How brain healthy is your lifestyle? #ClinicSpeak #ThinkSpeak #BrainHealth
Someone asked yesterday about why did I give George Jelinek’s book ‘Overcoming MS’ a positive review and yet we don’t promote it on the blog? Very simple our policy is not to advertise commercial products on this blog and if we promoted OMS then what about the other MS-related lifestyle and wellness programmes?
Why did I give OMS a positive review?
The principles that underpin OMS are scientifically sound, but a lot of them are not evidenced-based, i.e. they are not supported by randomised controlled trials. Some of the lifestyle recommendations in OMS are also quite extreme and hence are very difficult to follow. I view George Jelinek as the lifestyle-wellness equivalent of the ‘ultra-distance marathon runner’. You don’t need to run ultra-distance marathons to derive the benefits from running, some people do just fine on subscribing to and running regular 5km Park Runs. It is horses for courses. I think the important messages in OMS and other lifestyle-wellness programmes are:
- Lifestyle-wellness interventions are not alternative medicine, but complementary; i.e. you need to do them in addition to taking for example DMTs.
- Lifestyle-wellness interventions need to be personalised. In particular they need to be affordable, compatible with your culture, your worldview and your belief systems.
- Lifestyle-wellness interventions fall on a continuum they are not all or nothing phenomenon. You can engage with some aspect of a programme and not others. In other words doing something is better than doing nothing.
- You need to be self-motivated to stick to a healthy lifestyle and wellness programme. I think herein lies the secret of the success of the programmes. Setting goals and sticking to them is self-rewarding. The rewards centres in the brain make you feel good about yourself and motivate you further. The downside is that when you slip you have a sense of self-loathing and guilt. These emotions are part of the package; they are the regulatory or negative emotional feedback loop. My personal opinion is that slipping occasionally is fine, but you need to earn the off-days.
- Lifestyle-wellness programmes take a holistic view of the management of disease. Saying this is easy; but it is very difficult to set-up a lifestyle-wellness service in the NHS. What is the evidence and how do we show that the programme will be cost-saving to justify the investment? In addition, adherence rates to lifestyle-wellness interventions is very poor. Why? Any ideas on how to improve adherence rates?
- Lifestyle-wellness interventions are for everyone regardless of whether, or not, you have MS. This is why we set-up the Barts-MS Brain Health challenge. Getting HCPs to personally engage with their own Brain Health would make them think about their patients’ health. In addition, patients’ are more likely to take advice seriously from a Brain Healthy HCP than from a HCP who is unhealthy. If you smoke, are unfit, overweight and eat badly can you really tell your patients to stop smoking, to start exercising, change their diet and to lose weight?
- Most lifestyle-wellness interventions are common sense with an evidence-base from outside the field of MS. However, like any other field the lifestyle-wellness space is full of quacks and charlatans so be careful to accept anything at face value. Do your research and ask questions. For example, what is the evidence that you need to follow a gluten-free diet? Unless you have documented gluten sensitivity there is no evidence. Similarly, the war on fats, and saturated fats, is built on a very poor evidence base. It is clear that fats, and saturated fats, are not bad for you if eaten in moderation. I am sure more evidence will emerge around this issue in the next few years. It is clear that at present ‘processed carbohydrates’ are in the dog house and justifiably so. However, this does not mean you have to go on the Banting Diet and exclude all carbohydrates from your diet. It is all about moderation and balance.
- Please let common sense rule the day and if you find you like, and enjoy, running 1 km or 5 kms, who knows you may gradually extend your runs to 10km, half-marathons, marathons and possibly ultra-marathons. The intensity and distance are not that important it is getting started and staying committed that is important.
Today is the beginning of the rest of your life. Just Do It!
Please remember that 'Today is Yesterday's Tomorrow'.