Podcast Summary: MS Living Well - "Beyond the Prescription Pad: Complementary and Alternative Medicine for MS"

Host: Dr. Barry Singer
Guests: Dr. Elizabeth Silberman, Dr. Daniel Bandari
Date: July 1, 2025

Episode Overview

This episode, hosted by Dr. Barry Singer, delves into the world of complementary and alternative medicine (CAM) in Multiple Sclerosis (MS). While disease-modifying therapies (DMTs) are the bedrock of MS management, there is surging interest among patients in CAM approaches—ranging from mind-body practices (yoga, meditation, acupuncture), supplements, diets, to alternative therapies. Dr. Singer interviews two expert neurologists, Dr. Elizabeth Silberman and Dr. Daniel Bandari, to unpack the benefits, risks, trends, patient motivations, and scientific evidence surrounding these supplemental approaches.

Key Topics and Discussion Points

1. Understanding Complementary vs. Alternative Medicine

[02:11]

• Complementary therapies are used alongside standard medical treatments (e.g., acupuncture for pain with usual meds).
• Alternative therapies are used instead of standard treatments (e.g., dietary interventions in place of MS medications).
• NIH has often used these distinctions, though some favor the broader "integrative medicine."

Quote:
“The same intervention could be both alternative and complementary.”
— Dr. Singer [03:00]

“Yep, that’s exactly right.”
— Dr. Silberman [03:04]

2. Prevalence and Patient Motivations

[03:12], [03:54]

• CAM is widely used: In Dr. Silberman’s 2018 Pacific Northwest survey:
  • ~40% use mind-body therapies (massage, yoga, acupuncture)
  • ~40% use specific diets
  • ~30% use cannabis
• Motivations include:
  • Desire for active participation and personal responsibility in care
  • Dissatisfaction with current treatments
  • Seeking holistic or more “wraparound” care

Quote:
“They viewed CAM therapies as a way of being part of the treatment decisions.”
— Dr. Silberman [03:58]

3. Sources of CAM Information

[04:46]

• Most patients turn to the internet and online communities (Facebook, Reddit).
• Some consult naturopaths.
• Lack of robust, randomized trials makes filtering evidence challenging; provider guidance is key.

4. Demographics and Who Uses CAM Most

[06:08]

• CAM use is higher in:
  • Older populations
  • Patients with progressive MS
  • Those already using multiple CAMs
  • Highly educated individuals

5. Supplements and Herbal Remedies

[06:55], [07:09]

• Vitamin D is most common (~80%)
• Multivitamins are used by ~45%
• Herbs (notably turmeric, gingko) are taken by 17%; turmeric particularly valued for perceived symptom relief
• Cautions: Supplements that boost the immune system (like echinacea, ginseng, kava kava) may be risky for MS

Quote:
“Not every supplement, as you know, is quite beneficial in MS patients. Some... may ignite inflammation within them.”
— Dr. Bandari [21:23]

6. Diet and Nutrition Trends

[08:14], [09:08]

• 40% use diet therapeutically; 60% of those find it helpful.
• Popular diets: high-protein/low-carb, wheat-free; increasing interest in intermittent fasting.
• Mediterranean and modified Paleo (e.g., Wahl’s protocol) recommended by clinicians for sustainability and overall health.
• Weight loss correlates with reduced fatigue.

Quote:
“For patients with MS with fatigue, any diet that leads to weight loss tends to improve fatigue.”
— Dr. Silberman [09:40]

7. Mind-Body and Physical Therapies

[10:02], [11:42]

• Modalities: yoga, massage, acupuncture, stretching, tai chi, qigong
• 60% perform regular stretching; insurance increasingly covers medical massage, sometimes acupuncture.
• Exercise: 60% walk regularly, more swim; guidelines encourage 30 min aerobic exercise, 3x/week.
• Preliminary research suggests a potential role for exercise in myelin repair.

Quote:
“Adding in some of these mind body therapies... can be really beneficial.”
— Dr. Silberman [10:59]

8. Cannabis

[13:13]

• Used mainly for sleep, pain, anxiety, spasticity.
• Best evidence supports use for MS-related spasticity.
• Risks include cognitive side effects and lack of standardization.

Quote:
“Cannabis can lead to thinking problems... it’s important to make sure that patients are talking to their physicians.”
— Dr. Silberman [13:45]

9. Why Some Patients Pursue Only Alternative Therapies

[15:20], [25:53]

• Most common in progressive MS groups where DMT options are fewer/effectiveness less certain.
• Distrust of the medical system and desire for empowerment.
• Risks are substantial: some alternative therapies have caused harm (e.g., venous stenting, bee sting therapy).

Quote:
“One of our jobs is to make sure we’re helping our patients make decisions that feel as informed as possible while still maintaining a relationship.”
— Dr. Silberman [16:11]

10. Discussion of Specific Alternative Therapies

Venous stenting/CCSVI

[31:07], [32:05]

• Initiated in 2006 but shown to be ineffective and even dangerous (risk of bleeding, stroke).
• Expensive and led to significant patient harm.

Bee sting therapy and dental fillings

[34:08], [35:24]

• No reliable evidence of benefit for MS; risks outweigh unsubstantiated positives.

Hyperbaric oxygen therapy

[30:19]

• No clear evidence of benefit for chronic MS, despite patient anecdotes.

Low dose naltrexone (LDN)

[29:13]

• Mixed evidence; minor improvements in quality of life, but no robust support for MS disease control.

11. Provider Perspectives on Navigating Patient Choices

[20:16], [27:31]

• Open communication is essential.
• Some supplements may be dangerous; patients should inform physicians.
• Decision-making should be collaborative, balancing patient preference and clinical evidence.

12. Mindfulness & Gut Microbiome

[35:50], [37:10]

• Mindfulness, meditation, Tai chi, yoga: strong anecdotal and emerging scientific support for reducing stress and improving quality of life.
• Gut health (probiotics) is a growing area of interest; maintaining a healthy gut flora may aid overall disease management.

Quote:
“I call it downtime for our brain—and that can provide some solidarity to their homeostasis...”
— Dr. Bandari [36:03]

13. Unanswered Questions and Research Gaps

[18:19]

• Evidence gap for many supplements (e.g., antioxidants like alpha lipoic acid). Ongoing trials may answer efficacy questions, particularly for progressive MS.
• Need for large, randomized studies on diet and alternative treatments.

Notable Quotes and Memorable Moments

• “My hope is that in 10 or 15 years, we’ll be able to give a little bit more of a holistic approach.” — Dr. Silberman [16:27]
• “Some misinformation online can easily flourish like a fire.” — Dr. Bandari [25:56]
• “Neurologists and chiropractors always have a little bit of a conflict when it comes to certain part of the body, including the neck.” — Dr. Bandari [24:52]
• “Combining everything…physical therapy, yoga, pilates, mindfulness, diet, exercise for your quality of life. That’s what I tell the patients.” — Dr. Bandari [38:35]

Timestamps for Key Segments

• 02:11 — Definitions: Complementary vs. Alternative Medicine
• 03:12 — Prevalence among MS patients; survey data
• 03:54 — Why patients pursue CAM
• 04:46 — Where patients get their CAM info
• 06:08 — Who is most likely to use CAM
• 06:55 — Supplements and herbal usage trends
• 08:14 — Diet trends and outcomes
• 10:02 — Mind-body therapies overview
• 11:42 — Exercise recommendations
• 13:13 — Cannabis in MS: uses and risks
• 15:20 — Patient rationale for alternative-only therapies
• 16:43 — Risks of alternative therapies (e.g., invasive procedures)
• 18:19 — Research gaps and future directions
• 20:16 — Dr. Bandari on advising patients about CAM
• 22:05 — Diet approaches in California/Dr. Bandari's experience
• 23:42 — Acupuncture, massage, and chiropractic perspectives
• 25:53 — Why patients refuse DMTs and choose alternatives
• 29:13 — Low dose naltrexone and other alternative compounds
• 31:07 — Vein stenting (CCSVI): what went wrong
• 34:08 — Dental fillings, bee sting therapy
• 35:50 — Mindfulness, meditation, and quality of life
• 37:10 — Gut microbiome and probiotics
• 38:19 — Emerging trends in CAM

Final Takeaways

• CAM is widely used by MS patients, especially those with progressive disease or dissatisfaction with standard treatments.
• Open, evidence-based dialogue between patients and clinicians is critical—both to harness benefits and avoid harm.
• Some CAM strategies (like vitamin D, Mediterranean diet, regular exercise, mindfulness, and selected mind-body therapies) are well-supported and likely beneficial as adjuncts.
• Alternative therapies should never replace DMTs except in low-activity or patient-refusal cases, with vigilant monitoring.
• Beware of unproven, invasive, or high-risk treatments—solid clinical research remains the gold standard for guidance.