For many people with multiple sclerosis (MS), gaining weight is a frustrating reality. Causes include an improper diet, impaired mobility, and drug side effects. For example, symptom flare-ups are frequently treated with three to five days of glucocorticoids, a type of steroid that causes weight gain, says Kathleen Costello, MS, ANP-BC, MSCN, vice president of programs with Can Do MS, a nonprofit organization. “The fluid retention element of that will go away, but it can take time to shed the other weight,” she says. Putting on pounds is a common side effect of other medications such as pregabalin (Lyrica) and gabapentin (Neurontin), which are often prescribed to treat neuropathic pain in MS.
Symptoms such as fatigue, spasticity, depression, and anxiety often intertwine to contribute to weight gain. People who are tired or can’t move easily may become more sedentary and may consume more calories than they burn off, says Costello. “Depression and other mood disorders can have a huge effect on appetite, leading people to eat more and choose foods that might not be healthy.”
It may seem that the odds are stacked against you, but experts say these strategies will help keep your weight in the healthiest range possible for you.
Talk to your doctor. Weight gain can cause other medical complications such as diabetes and heart disease, says Michael K. Hehir, MD, associate professor of neurology at the University of Vermont in Burlington. Work with your doctor to nip it in the bud.
Manage medications. If a drug causes weight gain, ask your doctor if you can switch to a different medication or have the dosage adjusted, says Costello.
Brainstorm strategies. “If your doctor is putting you on a new medication, talk to him or her about its effects on weight,” says Dr. Hehir. “With steroids, for example, if you know your appetite is going to increase, you and your doctor can discuss ways to manage that side effect, such as devising an eating plan that emphasizes nutrient-rich foods that are less caloric.”
Get nutritional help. Ask your neurologist if there is a program in your area that offers counseling with a trained nutritionist who has specific expertise related to MS. “You want someone who can design an affordable, healthy diet that you can prepare,” says Costello. “Some universities have schools of nutrition that offer faculty/student practices where you can see a nutritionist at far less cost than one in private practice.” And many patient organizations, such as the National MS Society, have specialized nutritional information available on their websites.
Find ways to move. You may not be able to exercise the way you did before your condition progressed, but that doesn’t mean you have no options. If your balance is poor, for example, you could switch from an upright bicycle to a recumbent stationary bike at the gym and replace heavy free weights (which could injure you if you dropped them) with resistance bands and body-weight exercises like lunges and squats. A physical therapist or trainer at the nearest medical center can help design a program that works for you.
Get creative about exercise. Look for modifications—everything from wrist supports to help you lift weights to adaptive devices that can help you move—so you can keep exercising no matter what your physical condition is.
Stay positive. In some cases, despite everything you do, your weight will not return to what it was before. If that happens, acceptance is the next step. And focusing on things that bring joy.
(A version of this article first appeared in the December 2017/January 2018 issue of Brain & Life.)
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