Ologies with Alie Ward

Episode: Neuropatholmmunology (MULTIPLE SCLEROSIS) with Aaron Boster
Originally aired: September 3, 2025
Guest: Dr. Aaron Boster, board-certified neurologist specializing in MS, founder of the Boster Center for MS

Episode Overview

This insightful episode dives deep into Multiple Sclerosis (MS), an autoimmune condition affecting the nervous system. Host Alie Ward, whose own mother lives with MS, sits down with renowned MS expert Dr. Aaron Boster. Together, they break down what MS is, how it’s diagnosed, treatment breakthroughs, lived experiences, ongoing research, and what strategies can help people live well despite the diagnosis. The episode balances science, personal stories, and actionable advice, making it both informative and empathetic.

Key Themes & Discussion Points

1. Dr. Aaron Boster’s Personal & Professional Motivation

• Background: Dr. Boster’s uncle had MS, driving Aaron to specialize in the field from age 12 (05:13).
  • “I decided to be an MS doc when I was 12…nobody should make my family feel that scared and alone.” – Dr. Boster (05:16)
• Communication & patient education became his mission, leading to his popular YouTube outreach.
  • "If I can convey that same snippet of information and put it on the internet…you can watch it at 3 in the morning in your bathrobe. That's the right time for you." – Dr. Boster (07:03)

2. What is Multiple Sclerosis?

• Basic definition: An autoimmune disease where the immune system attacks the brain and spinal cord, causing neurological problems (09:44).
  • “Multiple sclerosis is an autoimmune condition where the immune system unfortunately attacks the holiest of holies, the supercomputer that runs the body.” – Dr. Boster (11:02)
• Symptoms: Vary based on attack location—vision loss, weakness, numbness, fatigue, “invisible” symptoms like cognitive issues, bladder problems, etc. (11:48, 21:18)
• Types/Subtypes:
  • Relapsing-remitting (periods of worsening and improvement)
  • Primary progressive (steady worsening without distinct attacks)
  • Secondary progressive (initial relapsing, later steady worsening)
  • Dr. Boster advocates for viewing them as variations within one disease (12:25–13:54).

3. Epidemiology & Risk Factors

• Prevalence: About 1 million Americans have MS (07:38).
• Risk factors:
  • Genetics: Not classic inheritance, but higher susceptibility in families.
  • Environment: Exposure to EBV (Epstein-Barr/mono), low vitamin D, smoking.
    • “Low levels of vitamin D pre puberty also change the risk.” – Dr. Boster (14:09)
    • “Exposure to smoke…can literally double an individual's risk to develop MS.” (14:09)
  • Ethnicity & Severity: Same incidence across ethnicities, but more aggressive course in African American and Hispanic populations (17:32).

4. Symptomatology & Living with MS

• Fatigue: Described as pathologic and overwhelming – “like pulling back-to-back all-nighters and then going to work” (22:05).
• Invisible Illness: Many debilitating symptoms are unseen, leading to misunderstandings from others (21:18).
  • “I'm not faking sick, I'm faking well.” – (21:18)
• Common complaints: Cognitive issues, bowel/bladder problems, mobility issues, heat sensitivity (Uthoff’s Phenomenon) (37:12; 38:55).
  • “If you heat the human body up, you leach the ions out, and again you have conduction block.” – Dr. Boster (35:04)

5. Diagnosis & Biomarkers

• Diagnostic journey: Often long and frustrating—vague symptoms, multiple misdiagnoses (23:05–29:22).
• MRI: Gold standard for diagnosis; looking for brain or spinal lesions.
• Spinal tap: Less common in US, more in Europe.
• New testing: “Octave DA test” – a blood biomarker, recently FDA-approved and rolling out in clinics (27:32).

6. Treatment Approaches

• Three therapeutic classes:
  1. High-dose corticosteroids for attacks (31:41)
  2. Symptom management (e.g., ampyra for heat, gabapentin for pain)
  3. Disease Modifying Therapies (DMTs) to slow progression (Ocrevus, etc.)
  • “It’s the only medicine that can treat both relapsing and primary progressive forms of MS.” – Dr. Boster (34:46)
• Ocrevus: First to show efficacy in primary progressive MS (34:46)
• Managing heat: Key for symptom control (35:04–38:55)

7. Exercise and Activity

• Old advice was to avoid fatigue by being sedentary – now debunked.
• Exercise shown to preserve function, cognition, quality of life; water exercise highly recommended (41:57–44:43).
  • “The less sedentary time you have, the better off the body is going to be.” – Dr. Brett Fling (40:24)

8. Everyday Strategies: Dr. Boster’s "5 for 5" Framework (85:59)

1. Exercise as part of your lifestyle
2. Eat smart (healthy, unprocessed foods & supplement vitamin D)
3. Don’t smoke (including cannabis smoke)
4. Daily practice of mindfulness
5. Take the most effective DMT you’re comfortable with, and ensure it works

9. Diet, Microbiome, and Other Health Trends

• No single diet proven to cure or slow MS, but healthy diet improves symptoms (53:48).
• Gut microbiome: Dysbiosis in MS; research emerging, no human therapies yet proven (62:31–64:36).
• Hydration crucial, though frequently complicated by bladder problems (54:56–59:03).

10. Comorbidities & Associations

• MS often coexists with other autoimmune diseases, especially thyroid disease (50:21).
• Family members often affected by other autoimmune conditions, even if not MS.

11. Gender, Hormones, and MS

• Onset 3x more common in women than men; increasing only among women since the 1960s.
• Estrogen protective. Pregnant people experience disease remittance in the second/third trimester (59:44–61:39).
• After menopause, disease course becomes equivalent between men and women.

12. Marijuana & Symptom Relief

• Medical cannabis helpful for spasticity, neuropathic pain, insomnia, anxiety (73:47–76:54).
  • “There are certain symptoms that are very well treated by cannabis…spasticity in MS is probably one of the most robust symptoms…” – Dr. Boster (75:55)
  • Patients should keep a notebook to track dosing and effects, as individual responses vary (79:40–83:10).

13. Research & Emerging Treatments

• Remyelination (re-growing myelin): The “holy grail,” not yet achieved despite attempts (68:09–68:40).
• Stem Cell Transplantation: Only for the most severe cases; not curative, carries significant risk (70:22–73:08).
• Recent breakthrough: BTK inhibitors (tolobrutinib) showing promise in progressive MS, with trials ongoing and FDA fast-track status (89:46).
• On a cure: “I don’t think we’re going to see a cure in my lifetime… But we can make MS bottom boring.” – Dr. Boster (91:10–91:45)

14. Practical and Societal Considerations

• Self-advocacy is critical: Speak up, demand accommodations, combat medical gaslighting and inertia (83:26).
• Accommodations at work or in public should prioritize life goals, not arbitrary toughness (95:13).
• FMLA and workplace adaptation are underutilized resources for MS patients (96:29).

Notable Quotes & Memorable Moments

• On patient education:
  “I can help someone’s family. That really fills a bucket for me.” – Dr. Boster (05:13)
• Analogy for heat sensitivity:
  “If you heat the human body up, you leach the ions out, and again you have conduction block.” – Dr. Boster (35:04)
• On self-advocacy:
  “It’s your life, your brain. And just because the doctor's not bothered by it doesn't make it okay.” – Dr. Boster (83:26)
• On medical marijuana:
  “In clinic, it works…I see it work routinely. Neuropathic pain, it works. Insomnia, it works.” – Dr. Boster (75:55)
• On making MS boring:
  “With the earliest applications of highly effective medicines…we can sometimes make MS really boring.” – Dr. Boster (91:45)
• On living with MS:
  “I want you to have more sex, climb more mountains…all the things. And I don’t want MS to make decisions for you.” – Dr. Boster (94:45)

Timestamps for Major Topics & Segments

• Dr. Boster’s origin story & MS mission: 05:13–07:03
• What is MS & how to explain it: 09:44–11:48
• Numbers, prevalence, famous cases: 07:38–09:20
• Etiology & risk factors: 14:09–17:03
• Invisible symptoms & patient experience: 19:06–23:05
• Diagnosis process, MRI, new biomarkers: 25:59–28:31
• Treatment classes & Ocrevus story: 31:41–34:46
• Heat sensitivity & Uthoff’s Phenomenon: 35:04–38:55
• Exercise, physical therapy, water exercise: 39:58–44:43, 41:57
• Dr. Boster’s 5 for 5 anti-MS lifestyle: 85:59–88:50
• Marijuana for symptom relief: 73:47–83:10
• Diet, vitamin D, hydration, microbiome: 53:48–57:16; 62:31–64:36
• Advocacy, accommodations, mental health: 83:26–98:05
• Cutting-edge research, BTK inhibitors: 89:46–90:53
• Outlook on a cure & “making MS boring”: 91:10–93:20
• Final advice & emotional burden: 93:20–95:13

Episode Takeaways & Actionable Insights

For People with MS & Their Loved Ones:

• Education & self-advocacy are vital: Don’t settle for unanswered questions or inadequate symptom management.
• Five strategies (‘5 for 5’): Exercise, eat smart (with vitamin D/water), don’t smoke, practice mindfulness, stick to your DMT.
• Experiment safely for symptom relief: With professional guidance, consider options like water exercise, physical therapy, and medical cannabis.
• Prepare and pursue accommodations: Identify your true goals and request support/resources to keep you active and engaged.

For MS Awareness & Research:

• Advances are ongoing in diagnosis (blood biomarkers), treatment (DMTs, BTK inhibitors), and symptom management.
• A cure remains distant, but the goal is to make MS a manageable, unobtrusive (“boring”) condition.
• The MS field is increasingly holistic—considering mind, body, and environment.

Resources & References

• Dr. Aaron Boster’s YouTube: Aaron Boster MD
• Dr. Boster’s Charity Pick: msviewsandnews.org
• Kid-friendly Ologies episodes: "Smologies"
• Further reading/studies: Linked at alieward.com/ologies/neuropatholmmunology

This episode provides not only a comprehensive, compassionate look at MS, but a hopeful narrative, emphasizing quality of life, empowerment, and the promise of ongoing scientific discovery.