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Smoking & Multiple Sclerosis (MS): What You Need To Know

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The relationship between cigarette smoking and MS (susceptibility & progression) and whether vaping/e-cigarettes are better options. 


Smoking can be a significant risk factor for developing multiple sclerosis (MS) and experiencing secondary progressive MS

MS is a chronic and debilitating disease that affects the central nervous system. It’s a disease in which the immune system mistakenly attacks the myelin sheath, a fatty coating in the central nervous system. 

One of the effects of smoking is an increase in the chances of developing MS. If you or someone you know is a smoker with MS, or you're curious about the connection between cigarette smoking and MS, you've come to the right place.

In this article, we'll examine the relationship between cigarette smoking and MS susceptibility, the link between smoking and MS disease progression, and whether vaping and e-cigarettes are better options. 

Link between smoking and MS susceptibility

How smoking increases the risk of MS has not been thoroughly studied. However, there are many ways in which smoking may contribute to MS prevalence.

  • Smoking may damage the blood-brain barrier
    A unique structure known as the blood-brain barrier shields the brain from potentially dangerous chemicals. The blood-brain barrier is made up of densely packed cells that block the passage of the majority of chemicals entering the brain from the blood. However, tobacco smoking may affect this barrier, allowing harmful substances to affect the brain and potentially trigger an autoimmune disease.

  • Smoking increases inflammation in the body
    Tobacco use may cause inflammation in the body, which can contribute to the development of MS and cause MS lesions. Inflammation occurs when the body experiences damaging stimuli such as an infection or toxic exposure. In cases of chronic inflammation, the prevalence of autoimmune diseases such as MS increases.

  • Smoking induces neurotoxicity 
    Cigarette smoke contains free radicals that may induce neurotoxicity. When combined with genetic and environmental factors, these substances can increase the likelihood of developing MS in current smokers, worsen disease activity, cause brain atrophy, and lead to disability progression.

Numerous studies have investigated the link between tobacco use and MS susceptibility. 

  • A study in neurology found that smoking was associated with a 1.5-fold increase in the risk of developing MS. 
  • A meta-analysis of 18 studies showed that current smokers experienced a 1.5-fold increased risk of MS compared to non-smokers. Whatever risk they experienced decreased after they quit smoking. 
  • Also, smokers may experience higher risks of conversion from relapsing-remitting MS (RRMS) to secondary progressive MS. This risk may increase with the number of cigarettes consumed.

All these studies prove that smoking cessation (and avoiding passive smoking) is one of the effective ways a person can reduce their risk of developing MS. If you already have MS, quitting smoking can help reduce the worsening of symptoms, improve quality of life, and slow the progression of multiple sclerosis.

Link between smoking and MS disease progression

Growing evidence suggests that smoking is linked not only to MS susceptibility, but also to progression of multiple sclerosis. Smoking exacerbates inflammation, which may worsen MS symptoms and cause disability progression. A study found that smoking increased the levels of pro-inflammatory cytokines in MS patients, which may contribute to disease activity.

Another mechanism by which smoking may contribute to MS progression is its effects on oxidative stress. Oxidative stress is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify them, leading to damage to cells and tissues.

A prospective cohort study investigated the association between lifestyle factors (including smoking) and disease progression. Smoking is associated with a higher risk of disease progression, and staying smoke-free is associated with a slower rate of disease progression.

What about vaping & e-cigarettes?

Electronic cigarettes (e-cigarettes) and vaping have become increasingly popular in recent years, and many speculations about their potential health effects exist. While research on the link between vaping/e-cigarettes and MS is limited, some evidence suggests that they also may be linked to MS susceptibility and disease progression. This is because vaping has been shown to increase oxidative stress and inflammation in the body, which may contribute to MS progression. 

Given the potential link between vaping, MS susceptibility, and disease progression, MS patients who use e-cigarettes or vape are encouraged to quit and to seek support from their healthcare providers.

Resources to help you quit smoking

  • 1-800-QUIT-NOW
    By calling 1-800-QUIT-NOW, you can access counseling, local support groups and help with obtaining medications that help with smoking cessation and prevent relapsing. 

  • QuitNow app
    We also recommend the QuitNow app which tracks the time, health benefits, and dollars saved from quitting — it also connects you to a community of other quitters.

  • Local providers
    We can also provide information about providers local to you that can assist you through the process of smoking cessation and help prevent relapsing. The hardest part is starting the process, and whenever you are ready we’d be happy to provide you with resources.

Additional tips to help improve your MS symptoms & slow disease progression

Diet and exercise

Regular exercise can also play a significant role in managing MS symptoms. It can help improve strength, balance, and overall mobility, as well as reduce fatigue, depression, and other common MS symptoms. Research has also shown that a healthy, nutrient-dense diet rich in Vitamin D, fruits, vegetables, whole grains, lean protein, and healthy fats can help reduce inflammation and oxidative stress in the body, which may contribute to MS symptoms.

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Support groups
It can be empowering and educational to be around others who also have MS. Many people develop relationships with people they wouldn’t have otherwise met outside of the support group. If you are interested in finding groups in your area, we recommend nationalmssociety.org.

Symptom tracking
Tracking your symptoms is helpful for you and your doctor to understand progression and/or improvement of symptoms — something that’s especially useful when you are on infusion therapy. There are many free apps (like Aby) that can assist with making symptom tracking easier. Having an app on your phone makes it easy to share any new or changing symptoms with your provider when you are at your appointments.

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