← The MS Trust podcast
The MS Trust podcast
MS brain health & wellbeing: movement, sleep, stress, diet and making meaningful changes
01:18:53
Loading summary
Transcript95 lines
- [00:00]
A
When we talk about the brain health in ms, we really talking about the protecting the future version of ourselves or yourself through small daily habits that keep the brain adaptable, calm and supported.
- [00:31]
B
Hello and welcome to the Ms. Trust Podcast. I'm Helena.
- [00:35]
C
And I'm Grace. We both work here at Ms. Trust, a charity that's here for the Ms. Community for every Ms. Every day.
- [00:41]
B
We are here to provide information and support and help people navigate Ms. Each and every day.
- [00:47]
C
And we're also working to drive excellence, equity and consistency across Ms. Treatment and care.
- [00:54]
B
Plus, we're powering research into the issues that matter most to people living with
- [00:58]
C
Ms. Today we decided to do a bit of a deep dive into what is brain health, why it matters, and the little things we can all do to protect our brain and support our thinking, memory and wellbeing and to guide
- [01:09]
B
us through it all. I've had the pleasure of interviewing Dr. Agnete Chokaine, who is great at practical advice on looking after our brains. We also caught up with neurologist Nikos Evangelou and postdoctoral researcher Sylvia Polly at the Ms. Trust conference recently where they spoke about their research into the the International Living well with Progressive Ms. Study. We asked them to share their thoughts on how people with Ms. Can make meaningful changes to support their well being. And in our conversation they dig into the practical side of their research, especially how to approach behavioral change when you live with ms, and they share some simple, realistic strategies to help you get started.
- [01:52]
C
So let's get into the conversation.
- [01:54]
B
The information shared in this podcast is not a substitute for professional medical advice. Always consult your GP, Ms. nurse or other qualified healthcare professionals. Making changes can be hard. Have you got any tips on how people might make a spa?
- [02:09]
D
So my first suggestion would be take your objective, for example, and make it smaller. And when you think you have made it smaller, just lower it down a little bit more. Because when you're talking about physical activities or other stuff, you really need to take it by step. So this is my first suggestion and the second one is try to reshape them, trying to tie them with your values. So not just say I need to do more physical activity, for example, but I really want to play with my son and so I need to be more physically able to do so. And so these will help you grow your motivation towards that change that might be needed.
- [03:03]
E
I think, I think you're absolutely right and you know, I could try to be another interviewer and you will say that actually because lot of us, we have our gaps that we have identified that they're affecting our well being. So how do we identify which is the number one target to change? To change.
- [03:25]
D
I think that we should ask the individual.
- [03:27]
E
Exactly. Ask the individual. I think that's the important thing. And I know that you know there are lovely centers that they have a number of questions. They say I will address plasticity and these kind of things. You know, sometimes we are missing what you know, how has your last year has been what's the main problem about your life? You know, we're focusing, how's your blood, how's your food drop and so on. And you know, let's work with what the people are telling us rather than necessarily going through the 1, 2, 3, 4, 5.
- [04:05]
B
Do you think there is any different approaches for when you're living with progressive Ms. Compared to like say if you're newly diagnosed?
- [04:11]
D
Good question.
- [04:13]
E
I think there are differences because in the beginning, you know, I think you know better than me. In the, in the beginning there is this psychological impact bum. You know, you have been given this diagnosis, you can see some bad pathways and you can see some other. So I think the uncertainty is more in the beginning once you get into the progressive ms, different types of progression, not that progression is, but then you have a little bit more formulated, you have adjust a bit. I have to carry this with me, I have to carry the diagnosis. And then you are a bit more, more stable in taking your decisions. What is the things that I need to change about myself.
- [04:57]
D
And also it kind of depends on the person because some person might be, I don't know, like now I have the diagnosis, I have to change everything about my life and going all in, into that direction on some other people can be more, I know taken aback by the diagnosis and so being more quiet, more I wouldn't say desperate, but more disheartened by the diagnosis. So they might postpone the changes and these might also happen when you have a new diagnosis with progressive Ms. So when you see one type of type to another and it really is a matter of trying to be aware of where you are and how you can rethink the services you are or the, the things you need to do to improve your well being, that makes sense.
- [05:56]
B
Where do people find support to help them achieve their goals to live well and thrive in daily life.
- [06:03]
D
You want to leave that for me
- [06:06]
E
to, you know, the, it's the nice thing, the nice thing that has happened. You know, there is lots of discards about well being and about wellness and you know, I presented in my talk that you Know, there is a wellness center, admittedly a private wellness center is opening even in. Not here where they will say that I will try to do a little bit of exercise, I will try to do a bit of things. So you know, you can try and you know, you don't necessarily have to go to a private sector, but there are lots of things that you can get inspirations from the, you know, from, from the Internet, you know, to, to the, to the local environment. And, and it's not, it's not, not medical, you know, because it is not formally advised by. You're a mess nurse or your Ms. Doctor. It doesn't mean that it's not important. I think that is what they wanted slight, you know, break the barriers, find what is important to you. And of course the health professionals are very important in with their knowledge and the experience to tell you what has worked for other people. Something to try for you. Let's work together.
- [07:25]
D
Yeah. And relating to these last point you made, I think one important thing is to speak, speak with other people that are living the same condition. Because what we see sometimes is that after a diagnosis you isolate yourself and you have this feeling of being alone and of experiencing this for the first time that there's nobody that can understand you. And so having peer support in that can really help you and can also get you more access to services or resources that are out there, but you might not know of them because you are new to the condition or you have not been able to get this support from other.
- [08:10]
E
So like I am certain from the podcast, you have had so many good ideas and views that you have not considered yourself. And somebody comes along from Southampton and says, well, this is, this is what, what happens and said, oh, this is a great idea, isn't it? So you know, and we have listened, you know, I was attending the fatigue management and again the rehabilitation, the vocation rehabilitation, when it happens in a group, it's so much richer. You know, one of the comments the speakers has made rather than an individual just discussing, you know, it's great to have. And once you got out these difficulties, you know, do I declare I have multiple sclerosis or not? It becomes liberating. Then I'm learning from you, you are learning from me. And we are not the same. We don't have the same things, but let's learn.
- [09:04]
B
We need like wellness groups, not exercise groups, but wellness groups.
- [09:08]
E
Wellness groups. Yes, yes.
- [09:10]
B
Share ideas.
- [09:11]
E
You know, the wellness group, you know, you know, you know, the wellness group that on the first week will be, you know, a book club. But the second week will be yoga and the third week of the month will be something different. And so it doesn't necessarily need to be exactly the same.
- [09:30]
B
Just have to try whatever. Do you find what you like?
- [09:33]
D
Yes.
- [09:33]
B
And trying different things make you happily. Unless it's horrible.
- [09:39]
E
I mean, from my point of view, I think, you know, the maestros, the people with the mess is fantastic. So the only thing that it has been said for a long time and there are very good voices all around that let's try to see the individual as somebody that we're promoting the wellness. So let's not only see the disability of the left foot, you know, the left foot, we can live with the disability of the left foot if we have a general wellness. So I think, you know, from the interactions that we have had, you know, certainly in my clinic next week I will be slightly more wellness focused focus rather than have been a couple of weeks ago. And you know, if we all pick up a little bit of that, you know, as you said, change is slow to happen, but let's go in the right direction.
- [10:30]
D
Yeah, yeah. This was my first NS Trust conference. It has been great to meet with research and clinicians and also people that live with Ms. Because you can really get that input and you can really see in this type of events that our, the view that we're bringing forward. And of course it's not our idea that it's been around for many decades, but it's really much needed. Everybody asks for it and so we really need to make it a reality, make it a practice, make it the basic care. And so, yeah, we hope that this brings a change to the movement.
- [11:14]
B
Brilliant. So we're going to have a little chat about brain health and Ms. And with me today I got neurologist Dr. Agne Sokin who will answer some questions that I have on brain health. But before we start, for anyone who doesn't know who you are, Agne, do you mind giving a little introduction?
- [11:33]
A
Yes. Hi everyone. I'm so pleased to be today with you, Helena. It's such a pleasure to be part of your podcast. I think your podcast is classed as one of the top ones in the world podcasts in multiple sclerosis field. So it's great pleasure for me to get a chance to talk to you who is living with Ms. And you have a real world experience and you're also a host of this wonderful podcast under Ms. Trust. So yeah, so let's dive in and talk about the brain health. It's a Topic that is close to my heart and I always enjoy talking about the lifestyle medicine, the vitamin supplements, the, the qualities, the pillar of the life, all the pillars that, that are important in lifestyle medicine. So I am neurologist by background. I run multiple sclerosis service at Torbay Hospital, it's within the southwest of England. I'm also certified brain health ambassador or advocate under the European Academy of Neurology. This is the largest European neurology academy where the neurologists are being trained and have access to various different neurology topics and literature and educational webinars and seminars. So it's a nice European platform where we get all the access to the deep knowledge in neurology, including Ms. And I'm proud to be a certified clinician in this field and feeling very confident talking about the brain health. And when we talk about the brain health in ms, we're really talking about the protecting the future version of ourselves or yourself through small daily habits that keep the brain adaptable, calm and supported.
- [13:32]
B
Brain health is such a massive big topic because there's so many different things that it sort of covers, doesn't it? But if you're living with Ms. And you want to sort of build, you know, support their, your brain health, what, what do you think is the most sort of effective way of doing this?
- [13:48]
A
I guess the. It's about the small sustainable habits that reduce the inflammation, preserves the brain reserve and support everyday thinking as well as energy. And that involves not many things. We should focus more on the three pillars in day to day living because people get overwhelmed with the amount of the information that is available in this current world, on the media environment, in the clinics, outside the clinics, et cetera. So the key pillar to start with is move the body and movement of the body. We are built as a human beings to move. We're not built to sit on the sofa or sit on the chair at the computer desk all day long. The longer we sit, the longer we watch the screens, the more upset and depressed we become as this is the evidence based knowledge and with movement you improve the circulation. So with the circulation improved in your body, your nerves have a proper nutrition because the blood that supplies the nutrition to the nerves and also talking about the central nervous system and how the brain wires and how it connects and communicates with each cells. So we're talking about the neuroplasticity which can be enhanced if body is being moved, if you move your body, if you exercise, if you do any activity throughout the day. That's how the neuroplasticity new synapses are being formed. The previous injury that has been affecting your brain somehow the compensatory mechanism appears within the brain structures. And this whole process is called neuroplasticity. And then there is a, an element of the fatigue resilience. People feel often fatiguing is around 80% living with Ms. But the more you move the more you enhance their energy level. It may sound weird and people sometimes feel a bit worse after the exercise because of other phenomenons in Ms. Like Uthoff's phenomenon when the heats hit the body and the temperature dysregulation that can take a little bit of the reserve and energy but after effect is really really powerful. So it's one thing that you to remember is movement. The second one is to calm down the central nervous system. How do you do this? It's within the good quality of sleep stress regulation and being mindful and being responding to this thing things but not necessarily reacting that boosters all these kind of neurophysiological physiological mechanisms in your body that you, you get your cortisol level released, you get stressed, your, your heart over races and then you got chain of reaction in the body that is in keeping with their stress regulation. So. So we need to find a way to calm our central nervous system. And, and there are techniques which we will dive into deeper during this discussion today. But that's, that's the second thing calm the nose. And the third one simple pillar talking about the brain health is, is support the brain biology. So brain needs to be biologically supported how to do this? So it's a nutrition. So we need to give a nice foundation of nutrient of nutrients and nutritious value that that nourishes the brain at the molecule level, mitochondria level which is our ITP energy organelle that produces a lot of energy to our body to function. Okay. So we can do that with a proper nutrition. Not with the ultra processed foods, sugars and alcohol and smoking but with a proper good quality of the proteins. Whether it's an animal protein or plant based protein but and a good, good quality of the fluids throughout the day. Okay. So, so some fiber for the guts for the good quality of poo. I'm not scared and embarrassed to talk about this is part of our normal living and function of the body. So so and then to support brain biologically also means to adhere to the treatments and I'm talking about the disease modifying therapies. With only lifestyle medicine. It's not enough to support the brain at the Biology level and as well as to support the brain health from the biology is to pace yourself. If you're going to do all things in one day that you planned for the whole entire year, you're going to waste a lot of your reserves biologically within your body. And that doesn't make you feel good about yourself. So pacing yourself. So these are key three pillars. To repeat them it would be movement, calm your nerves. And the third one, look at your body as biological structure organs that works in unison like orchestra. And how do you support your body at the molecule cell level?
- [19:25]
B
I like that what you're saying about it, like an orchestra, because there are all these different components and everybody needs to play in harmony, don't they? So it's supporting everything. Let's start with the first pillar, shall we? Physical activity. You already mentioned that it's important for health. And I think people can stress about this sometimes because you hear about oh, let's get moving. But if you're somebody who might struggle with mobility issues or somebody who's never exercised, what sort of movement are realistic for different types of mobility. And what we're talking about here, we're not talking about signing up for a marathon, are we?
- [20:00]
A
I would like to extract the importance the gender difference in physical activity. So women are not little men, okay. And our biology, the hormones, metabolism is completely different from men bodies. We may think we are, you know, all human beings and everything. All the rules should apply to everyone, despite the gender. But there are some key elements that we need to think and remember. As a woman living with multiple sclerosis, what are the emerging evidence in physical activity is that we should consume adequate amount of the protein prior to the exercise and after to build the muscle. Okay. So no matter the level of your, of what you can do, you know, people are affected with Ms. By Ms. In various different ways and ambulation can be different to individual people with Ms. If you are living with advanced disease of ms, you may have limited mobility and that involves, you know, maybe working on the strength whilst you're seated or arm ergometry or some breathing exercises. People who are fully ambulatory and fully
- [21:29]
F
functioning, we're talking about the walk, going to gym, doing cycling, gym, static back and hard. There are some balance, coordination and you are not able to go on the roads with your bike. We're talking about the Blattus reformatus which is amazing for the poor and posture resistance using some resistant bs, healthy things like that. And then if there is a higher disability background fitting with M, we talk about the guided therapy, rehabilitation, people who calm the limbs. And there is a carer, a support worker who comes in as part of the caring routine, feeding, washing, there is a passive movement involvement, lifting the heavy paralyzed limbs.
- [22:21]
A
And then we are very innovative and we want to increase the neuroplasticity and think about how can we engage our brain into physical activity without doing a physical maybe activity. About the virtual reality, augmented reality, gamified applications and rehabilitation processes that are available and emerging in this world. Okay, so when we're talking about the female and male gender in terms of exercise program. So I just want to strike the importance that as a female we should have some protein intake before we go and run or do exercise. Why? Because we haven't got enough protein energy to do the exercise if we haven't eaten in the morning and we're just gone to do the run. And when we run or go to the gym without any food, our body is under a lot of stress whilst we are physically active. It's a stress at the end of the day. I don't like to go to gym. I go to gym, but I don't like it because it's a stress to my body. And if I am starving, I'm not having any intake of the food and I go to the gym, I'm even further increasing my cortisol level and I'm dropping my performance in the gym because I'm not completing the task and exercise in the gym because I haven't eaten, I haven't got a substantive fuel to run this session. Where men, they have a lot of more reserve and they can go to the gym without having having a breakfast and do this intermittent fasting and work it with a full capacity and then come back and have a big portion of the protein. Okay, I'm talking about the protein that we should have with every single meal. It's 1.5 grams per normal healthy pound of the weight. Normal healthy weight. Okay? So for me it would be 50, 60 grams with each meal. It's quite a high dose. Do we, when we, when we are eating, you know, and exercising, do we think much why protein is important? It builds the muscle. Okay. If we are eating and consuming too many carbs, I'm talking about them bread and wheat and, you know, pasta and all that jazz, you know, the carbs are not supporting our muscles as the protein. Protein is a carcass for our muscles to grow. And when we are exercising, we want to grow the muscles, not to waste them. Okay? There's a lot of information around and people are taking Mounjaro as you know, P1 inhibitors to, to work on their weight. I haven't got anything against it and it helped a lot of people. But what we see as medical community people on long or any other GLP1 inhibitor so they are getting malnutrition, you know, people have reduced appetite, they are not eating enough, you know, protein, they're eating some sort of chips and creeps and some carbs throughout the day, starving themselves. And they go into this kind of opposite losing weight weight in the, in the compensation of the muscle where that we need to re reduce the fats rather than muscles. And why is that? It's because not enough protein in their diet whilst taking the weight management injections. So be mindful about this. Okay. So just incorporating these things together because I know what the hot topics are at the moment in the world and what people are doing with their bodies. So don't lose your weight by exercising or not eating or eating something whilst you are consuming some weight management injections. So be mindful about this because your
- [26:01]
B
fatigue will just get much worse if you're not fueling your body correctly as well, isn't it?
- [26:06]
A
Yeah, totally with it. With a mobility, with the exercise form you are boosting your energy. Your fatigue is being managed better with adequate hydration electrolyte drinks. When you've done your exercise you should be consuming some electrolytes to balance that because particularly if there is a vigorous exercise program that you're doing some cardio hit whatever you lose and sweat your electrolytes, that needs to be compensated.
- [26:32]
B
Well, I think sometimes when we post any or you see any posts online about diet there will be people who are very gung ho in one way or another and some people actually very much demonize carbohydrates completely. Why your take on carbohydrates? When it comes to sort of brain health and supporting
- [26:53]
A
doing physical activity, we still need carbohydrates. It converts in our body as a glucose. You know, our brain and muscles, they require the in particularly after, after exercise we need some carbs and even before going into the, you know, you go, you're gonna go to do some exercise. So having some sort of carbs is, is, is essential. So I'm not advocate for protein only or ketogenic diet only. I'm not sticking to any label here trying to emphasize is that think and be mindful what you eat and make sure that your protein is higher intake than the carb intake. But you need both in a way to fully Function okay. And always think about the, you know, have you eaten before you exercise, have you eaten after, have you take a proper intake after you've done exercise? All we need is to build the muscle. And to build a muscle we need a protein. As, as this is the simplest rule ever. And, and you know, whatever diet you're following, it needs to be, it needs to be fresh, it needs to be seasonal, it needs to be green, it needs to be colorful on your plate, it needs to be organic and it needs to be done from the scratch, not processed foods that we go into the shopping center. It's colorful, the labels are nice, the placement of these, of these items are in front of the raw. When you go into the shopping center you get all these processed foods displayed in front of you. But you need to go deeper into the shop and look around for more fresh and raw organic products that are displayed most at the bottom of the, of the shop or somewhere in the middle.
- [28:38]
B
Can be very confusing and complicated when you. But you can get help, can't you? I mean there are for instance dietitians within the NHS that you could get referred to if you are really struggling with this.
- [28:52]
A
NHS at the moment is in a very challenging situation. Getting to see the nutritionist, dietitian, weight management specialist. It's a year or two to get into the, into the clinic. Depends where you live. But you're totally right if you are feeling lost and you need some further dedicated tailored personalized guidance. So it's seeing the nutritionist, licensed nutritionists and then you know, under NHS you get a dietitian if you struggle with a swallowing function, if there are foods that you can't chew, you know, so you get a dietitian who approaches you and sets up a dedicated plan at some of the services instead of waiting to be seen by a specialist nurse or consultant neurologist. There are ways to self referral and explore that via NHS app, whether you could potentially self refer to these other specialists that are available in the community to give you some concrete plans how to navigate with your diet. Okay, so you may be able to self refer.
- [30:04]
B
So let's talk about sleep, shall we? That also obviously plays a big role in thinking and energy. What would be your take on how to improve sleep? Because we know that this is something a lot of people with Ms. Struggle with.
- [30:19]
A
Sleep is super important. During the deep sleep, the brain activates its own cleaning system. It's called glymphatic system. And think about this system as a nighttime washing cycle of the brain. It's Like a washing machine. Right. So as we function every day, you know, lots of going on throughout the day. So there are some immune signaling, there is a stress hormone like cortisol. Inflammatory cytokines are being released in the, in the body. So when the sleep is disrupted, the brain doesn't just feel tired, it can become more reactive and more inflamed if we're not too careful. And by engaging with a good quality of sleep, we can balance these kind of activities in our bodies and clear that waste, a bioproduct that is being accumulated throughout the day and it only can regulate the inflammatory process. I'm not saying that sleep is like a equivalent to the treatment and is going to reduce the inflammation, but it really helps to perform throughout the day to improve the energy. And, and if you have a poor sleep, it makes fatigue more worse. Thinking slower, mood feels worse, you're more depressed, et cetera, et cetera. And what would be like practical steps for the listeners. So the consistent waking up time. I have people who are like living with more advanced disease and they wake up in the middle of the day and look, the day is gone. The following day they may wake up at 8am, et cetera. The consistency of waking up time needs to be in place because once you wake up at 9am you can set up yourself for the whole day because usually you have to take tablets, you have to take some medicine and that needs to be spread across the day. And if you are waking up in the middle of the day or 2pm, you're stepping out of your bed, you know you missed the whole morning where you could potentially had some cover for your spasticity, spasms in your muscles, maybe some neuropathic pain relief that gets you going throughout the day. So consistency in waking up is super important. Living in the dentist now, every morning we should have some light exposure into our retina because that's how we prep our bodies for the good night's sleep. The melatonin, which is our hormone in our body that stimulates our biorhythm, that's how our brain interprets day and night, is being produced in the early morning hours when we look at the sun directly. Okay. And if people don't have an opportunity to look, and they live in the Norway and Sweden and they have poly nights, etc. When they haven't got that sunshine. So taking melatonin, melatonin depends where you are and how you pronounce this word. I'm being corrected most times. So that could replace your internal melatonin. In your body and help you with getting asleep. So, so the natural way of getting melatonin is a light exposure early in the morning when you look directly to the sun. So having a coffee matcha tea in the morning, sitting in the balcony, sitting by next by your main door of your house or flat, wherever you live, is the way to start your day. Even if you are in a wheelchair, somebody could wheel you out and about and you could get that sunshine. Okay. To get you ready for the evening. The same looking at the sunset also gets your brain prepped for the good night's sleep. Next is reducing the caffeine intake. Okay, so according to the guidelines and if we look at the stroke prevention guidelines, we should consume no more than three cups of coffee a day. More is overdoing, less. It's okay. One cup of coffee in the morning is totally fine. But just bear in mind that people do consume in Britain in particular, I notice a British black tea with a milk and they have seven, eight cups of tea throughout the day. What does that mean? You have a huge amount of caffeine because that comes with a black tea. Exactly the same comes with a green tea. People don't think it, they think it's a, it's a herbal tea, but actually it's, it's full of caffeine in it. Okay? So be mindful to reduce the caffeine in the, in you within your day, day to day living. Okay. When we hit the bedroom, it needs to be decluttered, it needs to be cool, dark bedroom. Some people benefit from having cool sheets, cooling sort of beddings, you name it. There are loads around to cool the body temperature. Why it's important because we have a better quality of sleep if our bodies is cooler. And that's why the hot baths and saunas works. Because whilst your system, your body system is cooling down, that's the process on its own improves the quality of sleep. Okay? That's what we get this kind of stress to our body. Hot bath, hot sauna, and then throughout the night our body tries heavy to cool down and that improves, it deepens our sleep. And then the final thing that is a common pitfall and it's a problem for majority is that people have some hyperactive bladder, they have to wake up five times at nighttime. Victoria we call this some people have spasms, spasticity. These symptoms of Ms. Needs to be addressed and that could be addressed by your healthcare professional. So it could be managed. Well, if somebody is going to listen to your symptoms and tackle them with personalized plan for your symptoms. You should have better control of quality of your sleep if your symptoms of Ms. Are tackled and improved.
- [36:43]
B
I love all those tips. I think it was about two years ago, went through CBT training for sleep training specifically. And I was very dubious to start with it, with this kind of getting up at the same time and going to bed at the same time and scaling back on things. But once I started following the plan and it took a little while, my sleep improved so much. But I think I was very resident in the start to actually do it because it was like, well, surely I, you know, this is, but actually it did work for me. So I, I, I think it's absolutely worth trying. But it, but it does take a little time.
- [37:18]
A
It's having a plan. Right Helena? So yeah, it's, it's always not, not a fixed one, a flexible one. You know, you have to gradually incorporate these kind of different things in your life and explore like what, what suits for one, does it. I'm not advocate for having a sauna because it may bring on your worsting of your symptoms. It's a general rule, just keep it cool. Your bedroom needs to be cooler than the rest of your house because that's where you achieve better quality of sleep. You know, if it is too hot, you sweat and you get restless legs and you're moving, you know, in your bed, you're trying to find your, your good positions. It's a battle, you know, the calmer you are, the better the quality of sleep is going to be.
- [38:02]
B
And I think also that's another thing, isn't it? Because when you know that sleep is going to improve and you can't and you get almost like, oh, I need to sleep. And then you get stressed about it. And that doesn't help the situation either. But I think when I was doing the sleep training, they definitely said that if that happens, don't lay around, but actually get up and do something very boring, read a very boring book and maybe that will then set you to be tired again and you can try and go back to sleep. But I do remember getting really stressed about this, going to bed at the same time because I thought, well, what if I go out late or I'll go to a concert or if I have parents evening, I can't go, sorry, I have to go home and sleep. But like you say, you need to be flexible about your plan as well.
- [38:43]
A
Yes. Yeah, we sometimes over, over, over think about the sleep and this kind of overthinking that I need to now have A good quality of sleep. It's another sort of layer on us and causes an anxiety that you sort of people lay down in bed and sort of thinking, oh, I need to have this good sleep of night and it doesn't happen to me spontaneously, what should I do? Like and you, you start getting stressed about, you know, so, so it's another sort of caveat to not to be caught in, you know, over emphasizing or overthinking about the good quality of sleep. It needs to be a natural process. And whatever works for you, whether counting sheeps or listening to the music or reading book or something boring, monotonous, could engage you into the phase of sleeping. Some sort of theories around, like when you are in bed and you're struggling to fall asleep, you have to sort of almost induce like a rapid eye movement activity. You look to the left and right and up and down and you sort of slow down your breathing function and that potentially improves your quality getting asleep. So I think you need to expect experiment by yourself and see what works for you. I can't give you a personalized advice here, nobody can. I think it's a bit of a try and error as everything in this life, the main focus, if you set up this flexible goal, I need to focus on better sleep. And how I'm going to achieve that is step by step. Maybe starting with putting down your mobile phone in the locker for two hours before bedtime, that maybe it's a start starting point to reduce the blue light and activation and stimulus on your brain. That could be a good tip to start with.
- [40:35]
B
Speaking of thinking cognitive fatigue, that's a huge issue for, for many people with ms, me included, I would say what strategies could actually help people manage in daily life?
- [40:48]
A
No, because I don't live with the ms, but I only learn from my patients and who's done well with preserving the energy. And also I'm talking about the cognition. You know, when you struggle with thinking, processing, executive function, planning, et cetera. It's very interconnected with stress, you know. So again we're going back to sort of how to manage maybe stress and we'll talk maybe in a minute about this. But it's interconnected in a way, you know, but the tips that I learned from my patients is energy budgeting. Basically it's a spoon theory. If you have 18 spoons to manage the day and if you're going to use half of them in the morning, so what's going to left for you in the afternoon is upon you. So you have to sort of Work with yourself and think about, okay, if I only use like two spoons as part of my sugar spoons, let's imagine that as a part of my routine in the morning. Maybe I'll have more energy throughout the day and midday and finish my day with a cup of tea, feeling chilled and relaxed. So pacing yourself and also dividing your tasks into smaller tasks throughout the day, you know, don't do all the things in one session in one hour. You know, spread across, have regular breaks and, and also, you know, a lot of people ask me, say, hey, you're doing so many things. You're running this podcast of be well with Ms. You're writing blogs and you're present on the media. You're doing your full time neurology job. You're now educating epic. This is our new EPR system that we, our trust moves on in, in April. And I'm educating other consultants and nurses how to use it. How do you sort of fit in all that jazz into your one, one single day? My, my common answer is that, you know, I do one thing and I get tired as everyone else, but then I, I go and do another job and, and I rest somehow, you know, so, so what I'm trying to say that you need to alternate your cognitive versus physical tasks throughout the day. You, you do one thing and that, that, you know, takes your energy away and you feel a bit exhausted and tired. Then you move on to another thing to do. Maybe it's more physical, maybe it's more joyful and playful. Maybe you do some, you know, you go out and you, then you go and do some, you know, tasks in the office, etc. So you alternate these things throughout the day and that keeps you going. You just, you don't, you can't just sign to one task and carry on throughout the day, which will exhaust you enormous big time. But if you spread across mindfully, I think that will keep you going. And always, always don't forget to schedule breaks, you know, before your exhaustion hits you. Helena, you should have a bit more tips to share, I think. How do you navigate with your cognitive fatigue? What are your strategies?
- [43:51]
B
I think what you said is fantastic in the way of like actually mixing up the sort of sitting in front of a computer with making sure that you do something that is a bit physical. Because I often find that if I do a lot of physical things and then sit down, I might struggle to actually get up and do stuff afterwards because I'm sort of, my body is tired then and I just want to rest. So I like the idea of mixing it up a little bit and not just sort of concentrating on that one thing because sometimes I can get a little bit like hyper focus and I'll just sit by the computer for a really long time and then afterwards I can't string a sentence together because I've just been overspent on that. So I think it's really hard to manage it. But it's really important to manage that bit totally.
- [44:39]
A
We all struggle. I think you don't need to have Ms. To manage your time and how we spread across and whether we spread ourselves thin or thick, it depends. But I think working with yourself, identifying these red flags and alarms in, in your body that okay, it's too much now I need to pause up and do something different. It doesn't mean that I need to stop from activities I'm doing throughout the day, but maybe change, change the task, you know, because that will, will be less, maybe exhausting and overwhelming.
- [45:14]
B
And I think I'm. I like a to do list and I quite like an old fashioned to do list which is on pen and paper so I can actually physically go when I'm done with it. But I also try very hard not to feel too bad about at the end of the day if I still have tasks there because quite, quite often during the day more tasks will make its way onto the list. And I think again that comes back to that kind of being a bit flexible and being not so hard on yourself because I think we're often so much harder on ourselves than we are on someone else. If a colleague of yours or if your family member sort of said I'm so sorry, I was meant to finish this today but I just didn't have the time to do it. Most of the time you're not going to fly off the handle and start shouting at them, but you might do that yourself. So I think just kind of a bit compassionate against yourself helps as well
- [46:01]
A
and also ask for help. You know, if you feel like you're struggling to do things, you know, and you need some sort of support and help, always ask for help. You know, people are really kind, you know, and people around you. I'm sure by this time moment you have a nice network. If you haven't created one, please do. Because living with a chronic condition, you read you need a support, you know, you need a good network support, you know, whether it's from care perspective, medical perspective, friendship perspective, anything, you know, whether school runs, whatever it takes, you know, always have that kind of safety net that really if needed. If you feel like you're in crisis, you, you give it one call and these people are around you to, to support you, to be around, give you a hand, just give you some sort of, you know, just sometimes it's enough to give a bit of a good talk and sort of encouragement verbally. You know, they don't necessarily need to do some physical cleaning for you, but you just having sort of, you know, a nice chat and look, you're already sparkling and buzzing with the energy that you get from other people. So especially connection is, you know, social connection is the driver for community in general to feel good about yourself, to complete the task, to avoid procrastination. You know, depression and anxiety is one of caveats that people get into. Sometimes you need to be in that situation then jump back into where you were, you know, with, with some support and help and, and, and carry on with your activities. We all fluctuate. We're living in the quite a nutty world at the moment. It, it's difficult not to be anxious about things but forming the right relevant people around you that you can talk through, to talk, talk your heart out is not feel alone and isolated is something that I highly recommend for everyone.
- [47:58]
B
I think the, the social connection is something that's so important and something that I sort of learned more about that as I gotten older that quite often if I'm struggling with something and you have these certain people that, that will actually just like you say when you talk to them, you'll feed off them and you'll get some of that energy just transferred by just talking to them because they're nice and supportive. There will be some people that might be a bit like energy thieves as well. Those who maybe need to be aware of that as well. But I do think it's. And yes, you're so right about asking for help as well. And I often feel like sometimes as a mum I would feel guilty about like oh, I'm not doing everything for my children but actually giving the children some responsibility to help out with cooking or doing a bit of, you know, cleaning and things like that that sets them off for learning things that they will need to learn anyway because you know, that's part of life skill.
- [48:54]
A
It's a life skill. They need to be independent. I had a conversation the other day with my patient, she said, you know, I have 18 years old and 14 years old children so it's getting better. And I learned one trick. I pay £5 for my 18 years old daughter who's got a driving License and she takes my youngest daughter to the after class activities. I'm happy I can rest and do my bit and meditate and exercise. And then my, my, my eldest child is happy because she gets, you know, earn some money to, to take her sister to the after class, you know, so it works very nice. So these kind of simple techniques that really helps women, you know, busy women living with chronic condition to look after their family, like it doesn't make you a bad person. Really gives you a lot of skills, life skills. And I don't know what's, what's good life is these days. You know, we all have to have these different experiences to become human beings.
- [49:59]
B
Yeah, it's so true. And you don't know what's, you know, situations change all the time and there is obviously support for young carers as well that we can link to some, some, some of the organizations out there. I, When I was 16, my dad passed away. So I ended up sort of trying to take on some of the tasks I used to do because my mum hated things like, you know, mowing the lawn or doing the gardening and, and things like that. And, and sometimes I probably made a complete hash of it because I wasn't very tidy with it. But the grass got cut, even if it wasn't beautifully cut. But, and I did learn something. So I, I think I try to, to approach life with a bit like that. It doesn't need to be perfect. If it gets done, that's, that's a bonus.
- [50:42]
A
Yeah, it shapes you, who you are today, you know, so all your experiences, you know, and we, we, we go through the life and we accumulate these experiences no matter whether they are bad experiences, good experiences. It's, it's. These things just shape you. I wish to everyone that nobody's got like horrible experiences, you know, I'm talking about the extremes, you know, but you know, good days and bad days and you know, challenges with the finances, challenges with the physical activities. It does shape who you are now. Like, you know, look at you. Sometimes we sort of, we, we try to chase someone else's lives rather than our owns and, and, and we start feeling upset looking at, on media, Instagram, all these fancy trips and travels that people do. Part of this is not a reality that there, there is probably an argument behind the camera, you know, maybe some big fight, but they just needed to take this nice picture with the family and show to the world, you know, so we're getting probably half of the picture of the reality our minds. We build the stories that how Unhappy and how vulnerable and sad we are, you know. So I think my recommendation would be live life that is here and now, always and in front of you, you know, rather than sort of looking at the back and looking into the too much into the future, worrying about things or looking at other people's lives which always going to upset you because it's not your life, you know, it's different and not necessarily as better, although it may look.
- [52:19]
B
Stress, you mentioned stress. A certain bit of stress is kind of normal in life, isn't it? But then if stress snowballs, that can make things like fatigue and cognitive symptoms far worse. Well, have you got any good tips on managing stress with ms?
- [52:38]
A
What I learned from my patients, people who really do well with resilience to stress. Because stress is every day, it's going to be today and it's going to be tomorrow and it is now. Maybe stress like having being interviewed, it's a stress being interviewed is this tra. You know, we are exposed by the stress every single minute. I think it's just the way how we handle that, how do we, you know, respond. And I just want to maybe take you a bit of it sort of to grounded techniques more so than anything else. You know, it's simple practices, it's bringing the tension into now and it's bringing to your breathing, you know, not exaggerating your breathing, not to sort of adding new layers or discovering new patterns of breathing, but just taking a focus on what you're currently doing. Are you sitting? Are you standing? Are you walking right now whilst listening to this podcast? Are you being mindful, you know, are you thinking about the 20 jobs you need to do today whilst listening to this as well. So I just want to sort of take you to the sort of where you are, like feel your feet, feel your hands, feel maybe your seated ground and and maybe take your focus and attention to your breathing. Are you breathing in as I'm doing now and breathing out whilst I'm talking? Because it sort of smooths my voice if I talk and breathe out at the same time, you know, so these kind of things really matter and also underestimated power of nature. You know, go out, sit under the tree. This kind of nature exposure is really healing and is empowering most of us. You know, when we are feeling stuck and we haven't got an answer, look after 5, 10 minute walk just around the block, you sort of come up with a conclusion what you should do or shouldn't do, shouldn't be doing in this life. So structure your Routines, you know, ask for help, engage with people, form your network who's going to be your support network and reduce the decision overload. You know, as a healthcare providers, every day we have to make 30, 50, 100 decisions towards someone else's health. For example, how do I unwind? You know, I choose some activities that I don't need to make any decision, you know, so I do opposite. And if I'm tired on making decision on one principle or one project, I move my attention to another one to make a decision because that rests your mind from one task to another, as we spoke and discussed that earlier. You know, try to avoid the overload that keeps you going. Right, so stress doesn't cause Ms. But it amplifies how your symptoms feel. You just need to be mindful about this.
- [55:43]
B
Sometimes hear people talking about cognitive assessments. What are these? And how can specialists actually support in this? We think people like neuropsychologists or occupational therapists, what is there to offer?
- [55:59]
A
I think we, first of all we need to identify what's the matter. Psychologists are rare gems in the pool of Ms. And in particular now in the current busy NHS environment, I think we need to sort of search for signs. First of all, working tasks takes longer. That's already a bit of a signature.
- [56:23]
F
Hmm.
- [56:23]
A
I used to do this task in five minutes, now it takes me an hour. So then, you know, losing the mental stamina, you look at the page of things and you can't understand what is required from you. Like you haven't got to comprehension, you know, what you're reading or what other people are telling you. And then you sort of start noticing irritability and it's like, oh my God, it's too much, I'm overwhelmed. I. I can't complete. You procrastinate, you, you wash your house, wash dishes before you actually open the computer and do the job that's been asked by your manager, you know, so these kind of signatures and also for example word finding difficulties or people are struggling to multitask, you know, they can't do, you know, looking at the computer and then talking to the colleague that is asking a question. So this is kind of multitasking struggle. So these are sort of raw that you know, would or situations that explain why you may need a neuropsychologist assessment and cognitive strategies that neuropsychologists could put in in place. Also thinking about, you know, do you need some sort of a real life adaptations and pacing yourself, maybe some advice and plan how to sort of navigate throughout the day having this kind of cognitive issue, what's your environment like? You know, are you cluttered into various different books sections, you know, some sort of papers and documents that you're losing your momentum and you don't know where things are? You know, do you need to sort of a bit of environmental work around you where you work, where you do your day to day? Maybe there is a communication and processing issues. There are specialists called speech and language therapy, see CLT as we call they are available and some of them are. You can self refer as as well as you can self refer to occupational therapists within the different regions and sites. So explore that instead of going into this kind of vigorous and quite, you know, extensive circle of seeing the neurologist, seeing a nurse seeing this and that, who is difficult to contact these days. Maybe you just go straight away to the physio for some sort of dual tasks and mobility, cognition overlap exercises, you know, that trains your brain to multitask. Or maybe you can access to speech and language therapists who could help you with the communication slowing down, finding the right word to choose and tips and tricks how to communicate. You know, they are fully capable to give you that advice. Or maybe you need some cognitive strategies that the only psychologist who could, who could do the whole full battery of the cognition screening could give you dedicated exercise throughout the day or some tasks to follow that you can manage and navigate quite nicely with the deficits you've got day to day.
- [59:21]
B
You mentioned Instagram before. I'm gonna segue from Instagram to something that especially comes up on my feed all the time because I guess I'm a woman of that certain age and that is people trying to sell me all kinds of supplements. And I think we see in our Facebook group at the Amherst Trust an awful lot about different supplements before now. We spoke to you, I think it was about two years ago about supplements before. But I guess things change since then as well. What should people even understand before they decide to dip their toe into the world of supplements?
- [59:55]
A
Because there's a lot, I think if you want to dig deep, I think we covered a lot into previous episodes. You want to listen to what vitamins and how they work work and what should you take. You need to go and listen to another episode maybe just to touch the and brush through things that key messages are that supplements are not equivalent to disease modifying therapies. Let's agree on that. Okay. Any supplement, any natural remedy herb is not equivalent is not sufficient enough to cover and modify the immune system and to prevent from the Relapses and progression of Ms. Okay, so, so we have to agree on that. Natural doesn't, doesn't equal safe. You know, you get a lot of claims of oh this is natural way of da da da. It's not safe enough. Sometimes it can be harmful. I have, I can give you an example. I have a patient who took some extra beside the disease modifying therapy, some extra herbal remedies and that disarranged the liver function and enzymes went through sky high. And we had to battle that to wean off these herbal medicine, you know, because they work via the same enzyme in the liver and enhances the potential of the, of the enzyme and also increase the liver enzymes which really is disruptive. And then as emetics we are then start worrying unnecessary without a good foundation and evidence that these herbs are working. But they are, they are really upsetting the liver function. So really be careful and also always, always check interactions with neurologists, pharmacists. Pharmacists are very, very good at it. They're trained to tell you information which drug intervenes with each other. So instead of going into finding the busy neurologist who's in the clinic at the moment, seeing Ms. Patients, other Ms. Patients, you just go to the pharmacy, boots pharmacy, voice pharmacy, any pharmacy in the UK and say hey, I take these drugs, are they interacting? I'm taking these supplements and these herbs are they going and disrupting my liver function or not? All these things can be answered very easily with a consultation with a pharmacist. Now the realistic way of taking supplements and people do. My patients do take supplements and sometimes I do recommend. I think we all agree that vitamin D3 is one of the vitamins. Particularly if you are further away from equator. Not enough sunshine now the sunshine is coming through. Maybe day one today that we got a full grown spring coming. Whilst we are recording this episode. I felt it Helena, you felt too make such a change some suggestion that this ring is here. So I think in autumn time starting from October until, until April we should take vitamin D3 and, and recommended doses are high 4,005 or 5,000 international units daily. Oily capsules. I'm repeating myself. Oily, oily, nobody listens and I'm going to repeat again. Oily capsules. Only the tablets that you're consuming. So the vitamin D soluble fat, vitamin dissolved into soluble fats basically and only can be absorbed in the guts if it is an oily environment for it. Okay, so there are some vitamins, vitamin D, K, E that are soluble fat Vitamins and they can only be absorbed if they are coming as oily substances. Basically, if you bought already a vitamin D, which is tablet, maybe take it with a spoon of the good quality extra virgin olive oil. One spoon with it. I'm talking about the good quality extra virgin olive oil. The mass production is poor quality. You don't have flavonoids and antioxidants in it. So it needs to be a good quality. Small amounts daily, maybe. Okay, so this is a bit of a nutritious diet advice then. Omega 3 is A, is another vitamin which is a, a modest moderate, a modest general health support, non Ms. Specific cognitive treatment or supplement. Not a treatment, a supplement, I would say which is good for cardiovascular system. Somebody who lives with a high cholesterol, high blood pressure. It's ideal vitamin supplement to be. And in combination with vitamin D3, if you look at some population studies, it suggests it could prevent some autoimmune diseases. If you take vitamin D3 and omega 3 together, it's good, good vitamin to be vitamin B12. If you have low level of vitamin B12 or iron, you could supplement yourself with these vitamins. Now, magnesium is another one that has been popular between people who live with Ms. It's, it's good for cramps, muscle aches, and it's also amazing supplement at nighttime for insomnia and good quality of sleep. There are different, different magnesium from glycinate to L Threonate, et cetera, et cetera. I think you need to try and see. L Threonate penetrates the brain barrier and improves the sleep according to some of the evidence. So it's a good one. Glycinate is also a good one for insomnia. So try and see. It's a supportive way, but not transformative. Okay.
- [65:43]
C
Now
- [65:45]
A
when we talk about the safety and we need to sort of think about, okay, how to maybe read the label of the supplements and what is the good quality supplement? Because we want a good quality of supplement and I think what's written on the pack matters. So couple things to remember when you look and choose the supplement. The labeling needs to be clear of active ingredients with amounts. Okay. It needs to be listed as a milligrams or micrograms per dose and percentage of rnrv, which is nutrient reference value. Okay. So look for the clear active ingredients on the bottle or on the package. Also, the vitamin supplements should instruct the dosing. Okay. How many capsules, tablets to take and when. So this is important to avoid excessive intake. Okay. We don't want to overdo the supplements, it needs to be clearly written how many, when to take morning, evening. It doesn't if it doesn't specify when but it should say once a day. For example, magnesium, it's a night supplement, not a daytime. It slows you down, relax the muscles, it prepares you for the night's sleep because it relaxes the muscles. So magnesium is a night evening omega 3 vitamin D3 is, is probably morning vitamin E, which is another soluble fat vitamin and strong antioxidant is an evening supplement. You know these things are important. On the label should say food supplement designation. Okay. This means that it follows the UK food supplement regulation and labeling rules and it doesn't imply medical benefits. Okay? So this is not an active ingredient, it's not a drug, it's a supplement. It should clearly, clearly state on the bottle that this is a food supplement. Also on the bottle it should be clearly written manufacturer details, company's name, address, best before date, expired date, okay? Freshness, traceability, all that needs to be on the bottle. And also what's important, allergen info. Whether it's a gluten free dairy, soy, whether it's present in this package or not, it needs to be clearly documented. And then there is also a certification. So look for independent badges, third party verification marks. So through these are, they aren't mandatory on UK regulation and supplements but third party logos like USP and NSF they can address further that you know, these products were certified by the third party. Okay, Third testing badges. So it gives even more quality to the supplement that you take. Another thing to remember, you know when we go on media and we start engaging with some sort of forums and reading some news and reading some influencers posts and blogs, etc. So we see a lot of herbalists coming and commenting underneath and they are sort of trying to sell the, you know, the herbs and they, they marketing this kind of unspecified blends, they hide the ingredients and amounts and it's not transparent, it's not clear. And this is kind of a red flag to avoid, okay? Also what to avoid is the high dose single fat soluble vitamins. I'm talking about the vitamin K, vitamin E, I'm talking about the vitamin D, I'm talking about vitamin E. You know, probably I'm repeating now myself but you know, high dose of soluble vitamins can be harmful. Okay. So be, be, be careful. Check always with the, you know, with the pharmacist whether you know, the dose is not exceeding the maximum daily dose. And the herbal brain boosters, so limited Evidence, guys, is really, we don't have any evidence if at all. Safety varies and interactions with Ms. Existing medicine are possible. I'm talking about the St. John's wart drug interactions, okay? High dose biotin interference with, interferes with the lab results. It can cause thyroid toxicosis and abnormal thyroid hormones. So some of the herbs as you listen to, to my example patient who's also a good friend of mine,
- [70:52]
F
so
- [70:52]
A
the herbal immune, they are immune stimulants and theoretically risks with immunotherapies. And I think it can interact with for example anticoagulants. If you are taking warfarin, it can lower the efficacy of the warfarin. So it's really checking every single compound and in particular if it is blended and not clear what compounds in it, you know, that needs to be clarified for sure because it's important to know what you put in your body because you know everything in, you know, these herbs are ancient medicine. You know, there are some immune boosters, some high dose medical mushroom extracts. You know, they are not simple supplements. They really can intervene and interact with the existing disease modifying therapies, antidepressants, pain medication. And the risk is real.
- [71:56]
B
Do you think when people come to fill in forms, Marisol said, are you on any medication that people put the medication, but they often don't put the supplements that they're on.
- [72:05]
A
I think we need, as a medics, we need to know what supplements, what medication patients are taking because we can identify if there are some, you know, high dose of soluble fat vitamins that exceed the normal, you know, accepted healthy dose. So we can sort of then intervene and say, Hey, 10,000, 20,000. Vitamin D3 is something that I'm concerned about if you're not getting your calcium level checked because hypercalcemia can injure your soft tissue, your connective tissue and some vitamin K, like you know, some discussions around that people should take vitamin D and K together. But if you're on warfarin, you have to be careful because vitamin K interacts with warfarin anticoagulant, which can diminish the effect, you know, as a prevention from having thrombus. If you're living with atrial fibrillation, for example.
- [72:58]
B
So always, always tell your health professionals what you are putting into your body, be it medication or supplement. I loved a quote that you said in the previous recording we did with this when you said you might just end up with expensive urine because it does, does seem like a lot of these things cost a lot and they
- [73:16]
A
promise a lot yeah, yeah, this, yes, this famous saying, right. Hello from the previous episode. You know, some of the supplements probably is not going to harm you, but it will make your urine more expensive.
- [73:28]
B
But yes, we will link to that podcast because it was brilliant. It was very interesting. Certainly my final question because this has been very, very interesting and it's been a lot. If people are feeling a bit overwhelmed after listening to all this and think, oh my goodness, there's so much stuff that I need to do now, what's one habit that you would encourage people to start by focusing on?
- [73:51]
A
Give you some where we started. So I'll give you three options. Option number one or option A, movement. Move your body in the way that feels possible today. B. Option B is a sleep rhythm. Protect your sleep as it were. You're part of the treatment. Okay. Treat your sleep as part of your care plan. And option C is self compassion pacing. Build a rhythm that brain can sustain. It's manageable and brain can thank you after all.
- [74:26]
B
Fantastic. And before we go, just tell people how they can find your podcast as well.
- [74:31]
A
Oh, okay. Yes. So I am heated podcaster and full time neurologist. An interesting combination. But you have listened to my tips and tricks today. How I manage my my day and how I pace and I have how I deviate my attention from one task to another. So you can, you know, implement these strategies in your day to day and maybe you'll become a podcaster too, who knows. But you can find me on www.bewellwithms.com. it's a one word and b is double E. Be well like B.
- [75:05]
B
Thank you so much. Acne. It's been very, very interest. During my interview with Agne, we also talked about another podcast episode. This was called avoiding the brain drain in Ms. How to keep your mind fit and fed. In this we explored the benefits of exercise and diet along with a deep dive into the different supplements that may support brain health. You can find the link to that episode in the show notes. Now, Grace, I know you don't live with Ms. Yourself, but it works for. Spoken a little bit about brain health in the office, haven't we when we were preparing for. For, for this. So have you got any sort of go to brain health habits, something like the one thing that you like to stick to?
- [75:46]
C
So yeah, I am actually obsessed with journaling before bed. So this has become an absolute staple in my nighttime routine and it really just helps me to wind down and sleep and go to bed without those racing thoughts. So I tend to jot down all the thoughts, thoughts that I've had throughout the day and particularly when I'm jotting down the worries. This is what really helps me because the act of physically writing them down just somehow gets them out of my head and enables me to sleep. And it was quite a hard habit to stick to at first because it felt slightly strange. It was a bit like, who's going to read this? But now I can't go without it.
- [76:21]
B
Oh, I love that. That's one of those things that I'd love to try. I found the I have such a stupid reason for not journaling is because my handwriting is so ugly. I just don't want to look at it.
- [76:35]
C
Well, you can tell my mood by my handwriting in the journal. It's quite funny.
- [76:41]
B
Well, for me, I think it's movement. I've spoken many times on the podcast about my love for running, but obviously it doesn't need to be running. I think sometimes, you know, just making it outside like Athena mentioned, just like getting outside in the morning and seeing a bit of daylight. We've had a long gray winter and I think it makes such a big difference now when you can go out in the garden and have a cup of coffee or some healthy water and just, you know, hear a bit of birdsong and see a little bit of sun and I think, you know, but sort of bringing it back to movement, I think, going for like a walk, I think, even if it's just a short one, I think fresh air and moving my body, just definitely health, both my thinking and my mood.
- [77:27]
C
I completely agree. And I think the key message here is that your brain health habits don't have to be perfect, they just have to be yours and feel realistic.
- [77:36]
B
If you have any questions about demos, whether that's something we discussed today, like brain health or any of the different approaches to managing brain health that Agni spoke about, or pretty much anything else with regards to Ms. Remember our free helpline is here for you. You can call us on 0800-3238 and 39. That's Monday to Friday, 10am to 4pm excluding bank holidays. And if you leave a message they will get back to you. You can also drop an email on
- [78:10]
A
helplinestrust.org you can also follow ms.trust on
- [78:16]
C
Facebook, YouTube, TikTok and Instagram for updates, videos and lots of useful content. Also don't forget you can can listen to this podcast on Spotify, Apple Podcasts and Amazon Music and the video version will even be up on YouTube too.
- [78:30]
B
And if you enjoyed today's episode. It would really help us if you would leave a rating or a quick review on your favorite podcast app. It makes a huge difference in helping other people to find this podcast.
- [78:43]
F
Certainly.
- [78:44]
C
And thanks for listening, everyone, and we'll see you in the next episode.
- [78:47]
B
Bye.