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Can’t Stomach MS? You’re Not Alone

Certainly, anyone can have heartburn after eating certain foods, eating heavy meals, or eating late at night. But what about the times you watch what you eat, keep portions light, and avoid eating too close to bedtime?

People with MS may experience digestive problems for a variety of reasons that may actually be linked to their illness.

If you have MS and roll into bed with an inexplicable case of acid reflux that keeps you up all night, it could be connected to your autoimmune condition.

What is gastroparesis?

This uncommon condition describes a dysfunctional digestive system which cannot move partially digested food from the stomach to the small intestine effectively. Some refer to this as “stomach paralysis.”1

Gastroparesis can occur in MS, leading to heartburn, bloating, or acid reflux.

If this happens at night, you’re in for several unpleasant hours of sleeplessness trying to find a position to sleep that doesn’t allow the regurgitation of stomach contents into one’s esophagus (also known as gastroesophageal reflux disease, or GERD). Gastroparesis famously robs people of sleep. It’s this very real disruption you should avoid, as getting adequate sleep is critical for fending off daytime fatigue, chronic pain, and other symptoms of MS.

Though it’s commonly linked to MS, Parkinson’s disease, diabetes, and other chronic conditions, gastroparesis can happen to otherwise healthy individuals.1

Links between MS and gastroparesis

Research published in 2018 in Frontiers in Immunology looked at the relationship between latitude, vitamin D deficiency, melatonin levels and the digestive system as a way to better understand how MS develops.2

They found that deficiencies in melatonin and vitamin D (due to lower light levels in latitudes far from the equator) can impact the ability of the intestines to absorb calcium. This leads to the potential for developing gastroparesis because the digestive system needs adequate amounts of calcium in order for the smooth muscles of the intestine to contract properly.

What about other MS-related stomach issues?

Take heart: If you live with MS, and have symptoms like heartburn, bloating, or reflux, this doesn’t necessarily mean you have gastroparesis. It might just be the random discomfort of a rich meal eaten late.

It’s when you have ongoing problems with these symptoms, and they disrupt your sleep at night, that you are encouraged to talk to your doctor.

One very real concern with nightly acid reflux is the possibility you have untreated sleep apnea.3 Sleep apnea is fairly common among people with MS due to potential miscues from the brain to the respiratory system during sleep.

Other causes for tummy troubles

  • Stress is a well-known factor for stomach upset, so you might want to consider whether you’ve had to manage a crisis recently or have untreated anxiety
  • People who carry extra weight are more likely to experience reflux, as well. In addition, recent studies show MS may progress and worsen in those who have a higher body-mass index.4
  • Another consideration: MS is a disease that causes muscle spasms. It may be that the lesion activity unique to you is having an impact on signals between the central nervous system (CNS) and the digestive system. This is known as neurogenic bowel dysfunction.5 Irritable Bowel Syndrome (IBS) is another condition of the digestive system found to be more common in people with MS than in the general population.
  • Sometimes you can also experience persistent hiccups, which are related to MS-linked spasms in the diaphragm that may be due to damage to the phrenic or vagus nerves.6
  • Finally, medications to treat MS and its symptoms are well known to have adverse side effects that include heartburn, bloating, nausea, diarrhea, and constipation.7 Other medications that can slow down the emptying of the stomach include opioids, some antidepressants, blood pressure drugs, and allergy medications.8

Relief for stomach problems when you have MS

The most logical approaches for gastroparesis and other stomach troubles include those which help the stomach to empty completely. These can include medications, some alternative therapies, and supplements.

Other ways to avoid the unpleasant symptoms of poor digestion caused by MS include these dietary and lifestyle modifications:1

  • Eat smaller meals, more frequently
  • Avoid high-fat foods
  • Avoid foods that you know will upset your stomach
  • Drink adequate amounts of water throughout the day
  • Mild exercise to help boost your metabolic processes
  • Avoid carbonated beverages which contribute to “acid stomach”
  • Avoid smoking or drinking; both interfere with healthy digestion
  • Stay upright at least 2 hours following your evening meal, or eat an early dinner

An occasional bout of heartburn or stomach upset shouldn’t be something to worry about. If it’s disrupting your sleep, night after night, you’re best advised to look into the reasons why with a visit to your doctor, who can help you find the relief you need.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Smith, L. Gastroparesis: What you need to know. Medical News Today. Updated June 15, 2018. Accessed June 17, 2019. https://www.medicalnewstoday.com/articles/313873.php
  2. Ghareghani M, Reiter RJ, Zibara K, Farhadi N. Latitude, Vitamin D, Melatonin, and Gut Microbiota Act in Concert to Initiate Multiple Sclerosis: A New Mechanistic Pathway. Front Immunol. 2018;9:2484. Published 2018 Oct 30. doi:10.3389/fimmu.2018.02484
  3. Acid reflux and sleep disorders: Both can be hidden. American Sleep Apnea Association. Accessed June 17, 2019. https://www.sleepapnea.org/acid-reflux-gerd-sleep/
  4. Body mass index may play a significant role in the progression of multiple sclerosis. Eureka Alert. Published April 11, 2019. Accessed June 17, 2019. https://www.eurekalert.org/pub_releases/2019-04/asrc-bmi041119.php.
  5. Preziosi G, Gordon-Dixon A, Emmanuel A. Neurogenic bowel dysfunction in patients with multiple sclerosis: prevalence, impact, and management strategies. Degener Neurol Neuromuscul Dis. 2018;8:79–90. Published 2018 Dec 6. doi:10.2147/DNND.S138835
  6. Kuriakose, T., Raj, A. A Review on Multiple Sclerosis and Persistent Hiccup Management. European Journal of Pharmaceutical and Medical Research. June 15, 2018. Accessed June 17, 2019. https://www.ejpmr.com/admin/assets/article_issue/1533037465.pdf
  7. Nurse’s Quick Reference: Caring for Patients with Multiple Sclerosis. National Multiple Sclerosis Society. Accessed June 17, 2019. https://www.nationalmssociety.org/NationalMSSociety/media/MSNationalFiles/Brochures/Ayag_Nursing-Book_Final.pdf
  8. Gastroparesis. Mayo Clinic. Accessed June 17, 2019. https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787

Comments

  • Tazz
    5 months ago

    An interesting article. I haven’t come across digestive issues being linked to MS before, but it does make sense if you have lesions in place which might cause some problems.

    Like most people I’ve had minor digestive issues at various times in my life, but never anything more than a minor irritation or inconvenience and certainly not long term. However, I’ve now got two problems which are a constant issue and drive me nuts many days. The first one is ongoing reflux and burping which only became a problem after I came off steroids. I was on prednisolone for three months to try and tame an over-active thyroid which occurred as a side effect of a medication. Because of the known risks of stomach ulcers with ongoing oral steroids my Dr put me on a proton pump inhibitor while I was on the steroids. Once I was able to taper off the oral steroids I was also able to stop the PPI and that’s when I suffered a major rebound of acid reflux etc. Unfortunately my Dr’s resonse was to suggest that I go back on the PPI as a “fix” for the rebound…….. !!! I’ve mostly worked my way through this without going back on the PPIs as they are not without their own little collection of side effects I really don’t need.

    The other interesting problem I am curious about whether other people have experienced is to do with my nose running. I had a major health problem a couple of years ago when I spent some time in Intensive Care in a coma. Ever since then I have a nose which runs whenever I have eaten, or when I (ahem) empty my bowels, and I also get sneezing fits after eating a meal. Mr Google came up with a condition called “gustatory rhinitis”, and I would be interested to know if other people have either developed the same problem, or experience it when their MS is “playing up”

  • TK Sellman moderator author
    5 months ago

    That’s interesting… I have never heard of that. Have you asked your neurologist about it?
    Tamara

  • potter
    5 months ago

    I started having stomach issues when I started taking Tecfidera. My neuro recommended I take a probiotic in the morning. It really helped, I am no longer on Tecfidera but I still take the probiotic. It helps keep my stomach balanced. Potter

  • TK Sellman moderator author
    5 months ago

    Researchers seem to think there are links to “gut health” and MS severity, so if a probiotic helps, why not? As far as I’m aware, they’re safe. Thanks for sharing your experience, potter.
    Tamara

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