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Living Well with Multiple Sclerosis
Bonus from the Archives: Lifestyle Choices for MS with Dr Aaron Boster | S8 bonus
00:30:49
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- [00:00]
A
I think there's many reasons why it's appropriate to apply these concepts of healthy living, of exercise as part of your lifestyle, as clean eating, whole foods, of not smoking to the village members. Now, in addition to that, it's true that family members of people impacted by Ms. Have a slight increased risk to develop ms, and so it is very sensible to avoid tobacco and to supplement vitamin D, for example.
- [00:29]
B
Welcome to Living well with Ms. This show comes to you from Overcoming ms, the world's leading multiple sclerosis healthy lifestyle charity, which helps people live a full and healthy life. Through the Overcoming Ms. Program, we interview a range of experts and people with multiple sclerosis. Please remember, all opinions expressed are their own. Receive monthly tips and ideas about Living well with Ms. By signing up for our newsletter@overcomingms.org Newsletter and now, let's meet our guest.
- [01:06]
C
In today's episode, we'll be talking about how lifestyle choices affect people with Ms. For this episode, I'd like to welcome back Dr. Aaron Boster. Dr. Boster decided he wants to become an Ms. Specialist at the very young age of 12 when his uncle was diagnosed with Ms. And he now runs a very popular YouTube channel with literally hundreds of episodes and regular Q and A sessions covering every aspect of it. And I thoroughly recommend you have a look at this excellent resource. So, Dr. Boster, welcome, and one of the episodes of your YouTube channel that was particularly interesting was your 4 for 4 approach. And I'd like to discuss this with you and how lifestyle affects people with Ms. And how they can affect their disease outcome using lifestyle choices.
- [01:54]
A
Howdy, Jeff. Thank you so much for having me back. It's a pleasure to talk with you again. And thanks for giving me an opportunity to talk about this 4 for 4 concept. The goal in clinic is to help someone be the most awesome version of them possible, despite having to have Ms. And it's a fool, in my opinion, that thinks that you can accomplish that goal simply with a medication. When you boil it down, there's a partnership, there's a team trying to help someone with Ms. Achieve their life goals and avoid neurological disability and to be the best they can be. And it requires both the clinician to do their work and it also includes the person impacted by Ms. And their family. They have a responsibility as well. And so the 4 for 4 concept is an easy way, at least conceptually for me, to think about the things that I'm hopeful that someone with Ms. Will embrace to help them be the best they can be. And there's really four aspects that I try to talk to folks about. So the first one is to not smoke cigarettes. It turns out that smoking tobacco increases the risk to develop Ms. And if you have ms, smoking tobacco speeds up the disease course and in some studies, by almost 50%. Now, fortunately, if you stop smoking, it reverses this risk. And so I would submit that smoking is probably the best way to make you get worse fast with multiple sclerosis. Now, you would be amazed, Jeff, here in the United States, of how many people smoke and how many people with Ms. Smoke and don't know it's bad for them. They're unaware. And so the number one thing I talk about in the 44 concept is the importance of not smoking. Now, if I extend that a little bit, I would also like to include the fact that we have to think about other cardiovascular risk factors. My friend Gavin Giovannoni talks quite a bit about brain health. And really, when you look at what we're both discussing, it's about avoiding other cardiovascular risk factors. So in addition to smoking, things like managing diabetes and high cholesterol and high blood pressure and are also really important to slow down Ms. And what I mean by this is if you have uncontrolled diabetes or uncontrolled high blood pressure, it actually makes people with Ms. Get worse faster. And so that's all kind of encapsulated in the first piece of this four for four, which is to not smoke.
- [04:34]
C
I think a lot of people actually do think, because I've come across people, they're saying, well, I'm not so worried about smoking because I'm not as worried about lung cancer. I've got ms, and I'm just worried about that. But actually, what you're saying is that those factors that might be affecting whether your risk of heart disease, your risk of lung cancer, they're actually going to directly affect your Ms. Prognosis as well.
- [04:58]
A
That's exactly right. You know, and to talk about smoking a bit more, when you take some tobacco leaf and you light it on fire and then you suck in the smoke into your lungs, that is a very, very inflammatory thing to do. It creates a tremendous amount of inflammation in the body, and it's not limited to your lungs. There's multiple reasons why smoking riles up the immune response, gets the immune response very, very active. And that's to the detriment of someone with an autoimmune condition. So you're absolutely right. The public messaging is out there that smoking can cause cancer or that smoking can increase the risk of a heart attack. Those things are certainly true, but unfortunately, most folks don't know that it can make Ms. Worse. And so that's why I really feel that the first piece of being 4 for 4 in your fight against Ms. Is to not smoke cigarettes.
- [05:56]
C
And how about vaping? If someone were vaping, would that be as bad or not bad at all?
- [06:03]
A
It's an excellent question. And I think that literally day by day, we're learning more about vaping. So vaping tobacco is a new way of ingesting tobacco. And the upside is thought that you're not combusting the tobacco, you're not setting it on fire and breathing in the smoke, you're simply heating it up so that the, I don't know, essential oils is not the medical term, but so that the particulate matter is kind of turned into a vapor and then you breathe in the vapor. And we don't have good studies to tell us about the effects of vaping. Now, it would appear at first blush that that's better for you than smoking. Except I don't know that we completely know that. Now, given that I practice Ms. Neurology in the real world with real life human beings, I can't wait around for 30 years from now when we have that answer. And if I was proposed someone smoking an analog cigarette today versus vaping, I would ask them to vape. You know, they're not breathing in the same carcinogens. And I think that there's ways of helping people kick the nicotine habit through vaping. You know, I've had some success in clinic where people, as they buy new, I think they call it juice, you know, the liquid that you put in the vape pen, you can actually decrease the increment of nicotine. And so I've actually successfully used vaping as a way to help people transition first off of analog cigarettes and then ultimately off nicotine in its entirety.
- [07:38]
C
So ideally don't smoke at all. But vaping might be probably less harmful alternative and might be a good way of actually getting off smoking completely.
- [07:52]
A
Yes, sorry about that. Yes, that's right. There are some developing concerns that when you vape, there's some other chemicals that you're breathing in. But I think to speak in generalities, you hit the nail on the head. If I had to pick between the two, I think that vaping might have an advantage over an analog cigarette.
- [08:12]
C
Okay, and so what's the next of your pillars or your 4 for 4?
- [08:17]
A
So after avoiding tobacco, the second element in being 4 for 4 is to exercise as part of your lifestyle. And so it's fascinating that people with Ms. That exercise as part of their lifestyle fare better later in life than those that don't. And there's a lot of different ways of thinking about this, but let me just share a few with you. If you think hypothetically, let's take someone impacted by Ms. And we clone them. So we're going to have to get permission from their spouse and a bunch of other hoopla, but we now have two versions of the same human. Clone A and clone B. And we give clone A daytime soap opera TV and chocolate cake. And we give clone B a treadmill in carrots. We get back together five years later, clone A is deconditioned, they're overweight, their cardiovascular system is not very in shape, their balance and flexibility is not super, but they have a great love of chocolate cake and they can tell you any trivia about daytime tv. The clone B is now conditioned, they're in shape, they have a strong core, they, they have strong legs, they're flexible, their cardiovascular system is in tip top shape. And you have these two clones and then they both suffer the same attack of left leg weakness. They have an Ms. Attack that hits their left leg. Clone A is seated in a wheelchair, hopeful they may recover one day. Clone B is limping, going to work. And all we did in this example, Jeff, is we allowed clone A to become deconditioned and we pre habilitated clone B. And I won't insult you by asking the obvious question. If you were to pick who you'd like to be, of course you want to be B and not A. And so again, this has nothing to do with Ms. Disease modifying therapies. This has everything to do with lifestyle. There's a lot of invisible symptoms in multiple sclerosis and it's the bane of many peoples with Ms. Existence that, honey, you look so good. End quote. To the casual outside observer. They have two arms, they have two eyes, they have two legs, they don't look sick, supposedly. And yet when you look at people with Ms. And you talk to them, fatigue, pathologic fatigue is the most prevalent symptom and it's the number one reason people leave the workforce. And if you're not impacted by ms, I'd submit to you, you probably don't understand the degree of fatigue that someone with Ms. Might experience. Depression is twice as likely in someone impacted by Ms. Than in the general population. There's a plethora of other invisible symptoms such as cognitive fog or difficulty with cognitive processing, exercise, ameliorates all of those. So exercise has been shown to increase sleep quality, to improve energy levels, to decrease pathologic fatigue, to improve cognition. I could go on for quite some time listing the benefits of exercise and. And it's not a medicine, it's free. And so it's not easy to be impacted by Ms. And go exercise. I'm not suggesting for a moment you just need to get off your duff and work out, but I do think that there has to be a constant and unrelenting effort towards being in shape.
- [11:40]
C
Is there an advantage to types of exercise? So whether it's cardiovascular or someone's pumping weights, is there a difference in that?
- [11:50]
A
Yeah, my opinion is the best kind of exercise for you is the exercise that you're willing to do long term. So we don't have solid evidence that unequivocally proves that cardiovascular work is great and lifting weights is bad. That data doesn't exist. And when you look at the clinical studies that have been done trying to study exercise, they're not giant, largely powered studies the way we see with Ms. Pharmacology trials. They're normally small, single centered studies which makes big, sweeping statements or conclusions challenging. But if you, for example, are passionate about yoga and yoga is something that you can get yourself to do a couple times a week, forever, man. I want you to do a lot of yoga. If you are a weightlifter and you love being in the gym, then that's what I want you to do. Again, I practice Ms. Neurology in the real world. And until we have firm data that states that this is the answer, the very best version of exercise, I am happy to have you do what you're interested in doing. It's my experience that if I ask you to do a form of exercise that you don't like, you're going to do it for about three weeks and then you're going to stop. And so I really feel like you have to find something that you enjoy. Now, with that stated, there are certain forms of exercise that I think can be more palatable or more tolerable for people impacted by Ms. Water is really special because in the water you weigh less. And so if you have a weak leg, which is hard to run on, you can probably walk in the water or swim in the water. Despite that weak leg, if you have spasticity, the water seems to make the spasticity better. If you are off balance and you keep falling to the left, the water pushes back to the right. If you easily get overheated in short circuit, when you get overheated in the water via convection, we pull the heat off your body. So sometimes I recommend walking laps in the pool or swimming or participating in a water aerobics or Zumba class. So that can be a really great way of exercising with Ms.
- [13:59]
C
I personally find that if I do a lot of exercise, normal exercise, walking the dog up hills and things, then it makes my symptoms worse. So in a short, not long term, but short term for the rest of the day, I won't be doing an awful lot of walking around because my legs are tired. But if I go for a swim in the morning, interestingly, that doesn't happen, I actually feel better. So it doesn't actually have that negative short term effect when I go swimming, even if I'm swimming quite hard.
- [14:33]
A
You bring up an excellent point. And another important piece to that, if I may, is the fact that we can't approach exercise with Ms. The way that we did in primary school or in high school. I talk about the high school mentality and so I hearken back to the glory days of high school, where if you can run a mile, then you can run two miles, and if your friend can run two miles, well, you sure as heck can run four. But if you stop exercising, even for a short period of time, you just stop everything. And one of the key elements to success with exercise and Ms. Is to incrementally increase what you're doing. And I'll use your example of walking really hard with the dog up hills and then having your legs not work great for the rest of the day. If you instead, for example, were to take very short walks, using the following day as your metric of success, if you could exercise in whatever capacity and the next day was a normal day for you, then I would submit you didn't overdo it. And it might not feel like you're putting in good work. You know, you're not really working out real hard, but if you slowly incrementally increase that, there's almost no limit to how far one can go. And I think that's an important point in the way that we approach, the way that we approach exercise in ms, sometimes it's very challenging to ferret that out on your own. And we leverage experts such as neurophysical therapists to guide patients as they start their journey and exercise. I'm delighted to hear that when you swim that it works great for you and I think that's fantastic. I hope that people listening to this podcast will contemplate what kind of exercise works best for them.
- [16:21]
C
Okay, so really just go with the exercise that you will continue to do regularly. That's the best exercise for you.
- [16:29]
A
That's my opinion.
- [16:30]
B
Do you want to live well with MS? Join the Overcoming Ms. Community in the LiveWell Hub. It's your place to get support, find connections and feel motivated to make positive lifestyle choices. Download the LiveWell Hub in your app store today or visit Hub the to join. We hope to see you there.
- [16:53]
C
Your third pillar, vitamin D, which you've actually expanded to encompass a healthy diet. We've had a session already on vitamin D, so just so briefly, talking about vitamin D, but also the diet aspect of it, because that's probably the aspect that everyone takes from, certainly from the OMS approach. So all my friends think I'm doing a diet. And I have to say to them, no, there's a bit more than doing a diet, but because it's more visible, they think, oh well, he's not eating the unhealthy. I had a terrible diet before, to be honest, I'm not eating the unhealthy food anymore. Is visible. They see it when I go to a restaurant, whereas they don't see the other aspects of my OMS protocol or my Ms. Treatment. So for your third pillar, what are your recommendations about diet and vitamin D?
- [17:55]
A
Absolutely. It's something when someone's diagnosed with ms, invariably within the first conversation they ask about diet. Is there a food that I should avoid? Are there certain things that I should eat? When you look at the scientific studies, there's no study that shows that you can slow the disease down, but that doesn't mean that the diet can't impact and it most certainly has a giant impact in Ms. And it's extending to energy levels and to cognition and to a bunch of other very, very important areas. Now, to get just a level deeper, and we mentioned vitamin D, low levels of vitamin D pre puberty increase a given individual's risk to develop Ms. You and I both live pretty far north of the equator and we don't see a lot of sun in our respective countries. And as such, we both probably have relatively low levels of vitamin D because you get your vitamin D from the sun. Supplementing low levels of vitamin D would appear to be protective against getting Ms. And if you have multiple sclerosis, when I look at the breadth of data, supplementing low levels of vitamin D is correlated with better outcomes. Low levels of vitamin D in specific do have an impact on the course of the disease. And so we check vitamin D levels in patients and if they're low and for me low is under 50, then we supplement to push it up. But I have, as you point out, extended this third piece of being four for four to include other aspects of diet. And my opinion increasingly is that as you figure out the right diet for you, I want people to avoid a couple things. I strongly recommend avoiding processed foods and I strongly recommend avoiding sugar laden foods. I'm increasingly becoming a really big believer of eating real food. Many red blooded Americans, Jeff, don't eat real food. They live off of soda or diet soda and they eat fast food, which isn't actually food. If you buy a cheeseburger from a fast food joint and unwrap it and put it on your desk several years later, I'm not joking, it looks the same. It doesn't rot, it's not real. Real food should spoil. When people ask for diet recommendations and they say, what about this, what about that? The one thing that I think is consistent, that I really strongly recommend is to avoid processed foods and foods with added sugar. When my patients. Correct, correct. When my patients have embraced this, almost uniformly, they're shocked. They come back and say, oh my goodness gracious, my energy levels are better. I'm less depressed. Xyz. And it's really exciting for me when they discover this again, it's something that they control. Many of us fall into a lifestyle where we're not really taking time to prepare food properly and to sit down and eat meals. And we're eating on the go and we're shoving things in our mouth that aren't actually food.
- [21:17]
C
We have in the uk there's a doctor called Ranjan Chatterjee who's done some TV episodes for the BBC. And one of the things, he actually has a four pillar plan, which is not dissimilar, but it's for general health. But one of the things he says about the diet aspect is to look at the number of ingredients. And he said if something has got more than five or six ingredients, then it's a simple test really to say that's probably quite heavily processed rather than having to. When you, sometimes you turn things over, the ingredients list is about 50 ingredients long and those are likely to be the culprits. Something that's heavily processed. Would you agree with that?
- [22:03]
A
I would agree with that. What I typically will tell people is if you look at the ingredients and you can't pronounce the words or you don't know what the words are, that's not food. So I like to eat things that have ingredients like apple that's it. It's an apple. There's no other ingredients. I'm holding a piece of fruit, it's an apple. But if you look at an apple fritter, which is you buy in a vending machine and you look at the plastic in the back and it's got all the ingredients, you're spot on. Number one, it's got 25 ingredients. And number two, the vast majority of those ingredients are chemicals that you can't pronounce. So I like his idea very much. Another way of thinking about it is if you don't know the words, then that's probably not food.
- [22:46]
C
Okay, excellent. So the OMS approach of eating a whole food based low saturated fat diet is largely similar to your approach. That would be a sensible choice, I think.
- [23:02]
A
So you bring up a very important point before we move on. When you're thinking about diet, we know that uncontrolled cardiovascular risk factors make Ms. Worse. And so having a heart healthy diet has a dual advantage. Not only does it help with cholesterol and risk of heart attack, etc. But it also has a secondary benefit to someone with an autoimmune condition like Ms. So I do embrace that concept. I think that's an excellent recommendation for
- [23:35]
C
people impacted by Ms. And there's some people, do they think the lifestyle approach to Ms. Precludes them from taking medication? And there are certainly there are a number of people who are treating, if you like their symptoms with lifestyle choices and no medication. But would you say that the fourth pillar of your four for four, that medication is something that works alongside these other things or is an alternative to the other approaches?
- [24:11]
A
The fourth piece of being 4 for 4 is to take an Ms. Medicine and make sure it's working. If we could adequately control the disease without medicine, that would be fantastic and I would endorse that. But the reality is that these benefits are cumulative. And it's not like a piece of pie where you have this one or that one. We can do it all at the same time. And I think that they complement one another. So I sometimes say I'm not proud. I don't care how we get you there, but I want you to achieve your life goals. If you want to climb Mateu or you want to finish your PhD, or you want to walk your daughter down the aisle 30 years from now, that's our goal. I want to use every modality that's currently available to help you achieve that goal. Yes, I want people to not smoke. Yes, I want people to supplement vitamin D and to pay close attention to their diet. Yes. I want people to exercise as part of their lifestyle. And in addition to taking an Ms. Medicine and making sure that it works.
- [25:11]
C
Okay, that very much aligns with the OMS protocols. But there are some other protocols in the OMS approach, and one of those would be stress reduction and specifically encouraging mindfulness or other stress reduction techniques. And how would that fit with your 4 for 4 approach?
- [25:32]
A
I think that that is a fantastic recommendation, and I wholly endorse mindfulness. I wholly endorse stress reduction. I hate it when doctors tell people to remove stress. It makes me want to smack them about because I don't know how to remove stress. Like clipping your toenails. Everyone has stress. And even fantastic life events such as getting married or buying a new home or getting a promotion, those are stressful events. Sometimes some of the most stressful events, nobody goes home at night, Jeff, and says, honey, let's get stressed out. That's not something you hear people say. And so we know that stress can have an impact on Ms. Symptoms. And to be the most awesome version of us possible, I think that we have to learn to manage stress to the best of our ability. Exercising as part of your lifestyle affords us at least one avenue for stress reduction, because there's excellent data supporting the idea that. That exercising as part of your lifestyle reduces stress. I, as an allopathic doctor, an md, was not formally trained in mindfulness or the benefits of, let's say, for example, meditation. And yet I am increasingly becoming enamored with these concepts. And my patients that are able to practice mindfulness, my patients that are able to work to reduce the stress in their life, anecdotally, Jeff, they fare better. They do better. And so why would we not want to bring that to the table? I think it can only help us. I think that's probably true for human beings in general. But people impacted by Ms. Probably have an additional benefit to learning how to manage stress in their life.
- [27:14]
C
Okay, that's really useful. And the final pillar of oms, which you don't mention, is that it's useful to apply some of these techniques to family members because they have an increased risk of getting Ms. In the future. So is that a sensible approach?
- [27:35]
A
I think it is, but for a couple different reasons. So you don't get to have Ms. By yourself. You know, you have Ms. With your village. And it's my opinion that I want you to have the biggest village possible. And I volunteer to be a village member. You know, your clinician, your clinic nurse, the social worker, your spouse, your children, your parish priest, your neighbor. This is your village and you don't go through this life impacted by Ms. Alone. You do it with your village. Rallying the villagers to support you in a healthy manner is simply brilliant. And if you think that a care partner isn't impacted by ms, you've never really had a frank conversation with a care partner. I was a family member of someone impacted by Ms. Decades before I became an Ms. Doctor. To tell me that my family wasn't impacted by the disease is nonsense. And so I think there's many reasons why it's appropriate to apply these concepts of healthy living, of exercise as part of your lifestyle, as clean eating, whole foods, of not smoking to the village members. Now, in addition to that, it's true that family members of people impacted by Ms. Have a slight increased risk to develop ms, and so it is very sensible to avoid tobacco and to supplement vitamin D, for example. I think that's an excellent recommendation.
- [29:07]
C
Thanks very much again and I'd like to just finish up by saying thank you for joining us and to again recommend that people have a look at your YouTube channel because there are regular updates and a huge amount of resources available there and as I said, literally hundreds of episodes and you can go back through and have a look and find huge amounts of advice on that YouTube channel.
- [29:31]
A
Thank you Jeff. You can find me on YouTube just by typing in my name. Aaron Bostermd is the name of the channel and it's my goal to help people impacted by Ms. To be the best version of them. I want to try to empower, educate and energize people impacted by Ms. Thank you for giving me the opportunity to talk with you today.
- [29:51]
B
Thank you for listening to this episode of Living well with Ms. Please check out this episode's show notes@overcomingms.org podcast. You'll find useful links and bonus information there. Don't forget to subscribe to the podcast so you never miss an episode and please rate and review the shout to help others find us. This show is made possible by the Overcoming Ms. Community. Our theme music is by Claire and Mac Dean. Our host is Jeff Alex. Our videos are edited by Lorna Greenwood and I'm the producer, Regina Beach. Have questions or ideas to share, email us@podcastvercomingms.org we'd love to hear from you. The Living Room with Ms. Podcast is for private, non commun commercial use and exists 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.