MS Living Well Podcast: “Boosting Brain Health: Blueprint for MS”
Host: Barry Singer, MD
Guests: Dr. Augusto Miravalli & Dr. Lisa Doggett
Date: June 10, 2025
Episode Overview
This episode of MS Living Well focuses on building a practical, evidence-based blueprint for maintaining and boosting brain health while living with multiple sclerosis (MS). Host Dr. Barry Singer interviews two leading MS experts—Dr. Augusto Miravalli and Dr. Lisa Doggett—who discuss the vital role of lifestyle choices and habits alongside medical treatments for protecting and enhancing cognitive and physical function over the long term with MS. They cover the latest research, personal strategies, and actionable advice on exercise, sleep, diet, social connection, mental health, and more.
Key Discussion Points & Insights
1. What is Brain Health and Why Is It Crucial in MS?
[02:03]
Dr. Miravalli explains brain health as the ongoing process of attaining and maintaining the brain’s optimal function to support physical, cognitive, and psychosocial life at every age.
- “It’s an ongoing process... you’re never too young or old to start taking the first steps to attaining brain health.” — Dr. Miravalli [02:24]
- Early intervention and education, such as avoiding smoking and pursuing lifelong learning, have long-term positive effects.
2. Lifestyle Factors: Exercise, Sleep, and Smoking
Exercise
[03:51 – 06:11]
- Regular physical activity improves endurance, mobility, balance, and can significantly reduce fatigue, but benefits for fatigue may take up to 15–24 weeks.
- Guidelines: Aim for at least 2.5 hours per week, split between aerobic and strength training.
- “Even moderate exercise, 2–3 times a week for 12 weeks, is enough to see improvements.” — Dr. Miravalli [04:25]
- Morning exercise is often easier for people with MS due to energy fluctuations.
- “Exercise in the morning is the way to go. By the end of the day, the tank is empty.” — Dr. Singer [05:29]
Sleep
[06:29 – 07:58]
- “Sleep is another of those pillars of brain health… microglial cells—‘the janitors’—clean up debris from inflammation at night.” — Dr. Miravalli [06:34]
- Disrupted sleep, from common MS symptoms like nocturia or pain, can impede the brain’s restorative processes.
Smoking
[07:58 – 08:49]
- Smoking worsens brain atrophy, increasing the risk and rate of brain aging and MS progression.
- Brain atrophy in untreated MS: 1–1.5% per year (vs. 0.2% with healthy aging). Smoking adds to this loss.
Cannabis
[08:49 – 09:34]
- Cannabis may help with spasticity and pain, but overuse can worsen cognitive processing speed—a function already affected in MS.
3. Neurologic Reserve, Early Treatment, and Brain Health Measurement
[09:34 – 13:08]
- Neurologic Reserve: Described as “hardware” (brain structure) and “software” (functional adaptability).
- “The more we challenge the brain with diverse activities, the stronger our active reserve.” — Dr. Miravalli [10:51]
- Early Treatment: Highly effective therapies early in disease make a significant difference by halting inflammation and preserving reserve.
- Measuring Brain Health: Combines physical assessments, cognitive screening, personalized neuroresilience programs, and lifestyle evaluations.
- “We do a 25-foot timed walk, cognitive screening... and have a brain health clinic covering diet, exercise, sleep, and more.” — Dr. Miravalli [11:37]
4. Cognitive Stimulation and Social Connection
[13:08 – 14:24 & 27:00 – 28:16]
- Cognitive exercises like reading, learning new skills, and maintaining social life are critical.
- “Social isolation almost doubles the negative impact on brain health compared to smoking.” — Dr. Miravalli [13:46]
- Dr. Doggett emphasizes prioritizing relationships, reconnecting with loved ones, joining support groups, or volunteering.
5. Technology & the Future: The Role of AI
[14:24 – 15:19]
- Use of AI and apps may soon help monitor brain lesions and symptom progression, giving patients and doctors more detailed insights.
6. Dr. Lisa Doggett’s Personal MS Journey & Lifestyle Medicine
[16:15 – 19:01]
- Dr. Doggett, living with MS, doubled down on her already healthy lifestyle after diagnosis—emphasizing the randomness of MS onset but the importance of self-care.
- “I almost thought, what's the point of a healthy lifestyle if I still got MS? But I realized, even if I can't cure MS, I need to manage my symptoms and prevent another chronic disease.” — Dr. Doggett [17:10]
- She highlights the value of experimenting (sleep hacks, diet tweaks, mindfulness) to find effective, individualized self-care strategies.
- “Mindfulness meditation helped more with my symptoms than anything else.” — Dr. Doggett [18:32]
7. Lifestyle Medicine: Holistic Support for People with MS
[19:03 – 21:43]
- Six pillars:
- Healthy eating (whole food, plant-predominant diet)
- Physical activity
- Restorative sleep
- Stress management
- Avoidance of risky substances
- Positive social connection
- “Lifestyle medicine can help manage and reduce symptoms. Healthy habits can reduce the incidence of diseases—coronary artery disease by over 80%, diabetes by over 90%.” — Dr. Doggett [19:53]
8. Diet & Supplements in MS
[22:59 – 26:41]
- There is no single “MS diet,” but whole food, plant-heavy diets lower risk for comorbidities.
- She steers patients away from sugar-sweetened drinks and ultra-processed meats, encourages adding more fruits, vegetables, legumes, nuts, and whole grains.
- Supplements: Vitamin D and B12 are important for some; supplementing should be personalized and monitored by a doctor.
- “Supplements are not regulated like medications... frequently, the contents inside don't match the label.” — Dr. Doggett [26:36]
9. Mental Health, Resilience, & Stress Management
[28:16 – 31:58]
- Over half of MS patients face depression or anxiety.
- “Daily exercise, prioritizing sleep, meditation, nourishing my support circle—these help a whole lot.” — Dr. Doggett [28:57]
- Stress tools: self-soothing (music, dance, yoga), hobbies, gratitude, writing, and, when needed, professional counseling.
10. Advice for the Newly Diagnosed & Sense of Purpose
[30:42 – 33:06]
- “An MS diagnosis is scary... it’s okay to feel all the things. It’s not hopeless. New treatments can help slow progression—a combination of medication and lifestyle is best.” — Dr. Doggett [30:49]
- Defining and maintaining a sense of purpose, setting goals, and adjusting expectations keeps life meaningful, even as abilities change.
- “Everyone has something to offer... reflecting on when you felt fulfilled, what activities you enjoyed, who you liked spending time with—bring those into your life now.” — Dr. Doggett [32:17]
Standout Quotes & Memorable Moments
-
On Hope:
“You’re never too young or never too old to truly start taking the first steps of attaining brain health.”
— Dr. Miravalli [02:27] -
On Exercise:
"It takes some time... what happens with exercise is there's this reorganization of the networks in the brain."
— Dr. Miravalli [04:36] -
On Lifestyle Doubts:
“What’s the point of a healthy lifestyle if I still got MS?... I actually took the opposite approach."
— Dr. Doggett [17:12] -
On Social Isolation:
"The negative impact of social isolation for brain health almost doubles the negative impact of smoking."
— Dr. Miravalli [13:46] -
On Supplements:
"Supplements are not regulated by the FDA... frequently the content inside doesn't match the pill container. That is a huge concern."
— Dr. Doggett [26:36] -
On Sense of Purpose:
"Figuring out what your purpose looks like can really help. It can change over time... but everyone has something to offer."
— Dr. Doggett [32:08]
Timestamps for Key Segments
- 02:03 – What is brain health, and why does it matter?
- 03:51 – Exercise and brain health data
- 06:29 – Importance of restorative sleep
- 07:58 – Impact of smoking and cannabis
- 09:34 – Neurologic reserve explained
- 11:06 – Early treatment’s effect on brain health
- 13:08 – Cognitive stimulation and social connection
- 14:24 – The role of AI and digital health in MS care
- 16:24 – Dr. Doggett’s life at diagnosis and first adjustments
- 19:03 – What is lifestyle medicine?
- 21:43 – Defining brain health for people with MS
- 22:59 – Diet and supplements: practical recommendations
- 27:00 – Why social connection matters
- 28:16 – Managing mental health: depression and anxiety
- 29:34 – Tools for stress management
- 30:49 – Advice for those newly diagnosed with MS
- 32:04 – Finding and redefining sense of purpose
Final Thoughts
This episode underscores that while modern MS treatments are crucial, lifestyle factors—exercise, diet, restorative sleep, social engagements, stress management, and cultivating a sense of purpose—play an equally pivotal role in preserving brain health, managing symptoms, and living fulfilling lives with MS. Both expert guests advocate for integrating evidence-based, practical lifestyle strategies alongside medical therapies for the best outcomes.