S4E31 Introduction to Overcoming MS with Dr. Jonathan White (webinar highlights)

Geoff Allix: Welcome to living well with Ms. The podcast from overcoming Ms. The world’s leading multiple sclerosis, healthy lifestyle charity celebrating its 10th year of serving the Ms community. I’m your host, Geoff Allix. The goal of our organization and this podcast is to inform, support and empower people with MS to lead full and happy lives. 

We’re excited. You could join us for this new episode. Make sure to check out this episode, show notes for more information and useful links. You can find these on our website at overcomingms.org/podcast or on whichever podcast platform you use to tune into our program. If you enjoy the show, please spread the word about us on your social media channels or leave a review wherever you tune into our podcast. Have questions or ideas to share? Email us at [email protected]. Or you can reach out to me directly on Twitter @GeoffAllix, we’d love to hear from you. Finally, don’t forget to subscribe to Living Well with MS on your favorite podcast platform so you never miss an episode. And now let’s meet our guest for this episode.  

Welcome to the Living Well with MS podcast. Today’s episode features highlights from the Introduction to Overcoming MS webinar presented by Dr. Jonathan White, recorded live in front of our global audience as part of the Finding Hope with OMS series. To join us live for the next webinar or watch the original presentation head to our website overcomingms.org 

Dr. Jonathan White: Hello everyone. Good morning. Good afternoon, evening. Wherever you are in the world. 

You’re really very welcome to this first episode on our new webinar series. Finding Hope with MS and intro an introduction to the OMS program. As Sian said, I’m Jonathan White, more commonly known as Jonny to almost everybody in the world. I’m an obstetrician and gynecologist by training. I’m not a neurologist. 

My main area of, of interest and work is in early pregnancy and in recurrent pregnancy losses. And I run a clinic in that field in a district general hospital in the north coast of Northern Ireland where I live and work. So you’re all really, really very welcome today. For some of you, it’ll be your first dipping of a toe into the world of OMS for others it might be first experience with MS at all full stop and whatever your past experience is, please know that this is a place where hopefully you’ll find information, support and hope along your journey. Before we get into the main thrust of the presentation, I should probably tell you a little bit about myself and my MS journey. So. I was diagnosed with relapsing remitting MS in October, 2015 following a very acute onset of symptoms in the months before that, and it culminated one Sunday afternoon with me taking myself to my local emergency department and saying, I think I’ve got MS I need an MRI scan. And the doctor sort of laughed at me and said, typical medic over diagnosing. 

You’ve probably slipped a disc, your neck, let’s get a scan. And the scan showed inflammatory relations throughout my brain and my spinal cord. So I won that one. And I, I sat in front of a neurologist a few days later who said, well, it’s 50 50, you’ve got clinically isolated syndrome, 50 50, it’ll become MS. 

What we’ll do is we’ll scan you in six weeks and if there are new lesions, then you qualify for treatment. So six weeks later, I sat in front of her again with my fiance, now wife, Jenny. And was told there are two more lesions on that scan. Not I’m very sorry, Johnny. You have MS, but there are two more lesions on that scan and that’s a, a different talk for a different day on how you impart bad news on people. 

But that certainly wasn’t the way I would’ve chosen to find out that life changing diagnosis from that day on. I decided that I needed to find. More about this disease. Cause I didn’t know very much about it. And what I could do to help me stay well. And I asked the neurologist, I said, is there anything I should be doing? 

Do I need to change my diet? Reduce alcohol, caffeine, start smoking and then stop smoking exercise, more lose weight. And she said, no, there’s no evidence for any of that. Just take the medication that we give you and I thought to myself that that just doesn’t sound right. This is a disease that didn’t really exist a hundred years ago and yet neither, almost 3 million people around the world are affected by Ms. 

Genetics don’t change that fast through something in our environment, what we eat toxins in the environment, et cetera, must be playing a role in this. And it led me on a quest, which fortunately find George Jelinek, professor George Jelinek’s work in the Overcoming MS textbook, which I inhaled in about three days. 

And it’s safe to say it’s changed my life ever since. As somebody with MS it gave me vital information. As a doctor, I greatly appreciated and respected the amount of references and the huge amount of research that had gone into writing the book. But probably most importantly, as a, as a human being in a very, very dark time, it gave me hope. 

And it’s that hope that I want to try and impart to you today, along with some facts about the OMS program. Before we do that, we probably need to talk a little bit about what MS is, because for some of you, you will be given this life-changing diagnosis and not being told very much about it at all. So what is multiple sclerosis? It is not a particularly scientific word. 

It just means that there are lesions throughout the body. In more than one location, sclerosis means scarring thickening or hardening. So it’s not specific to this condition. For example, Atheros sclerosis is scarring or thickening or hardening of, of the coronary arteries in the heart. It’s a disease of the brain on the spinal cord. 

And those two things together make the central nervous system or the CNS, the peripheral nervous system, which you may have heard of is essentially the nerves after the point of the spinal cord and die. So outside of, of the, the brain and the spinal cord themselves, Ms is the most common disabling neurological condition of young adults. 

It’s condition that’s most commonly diagnosed when people are in their twenties and their thirties. And it’s three times more common in women than men, but we don’t fully understand why that is. Currently there is no cure for multiple sclerosis, but what we are here to tell you over the next number of webinars and through our work in general is that recovery is possible with this condition. 

Epidemiology is a word we’re all too familiar with. And given the COVID 19 pandemic, but it essentially means a study of how often diseases occur in different groups of people and why they happen. We know that approximately one in 600 people in the UK where I live are affected with MS and that gives us a total of around 130,000. 

It’s around one in a thousand throughout the world, giving us around 3 million people affected by the disease. We also know that the rates increase directly as you move north and south of the equator, which I’ll explain later. And we also know that it’s becoming more common, partly because we’re getting better at monitoring and diagnosing it, but also because it is simply becoming more prevalent. 

And that’s likely, certainly in part to your increasingly unhealthy lifestyles and, and westernization of the Western diet or standard American diet as often called, nothing against America, but it’s just often known a SAD. So it’s important that we get down into the basics here, the building blocks of the nervous system and those aren’t neurons. 

And myelin primary role is to increase the speed at which the transmission occurs. So that instead of running in a straight line, signals can jump from sheath to sheath. And it’s the myelin sheath that is affected by MS. That is damaged and it’s, it’s damaged to the sheath that causes the symptoms that we’re all too familiar with. 

We also need to talk about immunology, which is a filthy word. Certainly when I was at medical school, because it is so unbelievably complicated. But in simple terms, And I’m deliberately trying to keep this simple for my own benefit. As for all of you, there are two concepts you need to be very aware of when it comes to MS and immunology. 

The first is a blood brain barrier like passport control, which again is a hot topic in the current circumstances, which we find ourselves. So it’s the brain security system. It’s an extremely selective barrier that lines the brain’s blood vessels, and it’s there to stop many substances from getting through and into the brain tissue itself. 

Really all the brain wants to get out of the bloodstream is glucose and oxygen and give all the toxins from metabolism within the brain tissues back into the bloodstream to be cleaned. It certainly does not want white blood cells getting across and into it, but in Ms. It, they do. And it’s because the barrier becomes leaky. 

The other thing that is really important to understand is something called the TH1 and TH2 immune response. It’s essentially a Seesaw balancing act in the immune system. Now there are lots and lots of different aspects here, but this specifically refers to the balance of inflammation and anti-inflammation repair. 

TH1 is that side of the immune system we need, whenever there is a threat or attack. So it’s to mount that immune response to mobilize the trips, if you like, and to prepare for attack. TH2 on the other hand is when the attack is over that the, the trips go back to the barracks that there’s anti-inflammation and, and repair being promoted. 

Neither are good or bad. You need both, but they should be in balance with each. And an MS. Unfortunately there tends to be a great imbalance towards TH1. So what is it that happens in MS? Well, it’s an inflammatory delmilinating, which means removal of Mylan condition of the CNS. So the immune system the immune cells get across the blood brain barrier when they shouldn’t the immune system mistakenly attacks the mile in sheath nerve impulses then are slowed or distorted or not transmitted. 

And that’s what gives us the symptoms, numbness, the tingling, weakness, balance issues, coordination problems, cognitive issues, bladder, bowel, you name it almost anywhere that a nerve supplies can be affected by MS and no two people with the condition will have the same symptoms or presentation after that initial attack, then scarring forms of that inflammation site. 

And in the early stages of the condition, you do get some remyelination from the little cells called Oligodendrocytes. But with time, that process becomes less efficient and less effective. And we know that over time, if myelin is not putting the nerve fiber, it’s extremely prone to damage and destruction. 

And over time, the nerve fiber often dies. Cell death of the nerve fiber is often called external loss, which is something that you may have heard of before. So what causes MS? Well, there’s not one cause there’s multiple complex interacting factors at play here in terms of genes. It’s not considered a truly genetic disease. 

I’ll explain why, firstly, because there’s more than 240 genes indicator. There’s not one gene for MS that you have, or do not have. It’s a, it’s a very complicated mix of lots and lots of genes and their. We also know that the incidence is in, in identical twin. So those that share their DNA completely is only one in four. 

So if it was a truly genetic disease, both twins would get it. If one at MS the other should get it, but that’s not the case. So it tells us there’s something more than genes involved in this condition. We do know, however that if you have MS, it does increase the risk of your siblings and your children or your offspring being affected. 

So the risk is approximately seven times higher from my brother and sister by virtue of my MS, which equates to risk of around one in 37 for my children. It’s five times higher. So it’s a risk of one in 67. Remember that, and where I live, the risk is approximately one in 600 in population. Infection is a really big area of research at the moment. 

There’s no single one agent that’s been identified, but there’s a great theory or body of work going towards the theory that Epstein Barr virus, that causes glandular fever could be a, a major contributor to MS. And we knew that it’s, if it is gonna be an infection, that’s playing a part, it has to be one where there’s an abnormal, delayed immune response to an infection that can lie dormant within the body. 

And we know that EBV glandular fever can do that. We also know that if you’ve never been in contact with E B. You’re very unlikely to develop MS. And that the later in life that you’re exposed to it and the worse your symptoms were from glandular fever, the more likely you are to get MS. So there certainly is a connection that is being actively explored at the moment. 

In terms of environment, I’ve already mentioned, we know the incidence is lowest at the equator, and that’s probably due to the fact that the sun’s UVB rays are strongest there, they weaken directly as you move both north and south. And the incidents in Scotland is approximately the same as it is in the south island of New Zealand, which are at the same latitude north and south. 

There’s some interesting things at play here though, because we know that if you live in a low risk area to the age of 15, that your risk will remain low, even if you move to high risk area. So say you were brought up in central America or in Brazil, for example, and then you moved to Norway. After the age of 15, your risk would remain low. 

There was undoubtedly something in early life and programming the immune system that plays a part in this ally to that. We also know that some ethnic groups, particularly the Inuit have a very low incidence of MS. Even though they live in a very, very high risk area. They don’t have any significant sunlight for at least six months of the year. 

Probably two factors, at least plus genetics there, one being vitamin D and the other being their very high, sorry one being the major one being omega3 actually the fact that they eat so much oily fish is very high in omega3 and also contains a dose of vitamin D that they may not otherwise get from the sunlight. 

Vitamin D itself. Well, we know that low levels of the vitamin and in many Northern European countries, like my own, for example, vitamin D deficiency affects 50 to 80% of us during the winter time. So it’s incredibly common, low levels are associated with an increased risk of MS and of also progression of the disease. 

If you do have it, the reason for that is because it’s an incredibly potent regulator of the immune system and Western lifestyles. While you’re gonna hear plenty more about that a bit later.  

The types of Ms. I’m just going to discuss briefly, but it’s suffice it to say that we don’t neatly all fit into one box. The classifications are changing rapidly, but there’s still essentially 4 main types of MS. Relapsing remitting MS, secondary progressive primary, progressive and relapsing progressive MS. Although that last term is becoming less favorable at the minute within relapsing remitting, we have benign MS, clinically isolated syndrome and rapidly evolving severe RRMS, which is a term that is essentially being coined in the era of the modern disease modifying therapies to try and risk stratify people to who, who needs the more potent therapies or who would be entitled to them. 

We know that secondary progressive MS affects up to 66% of people after 24 years. So these are people initially diagnosed with relapsing remitting, and primary progressive affects 10 to 15% of those diagnosed. And this is characterized by progressive disability from the outset. Usually without relapses, although you can have episodes of relapse, as well as progressive disability from the of disease. 

That’s also a particular hallmark of relapsing progressive, where you get relapses, but you get much less complete remission would in relapsing remitting MS 

so traditionally it’s characterized as symptomatic episodes with partial or complete recovery, but that’s very misleading because we know that there’s a real iceberg phenomenon here. 

On average, there are 10 lesions on an MRI scan for every one relapse. So you can have an awful lot of active disease, but not know very much about it. Clinically a relapse is defined as appearance of a new symptom or worsening of all symptoms that last for over 24 hours. But in the early stages of the disease, personally, for me, I find it extremely hard to tell what was a bad day and what was the relapse. I find that very, very difficult. And that’s a story that you hear very often the frequency of relapses and the severity of the symptoms are extremely unpredictable and vary hugely from person to person. But we know on average without treatment, there are one to two relapses annually in what we call the natural history of the disease, the medical therapies the DMDs or DMTs are called reduced relapse frequency, and some have now been shown to slow disease progression over time. 

In terms of the impact of the condition in a UK centric model, the cost of our economy here is 4.2 or up to 4.2 billion pounds annually. We know that employment state varies hugely, but that early retirement affects probably a quarter of people with MS in Europe. And on average, it results in a loss of 10 working years, perhaps through sick leave, less than full time working and or retirement. 

We know that half 50% of people with MS suffer, at least one clinical episode of depression, and one in four people could be diagnosed with PTSD symptoms following the, the actual process of diagnosis. You don’t need me to tell you that impacts upon the whole family and everyone that cares about you and most people that you care about. 

Most people are diagnosed at a time in their life when they’re making really major life decisions starting or changing career, do they settle down and get married? Do they start a family? Do they take a year off and go and travel the world? Do they start a new, crazy hobby? It’s also really important that we bust some myths about MS. 

And there are many, so the first to say is that MS does slightly reduce your life expectancy by around six years. But I would hesitant to add that that is a figure that was coined many years ago at a time when the treatments were much less effective and much not just commonly used. To also put it into perspective a diagnosis of diabetes will reduce your life expectancy by around 10 years on average. So MS is not considered a terminal illness. Despite what some insurance companies will say, the majority of people will not need to use a wheelchair regularly. We know that over two thirds of people are ambulance still after 20 years living with the condition, you should not reduce your levels of physical activity by virtue of having MS. 

In fact, the opposite as I will explain, and you won’t necessarily have to stop working just by virtue of the disease or the condition. Importantly, for those of us who are of child bearing age or, or female, there’s no direct effect on pregnancy outcomes. So there’s no increased risk of miscarriage of still birth of small babies of early babies. 

There is a slightly increased risk of Caesarean section, but that’s generally due to obstetric anxiety rather than any direct correlation between the condition and the pregnancy itself. We also know that pregnancy is protective and that relapse rates are generally reduced during pregnancy. And in what we call the postpartum period after baby is born, there is a medium to long term up to three year benefit in terms of relapses and disability progression from pregnancy. Breastfeeding is protective both to the mother and to the baby. And we know that exclusive breastfeeding for six months reduces the child’s incidence of MS by approximately 50% throughout their lifetime. So it cannot be overestimated its importance there. 

So to the OMS program, then it was previously been known as the seven step OMS recovery program. But really it’s probably best not to think of it as step by step on following a ladder, but rather of a circular diagram where all the parts connect together, the because they, the sum of all of this is much greater than the individual parts. 

So namely the parts of that circle are diet sunlight, and vitamin D exercise, meditation, medication, family prevention, and change your life for life. And we’re gonna spend some time know just going through each of those various components. So if anybody knows anything about the OMS program, they usually know that it involves a diet and it is the cornerstone of the OMS program. 

Contrary to what most people think it is not a low fat diet. It’s a low saturated, fat diet. And that’s very important. The primary evidence for that comes from professor Roy Swank. Who’s the gentleman on the right of the screen and his pioneering work the west of America in the 1950s, where he followed 150 people with MS and also their families, because in those days, people listened to their doctors and did what they were told. 

And if he said, you’re starting this diet for your MS generally the whole family did the same thing. Remarkably he followed those people for 34 years. And in fact, actually almost 50 years of follow up over time. If you think that the average drug trial lasts a year, two years, three, five years at most, that is truly astounding. 

It was also published in the Lancet in 1990, which is consistently one of the highest peer reviewed journals in terms of rank throughout the world. But unfortunately his findings were largely ignored by the medical community to briefly explain why Professor Swank started his study in a time when evidence-based medicine didn’t exist. 

So he was being judged. Then when he published his results by a standard that didn’t exist when he started. So there was criticism that those investigating the people with MS, following the diet and not following the diet, knew what the doctors taking the results knew which group the patient was in, and that could lead to bias. 

And that is a very valid point. But given that the, the facts that they were recording were was the patient well, and ambulatory, did they use a stick? Were they wheelchair bound? Were they bed bound or were they dead? It’s it is rather difficult to, to see how that in all good consciousness and faith, they could be faking those results. 

Regardless of that criticism, it had remarkable results. It showed that a diet low and saturated fat. So under 20 grams per day, significantly reduced disability, accumulation rates and disease progression over time. It reduced relapses by 80% at one year. And by 95% at five years, 34 years later. So this is at least 34 years after diagnosis of MS. 

95% in the low fat group were well. And they were ambulant.  

So why, why does it matter? Well, it’s because you are what you eat, what you put in your mouth. Three to five times a day is your single greatest interaction with the environment. 

Remember that your cells are made of everything that you eat. The reason that it all comes down to fat here is because on the right, you will see cell membrane. This is a scanning electro micrograph of the fossil lipid BI layers. It’s often called that makes up the cell membrane of every single cell in our bodies. 

Those cell membranes are made of fats. Fats and oils are, are both the same thing. Fat generally means a solid oil means a liquid, but they’re all made up smaller building blocks called fatty acids and these are the things that make up our cell membranes. Saturated fats are those that are generally solid at room temperatures such as butter or The rind on a on a chop. 

They mainly come from animals when they are incorporated into the body, they are rigid. They’re sticky, they’re inflammatory, and they’re degenerative. None of these things are something that I want as somebody with a chronic degenerative neurological condition. Poly unsaturated, fat, meaning many unsaturated bonds in those little fatty acids two, which you might have heard of being a omega3 and omega six are generally liquids, and they mainly come from plants. 

And from seafood, these in turn, when they’re digested, incorporated into our body and absorbed makes cell membrane. Flexible less sticky and they resist degeneration. Also, these are the building blocks for the signals that the immune system uses to tell other parts of the body to light up inflammation or to rest and repair. 

So omega three are generally very anti-inflammatory and omega six is slightly more complicated, but are also generally pro-inflammatory we know that diets high in omega three shift that all important immune balance to TH2. So some of you who may have been doing some digging into OMS will perhaps have heard of the study, which is professor Jelinek’s work at the NEU at the university of Melbourne. 

And that essentially took 1500 people around the world with MS and follow them up through self-reporting questionnaires as to various aspects of their health, their quality of life, mental quality of life, and various other factors. And what we find was that people on a meat-free and dairy free diet at a significantly better quality of mental and physical health. Those taking daily flaxseed oil, and we would normally advise 20 to 40 mils of fresh cool press flaxseed oil daily with thes program, which is extremely high in the omega3 had a 60% reduced relapse rate. And we also find that eating fish three times weekly reduced the relapse by 50%. Dairy, many will know is a bit of a no-no on the OMS program in fact it’s an absolute no-no for two reasons. There’s a protein within dairy milk that is extremely like meylin. It shares a lot of the structure with myelin. So to those who have an immune autoimmune response against myelin, it it’s extremely pro proinflammatory and it’s akin to throwing petrol and a lit bonfire. 

So there’s one aspect there and also it’s extremely high in saturated fat. So those two things together are not good if you have multiple sclerosis. For those who enjoy a tip, you’ll be happy to hear that those taking moderate amounts of alcohol following their local national guidance actually had a, a better quality of life than those people who took very lower little alcohol or those who took too much alcohol as by standard definitions. 

So OMS recommends a plant-based whole food diet plus seafood supplemented with 20 to 40 mils of flexed oil daily. There’s obviously much more we could talk about there, but that would be the subject of a separate webinar where you’ll learn some really helpful tips and rest based and a bit more about the science behind things. 

So sunlight and vitamin D well, vitamin D as I’ve said, has a key role at regulating immune system. And in protecting the brain, we know that there’s evidence in a whole host of conditions for the benefit of vitamin D in terms of reducing depression, rates, hypertension, or high blood pressure, heart disease, diabetes, some cancers, and in my own field, pregnancy losses. 

There are substantial evidence, particularly for vitamin DMS prevention and in reducing the severity of the disease. We know that 75% of cases of MS could be prevented if vitamin D levels were over 100 nanomols per liter, which is the unit we use in Europe and Australian, New Zealand higher vitamin D levels result in less new lesions, less relapses and less shrinkage or atrophy of the brain over time. 

And if you were to increase your blood level of vitamin D by 15 nmol per liter, that was found in one study to reduce relapses by 57% and reduce new lesions also by 57%. We also see that over time, higher levels lead to less disability . It’s made in the skin on exposure to the sun’s UVB Ray. So UVA gives you the tan UVB is responsible for vitamin D and UVC is filtered out by the ozone. 

There its primary function is to absorb calcium and magneseum and phosphate from our guts. And it’s essential for growth and bone health. The skin will manufacture about approximately 1000 units per minute, to a maximum of 15,000 units daily. But that only happens if you’re in UV index seven or above, which in many places, north and south, and you need to be nearly naked in, in the sun exposure. 

So exposing less skin for longer will not increase vitamin D further because there is a limited amount of conversion that can occur in any one area of skin. As I said before, the UV index decreases directly as you move north and south of the equator. And importantly, we also know that small, regular amounts of sunlight and sun exposure are perfectly safe and they actually may prevent skin cancers especially malignant skin cancers, such as melanoma. 

If you are to get out in the sun, it’s best to take your 10, 15 minutes before you put your sun cream on and then put the sunscreen on because even factor eight or above will completely filter out UVB. Of course you should stop the point before you start to burn, if you have very sensitive skin. So in the OMS program, we’re aiming for a blood level of 150 to 225 nmol per liter, or if you’re in America, 60 to 90 nanograms per milliliter. It’s really important to say that that level would often be considered high on some laboratory reports, but it is perfectly safe in the vast majority of people. Vitamin D toxicity is extremely rare. It is only even a vague, small possibility at levels of probably 400 nmol per litter, but more likely 600 nmol per liter. 

And you need to take huge doses to achieve that. The dose that we advocate is between 5,000 and 10,000 international units of vitamin D daily or 15 minutes of some exposure, three to five times a week. If your levels are very low on your first test or when you’re first diagnosed, which is very common, a one-off mega dose of say 600,000 units is a very safe way to quickly increase your blood levels. 

It’s safe in pregnancy and breastfeeding. And in fact, it’s extra important in breastfeeding and pregnancy. Many governments around the world routinely advise a level or a daily supplement of 400 or at most 800 units daily. But it’s important to say that international endocrinology bodies would argue that doses of up to 4,000 units day for anybody are perfectly safe. 

So we’re not advocating doses much higher than that in certain people. But we also know that 10,000 units a day for the huge majority of people are absolutely safe. We also know that testing of your vitamin D levels can be difficult in the public sector. In the NHS in the UK will often not provide this, even though it only costs six pounds to laboratory to do it, but it can be arranged online. 

So there are two examples there, but depending where you live, there are almost certainly available options. Both of those are around 40 pounds Sterling and give you results within about 72 hours. I would usually suggest that you have vitamin D levels tested once in spring and once in the autumn so that you know what dose to, to take then over the winter months and also whether or not you can reduce your dose going in through the spring, the summer when the sun will be strongest. 

So exercise, then we all knew that exercise is good for us and there’s many positive effects. So it reduces our blood pressure, cholesterol levels or risk of infections protects us against heart disease, stroke, cancers, type two diabetes, osteoporosis, and dementia. And it reduces the risk of early death from all causes by up to 30% in many chronic disease conditions, exercise regularly is as effective as many medications. 

And in fact, there’s a publication today saying that in people with poor sleep habits or lack of sleep, that exercise can be really protective for the brain. In the past, people with MS were told to avoid exertion, and I was told this when I was diagnosed, don’t raise your heart rate too high. That could be dangerous. 

I’m not sure where that comes from. It doesn’t even make sense scientifically. But we now know that there are huge benefits from regular exercise: muscle strength, energy levels, reduced fatigue increases walking, speed, sexual function, bowel and bladder function and overall quality of life. It halves your risk of depression and it improves your cognitive performance, your information processing and your problem solving abilities. It, in part, we think that’s because it stimulates the neurons whose little building blocks of the central nervous system. 

And it strengthens the connections between them, which is really important. It reduces brain shrinkage. So it slows the rate of atrophy in the brain, which we know is higher and quicker in people with MS. And it also appears to slow disease progression over time. It promotes neuroprotection and neuro regeneration.  

We know that the greatest benefits are fined in those who go from sedentary lifestyles. So doing very little regular exercise to regular moderate intensity exercise and moderate intensity is usually defined as something where you can talk as you do it, but you couldn’t sing. 

I mean, I personally have never been able to sing doing any form of exercise, but there you go. You should start low and increase slowly. It is okay to push yourself with MS. You’re not gonna bring on a relapse by lifting one extra rep or, or swimming a little bit further or walking a bit further. It’s okay to go to the point of fatigue ability, but you also have to be mindful of limitations of fatigue, of weakness, et cetera. 

And some people will find that the increase in body temperature with exercise provokes symptoms. So we know that endurance training, so bands and weight exercises generally will cause less body temperature rise and will provoke less symptoms in those with heat sensitivities. A qualified trainer can be really, really helpful and design a suitable program for your abilities. 

And two resources I’ve just highlighted are one the MS gym with Trevor Wicken, who we have a partnership with as well as Dr. Gretchen Hawley in The MSing Link, OMS recommends 30 minutes of exercise, three to five times a week. And that is just what the standard recommendation is by many governments around the world. So it’s nothing extra, but it is extra important.  

So meditation and mindfulness. This is the thing that I personally struggle with the most. When I embarked on the OMS program, approximately five and a half years ago, it’s something I still struggle with slightly if I’m being completely honest, but it’s a vital part of my own journey with this condition. 

Mindfulness is defined rather arbitrarily as paying attention in a particular way on purpose in a present moment and nonjudgmentally by Jon Kabat-Zinn who’s widely thought of as the father of modern secular mindfulness meditation. There is a vast, vast evidence base on the connection between the mind and the body and how that in turns on how that in turn impacts upon our health. 

We knew that stress major life events can trigger MS selapses because they provoke a very strong TH1 immune response. There’s very clear literature to say that four to six weeks after a major stress event, relapse rates in MS significantly increase. And I have personal experience of that. And it really goes back to the evolutionary fight or flight response, the saber tooth tiger. 

When we lived in the cave. If you like, when we see a threat, the body, doesn’t, it doesn’t matter what that threat might be. The response is the same. It’s increased adrenaline secreting from the glands on top of the kidneys to increase our heart rate or blood pressure to send blood to our muscles in case we have to fight or to run. 

And also to turn on inflammation, we’re expecting insult and injury. We need to be ready to mobilize the immune system and to thicken the blood to in case we have a life threatening injury and, and hemorrhage. So those things are okay. Should there be a short threat such as tiger. It’s not when that is imaginary or it’s never ending, potentially worrying job commitments. 

We can’t avoid stress, but we can change how we respond to it. And meditation very clearly has been shown to shift the immune balance over to that TH2 side of the seasaw. Regular mindfulness practice increases the gray and white matter in MRI scans, it promotes neuroplasticity so that re-routing of signals around damaged areas and creating new neural networks. There’s a fascinating area of research regarding telomeres and teleomeres the little caps on the ends of our DNA strands in each of our cells. And we know that they get shorter as we age, and as they shorten the risk of age related diseases increases. It has been clearly shown now that mindfulness lengthens telomeres and prevents them getting shortening, shorten, shortening over time, rather, and that in turn reduces your cellular age. And in fact is effectively making you younger. 

It improves quality of life and protects against depression, specifically in MS and NICE, the regulatory body in the UK. now has mindfulness as a first line treatment for depression anxiety. We recommend 30 minutes of meditation daily, and I just wanna draw your attention down to the bottom right of the screen, which is a film called the connection made by Shannon Harvey. 

Who’s a great friend of OMS and is available on iTunes and features amongst others Professor George Jeline k. This is a film that we have shown at our retreats previously and is really great introduc into the field, mind, body medicine. 

So medication briefly, we could obviously talk about this at a webinar on its own, right? But it’s important to say that OMS is not against disease modifying drugs. I think in the past, there was a perception that OMS was the slightly alternative area to pursue. And if you were going to that route, you were then against medication. 

That was us versus them. That could not be further from the truth. It should be of us and them together. We know that early medical treatment can alter the disease course in MS. But there are many issues to consider when you choose a treatment and you need to take time and have the space and opportunity to address these with your doctor and or your MS nurse. And that often in the modern health system is sadly and sorely. Because you need the support, the time, the space to weigh up the benefits with the risks of potentially very serious side effects that can come with these medications. Currently there are 12 disease modifying drugs licensed to treat relapsing remitting, MS. 

They have been shown to variably reduce relapse rates and their severity of, of the relapse, but also to reduce disease progression. One treatment has now been licensed for active secondary progressive MS called Siponimod. And one is licensed to treat early primary progressive MS which is called ocrelizumab. 

There are criteria for both of these drugs and it, the availability changes depending on where you live in your healthcare systems. But the point to remember here is that this was not the case even two years ago. And that landscape progressive MS treatments is changing rapidly as is that of RRMS. 

Prevention for family members. Then for some of us, this is possibly most important area of the MS program for others. It, it’s not a concern, but it is worth taking a moment to discuss. We know probably that genetics accounts for around 25% of an individual’s risk of MS. So that remaining 75% is the environment in which you live and what you expose yourself to. 

So if you think of genes effectively load the gun, but your environment pulls the trigger. As the analogy itself often used. So one release put, pull on the trigger, cigarette, smoking, it doubles your risk of developing MS and your lifetime. And you’re four times more likely to develop progressive MS. 

And on average, eight years earlier, and that’s a dose dependent effect to the more you smoke, the more likely it is passive smoking around a child doubles their lifetime risk of Ms, which vitally important that you keep children away from passive smoking. And of course moving in general vitamin D we know that low dose frequency on exposure and we’re in the wintertime 5,000 units daily aiming for a level of 100 nmol per liter. 

This is prevention rather than people who already have MS is perfectly safe and could reduce the incidence of MS. As I said, by around 75%, the dose for children and babies is lower. And it’s usually 1000 units per 10 kilograms, but that Supplementation with vitamin D for babies should start for the mom in her pregnancy diets. 

It’s difficult obviously to study diets and people who don’t have MS. And follow ’em up to find out what the outcomes were. But Swank did do that. And in the families that adopted the low saturated fat diet, there were zero reported cases of MS. So we would extrapolate that with the slightly updated and changed version of the OMS program, which is reflects modern understanding of dietetics, which is plant based and whole plus minus seafood. 

That that should also have a protected and positive effect with additional supplementary flexed oil to provide a omega3 stress is unavoidable, but we can stress better. We can find ways of coping with stress of managing our stress and doing it together as a family unit. And with your friends, as Benjamin Franklin said, an ounce of prevention is worth the pound of cure and never a truer word was spoken. 

So to hark back to the HOLISM study and what it showed about the program in general, well, improved health outcomes with the OMS program, a 60% relapse rate reduction with flaxseed oil, 42% less chance of disability progression with a healthy fat diet reducing relapse rates by a third on any dose of vitamin D and a significant risk reduction in depression and fatigue levels. 

Part two of HOLISM is now being analyzed to see how these changes to lifestyle affect MS in the long term.  

So the last aspect is about changing your life and changing it for the rest of your life and for life. On the top, right? You see the acronym smart. And this is a, a bit of a buzzword used in the science of change at the moment that if you were any, any variable, you’re changing should be a specific, measurable, achievable, realistic, and timely change. 

You are not to blame for getting MS, but you are the best person to deal with it. The way that OMS firmly believes is the best way to deal with it is to eat a plant-based whole food diet plus seafood. If you like with daily flax seeded oil, to get enough vitamin D either through sunlight or by taking five to 10,000 units a day exercise for 30 minutes, three to five times per week, meditate for 30 minutes daily, work with your doctor and take medication if it’s necessary and right for you and prevention for your family members, all the elements we’ve talked about are effective in their own, right. 

But the stop that they work best when they put together. But this is a choice. And it’s your choice? I believe a a as do many people increasing numbers of people around the world that the scientific evidence behind the OMS program is extremely compelling and gets stronger all the time, but we can’t make you make that change. 

The choice is yours. We know that changing habits that can be difficult and it can take time. On average it’s around 66 days to change a habit and the odd slip up along the way doesn’t materially affect the outcome, the formation of new habits. I wanna just point out a book that I read about a year, well, maybe two years ago now I, that I find remarkable and so interesting and really clarified for me the science of change. So by James clear, it’s called Atomic Habits and it’s to do with the tiny, tiny little changes that we can make on our daily lives. That cumulatively have a massive positive impact. 

The analogy often uses about the cycling cycling team and they made all these micro gains in terms of bringing their own duvets and pillows. And they find that incre that increased performance by X percent, which coupled with Y achieved further improvements. And it’s really fascinating reason. I would, I would recommend it to you. 

Just as a final thought or two. Dr. Paul Paul Aebersold was a physicist in California in 1950s and a real pioneer in that field. And he basically found over the course of 12 months, 98% of the atoms in your body change. So 12 months from now 90% of the atoms you currently have, will not be there. There’s constant turnover and recycling and renewal. 

So it is never too late to make a change. I can’t finish without sharing my own philosophy for those who view of you who have heard me speak before you’re gonna have to close your ears for 20 seconds because you, you will have heard it. I am not a great poet. I, I do enjoy reading, but I’m not a greatly learned in the field of literature, but I do love films and I really love the James Bond films. 

And I’m a huge fan of Judy Dench and I love the films, Skyfall and the scene in particular, which she’s being grilled in the house of common select committee. And she quotes a poem that her husband taught her. Which for me sums up my own philosophy to MS. As a condition and to OMS as a way of living that’s by Alfred Lloyd Tennyson  

“Though much is taken, much abides; and though We are not now that strength which in old days Moved earth and heaven, that which we are, we are; One equal temper of heroic hearts, made week by time and fit, but strong and well to strive, to seek, to find and not to yield.” Thank you very much for listening and for joining us today. I hope you have learned something new. 

I hope it’s put you on the path to, to OMS or maybe just giving you something to think about in your journey with MS, but whatever that might be, I wish you health and happiness and every success. So thank you very much.  

Geoff Allix: Thank you for listening to this episode of living well with Ms. Please check out this episode. Show notes at overcoming Ms. Dot org slash podcast. You’ll find all sorts of useful links and bonus information there. Do you have questions about this episode or ideas about future ones? Email us at podcast overcoming Ms. Dot org. We’d love to hear from you. You can also subscribe to the show on your favorite podcast platform. So you never miss an episode living well with Ms is kindly supported by a grant from the happy charitable trust. If you’d like to support the overcoming Ms. Charity and help keep our podcast advertising free, you can donate [email protected] slash donate to learn more about overcoming Ms and its array of free content and programs, including webinars, recipes, exercise guides, OS circles, our global network of community support groups, and more. 

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Living well with Ms. Family of podcasts is for private non-commercial use and exist to educate and inspire our community of listeners. We do not offer medical advice for medical advice. Please contact your doctor or other licensed healthcare professional. Our guests are carefully selected, but all opinions they expressed are solely their own and do not necessarily reflect the views or opinions of the overcoming MS charity, its affiliates or staff.