Ask the expert: smoking and MS

18 October 2023

man smoking cigarette

For Stoptober, we’re talking about the effect of smoking on multiple sclerosis. Here we chat to neurologist, Professor Richard Nicholas about the impact smoking can have on your body. We ask him about the benefits of quitting smoking and the support that’s available to help you stop.

He draws on his experience being involved in the UK MS Register. This is an ongoing research project which allows people with MS to share information about their condition as it changes over time.

What evidence is there that smoking is bad for people with MS?

Richard says: This is something where the research has been developing over many years. Smoking isn’t good for us in general. It affects the lungs and causes blood vessel damage in people over time. It can also cause other conditions to develop (known as comorbidities) as smoking causes other damage in your system, eg to the lungs. This can have an impact on MS symptoms.

In MS, you're not functioning optimally in terms of your nervous system. When you have MS, it’s important to keep your general health good, to keep all the other bits of your body working at their best. For example, by staying active and eating healthily. Keeping your body healthy gives you the ability to compensate from the damage that MS can cause.

So, has MS itself been affected by smoking? There's quite a lot of data that's accumulated over the years which shows that, over time, smoking causes the condition to get worse a bit quicker. One of the problems we have then is, why? Is it because people who smoke have other things wrong with them? It appears not so. It’s been shown that smoking causes damage that makes MS worse. 

What is it that's bad about smoking?

Richard says: We don't have all the answers, but we think that the smoke itself is the issue. It's not so much the nicotine side of things, but inhaling the smoke itself. This is what causes damage and inflammation in the blood vessels. The good news is that if you stop smoking, this damage can go away quite quickly. 

What about vaping?

Richard says: In the MS Register, we've started to look at vaping. Some vapes have nicotine and some are nicotine free, but they all have a lot of smoke. Is that smoke good for you? I think that’s the question for a lot of health issues that we're still trying to understand. But certainly, things like nicotine patches, and other interventions like this, don't have the same issue. 

What are the benefits of stopping, or reducing, smoking?

Richard says: One of the things that we showed recently in the MS Register is that a lot of things can get worse when you’re smoking. However, stopping smoking can make things better again. One positive thing is that if you can stop, your body does repair, and the damage caused by smoking can improve. As well as this, your risk of cancer goes away after about five years and your risk of stroke goes away even sooner.

One other thing we found is that if you smoke less, that is also better for you.

In relation to MS specifically, stopping smoking is about as effective as taking a disease modifying drug. This is a very significant effect. Over time, that keeps people well for longer.

Stopping smoking is about as effective as taking a disease modifying drug. This is a very significant effect.

Professor Richard Nicholas

What about smoking cannabis?

Richard says: Cannabis is a difficult area. In terms of taking cannabis, we generally feel smoking it is the damaging thing. When you smoke cannabis, you tend to do it without a filter. Therefore, it's much more damaging to the system in general. In people who smoke cannabis, it can cause problems around the mouth like ulcers.

Can smoking worsen MS progression?

Richard says: Yes, we’ve looked at this in the MS Register. We've got about 17,000 people who've answered surveys and 5,000 regular users who fill in questionnaires every six months. From this, we can work out how people with MS are changing over time. We can pinpoint starting treatments or other interventions. We can see when people start smoking and the subsequent damage it causes over time. For example, it can affect your motor function in terms of walking. 

What support and treatments are available to help you stop smoking?

Richard says: There are a range of nicotine replacement therapy (NRT) treatments available. This is because it’s the nicotine which people get addicted to. There are local stop smoking services where you can arrange an appointment with an adviser. There are also support groups you can attend in your local area. We would say go and see your GP and get their advice about stopping smoking initially. More details can be found on the NHS website.

What would you say to someone who lives with MS and is thinking about stopping smoking?

Richard says: The problem for us health professionals in terms of telling people to stop smoking, is there’s obviously a health benefit. But from the perspective of someone with MS, does smoking bring other benefits to their lives that they don’t want to lose? Smoking can be an important part of people’s social lives, for example, and help them to unwind on days where MS may bring very real challenges. Therefore, the conversation around stopping can be tricky.

Generally, I would say, that stopping smoking is a good thing to do. It's not easy, though. Having support is important. You have to make up your mind that you’re committed to stopping. It can be very difficult as it’s a habit that many people enjoy. What I would say is to reduce smoking slowly. Even if you halve it, you're starting on the right road. Start small. Stopping smoking is important for your health down the line, particularly if you have MS. Taking manageable steps is important.

Professor Richard Nicholas is a neurologist with an interest in MS. He works at the Imperial College Healthcare NHS Trust. He is involved in the UK MS tissue bank and the UK MS Register.

You can sign up for UK MS Register here:

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