Monday, 28 August 2017

#ClinicSpeak & #DietSpeak: could diet be the next DMT?

Are you what you eat? How healthy is your diet? #ClinicSpeak #DietSpeak

Whilst on holiday I spent several days with a very good friend of mine, from South Africa, who now lives in the US. His wife is a card-carrying dietician, who runs her own consulting business that helps athletes, companies and individuals improve their health and wellness through diet and exercise. After listening to her and seeing her methods in action, it became clear to me that my approach of leaving dietary and exercise interventions up to you and your general practitioners to implement is wrong; it doesn't work. As part of 'the holistic management' of multiple sclerosis, we need to engage with lifestyle and wellness interventions more proactively. I am convinced they should be promoted as part of our disease-modifying therapy offering. 

The saying 'you are what you eat' may be overused, but it captures the essence of what you need to do to optimise your health and wellness. We are aware from a recent dietary audit of patients attending Bart-MS that the average diet of pwMS living in London is very poor. Our interpretation of the audit results was that it is not MS specific, but simply reflects the poor diet of the general population of London, and presumably the whole country. Despite ongoing public health campaigns and wide media coverage on healthy eating, it is clear that most people either don't listen, ignore the advice or don't feel it is necessary to change their behaviour. I am aware that the issues around healthy eating are complex and that the food landscape is mired in politics and is heavily influenced by big business with vested interests. 


From 'Viva: You are what you eat'

We have tended to shy away from promoting any specific diet for the management of MS. Saying this I have done several posts on diet and its effect on MS; two particular posts, one on ketogenic diets (5th-Jan-2016) and the other on intermittent fasting (30th-May-2016) generated interest and quite a lot of discussion. There is emerging evidence of that intermittent ketosis and fasting may have general health benefits, which include potential benefits for pwMS. I, therefore, plan to do a series of posts on diet and nutrition in relation to MS over the next few months. These will be general posts about diet and nutrition and will give advice on what you can do to optimise your own diet to improve your general health and wellness. The aim of this exercise is to generate content to produce a #ClinicSpeak tool to help you manage your diet as part of the holistic self-management of MS. 


Please note a themed series of posts in relation to one topic, that is not specifically related to research or a political campaign, is something we have not done before. Is this something you would find useful going forward? We could, for example, do a series on bladder management, DMT monitoring, etc. This content could then be migrated onto a curated site such as ClinicSpeak to make navigation easier. Thoughts? 

CoI: nil in relation to this post

25 comments:

  1. Very good idea. Do you mind providing us with a list of topics you will cover? We may have some specific areas we want covered. I note that you are posting before sunrise again. Shouldn't you be in bed asleep?

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  2. http://vivamanchester.co.uk/you-are-what-you-eat/

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  3. I think this crosses over with the rejuvenation post the other day. Many (but not all) PwMS are looking for thoughtful, good clinical advice, from experienced clinicians. I find the information on a few other MS sites very bland and superficial and so neutral and politically correct as to be useless. Forums have some good 'patient' experience help but there is also a lot of misinformation there as well. In depth discussions about clinical issues, with both sides of the story and with a bit of passion are what I need. I would be very happy for more 'clinic speak' topics.
    I am fully aware that I must maintain a good diet, exercise well and sleep well (note to GG, 05.22 post) and although these posts may irritate trolls as they are not about cure, they act as encouragement to me.

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  4. Looking forward to this series and others - like the idea of migrating clinicspeak to a more manageable forum. Keep up the good work team barts

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  5. I also am looking forward to these future posts/series! Thank you, thank you!

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  6. Gavin, in case you are already planning to print #YouAreWhatYouEat on T-shirts, I really don't like the simplification of this saying because I also "am" what I drink, think, do, avoid, etc. And I don't become a chicken because I eat one (which as you know I don't do anyway). Fundamentally, healthy eating for pwMS is very similar to what any sensible person should do plus vitamin D supplementation. Depending whether & how digestion, bladder and bone health are affected, things become more complex and specific to pwMS.

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    1. Dr K, I think you have missed Prof G's point. Our diets are dictated by Big Business. We have had the wool pulled over our eyes and have been misled by the medical profession. I sincerely hope he puts the record straight. I very excited that you have decided to take this topic on and hope you want toe the party line.

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    2. There is plenty of good advice on healthy nutrition, and you're only as dependent on big business as you allow yourself to be. It's largely your choice at the till what you buy. A very different proposition compared to DMT where price fixing seems prevalent and choice limited by eligibility criteria. I have no issues with good dietary advice, including a series on #ClinicSpeak, but YouAreWhatYouEat is - as Gavin days - overused, and in my view plain wrong, and certainly does not comprehensively capture "the essence of what you need to do to optimise your health and wellness".

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  7. This is likely one of the most important posts made on this blog, even considering all of the expert drug treatment discussions. Maybe the scientist in all of us is just getting a little bit more street smart.

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  8. I follow a "strict" Paleo Diet mostly small amounts of meat/fish and lots of veggies and good fats, I don't eat fruit at this stage anyway, just the odd punnet of blackberries, it's been great for my health and well being, I have more energy, my brain fog has improved, I've lost about 25 kilograms in weight all up and I've been able to start exercising. I'm in a state of ketosis 95% of the time.

    I still have a few kilos to lose, but I'm eating more healthily than I ever have before. I eat a nutrient dense diet instead of a carb dense diet. I follow Loren Cordain and Terry Wahls mainly. I don't get sucked into Paleo Food Bloggers recipes that are full of some form of sugar...

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  9. I would welcome scientific advice on diet. I am completely turned off by the "cure" diet stuff that is around which generally seems to exclude a vast range of various types of foods and which often contradict each other.

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  10. Starvation is antiimflamatory .Also increased autophagy

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  11. Starvation (more)http://www.nature.com/nri/journal/v15/n4/full/nri3832.html?foxtrotcallback=true

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  12. Interested in your take on Valter Longo's work on 5 day modified fasts and whether you think there are especially "brain healthy" diets -- such as those recommended by Terry Whals or for Alzheimers (MIND).

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  13. This promises to be good. I wasted a lot of time when diagnosed on the various 'don't eat this' 'this aggravates the MS', when I should have paid more attention to my MS nurse's mantra of 'live well'. The message of 'the better your health OVERALL, the better the chances of keeping MS at bay' can get lost in the various dairy/gluten/paleo etc philosophies.

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    1. I concur with the sentiments of your post Anon: l would just add 'live as well as you can' and don't beat yourself up for the odd indulgence: Bank Hol weekend Indian take-away comes to mind!

      Prof G I will appreciate any posts re 'living well' (diet)

      SUPPLEMENTS: please include info pertaining to the benefits versus risks of those that have attracted me due to things such as anti inflammatory properties or potential benefits with regards to MS. I'm now swallowing VitD3, licorice, ginger, fish oils, probiotics, Alpha Lipoic Acid, Lions Mane, Oh and 5-loxin or GOPO because chronic arthritis runs in the family. I'm surprised I don't rattle! I'm careful to take breaks from each supplement and take after food so as to ensure my stomach is lined, plus monitor my well being, especially having received Alemtuzumab. I'm sure I can't be the only PwMS adding supplements to their diet in their efforts to 'live well'

      Look forward to the posts.

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    2. Wth so much supplements you should be carefull with their interaction with each other
      Ex: Ala interacts with moega 3 fatty acds

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    3. Thanks Luis for the note of caution. I do take some after breakfast and some in the evening after my evening meal. I don't take both licorice and ginger on a daily basis, but alternate. Also take as much as a month to six weeks breaks from some. The only ones I don't forego at all are the VitD3. I wanted to clarify so as to be sure of not appearing totally ignorant, or ignoring of, the complications of taking supplements - why I'd like the team to focus on the subject as part of the diet posts.

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    4. Also you such research (google maybe?)

      Anti and prooxidant activities of some antioxidants

      It appears that some have dual roles depending on manny factors

      Thanks
      Luis
      Luis

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  14. The evidence is overwelming
    A Diet Mimicking Fasting Promotes Regeneration and Reduces Autoimmunity and Multiple Sclerosis Symptoms.

    Dietary interventions have not been effective in the treatment of multiple sclerosis (MS). Here, we show that periodic 3-day cycles of a fasting mimicking diet (FMD) are effective in ameliorating demyelination and symptoms in a murine experimental autoimmune encephalomyelitis (EAE) model. The FMD reduced clinical severity in all mice and completely reversed symptoms in 20% of animals. These improvements were associated with increased corticosterone levels and regulatory T (Treg) cell numbers and reduced levels of pro-inflammatory cytokines, TH1 and TH17 cells, and antigen-presenting cells (APCs). Moreover, the FMD promoted oligodendrocyte precursor cell regeneration and remyelination in axons in both EAE and cuprizone MS models, supporting its effects on both suppression of autoimmunity and remyelination. We also report preliminary data suggesting that an FMD or a chronic ketogenic diet are safe, feasible, and potentially effective in the treatment of relapsing-remitting multiple sclerosis (RRMS) patients (NCT01538355)
    https://www.ncbi.nlm.nih.gov/pubmed/27239035

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  15. Prolonged Fasting Reduces IGF-1/PKA
    to Promote Hematopoietic-Stem-Cell-Based
    Regeneration and Reverse Immunosuppression

    Immune system defects are at the center of aging
    and a range of diseases. Here, we show that prolonged
    fasting reduces circulating IGF-1 levels and
    PKA activity in various cell populations, leading to
    signal transduction changes in long-term hematopoietic
    stem cells (LT-HSCs) and niche cells that
    promote stress resistance, self-renewal, and lineage-
    balanced regeneration. Multiple cycles of fasting
    abated the immunosuppression and mortality
    caused by chemotherapy and reversed age-dependent
    myeloid-bias in mice, in agreement with preliminary
    data on the protection of lymphocytes from
    chemotoxicity in fasting patients. The proregenerative
    effects of fasting on stem cells were recapitulated
    by deficiencies in either IGF-1 or PKA and
    blunted by exogenous IGF-1. These findings link
    the reduced levels of IGF-1 caused by fasting to
    PKA signaling and establish their crucial role in regulating
    hematopoietic stem cell protection, selfrenewal,
    and regeneration.
    http://linkinghub.elsevier.com/retrieve/pii/S1934590914001519

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  16. "Humans live on one-quarter of what they eat; on the other three-quarters lives their doctor."

    Egyptian pyramid inscription, 3800 B.C.

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  17. "Man is the only 'animal' who persists in eating when he is sick, even though he may have no appetite and food makes him nauseous...



    Why fasting bolsters brain power

    https://www.youtube.com/watch?v=4UkZAwKoCP8

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  18. I will watch for the future posts with interest.

    I think diet is huge but also complimentary to other therapies and strategies used. It is as simple as put good stuff in then it will not only make you feel better but give a better platform mentally too. A crazy, ultra strict diet maybe is too much but some basic principles of fresh food and limited to no processed stuff is a good mantra.

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