RealTalk MS — Episode 443: The 2026 ACTRIMS Forum (Part 3)

Guests: Dr. Helen Tremlett, Dr. Ilana Katz Sand, Kathy Smith
Host: Jon Strum
Date: February 23, 2026

Episode Overview

This episode continues RealTalk MS’s in-depth coverage of the 2026 ACTRIMS Forum, spotlighting the interplay between cutting-edge MS research and the real-world experience of living with multiple sclerosis. Host Jon Strum sits down with three influential voices:

• Dr. Helen Tremlett (UBC): Focus on the “prodrome” of MS, comorbidities, and pediatric MS research
• Dr. Ilana Katz Sand (Mount Sinai): The impact of diet on MS, new research on telomere length, and the evolving narrative around dietary interventions
• Kathy Smith (Patient Advocate): Rethinking MS course descriptors to better reflect the lived patient experience

Their discussions cover the evolving understanding of early MS, novel treatment targets, lifestyle interventions, and how changing disease labeling can improve care and research. The tone is informative, hopeful, and deeply grounded in both scientific rigor and patient advocacy.

Key Segments & Insights

1. Dr. Helen Tremlett — The MS Prodrome & Comorbidities

(Starts at 02:03)

Main Areas:

• MS as a Disease with a “Hidden Chapter”: Dr. Tremlett details how MS biological activity begins 5 to 14 years before typical clinical symptoms (the “prodromal phase”).

• Why Early Identification Matters:

  • Quote:

    “If the disease is biologically already started before that classical optic neuritis or that classical MS symptom, there’s potential opportunity to pick people up earlier and manage their disease earlier—and have the potential for biggest impact in terms of disability, regression, and future outcomes.” (Dr. Tremlett, 02:44)

  • Early treatment may dramatically affect long-term disability.
  • Understanding the prodrome could quicken diagnostic timelines.

• What the Prodrome Looks Like

  • Patients often visit doctors for issues like anxiety, sleep problems, fatigue, depression, or bladder and bowel dysfunction years before MS diagnosis.
  • But:

    “A lot of these things are not specific to MS and we can’t currently use them to identify people with MS earlier. But it does suggest we could pack together these signs and symptoms along with other biomarkers ... to be able to identify people earlier. We're just not there yet.” (Dr. Tremlett, 04:08)

• Comorbidities and MS Progression

  • Tremlett’s team reviewed over 100 studies, finding:
    • More comorbidities (especially 3+) are associated with faster disability progression.
    • Mental health conditions (depression, anxiety, bipolar), cardiovascular disease, and epilepsy increase risk.
    • Hyperlipidemia and migraine are associated with higher relapse risk.
  • Quote:

    “If we could manage comorbidities in MS more appropriately, could you then alter outcomes ... and ultimately benefit that person’s MS as well as the comorbidity itself? That really has to be demonstrated and studied further.” (Dr. Tremlett, 06:40)

• Environmental Factors & Pediatric MS

  • Tremlett and colleagues are studying the gut microbiome in children with MS.
  • Preliminary findings show:

    “We find differences between the children with MS and those without that do suggest there’s an upregulation of an inflammatory kind of related milieu in that gut microbiome, and that diet may play a role in that.” (Dr. Tremlett, 09:17)

• The Future of MS Cure

  • Tremlett envisions cures might come from both repairing damage and preventing disease onset.
  • Quote:

    “I do think that’s feasible, say in the next, in the foreseeable future, in my lifetime. I do hope that is an achievable goal.” (Dr. Tremlett, 11:10)

Notable Quotes and Moments

• On challenges for presymptomatic intervention:

  “It’s tough to randomize people into a study where they’re going to take an immune-mediated drug ... when, from their perspective, they have very few signs or symptoms.” (12:18)

2. Dr. Ilana Katz Sand — Diet, Brain Health & Biological Aging

(Starts at 13:28)

Main Areas:

• Diet and Brain MRI Integrity

  • Healthy diets, especially Mediterranean/MIND patterns, correlate with better brain MRI findings in MS.
  • Quote:

    “We do think that people who follow a diet that is in higher alignment with the Mediterranean pattern have an advantage.” (Dr. Katz Sand, 16:01)

• Top Diet Recommendations

  • Add: (1) Olive oil, (2) Berries, (3) Leafy greens (and nuts).
  • Remove/cut down: Ultra-processed foods, red/processed meats, sugar-sweetened beverages.
  • Quote:

    “Olive oil seems to be the strongest driver of the relationships we’ve observed ... We want to do our best to really avoid ultra-processed foods as much as possible.” (16:19)

• Relevance for Progressive MS

  • Dietary changes may still help those with long-standing, progressive MS.
  • Prior work found strongest diet-disability correlations in this population.
  • A clinical trial is proposed to specifically study this group:

    “We do think that this is a neuroprotective mechanism ... We actually have a trial ... focused on a progressive MS population because we do think this is so important.” (18:03)

• Synergy of Medical Therapy & Lifestyle

  • Katz Sand advises pairing medications with lifestyle modification:

    “My preference is for us to come at this disease with everything that we have. ... My patients who do the best in the long term are the ones who really do both of those.” (19:17)

• New Research: Diet, Telomere Length, and Disability

  • Longer leukocyte telomere length is associated with less disability progression over six years.
  • Both diet and telomere length are linked to changes in the EDSS (Expanded Disability Status Scale).
  • Telomere length mediates about 16% of the association between diet and disability progression.
  • Quote:

    “Leukocyte telomere length ... is associated in our sample with worsening of MS-related disability measured by the EDSS score ... Dietary habits were associated with EDSS worsening ... Telomere length explained about 16% of the relationship between diet and EDSS worsening.” (20:22–22:05)

Notable Quotes and Moments

• On patient hopes for dietary cure:

  “…Sometimes they’re a little bit disappointed with me when I tell them that’s actually not my recommendation. I really just think that we need to be thinking from all angles and we need these different approaches together.” (19:00)

3. Kathy Smith — Rethinking MS Disease Course Descriptors

(Starts at 22:30)

Main Areas:

• Problems with Current Labels

  • Current categories like “relapsing-remitting” or “secondary progressive” don’t always fit the day-to-day lived experience.
  • Quote:

    “From my perspective, they don’t really serve me anymore ... I still have the label ... of relapsing-remitting MS but I have not had a relapse in probably 17 years.” (Kathy Smith, 23:50)

• Capturing Hidden Progression

  • Many MS patients feel changes not captured on MRI or by current disease labeling.
  • The MS community is considering additional dimensions (biological, functional, lifestyle modifiers) in describing disease course.
  • Quote:

    “We might not throw away all the ones we currently have, but we would add other dimensions ... more functional daily living kinds of things ... and modifiers the patient can control for themselves.” (25:12)

• Why Rethink Now?

  • Advances in science reveal MS is a continuous disease with phases, not a set of distinct types.
  • Quote:

    “MS is one disease that may have distinct phases, ... but the science has advanced to allow clinicians and researchers to say, actually ... these are not distinct ... It’s all one disease.” (27:25)

• Benefits for Patients

  • Moving away from rigid categories reduces stigma and allows care that matches the true disease trajectory.
  • Opens door to more individualized, biology-driven treatment strategies.
  • Quote:

    “People don’t get pigeonholed or labeled ... with a much more sort of dynamic, continuous idea about MS, people would be able to move between phases, to sometimes get better, sometimes get worse, sometimes stay the same.” (28:35)

• Implications for Treatment

  • Could enable use of “progressive” strategies in “relapsing” patients based on biology, not labels.
  • Future clinic visits may blend MRI, clinical tests, biomarkers, functional assessments, and discussion of self-modifiable factors.

Notable Quotes and Moments

• On the community’s consensus:

  “I feel as though the community is really listening ... and trying to match up the course descriptors with what’s actually happening in reality.” (32:54)

Notable Quotes — Quick Reference

• "If the disease is biologically already started before that classical optic neuritis ... there's potential opportunity to pick people up earlier and manage their disease earlier."
  — Dr. Tremlett (02:44)

• "A lot of these things are not specific to MS and we can’t currently use them to identify people with MS earlier."
  — Dr. Tremlett (04:08)

• "Olive oil seems to be the strongest driver ... We want to do our best to really avoid ultra-processed foods as much as possible."
  — Dr. Katz Sand (16:19)

• "I always tell my patients that my preference is for us to come at this disease with everything that we have."
  — Dr. Katz Sand (19:17)

• "They don’t really serve me anymore ... I still have the label ... but I have not had a relapse in probably 17 years."
  — Kathy Smith (23:50)

• "The community is really listening ... and trying to match up the course descriptors with what’s actually happening in reality."
  — Kathy Smith (32:54)

Timestamps for Important Segments

• 02:03 — Dr. Helen Tremlett on the MS prodrome and early detection
• 06:40 — Dr. Tremlett on comorbidities and disease progression
• 09:17 — Dr. Tremlett discusses the microbiome in pediatric MS
• 13:28 — Dr. Ilana Katz Sand on nutrition and MS
• 16:01 — Katz Sand outlines dietary priorities for MS patients
• 18:03 — Relevance of dietary change in progressive MS
• 20:22 — Research update: diet, telomere length, and disability
• 22:30 — Kathy Smith on living with MS, current vs. ideal disease labels
• 25:12 — Expanding MS descriptors to include function and lifestyle
• 27:25 — Scientific and patient-driven push for descriptor reform
• 28:35 — Patient care benefits from a spectrum-based approach
• 32:54 — Community partnership in evolving MS language

Summary in Tone and Language

This episode fuses the voices of leading researchers and advocates with a practical, hopeful outlook. The conversation is clear, jargon-free, and deeply respectful of the patient perspective—balancing hard science with empathy and actionable advice. Each expert underscores how cutting-edge MS research is already informing better care pathways, with early detection, lifestyle modification, and patient-centered approaches at the frontier. Whether you’re a patient, clinician, caregiver, or policy advocate, there are immediate takeaways and a palpable sense of forward momentum.