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Smoking and Multiple Sclerosis: What Are the Effects?

Medically reviewed by Evelyn O. Berman, M.D.
Written by Nyaka Mwanza
Posted on March 25, 2021

Cigarette smoke has a universally negative effect on multiple sclerosis (MS), including the onset of the condition, its activity, and treatment success. The more you smoke, the greater your risks of developing MS, the faster the condition progresses, and the worse your disease prognosis is likely to be.

MS is a chronic autoimmune condition where the immune system attacks tissues in the brain and spinal cord. Tobacco smoking is thought to be one of many genetic and environmental risk factors involved in developing multiple sclerosis. Smoking likely triggers changes in your body (such as to your immune system, genes, or central nervous system) that combine with other existing risk factors to increase your susceptibility to MS.

Other risk factors linked to developing MS include:

  • Family history of MS or other autoimmune diseases like rheumatoid arthritis
  • Vitamin D deficiency
  • Certain infections such as Epstein-Barr virus

Among the risk factors for MS, smoking is one of the few that is modifiable, or that you have more control over. Here’s what to know so you can take steps to protect your health.

Smoking Increases Your Risk of Developing MS

Current smokers and ex-smokers are at significantly higher risk of developing MS than nonsmokers are. Some research indicates that people who smoke are nearly twice as likely to develop MS as their nonsmoking peers. The risk of MS increases with longer durations and greater intensity of smoking.

Secondhand smoke, also known as passive smoking, also contributes to one’s MS risk. The risks of secondhand smoke affect adults as well as children, who have an increased risk of developing MS later in life than their peers who were not exposed to passive smoke inhalation.

Smoking Accelerates the Progression of MS

In people who already have MS, smoking is linked to the progression of MS to more severe types of the condition.

People with clinically isolated syndrome (a single episode of neurological symptoms) who smoke are more likely to progress to a full MS diagnosis. Cigarette smokers with relapsing-remitting MS (RRMS) are more likely to advance to secondary progressive MS (SPMS) — a more aggressive form of MS — more quickly than nonsmokers.

People who have MS and smoke tobacco may also be more likely to have greater demyelination, more lesions or plaques, and more extensive brain damage than those with MS who do not smoke and are not exposed to secondhand smoke.

Smoking Worsens the Symptoms of MS

Smoking is also associated with worsening symptoms and a greater incidence of relapses or flares, with MS symptoms becoming more severe immediately after smoking.

MyMSTeam members’ experiences align with these findings: “Every time I smoke, I can barely walk, think, etc.,” shared one MyMSTeam member. “All my symptoms are magnified 10x right after I smoke.”

Another member also observed changes related to their smoking. “I've been noticing that I feel heavier and slower on the occasions that I do smoke. I've noticed a difference in my motor skills and vertigo for sure,” they wrote.

Smoking Decreases the Effectiveness of MS Treatment

Smoking appears to decrease the effectiveness of MS treatments. Specifically, it can interfere with the effects of some medication treatment regimens, including interferon beta 1a (sold as Avonex, Rebif, and Plegridy) and a disease-modifying drug for MS treatment called Tysabri (natalizumab).

How Do Cigarettes Harm the Body in MS?

Cigarettes contain chemicals that are known carcinogens (cancer-causing agents) and neurotoxins, such as cyanide, which may have a demyelinating effect — that is, they can destroy the myelin in nerve tissues the way MS does. Nicotine, an addictive chemical in cigarettes, has been shown to affect the immune system. Some experts believe the effects of these ingredients could trigger or worsen the overactive autoimmune response of MS that destroys the myelin coating of neurons.

Benefits of Quitting Smoking

If you’re a smoker, it’s not too late to quit for your health. Former smokers have the same risk of MS progression as people who have never smoked. You’re also less likely to see your MS advance to a more aggressive form of the disease, such as SPMS. Quitting smoking may also delay the progression of MS. Additionally, the protective factors associated with quitting smoking increase the longer you’re a nonsmoker: Each smoke-free year decreases your risk of progressing to a more severe level of disability, such as needing to use a cane, walker, or another assistive mobility device.

“It was a long, hard road,” said one MyMSTeam member, “but I quit smoking, and in the end it helped me to rehabilitate myself from MS. I have been 95 percent ambulatory since 1996.”

Smoking cessation may also reverse some of the adverse effects of smoking. After five smoke-free years, the DNA of the epithelial cells in a person’s lungs looks the same as the general population.

MyMSTeam Members on Tips for Smoking Cessation

One MyMSTeam member summarized quitting smoking as hard to do but said they “feel so much healthier now.”

Another member cited disease progression as their motivation to quit. "Smoking may progress the development of my disease. Smoking already was a contributing factor to getting the disease,” they said. “I love myself more than I loved smoking, so I quit cold turkey.”

Epidemiological studies suggest that efforts to reduce tobacco use may help lower the risks associated with smoking status and MS. Gradually reducing the number of cigarettes you consume is an alternative to quitting cold turkey, and some members have stopped smoking by using nicotine-replacement devices, such as vaporizers (vapes) or electronic cigarettes (e-cigarettes or e-cigs), nicotine patches, or nicotine gum. “I'm using Nicorette and e-cigarettes while trying to stop,” shared a MyMSTeam member.

Another member shared their strategy for quitting successfully this way: “You can wean your way down to zero percent nicotine cartridges and then quit altogether. It worked for me and it has been almost three years now.”

Nicotine has been shown to compromise the blood-brain barrier and may not be a healthier option for people with MS, so talk to your doctor about this option. Additionally, vaporizers and e-cigarettes may be a healthier alternative to traditional ones, but they also pose health risks.

Another member suggested chewing cinnamon sticks or chewing gum to satisfy the oral and hand fixation associated with smoking.

Other members report using medication for smoking cessation. However, like all drugs, smoking-cessation drugs such as bupropion (sold as Wellbutrin XL, Wellbutrin SR, and Aplenzin) come with a risk of side effects. “Chantix made my husband mentally unstable, and Wellbutrin made him more anxious,” one team member shared.

You and your health care provider should evaluate your options if you’re looking to quit smoking to find the best choice for your overall quality of life.

Smoking-Cessation Resources

If you’re finding it difficult to stop smoking on your own, you’re not alone. Help is available:

  • Call the smoking-cessation hotline to speak with someone in your state. Dial 1-800-784-8669 for English and 1-855-335-3569 for support in Spanish.
  • The National Cancer Institute offers an instant messaging LiveHelp hotline.
  • Smokefree.gov has a list of support groups, apps, and resources.

Connect With Others Who Understand

MyMSTeam is an online community of over 165,000 people living with or caring for someone with MS. You can also get emotional support and practical advice to help you quit smoking.

Have you successfully dropped your smoking habit? How did you manage to quit smoking? How long have you been an ex-smoker? Share your story in the comments below or by posting on MyMSTeam.

Posted on March 25, 2021
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Evelyn O. Berman, M.D. is a neurology and pediatric specialist and treats disorders of the brain in children. Review provided by VeriMed Healthcare Network. Learn more about her here.
Nyaka Mwanza has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.

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