an illness)
- Aspirin, to prevent cardiovascular events, should be discussed periodically with men (40 years and older), and women (50 years and older)
- For women at high risk of breast cancer, chemoprevention should be discussed
Counseling
At www.ama-assn.org, the American Medical Association (AMA) lists its recommended benefit package that they propose to be provided by public and private programs. (Please note that the AMA is not liable for any of the information provided, and instructs patients to see their physician for diagnosis, advice, and treatment.) Many of the preventative services agree with those listed by the AHRQ. Additional recommendations include:
- Health examinations/counseling with a physician every one to three years for individuals between the ages of 22 and 64 years; yearly exams are recommended for those between the ages of 11 and 21 as well as age 65 and older
- Cholesterol tests every one to three years between the ages of 22 and 64, then yearly from 65 to 70, and in later years, at the doctor's discretion
- Intraocular pressure measurement (IPM) should be done yearly for individuals 40 and older (to help check for glaucoma)
- Dipstick urinalysis yearly for ages 65 and older; fecal occult blood and digital rectal exam yearly for those 50 and older; prostate specific antigen (PSA) every three years from age 50 to 70; sigmoidoscopy (a thorough examination of the last two feet of the lower colon to screen for colon cancer) every three years, from ages 50 to 80, following negative results from two yearly exams
- Thyroid-function tests yearly for women, 65 and older
- Additional tests for high-risk groups
Oral Health
The American Dental Association (ADA) offers a wealth of information that may be found at www.ada.org; for those without internet access, the ADA may be reached at (800) 621-8099.
According to the ADA, good nutrition is linked to good oral health. They recommend following the USDA Food Guide Pyramid, as well as drinking water often. To further promote good oral health, individuals should not smoke or chew tobacco.
Good oral hygiene and regular dental care is important at any age. Adults of all ages can develop cavities and periodontal (gum) disease, both of which are caused by plaque (a sticky, colorless layer of bacteria).
The ADA recommends that people brush their teeth twice daily with fluoride toothpaste, and clean between the teeth daily with floss. People also need to see their dentist regularly. Some dentists may recommend an electric toothbrush, as well as floss that is fixed on a handle, for individuals with weakness or mobility problems. [Please note: a press release from Gillette in October 2004 stated that Oral-B CrossAction Power and PowerMAX Toothbrushes and Refills are not recommended for using to assist in brushing the teeth for individuals with special needs; apparently the brush head can become loose and swallowed in certain circumstances.]
Warning signs of gum disease include: gums bleeding while brushing; swollen, red, or tender gums; gums that are separating from the teeth; pus found around the teeth or when pressing the gum; any change to one's bite or how one's dentures are fitting; persistent bad breath or an unpleasant taste in one's mouth. Individuals experiencing any of these symptoms should visit their dentist as soon as possible. The earlier gum disease is addressed, the better the outcome.
Even those with full dentures should still visit their dentist regularly. During the exam, the dentist will screen for oral cancer, while checking the gums, tongue, joints of the jaw, and fit of the dentures. If dentures no longer feel comfortable, something has changed and the dentist should also be consulted before parts of the mouth are irritated.
For those who cannot afford dental care, many dentists offer lower rates to individuals on fixed incomes, and help is also available through dental society-sponsored assistance programs. The local dental society or social services can assist in finding low-cost dental care, including public health clinics and dental schools.
The National Women's Health Information Center at www.4woman.gov/faq/oral_health.htm also has much information on oral health. This center may also be reached by calling (800) 994-9662.
Common oral health problems include cold sores, canker sores, oral fungal or yeast infections, dry mouth syndrome, and oral cancer. Anyone suspecting that one of the latter (more serious) conditions ay be present, should see their dental professional. Care partners of individuals who are more severely disabled need to periodically check for oral abnormalities of which the patient might not be aware.
Smoking and Substance Abuse
Virtually every American is familiar with the dangers and long-term health risks resulting from smoking and substance abuse (including but not limited to alcohol, illegal drugs, and prescription medications). The government and several non-profit organizations offer assistance through the internet, publications, and telephone support to help end addiction.
Smoking
Why quit smoking? The National Cancer Institute lists these benefits:
Immediate changes: blood pressure, pulse, and body temperature elevated by nicotine return to normal (those taking blood pressure medications should consult their physician before making any changes); the body starts to heal itself; risk of heart attack drops; nerve endings begin to re-grow — taste and smell improve; breathing becomes easier; circulation improves and lungs strengthen; cilia (hair-like structures) on lung lining re-grows, allowing for reduced infection, congestion, coughing, and fatigue.
Other benefits over time: Risk of dying from lung cancer goes down, as well as risk of throat, bladder, kidney, and pancreas cancers.
Smokefree.gov at www.smokefree.gov helps people to quit smoking. Callers may also contact the agency at (800) 784-8669. The National Cancer Institute, which may be found at www.cancer.gov, has a Smoking Quitline at (877) 448-7848.Substance Abuse
Alcohol, drug, and other substance abuse carry many health risks, personal problems, and dangers to others. Health risks range from damage to the heart and other organs, to cancer and stroke — just to name a few. Personal problems resulting from substance abuse can lead to a host of issues — including family break-up and social isolation, depression and psychological illness, financial ruin, and even loss of employment and trouble with the law. Danger to others usually occurs when someone attempts to drive while under the influence, but someone in an altered psychological state can also incur physical and emotional abuse to those around them.
Street drug abuse is particularly dangerous. Not only are these drugs illegal, but such drugs are toxins to the brain. With a condition such as MS, which affects the nerves of the brain, no one should endanger their health and well-being through the use of illegal drugs.
If someone believes that he or she may have a substance abuse problem (including prescription drugs), or if a loved one appears to be in this situation, help should be sought immediately. Individuals may contact their physician for immediate, one-on-one help. Several help lines can also provide assistance. These include:
- Alcohol and Drug Helpline (800) 821-4357
- American Council on Alcoholism (800) 527-5344
- National Council on Alcoholism and Drug Dependence, Inc. (800) 622-2255
Other resources are available. Please call MSAA at (800) 532-7667 for additional assistance if needed.
Taking Good Care of Oneself
While this article could not include every aspect of staying healthy, it does address some very important issues. By following these guidelines (under the supervision of one's physician), members of the MS community may ensure that they are doing everything they can to promote good health, which in turn will enhance their quality of life.
Readers are also encouraged to seek fulfillment in the other areas of their health as well — including recreational activities for social and emotional well-being, and spiritual fulfillment for those who are inclined. Anyone experiencing depression or other emotional challenges should contact a medical professional. Good physical health also requires good emotional health.
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