S2E17 Overcoming MS from a Neurologist’s point of view with Dr Brandon Beaber

 
 

S2E25 OMS from a Neurologist’s POV 

 
 

 
 

Geoff Allix  00:00 

Support for the Living Well with MS podcast is provided by Overcoming MS, a global charity registered in the United States, United Kingdom and Australia, whose mission is to educate, support and empower people with MS in evidence based lifestyle and medication choices that can improve their health outcomes. Please visit our website at www.overcomingms.org to learn more about our work and hear directly from people around the world, about the positive impact Overcoming MS has made on their lives. Now on to today’s episode, joining us today is Dr. Brandon Beaber, a neurologist based in Southern California specializing in multiple sclerosis. And today we’re going to discuss his specific clinical philosophy regarding treating patients with MS. How lifestyle factors might affect MS and treatment of MS. And also talk through the main pillars of the OMS approach and his opinion of those factors in treating MS. So Dr. Brandon Beaber, welcome to the Living Well with MS podcast. And to start off with, I would just like to ask, what is your specific clinical philosophy, as a neurologist for treating patients with MS? 

 
 

Dr. Brandon Beaber  01:21 

Well, thank you for having me on Geoff. In general, I try to give people the best advice I can, based on whatever available scientific evidence there is. And if there’s no evidence available based on my clinical judgment and experience and expert opinion, because I want to give people the best chance to live the life they want to live, despite having MS while at the same time respecting their individual preferences, and culture and tolerance to take risks that after all, they’re the one who has to live the life and accept the potential risks, side effects. 

 
 

Geoff Allix  01:55 

And so would that include as well as medication? Would you include lifestyle factors within that as well? Or is it purely the medication choice that they would make? 

 
 

Dr. Brandon Beaber  02:09 

Well, certainly there’s a role for medication. But as is the philosophy of OMS in general, I think that we should try to do everything we can do to have the best possible health outcome. And in my opinion, there’s very strong evidence, really overwhelming evidence that MS is at least in part a lifestyle disease. And just to give you an example of why I know that to be the case, there was a recent study that found in Ecuador, the risk of MS is only about 1 in 25,000, extremely rare, whereas in the United States, it’s about 1 in 350. There was a study showing that in Syracuse, New York, the rate is about 1 in 222. It seems to be increasing, unfortunately. Whereas within southern California, Kaiser Permanente, the health management organization where I work, we did a study that found that Hispanic people have a roughly equal risk of multiple sclerosis compared to European people. So I highly doubt that Ecuadorians have some sort of genetic protection. I don’t have specific data on Ecuadorians. I like to go to professional conferences and talk to neurologists all around the world, and hear their experiences. And in some countries like India, Mexico, Syria, MS was thought to be extremely rare, whereas now it’s increasingly common. And it turns out that the rate of MS is increasing more in developing countries, and is relatively stable in developed countries, there still seems to be increasing in the United States. And when you talk to older neurologists, they’ll tell you, “Hey, listen, we knew what MS was it just wasn’t very common.” Yes, I’m sure there were some undiagnosed cases, because they didn’t have a lot of neurologists or MRI machines in certain areas. But the reality is the disease is becoming more common. And it’s almost certainly because of the development or westernization of these countries. 

 
 

Geoff Allix  04:08 

And also, there’s the distance from the equator, there’s certain maps available where they look at MS instance, how far you are from the equator. But then, so there’s that vitamin D element. But then also it does tend to be the case that the closer to the equator you are, then the less developed countries also tend to be like close to the equator. So could it be the westernization as you get further from the equator? Could it be the vitamin D? Could it be a combination? Could it be both? 

 
 

Dr. Brandon Beaber  04:43 

Well, you’re probably right that in Ecuador, the rate is going to be lower just based on proximity to the equator. But Mexico isn’t getting farther from the equator and India isn’t getting farther from the equator, but behavior is changing. People are more likely to wear more clothing to work indoors, to avoid the sun, wear sunscreen. So those changes could be increasing the risk of MS. The challenge is that there may not necessarily be a single identifiable factor. So one factor could be sun and vitamin D levels. Another factor could be westernization of the diet, eating more animal products, eating more processed foods, trans fats. Also there is what is known as the hygiene hypothesis. There’s some evidence that MS risk is inversely related to parasite exposure. If you grow up in an undeveloped country and walk around barefoot and drink unclean water, you get parasites and parasites are known to induce a T helper cell type 2 response, which is very similar to how some of the MS medications work, like Interferons. We know that the other T helper cell pathway the TH1 pathway is more associated with inflammation and MS. 

 
 

Geoff Allix  05:57 

So it actually could be that we are so risk averse to our infants, that it’s actually not benefiting them. 

 
 

Dr. Brandon Beaber  06:09 

Well, maybe there’s a trade off, we do have lower rates of dysentery, but you know, that may increase risk of autoimmune disease. 

 
 

Geoff Allix  06:17 

Yeah, and in no way am I encouraging people to be unhealthy with their infants. So what I’d like to do if we could just run through the key pillars of OMS, just to get your opinion. So to start off with, I think the the one I mean, often it’s referred to as a diet, we don’t like to think of it that way, because it’s more than just a diet. But I think the diet is the most outwardly obvious thing if someone’s following OMS. So essentially, a diet, which is low in saturated fat, avoids meat, except seafood, so any fish and seafood. Definitely not just reducing saturated fat, but not frying food and removing dairy from your diet. Are those pillars or lifestyle factors that you would think are helpful, or would you alter that in some way, in your opinion? 

 
 

Dr. Brandon Beaber  07:16 

Well, when patients asked me, I tell them that there’s no clear evidence to support a specific diet in MS. But I think that the recommendations of OMS are very reasonable, based on best available evidence, even though there isn’t definitive proof. So for example, you know, there is epidemiologic evidence that countries that have higher saturated fat consumption have higher rates of MS. There’s some evidence that trans fats, which are developed when you fry oils, and process oils, tend to make cell membranes stickier and tend to promote that TH1 response we spoke about. You know, when it comes to dairy, there is evidence that countries that consume more milk and cheese have higher rates of MS. There is a theoretical mechanism of action behind that. Dairy contains protein butyrophilin, which appears very similar to the immune system, to something called MOG, which is Myelin oligodendrocyte proteins. And there’s some evidence that Butyrophilin can trigger antibody production against MOG, which is one of the immune targets in MS. There is epidemiologic evidence that people who consume more vegetable protein and vegetable fiber have lower risk of MS. And that people who consume more fish have a little bit lower risk of MS. So I think there is reasonable evidence to make these recommendations especially since they’re extremely low in risk. But I wouldn’t tell someone that the OMS program is better than the Walls Protocol or better than the MS Diet, Best Bet diet or better than what Judy Graham recommends. I don’t think there’s any definitive proof. But I think it’s reasonable advice. 

 
 

Geoff Allix  08:59 

I think what the way my neurologist put it because I early on, said to him, this is what I’m thinking of following. And he said, well, there’s nothing proven, but in his opinion, it would reduce my risk of MS in an unproven way and also reduce my risk of heart disease, cancer, diabetes, and all manner of western illnesses. And then I need to weigh that up against the risk really, he said you might miss cheese quite a lot. But if I’m having seafood, I’m not missing any key vitamins. And having a low saturated fat diet with certainly reduction in red meat is not going to do me any harm. So if I’m willing to miss dairy then he said it won’t do me any harm and may well do me a lot of good not just in MS but equally in heart disease, cancer, diabetes and so on. 

 
 

Dr. Brandon Beaber  10:00 

Well right, and there’s some evidence that general vascular risk factors may be related to MS. We do know that childhood obesity is linked to higher risk of MS. Interestingly, that’s not as clear in adults. And there was a study showing that people who have a better diet, people who eat more vegetables and whole grains and less processed foods seem to have a slightly better prognosis on average in MS. And I know that Professor Jelinek’s study, the HOLISM study also supports his recommendations. 

 
 

Geoff Allix  10:33 

And so to go on to the next thing, exercise, so with someone whose father had MS in the 1980s, and ’90s, was discouraged from doing any exercise, that seems to have changed. And certainly in the UK, the official recommendation for me was certainly changed that, although exercise might temporarily exacerbate my symptoms. If I do less, then that level of exacerbation will kick in earlier. And then the way my neurological physio explained it, basically, it would just be a spiral downwards. And so I do less, it kicks in a bit earlier, I do even less kicks in earlier, and so on and so on. But if I pushed out against it, yes, I might temporarily have some exacerbation, but the next time, I might get a little bit further and a little bit further so I can push outwards. And then reduce that exacerbation caused by physical exercise, is that something you’d go along with? 

 
 

Dr. Brandon Beaber  11:38 

I would definitely go along with that. It’s unfortunate your father was given that advice. I mean, now everyone would recommend exercise, like you are getting at from a practical perspective, it may not necessarily work for some people to go until complete exhaustion, so that they can’t get through the day and go to the grocery store later. But you know, if you can do moderate regular exercise, slowly increasing what you’re able to perform, it’s going to help you in the long run. And I have some patients, they have a moderate degree of disability, but they’re still able to do fairly well, because they’re lean and fit and just generally healthy. And so even though they may have leg weakness, they could still walk long distances and do everything they need to do. 

 
 

Geoff Allix  12:21 

And would you say, is there any specific exercise, like is cardio better, or resistance and weights or any specific types of exercise? 

 
 

Dr. Brandon Beaber  12:34 

Well, generally speaking, I think that whatever you enjoy doing, and like to do and are able to sustain in the long run is probably the best thing. But I do think it’s a good idea to focus on, you know, cardiovascular exercise, and like cycling, walking, running, swimming, that kind of thing, just because I think it has a more pragmatic benefit. You know, it doesn’t matter if you can do a pull up. But it really helps a lot if you can walk a mile, so that you can go to the mall and go shopping, even if you have sort of some amount of disability. 

 
 

Geoff Allix  13:05 

Okay, that’s certainly the case with me, I, I think the distance that I can walk is one of the the primary issues I have, I would say, if I could walk a bit further, then it would make my life better. 

 
 

Dr. Brandon Beaber  13:19 

Exactly. 

 
 

Geoff Allix  13:21 

And the third one really is about mindfulness, but generally about stress reduction. So reducing stress, whether that’s through meditation, mindfulness yoga, really trying to keep your stress levels low. I mean, personally, I think it’s kind of a given now, but would you encourage an actual routine of saying, okay, I’m going to do half an hour of mindfulness a day or, or other stress reducing practice. 

 
 

Dr. Brandon Beaber  13:57 

I do think it’s a good idea to have some specific regimented plan, because otherwise, it’s hard to do it in the long run. You know, some people think about stress reduction in terms of avoiding stress. But you know, that’s not really practical. We have jobs, we have kids, we have things that we’re worried about, we really have to learn to manage stress. And I think mindfulness is great. I give my patients resources in mindfulness. And I think dedicating a little bit of time to it each day is the way to go. 

 
 

Geoff Allix  14:27 

Okay, and we’ve mentioned already about the distance you are from the equator and how that would affect vitamin D. So if people haven’t come across this, your body naturally produces vitamin D from sunshine. So firstly, there is and you mentioned actually before about some areas where risk factors went up as other ones went down and suncream and I’m aware that in Australia, certainly there had a big epidemic of skin cancer and they had what’s called the slip slap, slop routine where everyone, I can’t remember exact thing slip on a top slap on some sun cream, something with a hat, but basically completely cover up and the skin cancer rates went down. But the rates of MS and some other Western illnesses went up. So we don’t definitively know it was a vitamin D thing. But certainly as people’s skin exposure to the sun went down, then some things went down, other things went up. So it’s it’s fairly well believed that Vitamin D has a factor with MS. But would you encourage people to get more sunshine bearing in mind there is obviously a risk of with skin cancer, and would you encourage supplementation of vitamin D and bear in mind? I mean, some people are supplementing huge amounts. So the Coimbra protocol, they’re talking about massive quantities of vitamin D. So what is sort of safe levels if you’d encourage vitamin D supplementation? 

 
 

Dr. Brandon Beaber  16:06 

Well, yeah, to answer the second question, first, I do recommend vitamin D supplementation. I don’t think that the evidence is definitive. There’s definitely a link between risk of low vitamin D and prognosis and MS with low vitamin D, but it may be confounded by sun exposure. In other words, we’re giving our patients vitamin D, but maybe we should be telling them to go out in the sun. So the actual randomized trials of vitamin D supplementation and MS are not very favorable. Now that being said, I still recommend it. Just because I you know, think the risk is low, it may reduce the risk of other future conditions like osteoporosis, for example, which is actually more common in MS. So I do recommend vitamin D. And usually I go for a goal level of around 50 nanograms per milliliter or more. I know in the book Professor Jelinek recommends 60 nanograms per milliliter, which would be about 150 Nana moles per liter. If you live outside the United States, I think that’s fine, that’s reasonable. Most people would have to take about 5000 to 10,000 international units of vitamin d3 daily to achieve that. If you’re taking a lot, I do think it’s a good idea to check your vitamin D level. And if you’re taking massive amounts, like in the Coimbra protocol on a prolonged basis, there is some risk of you know, kidney stones and other vitamin D responsive problems. So you may want to be a little bit careful with that. And in the actual Coimbra protocol, they do recommend, you know, taking calcium and checking calcium and other things, I probably wouldn’t do anything that extreme. But I do recommend vitamin D supplementation to everyone with that. 

 
 

Geoff Allix  17:48 

And it’s quite straightforward to get a test actually have your levels depending I mean different parts of the world, some places will your your normal medical doctor will give you a test. But I think it’s it’s widely available on the internet to get a test whether you just take a finger tip, prick of blood, send it away, and they can test your vitamin levels. Certainly in the UK and the US it’s very straightforward to get levels tested. And the general recommendation is twice a year because once at the end of the summer, but in the fall or autumn or once the end of the winter, in the spring, just to check because obviously at the end of the summer, you might get much more exposure. So just checking your level six monthly to work out because some people need a lot more than others. With with it, some people have been naturally high level. But you mentioned about some sunlight as well. So certainly growing up, I think, again, with that skin cancer risk, we were always encouraged that probably 15 minutes before we left the apartment or holidays over on a holiday in the Mediterranean or in Florida or in Australia somewhere, then you were encouraged to make sure that you you were fully covered up with sunscreen before you left a good time before you left to make sure you didn’t get any exposure. Now, with what I’ve learned, I’m certainly encouraging my children to say actually, no, we’ll go out in 10 minutes, you’re not going to get sunburn. And after 10 minutes, then we’ll look at putting sunscreen on. So we’ve done this. We were in Thailand at Easter time. They didn’t get any sunburn in 10 minutes. And it just made me think okay, there may be they’re not getting everything from vitamin D. Maybe they there’s other things going on with the sun’s sunlight. Is that a sensible approach? Would you say? 

 
 

Dr. Brandon Beaber  19:47 

I think that is a sensible approach. There’s actually an area of research that I was not previously familiar with until I was doing the research for my YouTube video on vitamin D, which is the field of photo immunology. And it turns out that it can be shown that sunlight, specifically ultraviolet radiation has independent effects on the immune system, independent of vitamin D. And the way they prove this is they actually engineered mice to not have the vitamin D receptor. They are vitamin D receptor knockout mice. So vitamin D did nothing in these mice. And yet, they could still document that ultraviolet light had a slight immunosuppressive and immunomodulating effects. And so I think the evidence for sunlight is actually much better than the evidence for vitamin D in multiple sclerosis. And I think it’s very possible that vitamin D does nothing to MS compared to the sun. So full disclosure, I do have type one skin and I put on sunscreen this morning when I took my daughter to the park. So, you know, I don’t particularly practice that. But I do think it’s reasonable as long as you’re not getting sunburned to get some sun exposure. And yeah, maybe it increases your risk of skin cancer a little bit. But as long as you’re not getting sunburned, probably not that much. 

 
 

Geoff Allix  21:02 

So type one skin being if you’ve got that red head or blonde hair, that type of skin. 

 
 

Dr. Brandon Beaber  21:09 

Exactly, exactly. Right. 

 
 

Geoff Allix  21:12 

And you live in Florida. 

 
 

Dr. Brandon Beaber  21:13 

I live in Southern California. 

 
 

Geoff Allix  21:14 

Sorry. So yeah. So as someone with dark hair, who lives in Northern Europe, probably slightly different factors. But yeah. And the other supplement, which is regularly taken in OMS, is omega three. Now, certainly, there was originally a feeling that fish oil was a useful thing to take. And that’s that’s been changed since the early OMS books to encourage flaxseed oil. There are slight chemical differences, which I don’t pretend to fully understand. But certainly, there is believed to be some sort of factor between the levels of omega that you have. So whether Omega three, six and nine, and it was a trade off that the levels of Omega three were too low in comparison to I think Omega six if that’s right. Yeah. And omega nine is neutral, if I’m correct. And so it was sort of saying, Okay, we should try and redress the balance somewhat, by supplementing with Omega three, whether that be flaxseed or linseed oil, it’s in different countries, it’s the same thing. It’s either called flaxseed oil, linseed, or, or fish oil is the more traditional way. So again, would you go along with that? Or is there any risk of doing that? 

 
 

Dr. Brandon Beaber  22:44 

Well, there’s not a lot of risk. So the theoretical basis is that when people do research on ancestral diets, there’s actually a much higher ratio of omega three to omega six fatty acids. And it turns out that if you have a very high ratio of omega six to omega three fatty acids, which occurs with Western diets with a lot of vegetable oil consumption, then you tend to have more inflammation, and maybe higher risk of inflammatory disease and cardiovascular disease. Whereas the ratio in ancestral diet is closer to Omega three to omega six, one to one, or one to two, or one to three. It could be something like one to 12 so you’re barely getting any Omega three in a Western diet. Now, a lot of the dietary recommendations that OMS makes, may solve some of that problem. But in theory, you would still need to supplement a little bit, particularly if you’re not eating like grass fed beef and things like that. They’re pretty high in omega three fatty acids. Now, I wouldn’t say there’s as much direct evidence compared to something like vitamin D, but I think it’s reasonable to take these supplements. So it turns out that flaxseed oil has ALA, which is actually converted to EPA and DHA, which you would find in fish oil. So you would think that they would be the same equally beneficial, but for whatever reason, the HOLISM studies show that flaxseed oil supplementation slightly more associated with better outcomes. So yeah, I think it’s a reasonable recommendation, but I don’t think there’s as much evidence for it as for vitamin D. 

 
 

Geoff Allix  24:16 

Okay, and the final sort of core pillar, if you like, is is medication. Now, I think it’s as a neurologist, I would expect you to understand the benefits of medication, but just your approach to medication. Certainly, Aaron Boster has been on the podcast and he was very much of the opinion that you should really go with the strongest medication first. And then if that doesn’t work, then supplement potentially with a with a lower efficacy medication rather than the traditional approach, certainly, in a lot of the Western world, which is to go with the least strong, which does tend to be the least side effects as well. So starting and seeing how you go on, then if you’re actually still getting relapses, okay, maybe escalate a bit and then an escalate that way. So what’s your approach? Do you go with the strongest first or, or just start gently work your way up if necessary? 

 
 

Dr. Brandon Beaber  25:19 

Well, it’s very difficult for me to give a one size fits all approach, because every one is a little bit different. And certainly, I’ve seen some patients who have an extremely, you know, modest presentation of MS, where they have very minimal relapse, very few lesions, for example, which it’s difficult to recommend a highly aggressive agent like Lemtrada. But generally speaking, I would agree with him. So in terms of the overall research aspects, there are a couple of things that we found. One is that, generally speaking, treatments are more effective if they’re done earlier. And so, treatments are more effective if you’re younger, and you have less disability. So instead of waiting to see how you’ll do, it’s probably better to go ahead and take medication right away. The other thing is that the highly effective agents seem to promote a long term benefit that’s greater than the modest effective agents. So medication such as Lemtrada is probably going to lead to a better outcome on average, than a less effective medication such as Tecfidera. Now, unfortunately, and we were talking about this, before we started recording, all of the more highly effective agents do have greater risk. And so only you can decide what kind of risks that you’re willing to take. But I think that for most people, the benefits of taking a stronger agent are probably going to outweigh the side effects. And I have to say earlier in my career, and even more recently, I’ve had some patients who have been on modestly effective treatments seem to have all the good prognostic factors low disability, young, not very many lesions never had a severe relapse, and they just had a single, severe relapse that they didn’t recover from. And I wish that I had given them something stronger sooner, so I have been burned before. Now, that being said, I’ve also had some quite serious side effects from some of these agents, which I think we have to be aware of, and I don’t think I could give a one size fits all approach. 

 
 

Geoff Allix  27:22 

So it’s, it’s so up to the individual, if they’re made aware of the side effects, what they’re prepared to accept, and what risk levels are prepared to accept? 

 
 

Dr. Brandon Beaber  27:37 

Well, for instance, if someone has a very aggressive onset, very aggressive looking MRI, I’m going to try to strongly encourage them to go on a more effective agent. And I will tell them very clearly, listen, I don’t think you’re going to do well, you know, if you’re untreated or if you’re taking a modestly effective agent, you know, but in the more typical person with MS, I would sort of just discuss the risks and benefits with them. And I may say, “hey, if I were in your situation, I would do this. But you know, it may have some risks, you have to be comfortable with that.” And it’s interesting, it turns out that when people study risk tolerance, the people with MS are actually a little bit more willing to take risks than the doctors, doctors are really afraid of side effects. Because we really don’t want our patients to get them. But when you interview the people with MS a little bit more willing to take risks, because they’re afraid of becoming disabled. 

 
 

Geoff Allix  28:28 

Yeah, I think that’s and also I mean, personally, obviously, my father had MS. But I think most people I’ve met know someone else, whether that’s through MS societies or or just through friendship groups, and then you certainly are probably aware of that. It well actually, you’re aware of both sides of it. So I know now people who are running marathons, who’ve got MS. And equally people who have become disabled who have MS. So you kind of see the spectrum and think “well, okay, I know that I can be anywhere from you know, as fit as I’ve ever been in my life up to I could end up in a wheelchair.” So there’s there’s a very broad range. And yeah, there’s I think it’s probably a very personal choice as well. And it’s a very individual disease, because some people are affected much more than others. So it is quite difficult and I think medication and probably is a personal thing. 

 
 

Dr. Brandon Beaber  29:32 

I think the challenge is we can’t predict in advance what MS is going to be like. And we know that on average people who present with optic neuritis are less likely to become disabled later on and people who have spinal cord injury as their initial symptom, for example, but that’s just on the average there’s so much individual variation and the more experience I have doing this the less confidence I have in myself to predict the future. 

 
 

Geoff Allix  29:58 

Do you think that’s something that might change? I’ve certainly seen some press about this, that they may be able to more accurately predict the prognosis, the long term prognosis of someone diagnosed with MS. 

 
 

Dr. Brandon Beaber  30:13 

I think we’ll have some biomarkers that will correlate with prognosis. But I think we’re a long way away from being able to give people meaningful information that they can act on. 

 
 

Geoff Allix  30:25 

Okay, so having gone through the sort of core pillars, is there anything that you think we could do better? If someone’s following the they read Professor Jelinek’s book? They’re following everything in it? Is there anything that you would suggest that they might consider In addition, or that they might consider doing differently from that protocol? 

 
 

Dr. Brandon Beaber  30:51 

Well, the one thing I would give people a caveat is that I think that there’s a temptation to sort of replace one processed food with another. So you have to be very careful about that, you know, you don’t want to eat cream cheese and replace it with some sort of vegan cream cheese, you know what I mean, you want to try to eat whole foods, and avoid processed foods in general. And I think people should try to focus on increasing foods that are healthy, ripe for fruits and vegetables, rather than changing from two equally unhealthy foods. And, you know, I do think one of the problems with the protocol is, it’s a little bit difficult to do some of it like it’s very difficult to get adequate sunlight, particularly for women with the disease, you know, who aren’t exactly going to be comfortable walking around in a bikini unless they have a backyard. So those are the challenges. But I don’t think that there’s any single thing that’s wrong with the program, I think it’s all reasonable advice. What I wish we could do is try to get higher quality evidence. And one thing we do have to look forward to is that Terry Wahls is actually doing a clinical trial versus the Swank Diet. So maybe we’ll get some real head to head data, although it’s a little bit biased, because Terry, of course, wants her protocol to win. 

 
 

Geoff Allix  32:04 

And, yeah, and unfortunately, she’s basing it on the swank diet, which is the precursor to OMS. Certainly, but it’s certainly a fair way historically, back from where OMS is now. And a bit you’re right. I mean, it is frustrating. And certainly, obviously, there’s no drug company money in researching OMS, because they wouldn’t make any money from it. So And equally, the Wahl’s protocol, the Best Bet diet, none of these things are actually going to get any, any money from pharmaceutical companies. Unfortunately, 

 
 

Dr. Brandon Beaber  32:44 

There is no money in broccoli. And I don’t I don’t think Professor Jelinek is paying you much would be my guess. 

 
 

Geoff Allix  32:53 

He’s not paying me at all. So, but is there anything you’d add in? Would you say? It’s something that Aaron Boster has said, which is that he goes with a policy of if there’s something new, and there’s some press about what you think it might help, then his process was. Does it cost you a lot of money? What are the potential benefits? What are the potential side effects? And go with an assessment of okay, positive negatives? Does it cost me lots of money? If if all those things okay, then give it a try? And see, it’s not gonna do any harm? Okay, I’ll take a Vitamin C tablet or so for a month and see doesn’t make any difference. So is there any things additional things that you would suggest? Or is that a sensible approach? Would you try different things, because the the other side of that is that I came across a, another person who had MS very early in my prognosis, and he said, Be very cautious of chasing rainbows. As in, you’ll never get to the pot of gold. And so there’s a lot of things out there saying a cure with it was the one that it’s CCSVI. The I forget the exact terminology with it, where they look, it might be a vein that’s going into your, your brain and they could expand this, this, this vein, and it’s all due to that. And this, there’s a lot of potential cures out there. And you have to be quite wary of this one single thing. But, but would you encourage people to try things if they’re not, you know, if they’re low risk, or are there other things that you would suggest people try? 

 
 

Dr. Brandon Beaber  34:46 

Well, yes, I think that just to answer your question, you know, unfortunately, neurologists are a little bit cynical, because they’re just so many purported cures for MS. And we have to be a little bit dismissive of them or else we’ll be accepting any of them, all of them, and many of them don’t pan out, even if there is good initial evidence. But I agree with what Dr. Boster said, which is that, you know, if something is low risk and likely to result in other ancillary benefits, you know, listen, I’ve had people do the Terry Wahls protocol, which is, of course, not a proven treatment, and they have lost weight had better cholesterol profiles had better energy, it’s very unlikely to cause harm. Unfortunately, I don’t think it’s a practical approach to just try different things because multiple sclerosis is so variable, you know, even if you’re doing the right thing, you could certainly have a relapse or have a downturn, I think it’s reasonable to stick with the program. And unless there’s, you know, a reason to change it, try to stick with it and be disciplined with it. There’s a value in discipline and consistency. 

 
 

Geoff Allix  35:48 

So in summary to the the lifestyle approach for OMS, then you you would say that it’s a reasonable process to follow, and limits downside potential upside for following the OMS. Approach? 

 
 

Dr. Brandon Beaber  36:07 

Yes, I think it’s pragmatic advice, based on best available evidence, is it definitively proven? No, will it ever be definitively proven? Probably not anytime in the near future. But because we’re not going to get any better evidence, we may as well take action now. 

 
 

Geoff Allix  36:25 

Okay, and that’s something to think, as someone who has MS. That is, some time sometimes I find it slightly frustrating where they we won’t get treatment for a very, very long time. There’s there’s talk now about Metformin, potentially being a remylinating agent. And it’s now talked about going into human trials next year, but we’re going to be talking a long, long way away before we actually before that came to market, if it is proven, so there is a frustration with the length of time. And certainly yes, if it’s something widely available, so if it is vitamin D, or if it was omega three, for example, something that is widely used and safe, then I do think a lot of people would say actually, it’s there’s no risk, can you take it, so I’m going to take it now. Hopefully in 10 years time, they’ll say absolutely, everyone should take it. But yeah, there is certainly that frustration in someone who wants to be more active in their their treatment. So Metformin being being a case in point, it’s, it’s very promising. There’s it’s a widely used medication already, I believe, for diabetes. And so could we not take it now? Anyway, just in case, but that isn’t I know, that’s not the way that the way that’s the drugs come to market, unfortunately. And on that, actually, is there any area because the research, I mean, in the last few years, there seems to be huge numbers of different things happening in the MS research space. So is there any areas potentially on the horizon where things might change with with treatment? Possible prevention possible? If not a cure, certainly. A large amount of reduction in in symptoms and potential potential for remyelination and things like this is Is there things on the horizon that we could look out for that we could hope for? 

 
 

Dr. Brandon Beaber  38:38 

Well, I think there’s a lot of hope for the future in terms of advancing our standard disease modifying therapies. One thing that caught my eye recently is a new receptor has been discovered, which is specifically involved in trafficking B lymphocytes into the central nervous system. So the drug Tysbri works by blocking all lymphocytes, both T and B lymphocytes from entering the central nervous system, but this would be more targeted and potentially could have a strong benefits preventing MS really relapses new lesions while not increasing the PML and other infections. So that’s one thing that caught my eye. I definitely think that the remyelination therapies are something to look out for him. One of them is the drug Clemastine trade name Tavis in the United States. And that is an old anti histamine, which is not really used anymore because it’s quite sedating. But in an animal study, it was actually found to regrow myelin. And it turns out it does this not through the histamine receptor between different receptor called the muscarinic receptor. So the question is, does this help humans with MS and can the drug be modified to not have the sedating side effects? So that’s something that I would look at. There’s another drug called anti-LINGO, which is Opicinuma. That’s an acronym is a natural myelin growth inhibitor. And there’s a drug that blocks. It’s anti-lingo. And that is entering phase three trials for multiple sclerosis, I don’t think it’s going to have a huge benefit. But even if it had a modest benefit, it could be something that virtually anyone with MS could take us. There aren’t really a lot of side effects. And of course, there are many other things I could talk about. But those are few examples. So I definitely think there’s hope for the future. 

 
 

Geoff Allix  40:29 

Okay, that’s very interesting. So to wrap up, you in your opinion, it makes sense to continue with the approach that people following OMS are on. Certainly also speak to your neurologist and look into medication choices. And there is also some hope for the future. Would you go along with that. 

 
 

Dr. Brandon Beaber  40:53 

I would definitely go along with that you guys are doing great work. So keep up the good work. And if you need me back, I’m happy to do it anytime. 

 
 

Geoff Allix  41:00 

And another thing I would also like to mention that you have a book that’s recently released, as you’ve very generously given your time to the podcast, I feel we should mention that you do have a book, which is widely available through all normal channels. Amazon, books it up in other booksellers anymore. We don’t have very many. I think it’s mostly Amazon nowadays. I think well, if it’s an anything like my family, everything is bought through Amazon nowadays. But yes, I would like to make sure you do have a book out which is a very good read on multiple sclerosis as well. 

 
 

Dr. Brandon Beaber  41:35 

Thank you for that. I appreciate that. 

 
 

Geoff Allix  41:38 

Thank you very much for joining us, Dr. Brandon bear. With that, I would like to thank you all for listening to this episode of living well with MS. Remember that there is a wealth of information at overcomingms.org including show notes and an archive of all Living Well with MS episodes. Once again, that’s overcomingms.org. There you can also find OMS friendly recipes and exercise tips. Connect with other OMSers in your local area through our OMS circles program, and learn about the latest research going on in the MS world generally and related to OMS specifically, I encourage you to register on the site and stay informed about the latest news and updates. I also encourage you to subscribe to this podcast, so you never miss an episode. And please feel free to share it with others who might find it a value. Let us know what you think about the podcast by leaving a review. And if you have ideas for future episodes, we’d love to hear from you. So please contact us via our website overcomingms.org. Thanks again for listening, and for joining me on this journey to Overcoming MS and living well with multiple sclerosis. I’m Geoff Allix And I’ll see you next time