Living Well with Multiple Sclerosis

Webinar Highlights – All Things Overcoming MS Q&A with Dr. Jonny White | S7E15

Date: July 30, 2025
Host: Overcoming MS
Guest: Dr. Jonny (Jonathan) White – Medical Advisor for OMS

Episode Overview

This Q&A webinar episode, hosted by the Overcoming MS charity, features Dr. Jonny White—an obstetrician, gynecologist, and passionate advocate for the OMS program, who lives with MS himself. Dr. White fields a variety of pre-submitted and live questions from the MS community, offering practical, evidence-based advice about the OMS lifestyle, diet, symptom management, recent MS research, and living well with MS. The conversation balances up-to-date science with personal insight, focusing on issues often encountered by people affected by multiple sclerosis and those supporting them.

Key Discussion Points & Insights

1. Diet and Food Choices with OMS

• The Traffic Light System (00:00, 14:47): Dr. White uses a “traffic light” analogy to help people categorize foods as green (eat freely), amber (sometimes), or red (avoid entirely) during supermarket trips.
  • Red: Chocolate, dairy.
  • Green: Fruits, vegetables, pasta, rice, legumes.
  • Amber/Real Life: Foods with small amounts of less-than-ideal oils or ingredients, especially if far down the ingredient list.

“In real life...quite often [a product] will have one ingredient probably far down the list. You think: I don't really know that I want to be eating that.” – Dr. White (00:00)

• Takeaway Meals (04:54): Many takeaways can be adapted to be OMS-friendly, especially pizzas (without cheese, with approved toppings), Southeast Asian, and some Indian dishes (using tomato-based sauces and low oil). Key is to avoid deep fried foods and to communicate dietary needs with vendors.
  • “Pizza is very easy to make OMS-friendly. Generally speaking, if you take away the cheese, you can eat more of it, which is a bonus...” (04:54)

2. Women’s Health: MS, Menopause, and Hormone Replacement

• Estrogen and Primary Progressive MS (02:51): Current evidence is inconclusive regarding estrogen (HRT) as a treatment for MS post-menopause. It should only be used to manage menopausal symptoms, with awareness of associated risks, not specifically for MS.

"Should we be giving estrogen? The guidance and advice at the moment is no, that we do not." (03:59)

3. Symptoms & Disease Progression

• Leg Swelling and Redness (07:02): MS rarely causes visible skin changes like redness/swelling directly; if present, it might be indirect (e.g., nerve damage affecting blood flow). Sudden onset could be dangerous (like a clot).
• Paroxysmal Symptoms (Come-and-Go Symptoms) (12:44): Often relapses bring old symptoms back, especially with stress or infection. These do not always signify a new relapse.

“Paroxysmal means that they come and go...old previous symptoms can come and go.” (12:44)

• Moving to Progressive MS (18:57): Relapsing-remitting MS does not convert to primary progressive. Menopause can lower relapse rate but doesn't necessarily increase disability or trigger progression instantly.

“Just by virtue of going through the menopause, you're not overnight going to just suddenly develop progressive MS.” (18:57)

• Identifying Secondary Progressive MS (34:07):
  • “It tends to be a very insidious and gradual thing...it takes months or years to get a sense of it...” (34:10)

4. Life Expectancy & Disease Outlook

• Updated Life Expectancy (08:26): Old studies show a reduction of 6–10 years, but Dr. White stresses this is outdated, especially for those following the OMS program.

“If one follows the OMS program rigidly, it's not shortened. In fact, it's probably increased.” (08:26)

• Active vs. Inactive Disease (31:56): Even with “inactive” disease (no new MRI lesions), slow worsening may occur due to factors outside MRI detection, e.g., deconditioning.

5. Allergies & Sensitivities

• Dairy and Gluten (10:10): Dairy is always avoided on OMS—autoimmune reaction, not classic allergy. Gluten’s role is unclear; unless you have symptoms, there's no evidence to avoid it, and many gluten-free foods are highly processed.

“Avoiding dairy in MS is not the same thing as being allergic to it...you're extremely sensitive or your immune system is extremely sens to what dairy contains.” (10:10)

6. Dietary Oils in Packaged Foods

• Sunflower & Rapeseed Oils (14:28): Named, minimal amounts of rapeseed oil are acceptable if low on an ingredients list; sunflower oil less so, but small amounts are tolerable. Avoid unnamed "vegetable oil" and especially palm oil.

7. Medication & Treatments

• Latest Advances in MS Research (16:51):

  1. Progress in treatments for progressive MS (e.g., ocrelizumab, saponimod).
  2. Focus on myelin repair, though mass-market therapies are years away.
  3. Recognition of lifestyle medicine’s benefits for MS and other diseases.

• Fatigue Medication (29:41): Amantadine and some other medications can be tried for fatigue, but results are variable. Exercise is often the most effective intervention.

• Stem Cell Transplant (HSCT)** (27:08): Best evidence for early, inflammatory (not advanced) MS. Comes with significant risks, ideally not for all; mortality risk is 1–2%.

“HSCT is often bandied around as a cure for MS. And to be clear, it’s not—maybe in the future, but we simply cannot say that now.” (27:08)

8. MS in Children and Genetic Risk

• Risk to Children and Prevention (35:22):
  • Children of people with MS have roughly 5x higher risk, but still low in absolute terms.
  • 75% of risk comes from lifestyle, not genetics.
  • Prevention focuses on non-smoking, vitamin D, high diet quality, physical activity, and stress management.
  • “Your genes are not your fate... That’s the most important thing to say.” (39:11)

9. Other Noteworthy Points

• Propionic Acid & Gut Health (24:50): Early studies show supplementation may reduce relapses and slow progression, but best natural sources are hard to get on OMS. Some people try supplements, which show rare side effects.

• Symptom-Specific Advice:

  • Bowel issues—focus on dietary fiber and hydration (22:20).
  • Neuropathic pain—including the "MS hug"—can sometimes be eased with certain medications like some antidepressants or antiepileptics.
  • For fatigue, cognitive and physical, lifestyle approaches (exercise, sleep hygiene, meditation) can be as important as medications.

Notable Quotes & Memorable Moments

• On Genetics & Prevention:

  “Your genes are not your fate. There’s a phenomenon called epigenetics… The most important things you could be doing to stop your children developing MS: number one, don’t allow them to ever smoke…” – Dr. White (39:11)

• On Myelin Repair:

  “If you can repair myelin...you can reverse symptoms and reverse disability. Hand on heart there’s no treatment that’s going to be available to the mass market within the next couple of years.” – Dr. White (17:54)

• Coconut Syrup (21:22):

  “Coconut syrup and coconut water do not have the fat or the oil within it… there’s no particular reason why I wouldn’t consume it.” – Dr. White (21:22)

• On Exercise for Fatigue:

  “There is evidence to say that exercise in fatigue, which seems counterintuitive, is an extremely effective treatment and probably one of the most effective.” – Dr. White (30:29)

Timestamps for Key Segments

| Time | Segment | |-----------|--------------------------------------------------------------------------------------| | 00:00 | Introduction to the “traffic light” food system for OMS diets | | 02:51 | Menopause, estrogen, and MS | | 04:54 | Takeaway food and OMS-friendly adaptations | | 07:02 | Red and swollen leg: when is it caused by MS? | | 08:26 | Outdated life expectancy data and modern view | | 10:10 | Dairy and gluten sensitivity/allergy | | 12:44 | Paroxysmal (on/off) symptoms and relapse confusion | | 14:28 | Sunflower and rapeseed oil guidance in packaged foods | | 16:51 | Major research advances: progressive MS, myelin repair, lifestyle medicine | | 18:57 | Progression: RRMS to secondary progressive, menopause | | 20:21 | “Smoldering” MS and progressive disease framing | | 21:22 | Coconut syrup, is it OMS-friendly? | | 22:20 | Managing constipation and the “MS hug” in advanced/progressive MS | | 24:50 | Propionic acid, gut health, and fermented foods | | 27:08 | Candid guidance on stem cell transplant (HSCT) risks and candidacy | | 29:41 | Fatigue treatments, drugs, and practical strategies | | 31:56 | Why progression may continue even when MRI is “inactive” | | 34:07 | Detecting the transition to secondary progressive MS | | 35:22 | Genetic risk to children and prevention strategies |

Tone and Style

Dr. White is warm, candid, and personable. He openly shares when evidence is lacking, delivers opinions with nuance, uses memorable analogies ("petrol on a bonfire" for dairy's effects in MS), and empowers listeners to take ownership of their health, while respecting individual experience and encouraging questions.

Final Thoughts

This episode provides a comprehensive, science-based, and practical overview of the OMS approach and MS management. Dr. White consistently emphasizes that while MS remains a complex and evolving disease, knowledge, lifestyle changes, and a holistic, evidence-informed perspective can empower people to live well with MS today and in the future.