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Fatigue is one of the most common symptoms of MS and one of the most debilitating, negatively affecting quality of life in a number of ways. That's why it's important to talk with your physician about combating fatigue and preserving energy. The first step usually involves ruling out causes such as depression or medication side effects. Are you getting enough sleep? Sleep apnea, restless leg syndrome, and insomnia can rob you of the deep, restorative REM sleep needed to feel truly rested. To boost energy, some physicians prescribe medication, such as Provigil. However, nonpharmaceutical strategies can be effective as well in keeping the lid on fatigue. Here are five of them:

Eat the right food at the right time

No particular diet has been scientifically proven to prevent or reverse the effects of MS, though many people have anecdotally reported improvement in symptoms after following certain dietary protocols. Recent studies into diet and MS are beginning to add to our knowledge on how what you eat affects how you feel, including fatigue.

People with multiple sclerosis who for one year followed a plant-based diet very low in saturated fat had much less MS-related fatigue at the end of that year — and significantly less fatigue than a control group of people with MS who didn't follow the diet, according to an Oregon Health and Science University study presented this year at the American Academy of Neurology's annual meeting. Researchers say larger studies are needed to confirm these initial findings.

The study investigated the effects of following a diet called the McDougall Diet, devised by John McDougall, M.D. The diet is partly based on an MS-fighting diet developed in the 1940s and 1950s by the late Roy Swank, M.D. The McDougall diet, very low in saturated fat, focuses on eating starches, fruits and vegetables and does not include meat, fish or dairy products. To listen to the MSF's interview with Dr. McDougall go to MSFocus Radio at msfocusradio.org. Also, look for an article about the interview in the fall issue of MSFocus.

If you want to eat for energy, when you eat is as important as what you eat. The following consumption strategy advocates a measured approach:

• Don't skip breakfast. This can leave you feeling tired all morning.
• Eat smaller, more frequent meals. Aim for five or six meals per day instead of the traditional three. Smaller, frequent meals will give your body frequent energy boosts. Larger meals can make you feel more tired.
• Make sure you eat something at least every four hours.
• Avoid the mid-afternoon energy crash by having a mid-afternoon snack with protein (such as nuts).

Exercise

The research leaves no room for doubt: Exercise will help combat MS-related fatigue. In addition to increasing your capacity for activity, exercise will help you get a better night's sleep. In her book, Fighting Fatigue in Multiple Sclerosis, occupational therapist Nancy Lowenstein writes: "The key to using exercise as a rejuvenating activity is to remember that each day is going to be different, that doing a few minutes of exercise may be enough to get you going again, and that not overdoing exercise is important because too much exercise will make you more tired."

The good news is you don't need expensive equipment or a gym membership to get the exercise you need. Researchers from the University of Illinois recently reported that incorporating exercise into ordinary daily activities can be as effective as traditional workouts. As always, consult with your physician before beginning any type of exercise program.

Stay cool

There is a well-established link between overheating and fatigue in people with MS. Sensitive to warm temperatures, individuals with MS must literally learn how to "chill out" whenever the environment or activity turns up the heat. Because a rise in your core body temperature is to blame, targeting your "insides" is a quick way to cool down. Research during the past decade has shown that consuming a very cold drink, such as a slushy, can reduce core body temperatures. A healthy alternative is frozen juice bars, easy to make at home with juice and popsicle molds. To cool from the outside in, consider donning accessories and apparel that incorporate the cooling technology that is right for you. There are hats, vests, scarves, wrists and ankle bands with designs so discreet that only you know how you're keeping your cool. Many of these items can be obtained free of charge through the MSF's cooling program.

Hydrate

Limiting fluid intake is one way individuals deal with bladder incontinence because of MS. But be warned: Even mild dehydration makes it difficult for brain cells to communicate properly. It makes your blood volume and blood pressure dip, which slows the flow of oxygen and nutrients to your tissues, say Harvard researchers. Fatigue sets in when dehydration forces your body to work harder. To prevent dehydration, nutritionists commonly recommend consuming half your body weight in ounces. While that goal may seem a far reach to some with MS, it may help to know that water isn't the only option for hydrating, especially after physical exertion. Milk (including soy milk) rehydrates well because it replaces the sodium, calcium and other electrolytes lost in sweat — and that’s key to quickly restoring your body’s fluid balance. Nearly all food has some water in it. Natural, whole foods have the highest water content. Most fruit and vegetables contain 80 to 98 percent water. Eating dense vegetables such as cucumbers, tomatoes, jicama, beets, carrots or celery with a meal or snack is one of the easiest ways to improve your hydration. And remember, the mark of proper hydration is very light yellow-colored urine.

Budget your energy

Once you've done all you can to boost your energy stores, you can maximize productivity and fight fatigue by budgeting your energy. Begin by learning how to estimate the energy cost of different activities. Notice how tired you feel during and after things you do regularly. What activities do you consider to be the most essential, have the most value to you, or have a high priority for another reason? What time of day do you feel most energetic? Plan accordingly. Spend your energy on the things that matter most, remembering that your energy levels may vary from day to day. If you've had offers from others who want to help, don't hesitate to delegate some of the tasks you can let go of, so you can focus on your priorities. An occupational therapist can help you develop an energy budget as well as offer suggestions for arranging your home to help minimize fatigue.