Hi, I'm Nick. And I'm Helena. And we both work at the MS trust charity for people affected by MS in the UK, we are here to help you make sense of this.
Nick:
Welcome back to our podcast. It's multiple sclerosis, breaking it down. And today, we've got a bit of a special topic, because we're gonna be talking all about brain health. What does that mean? What is it? How can it impact MS, and what can we all do to improve our brain health?
Helena:
Let me start off by reading a definition of brain health from our website. If you're like me a little bit confused about what the concept actually means. Brain Health refers to the ability to remember learn, plan, concentrate and maintain a clear active mind. In MS the immune system mistakingly attracts and damages tissue in the brain and spinal cord, the central nervous system. And this results in lesions that can be seen on an MRI scan, a brain can compensate for some of this damage by routing signals or adapting healthy areas of the brain to take on new functions. And this capacity is known as neurological research, or brain health. And about half of people with MS will have problems with aspects of thinking at some time. Perhaps the memory attention span or concentration, these symptoms are referred to as cognitive problems. See I couldn’t even pronounce that properly. And taking steps to maximise brain health can protect against cognitive decline, and can help people to maintain a good quality of life as they get older. So it does sound like you know, fairly important thing to learn more about. I mean, it's really cool that the brain kind of can do the whole rerouting thing. So yeah, brain reserve really seems to be like a pretty good thing.
Nick:
Yeah, absolutely. I'm not sure. I've got my brain switched on quite yet. But I'm sure the listeners will bear with us. How can we how do we actually improve our brain health? Um, you know, we hear lots of lots and lots of things out there about diets, supplements, exercise, things like mindfulness and meditation and journaling. Like there's so many different things out there, isn't it? It's a bit of a minefield. And if you're anything like me, it can be slightly overwhelming, if you're not quite sure where to start.
Helena:
Yeah, I think you know, in some ways, you almost start by feeling guilty about the things that you're not doing. So it's a bit like, well, hold on. No, I don't know. It's just so much information overload. So in order to get some ideas about this, we contacted Dr. Agne Straukiene, who is a neurologist in Torbay in South Devon. And we became aware of Agne through her brilliant podcast, which is called Be Well with MS, where she quite often talks about how to improve your brain health.
Nick:
Yeah, and she was so keen to share like all of her knowledge with us all of her expertise on this subject. So without any further ado, let's jump straight into the interview.
Hi, and welcome back to our podcast, we're joined by a very special guest, who you might have seen online as well. And that host of the Be Well with MS. Podcast. I was wondering, could you introduce yourself for us?
Dr Agne Straukiene:
Hi, I'm Dr. Agne Straukiene a neurologists for 14 years I've been running MS service at Torbay in South Devon NHS Foundation hospital for seven years. My main focus is MS service improvement projects and I co developed multiple innovative digital platforms for patients and healthcare providers. Closer to my heart is the education and promotion of healthy living with multiple sclerosis. And digital tech actually helped me to promote this idea very effectively. And if you look at my entire MS patients cohort, they have fewer comorbidities in contrast to the rest of the UK. And there is a lot of energy and work involved into this process to deliver important messages. So we have established a healthy lifestyle clinics for people with MS in 2019, just before the COVID 19 pandemic hit us and we're lucky enough to be awarded with international MS. Brain Health award in 2022. So it's fabulous and fantastic to be on this show with you Nick, thank you so much for the invite. And I'm very excited to provide even more information about healthy living and how to preserve the brain health living with MS
Nick:
Wow, that's fantastic. That's brilliant to hear and it's great to hear the positive impacts so for the people living with MS who you're supporting as well that's amazing. Thank you.
Dr Agne:
It's my pleasure.
Nick:
Thinking about brain health for this episode, there's lots and lots of different aspects that people talk about and lots of different, I guess, trends that we might see on social media and the internet, around keeping your mind active, keeping things going in that respect. So we've got a few different questions. So the first one was exercise. So we often see people talking about exercise. And does that have an impact on your brain health?
Dr Agne:
Well, absolutely. As far as exercise on its own, nobody, nobody likes to go and do exercises, it's an extra effort and, and something that we sort of, generally are lazy to do. But the importance of the exercise is, is dramatic, it's enormous. The regular exercise has, has been shown to have a positive impact on brain health in people with MS and including improving the cognitive function and mood and emotions. So it's really powerful, also, getting a better neuroplasticity, which is a definition to describe a neuro wiring within the brain structures that improves the connection, the performance, the memory, the cognition, and everything else that you could benefit from doing the exercise. And the importance is, is that you do that very irregular, the consistency is super, super important. You know , you can do little things. But if you do that, every other day, it really improves your brain health. And the importance is the engagement and, and I think having a connection with the healthcare providers, and in particular physiotherapist, or some personal trainers, would help to find the activities that you enjoy the most. And it causes a lot of a lot of meaningful purpose in your life. And you know that you're going to stick with this programme if you enjoy it. So, so it's really important. And I know that a lot of people say, Oh, I'm so fatigued anyway and if I exercise, I get even more fatigue. So I think the problem is that if you are not careful and not pacing yourself with exercises, really, that's something that you feel the following day, and it's almost like it feels like a knock on effect. And people start disbelieved that exercise actually helping them. I think it's important to know that one small step at a time, and the consistency and anything that brings you joy. That's how you benefit the most from the exercise programme and having a chat with the experts and getting a programme that is dedicated and personalised to your needs.
Nick:
That sounds really interesting. I like what you said about having the small step for each exercise because I know for my partner who has MS. And for lots of people who are involved in the MS community, they will report that fatigue and on those particularly difficult days, it can seem like that extra step to take to exercise to follow their exercise programme. So I really liked what you said about taking it as a small step and just getting consistent. Try not to overdo it when you are exercising, we're not saying that people should go and run marathons every week or anything like that, but just those little steps to keep going. And what about some people who potentially will need to do their exercises seated in a wheelchair or, or even lying down sometimes.
Dr Agne:
Yeah, I think that there must be some individual programmes and I always say to my patients who are more advanced in their journey living with with MS and maybe have more disability and weakness in their legs. You can live life without legs, but without arms. If the function is still preserved in your upper limbs, you still should continue exercises in a seated position or lying down position whether it's passive or active exercises, it still wires your brain it's a stimulus to your brain to actually perform actually to produce more neurochemicals to send these chemicals to certain parts of the brain to improve your cognition, your emotions, your your feelings. So you get these positive endorphins, which is a happy hormone in your body that makes you feel so proud about yourself and so positive. So really, you know it's something to go for and exercise is just a small part of the whole well being and healthy living. It's not just exercising, and I think it's a combination of things you know, that could be classed as a healthy living? And I guess we would love to talk about this today too.
Nick:
Yeah, absolutely linked to exercise as you were saying about healthy living, does diet have any impact on your brain health?
Dr Agne:
Well, diet is a big big topic in general and loads of heated discussions in the in this world. So diet and nutrition plays an important role in managing MS symptoms and promoting overall health. There is no specific diet or the best diet that has been proven to cure or manage MS. But there are some dietary strategies that may help to manage symptoms and improve overall the well being living with MS. And here are a couple of examples. How can we help and promote with a very dense nutritious diet.. usually we're talking about the how to reduce the inflammation living with MS because MS is purely inflammatory condition, but then it can go into neurodegenerative process once the inflammation is its own peach. If we could call this there are some foods that could contribute to inflammation in the body. So it's important eating rich off anti inflammatory foods such as fruits, vegetables, the whole grains, lagoons, healthy fats that help to reduce the inflammation and improve the patient's symptoms, as well as there are loads of information about and promoting the gut health, their microbiome, emerging research suggests that gut microbiome, the collection of the batteries, or the micro organisms in the digestive tract may play a key role in multiple sclerosis. And eating the diet that promotes the gut health such as one that has got high in fibre, or fermented foods like yoghurt or kefir kimchi may help to support the gut microbiome and reduce the MS symptoms. And you know there are some supporting brain health certain nutrients such as omega three fatty acids and vitamin B. Very important for brain health and can protect against the multiple you know, brain damages eating diet rich off the foods like fatty fish and nuts and seeds and leafy greens the whole grains helped to provide these nutrients and also it's important to know that you know, people have to feel good after they had meal you know, if they feel after consuming certain products that you know, the energy is getting down and usually that happens with the gluten, dairy or sugar products. So, so individual choice and exploring a little bit bringing that awareness in your body about how you actually feel after this particular mealtime you know, and sometimes you know that you may feel that your gut function or your bowel function is upset about it, you know, consuming dairy or gluten like gluten is like a white bread and white pasta. If you feel like bloated and you have more gas for example, in your guts, you know that that's not that's not the product that you should pursue and if you feel like more drowsy and you want to go to bed and sleep through that's something to do with the poor choices of your of your diet, and there is no that no, no one, you know, can tell me that oh, this is the particular diet that I should pursue. No one size fits all diet for MS. Some, some people may find certain products that really worsens their symptoms, you know, they get more tingle, tingle in the body more, more pains and cold and hot sensations and hot flushes. So maybe the solution would be you know, bring that awareness and maybe have some discussion with a health care provider and registered dietitian who could potentially develop individualised dietary plan that meets your nutritional needs and supports the overall health and well being. So really, you know, what you should consume on a daily basis so, so really focusing on the anti inflammatory foods, fatty fish, nuts, seeds, dark leafy greens, you know, berries, nuts. Tumeric is an important spice that contains anti inflammatory compound, which is a curcumin it's been used in cooking a lot of Indian curries I made well our spice with a Tumeric. Olive oil again it's it's an amazing oil that has got a type of fat called oleic acid and it has got an anti inflammatory properties. Tomatoes. Again, it's it's high in Lycopene, a strong antioxidant that has got anti inflammatory properties. Green tea contains compound catechins, which have anti inflammatory properties too. However, be careful with a green tea because it has got a lot of caffeine in it and it could overstimulate your bladder. So people may have a bit of a hyperactive bladders, because of the consumption of the loads of caffeinated drinks, including green tea, so you have to make sure that you're well hydrated and you're not upsetting your, your your guts or bladder function. So again, listening to your body and following these signs and symptoms that your body produces the way forward.
Nick:
Wow,that was really comprehensive. And you covered lots of different ways of making sure you get that those healthy nutrients. Thank you so much. And, yeah, it's really important, isn't it, as we said to potentially if you can get to a dietitian, if it's something that you're really, really struggling with, if you're finding that you're you are feeling quite poorly after eating certain foods or your symptoms are worsening after eating certain foods. Thank you. In terms of at the moment, you know, people are struggling at the time of recording of this. We're currently in sort of a cost of living crisis, as they say in the UK. And people might be cutting back on things like the cost of food, for example, is it still possible to have that healthy diet that will support your brain health? With a bit of a lower cost? Do you think?
Dr Agne:
Well, in terms of the health, the quality of food we eat can affect our risk of developing various health conditions such as obesity, diabetes, heart disease in some types of cancer. So the high quality food that is nutrient dense, fresh and minimally processed is generally considered to be considered to be better for our health, then processed and packaged foods that are high in added sugar, sodium and unhealthy fats. Yes, the cost of food can affect our ability to access healthy and nutritious food. And some people may not be able to afford high quality fresh food due to financial constraints and can lead to a diet that is very much processed and less nutritious. It's important to think that, that diet and plant diet strategies could be economically cost effective. I mean, I think that there is a way to improve overall the cost and access to healthy nutritious food, but it requires a multi multifaceted approach. Some strategies, for example, maybe that maybe it's a way forward to improve the access to healthy food and increase the number of the grocery shops and farmers markets in the communities and that's how people will be almost forced, if that's probably a very strong word to say that but if there are no other option, just a healthy option that comes from the farmers, so people probably would consume that healthier option rather than this sort of a cheaper very kind of colourful, full of the sugar and salt options, but it's a bit of a pre planning and, and I think also, it's important to have a proper education about you know, how to choose the healthy options and I think that's where our healthy lifestyle clinics plays a key role for people to, to find the right product and this podcast as well is very educational to that brings a bit of awareness that, you know, canned products for oily fish in a can is as good as the fresh fish because you get the same level of they're very good fatty acid in your body, you know, or buying some bulk, you know, big bags of rice for example, or legumes or beans, you know, so, and pre planning maybe trying to sort of avoid the food waste and reducing that can help overall to improve the cost of the food that that's something that needs to be addressed to the whole nation, not just individual persons and maybe ordering some recipe boxes. That limits the consumption of the products and you're more focused on what you're getting for tonight’s dinner and maybe lunch you know, and get getting a bit better planning for maybe entire week or month utilising often the freezer for example, it gives you can you know, do some one week supply of cooking, you know, if you have that energy to do things and then put the food in the freezer and then get the food out of the freezer, you know, on the days that you have low energy and you feel bad about things, or maybe your symptoms are, you know, getting worse at some stage in your life, which we see a lot in our clinics, you know, patients are saying I got good days and bad days. And, you know, it's sort of the planning that is involved. And, you know, frozen vegetables are as good as, as fresh vegetables. And, you know, it's maybe tastes a bit different, but it's the same product and, and usually they are chopped, you know, in the bags, and, and you don't need to sort of spend time chopping. And if you have some grip weakness, you know, again, these chopped vegetables that are frozen, it's going to serve your purpose, you know, and it's going to make you feel better overall. So, so just, you know, keep in mind that it if the healthy food improves the brain health, there is no way and we have loads of emerging evidence and, and it's something to focus on, you know, and really help yourself there is nobody more important in this world and nothing is more important than your health and not being mindful and paying attention to what you should do and you shouldn't do. It's a no brainer, you know, it's only going to give you a lot of resilience, a lot of good feelings in yourself, if you are choosing right projects, if you're choosing the nutritious high density nutritious products to help you to feel good about yourself. And that will complement your exercise programme with because you know, we're only exercise its difficult to lose weight. Unless you're an athlete and marathon running and the Olympic champion, you know, you probably could, you know, manage your weight with exercises only. But you have to do a lot of a lot of exercise. But combining the exercises with the diet and diet play to even more role in managing your weight management. You know, if you want to lose weight, focus on your diet first, then exercise. But if you can combine these two together, you're going to win it, you're going to have the weight you want to have and loads of talks around intermittent fasting and which programme to choose. There are different strategies are for intermittent fasting and ketogenic diet. But more emerging evidence about the positive impact on your brain health is following the Mediterranean diet and a recent study that has been published suggest that people who are more precise in following the Mediterranean diet, they have 20% less cognitive issues. It says a lot 20% in medicine is a high percentage
Nick:
Linked to diet and to exercise our supplements. So now you've already mentioned a couple in the interview already. What's your opinion on supplements and brain health?
Dr Agne:
Well, I think we have limited evidence based information about the use and benefits of the supplements in particularly talking about multiple sclerosis. And I think more studies are required in this world to confirm their benefits. I think what I say often to my patients is that, you know, they consume various different vitamins and supplements themselves. And I always say that you're not going to harm yourself with it, it's probably going to make your urine a bit more expensive, more than anything. But some of the vitamins have some anti inflammatory properties, and some of them are good for general health in general. So talking about the most common vitamin that people are consuming is vitamin D. And, you know, some evidence suggests that vitamin D supplementation can be very beneficial because a lot of people with MS are vitamin D deficient because you know, we talk about the British people you know, it's a very dark country, not necessarily we get a lot of sunshine exposure. So that leads to people have vitamin D deficiency. You know, a lot of people work in the offices spend less time outdoors and that all contributes to the you know, having vitamin D deficiency. So to improve the bone health, Vitamin D plays a key role too. So, so I think some evidence from last year ECTRIMS in the posture session has been presented Vitamin D has got less effect on disease activity and doesn't prevent people from having a transition from clinically isolated syndrome to relapsing remitting multiple sclerosis. Some historical previous study suggests that here was some benefit taking them indeed in prevention of that so I don't know who to believe it this time, and I think we need to do a bit of more, more data on this topic. However, I would like to strike the importance that vitamin D is important for the absorption of the calcium from the intestines from the guts for maintaining adequate levels of calcium in the blood. However, the vitamin D increases the calcium absorption in the guts, and as a consequence, by increased the vitamin D level, and that could increase the calcium level in the blood. And if you have excess of the calcium level that is not properly utilised by the bones, the accumulation in the soft tissues can cause more harm. So this is where the vitamin K comes in. And vitamin K is essential for the activation of the protein called osteocalcin, which helps to incorporate the calcium into the bone matrix. So without the vitamin K osteocalcin remains inactive and cannot properly bind the calcium levels. So as a consequence, you get maybe weaker bones and more calcium floating in the bloodstream. So vitamin K helps to prevent the buildup of access of the calcium in the soft tissue so so when you purchase the vitamin D, so make sure that he has got plus vitamin K, because they work together to ensure that there is a proper calcium utilisation by the bones and doesn't accumulate the calcium into the soft tissue. Now, the other vitamin that people quite often consume is called vitamin B 12. Just bear in mind that multiple people choose now to be vegetarians, or vegans, and B, vitamin B 12. In particular is coming from soil, and usually animal products. So if you're not eating meat, so this is an essential vitamin supplement for you to take. And, and quite often people have vitamin B deficiency already. And that contributes further to the fatigue and cognitive impairment. So taking vitamin B12 really could help to improve the symptoms. Now, a lot of people discussing around antioxidants and one of the strongest vitamin is a vitamin form of the antioxidant is vitamin C. And it suggests that it may have anti inflammatory effect in our bodies. And of course more research is required in particularly when we talk about the MS. Alternative antioxidants that people consume is vitamin E. Some evidence suggests that Vitamin E has got a neuro protective effect. And again, very weak evidence, we still need to explore this evidence but it probably wouldn't harm you if you consume that. And I think I already covered about taking omega three fatty acid supplement there are some anecdotal evidence and some emerging evidence that it may reduce the disease activity but it's not robust data to confirm this evidence. So but anecdotally people have less disease activity if they are consuming Omega three omega three fatty acid. Now omega three fatty acid is it has got a very positive effect in cardiovascular diseases so it prevents the accumulation of the bad fat which is cholesterol and it's something that prevents from having an active inflammation on the vessel wall once the cholesterol plaque is created and if you develop it some people have a congenital cholesterol anaemia which is an increased level of the cholesterol in your body. So making sure that you're still on a good diet and maybe taking some omega three supplementation is something to seriously consider as the prevention of the cardiovascular events. So many other vitamin supplements are around and I can list a few of them. But not many are available in the UK and over the counter. For example melatonin is something that people are considering taking for insomnia. And a lot of this is in the USA you can buy that over the counter without any prescription its like a hormone that regulates the sleep and wake cycle and helps to improve their sleep quality. And it's something that it's a natural product that is produced in our bodies anyway by the pineal gland in response to the darkness. But you can take that as a synthetic product to regulate the sleep and wake cycle and improve the sleeping quality. There are some studies to suggest that but it really plays a key role in insomnia, also stress and poor sleep hygiene and other health conditions. It has got some sort of antioxidant effect in our bodies and also modulates the level of the certain neurotransmitters. Which is a neurochemical in our body to improve that sort of a good quality of sleep. The problem with melatonin is when we buy as a supplement, we don't know what the concentrate actual concentration is in that particular supplement, or tablet or capsule that comes from this medicine or supplement. So just be very careful. And if you aren't considering consuming the melatonin, it really needs to be a low dose as a starting point because five milligramme or 10 milligramme. If the five milligramme is effective, so you shouldn't be consuming 10 milligramme. And there is no evidence that 10 milligramme can be more effective than the five milligramme dose. Other supplements that sometimes I do recommend for patients to take in my clinics is magnesium, magnesium, and in particular threonate is a specific form of magnesium that has been shown in some studies that have a better absorption and penetration into the brain than other forms of the magnesium. And this supplement is very, very helpful for ability to improve the nerve function and also some evidence suggests that it can reduce the inflammation that is a powerful vitamin supplement. If you have muscle spasms and some sort of problems with falling asleep. It's really powerful. However, you need to consult with your healthcare provider before starting any supplement. And in particular, let's say magnesium because it can interact with biphosphonate which is a medicine that is being used in osteoporosis treatment and other bone diseases. Antibiotics certain antibiotics can have an interaction with magnesium, other muscle relaxants, you know a lot of people are on baclofen, gabapentin etc.. these are antispasmodic medicine and neurochemical. So you may have an interaction you know with magnesium so some blood pressure tablets, magnesium can interact with, for example, calcium channel blockers ACE inhibitors. So as a consequence, if you take the blood pressure tablet and magnesium on the top it can lower further blood pressure and you may become more dizzy and, and generally unwell. Other supplements to list valerian root, it's a herbal supplement that people use for centuries to promote their relaxation and improve their sleep quality. It's sort of a has got an extract and then it comes into the form of the capsule or tablet. It's not fully understood how it works and how it interacts with our GABA system which is gamma amino butyric acid system. A lot of drugs are built on this chemical. It's a neurotransmitter that reduces the neuronal excitability. So the neurons less excited about things if you consume the valerian root but again more research is required to see the actual effect and it might be harmful if you're overdoing things with all these supplements so being mindful and thinking about what other medicine you take a benzodiazepine group medicine that already gives us sedative effect and if you combine that with the valerian root it's not good for your body and your health. Alcohol you know if you combine the valerian roots with alcohol can increase this even further sedative effects and loads of drugs that we prescribe in our clinics, metabolise by the liver so and if you start consuming loads of other vitamins supplements or maybe you're just you know overloading your liver function so being mindful and careful you know in terms of your choices, another supplement if I could class this as supplement is the CBD compound is derived from the cannabis plant and it's been found to have a range of potential therapeutic benefits such as reducing anxiety improving sleep and a lot of people purchase that over the counter these days. However, more research is needed to fully understand the effect of the CBD on sleep and I think it's important to know where we buy, what we buy concentration of the of the CBD we buy basically it because it's not clear often. So, I have to strike the importance that there are some studies again to indicate that actually the CBD can affect more wakefulness and there are a group of people that when they take the CBD, they actually not sleeping at night time. And why is that because it has got some stimulative effect in our brain. So, I think you know, you may try and see if this CBD oil at nighttime keeps you awake. So, assume that the effects on your body that CBD has got is more stimulant. And you may consider if you have a high level of fatigue, you know, you may consider taking CBD in the mornings to see where that brings more, more attention more alertness, because the effect is been documented and has been researched in the past so really think and see how it does affect your alertness and wakefulness. And whether that causes drowsiness or not, and use that for a different purpose depending on what the effect is, or in particular on your own body. I think these are the main supplements that people consume. There is another one that people take these days it's lion mane, which is a mushroom. It's an interesting one. Some studies suggest that it may improve neuroplasticity and cognition and memory and performance. But again, it's difficult to talk about the supplement at this stage. Some anecdotal evidence suggests that it can help people with a stroke to recover quicker after they had a stroke. Not many research we've got in multiple sclerosis, but I know patients of mine they do consume their Lion's Mane supplement to improve their mainly cognitive function to be honest, and it's probably not going to harm you. But you know, you have to carefully consider where you're buying from, what effect it is on your body and how it's all feeling. You know whether that gives you more nourishment, more positivity, more positive effect, or actually it brings more symptoms. Like, you know, some of the patients of mine report the magnesium causes or vitamin D causes more constipation. It's not listed as a side effect, but it may cause the symptoms so you shouldn't be consuming and continuing the vitamin supplement if it causes a lot of other extra symptoms for you.
Nick:
Thank you, it's great to hear about the evidence base, or sometimes the lack of evidence base for some of those supplements and different things that you can take. Thank you so much. You mentioned there a little bit about sleep and how some supplements can affect sleep. How important is sleep to brain health?
Dr Agne:
It's enormous. How much of the positivity it gives a good quality of sleep like you know yourself like when you wake up and you had a good night's sleep, how you feel like what what, what flavours, what colours it brings into your, into your life and day routine, really you have more energy, less fatigue, your cognitive function improves, your symptoms are milder and this is what I hear very often from people and hence why I mentioned all the supplements that improves the quality of sleep because it's enormous, essential ingredient in healthy living it's actually part of fear or the pillars of the healthy living and healthy lifestyle having a good good night's sleep. There are so many studies emerging studies to suggest that it improves your mood, your emotions, your feelings, your physical ability, it slows down so many symptoms, they become much much milder. And sometimes to achieve that good night's sleep it requires a bit of effort. I do recommend for people to wake up in the morning and have this first sunshine exposure of the sun into your eyes. So you may look into the sun directly. Maybe it may hurt your eyes to look at the sun directly. Maybe you just have a look at the sun as much as you can. But early mining practices would indicate what the quality of sleep you're going to have at nighttime. So and that's the reason of having the sunshine. It produces the level of the melatonin in your body and the melatonin is a hormone that helps your brain to understand that this is the time this is the darkness, this is the time to fall asleep now. So it's essential practice. Also, try not to consume a lot of coffee, you know, have maybe a few coffees and your time limit of having caffeinated drinks is 2pm at the latest. Having exercise in the morning, that's how you prepare your body that you know you're going to function throughout the day, and then you're going to fall asleep at nighttime. So again, it plays a key role in getting a proper sleep hygiene. Depending what do you do in early morning hours, and within a few hours, you know, you have a sunshine exposure, you exercise, you have your breakfast, you have coffee, and then you perform and do your daily routine and tasks, you know, and then from let's say, 6pm, you dim all the lights in the house, you know, you don't need an artificial light to stimulate your brain further. And that's how you prepare your whole body for a good night's sleep. And you know, it really it has got to an enormous positive effect on your just general well being. And it's something that everyone should pursue some application of cold therapies in the morning cold showers again, that can prepare your body to function throughout the day. Warm applications like sauna, hot bath, again, that prepares your body temperature regulation also plays a role for good quality of sleep. So when we fall asleep, our body temperature drops, and the environment that we have we fall asleep needs to be a cooler. So some people use the cooling mattress to just to drop the temperature down because the natural process of our bodies is to drop the temperature then we fall into the four stages of the sleeping phases. So to get ready into that your body needs to work hard and how to help that you know, so it may feel awkward and odd saying oh sauna and hot bath, it's warm application to your body. But actually, your body starts cooling process once you once the application of the heat is on your body surface or skin surface. So by cooling system that exacerbates and increases the capacity to have a better sleeping quality by applying the heat, if that makes sense. So your body cooling system switches on. And that's how you, you prepare your body to fall asleep and have a good quality of sleep at nighttime.
Nick:
That's really good information isn't it to help everyone have that better night's sleep. In terms of learning new things and keeping the mind active. What happens as a result of that?
Dr Agne:
Well, there are so many different strategies how to keep your mind active. Starting with the obviously a good daily routine, you know, having good night's sleep, diet, exercises. And, you know, if you do the various different mind exercise, there are plenty of apps around you know, to keep your brain active to learn new things to nourish your brain function, you have always given exercise brain as our body becomes very lazy if we're not very careful. I always say use it or lose it. It's something that you need to incorporate in your normal daily practice and it always gonna give you a better cognitive performance. It's going to it's going to improve your quality of life, you will be up to date with everything you need to do without maybe documenting too much. Although it's a normal practice living with MS to keep the diary of the symptoms of the events or tasks that you need to do. We all do. It's okay. But the more you practice the more you use your brain the more you occupy with maybe learning new language maybe learning new things, maybe learning how to play the guitar if your hand function is still good, you know anything like that will give you better cognitive function better performance, physical symptoms improve and fatigue reduces and the overall quality of life is much much better if you choose the right exercises to keep your brain active.
Nick:
Definitely and, and link to kind of keeping your mind active and learning new things. mindfulness and meditation are very, very widely used, not just in the MS community, but I was wondering is, are there any links to your cognitive ability to your cognition to your brain function, and your brain health from mindfulness and meditation?
Dr Agne:
Well, mindfulness is something that is very close to my heart. I am mindfulness now teacher, I do help people to learn how to meditate. And that's, that's part of the healthy lifestyle clinic programme. I strongly believe in this method, I think it has a wide range of the positive impact on the physical and mental health for of people with multiple sclerosis. Leading to wide range of the symptom management such as fatigue, pain, cognitive impairment, and so many different meditation practices that are around there are formal and formal meditation practices, Tai Chi and yoga, they are movement, mindfulness activities, you know, so it has got a very helpful effect in managing symptoms such as reducing stress to start with, it's powerful, powerful, too, I can't strike the how powerful this tool is to manage the depression and in particular, the relapses of depression, you know, people get overcome the depression, and then they sort of relapse, they get go back into their, where they were before. So mindfulness helps to prevent that effect. And, you know, quite often, stress is, is the element that people live with, we all are exposed by the stress and it's our normal living, you know, it's the matter of how we deal with stress, what are coping strategies in place, and mindfulness plays the role in building that resilience and having that coping strategy, it's very common trigger for MS symptoms and mindfulness actually helps to, to overcome the stress level can be reduced if you practice the mindfulness daily to start with for eight weeks non stop, that's how your brain structure changes your limbic organ, which is an emotional brain shrinks over the time and it improves also, the prefrontal cortex function which is our executive function, which our rational brain to say, Okay, calm down, you don't need to worry about you know, where it limbic is like our primary brain it just flares up and we go into this sort of dwelling function that we sort of start producing more thoughts more thinking, emotions then kicks in and feelings kicks in as a consequence of the it's like a catch 22. It's a circle that you can control if you train your brain is like going to the gym, you train your brain, by implementing mindfulness practices and overall it improves the mental health you know, all the you know symptoms that are contributing to mental health flips such as depression anxiety to improve so, if you are practising then meditation and mindfulness, it enhance the cognitive function. cognitive impairment is very common symptom in multiple sclerosis and is seen 50% when people present with a first clinical attack of MS we call this clinically isolated syndrome people already have some cognitive impairment and if you look at the children and some studies that suggest that people with MS historically when they developed MS they already struggled in the past being children and performing at school you know, so there was some element of the cognitive impairment then but you can enhance that function if you meditate.. it's obviously increase your quality of life imagine if you have less stress or less responding to stress because you have a very decent coping strategies if your depression and anxiety is lessened, automatically leads to good quality of life and it's an amazing tool and actually as part of the be well with MS podcast I, I do meditation practices and I pre recorded some of the guided meditation for various different clinical situations for example, quite often very popular one is before starting disease modifying therapies how stressful this this journey is, you know, to start injectable to start infusions go to the infusion units and start these biologic agents that you have no idea what the side effects is going to bring, you know, causes a lot of extra anxiety and I actually help people to prepare for these, you know, injections or infusions and, you know, if you're becoming pregnant or you are pregnant, you know, you're also have a lot of worries and you're like how is going to be like what you what Mother you're going to be living with MS and cetera, et cetera. So, again, pre recorded meditations are very helpful to get your mind..it's a science based tool to improve the quality of life and there are so many other you know methods such as cognitive behaviour therapy is a form of therapy that helps people identify and change unhelpful patterns of thinking and behaviour it has been found to be very effective in reducing the symptoms of depression and anxiety in people with MS. Exercise has been found to be very very effective to like reducing depression anxiety you know in MS. So, social support maintaining social connection seeking support you know from other can be very very helpful in managing your emotions challenges living with MS you know, sharing caring sharing is caring, you know, joining some support groups engaging online in the communities with MS trust you know, you do guys amazing job you know, connecting, helping, providing, you know, setting the challenges and campaigns you know, how to be the best version, you know, living with this very debilitating catastrophic condition you know, if you think from another angle is really harmful condition you know, and, and you really need to find ways to, to really look after yourself to find the relaxation techniques, you know, that you know, relaxes your muscles and some deep breathing exercises. Guided imaginary can help to reduce stress and promote more relaxation, some cognitive rehabilitation exercises that you can achieve via neuro rehab services where you focus more on improving cognition, neuropsychologist we work on the memory attention deficits, you know, and sleep hygiene. It's enormous how, how it affects us in a positive way and impactful way on our mental health and, and maybe consider some cold therapies such as cold water immersion and exposure to cold and whether you know, and it improves the immune system, according to the emerging evidence reduces inflammation and increases the production of the brain derived neurotrophic factor. So if you sit in a sauna for 15/20 minutes, you have a 20% higher level of the neurotropic factor, which is our anti ageing factor. It's really something to consider you know, using all these applications and probably a lot of people are talking about the Wim Hof Method, which is a combined cold exposure, breathing exercise and meditation at the same time. It has been found to have a number of potential health benefits including improving the immune system, reducing inflammation, improving the mental health and there is no direct evidence to suggest that the Wim Hof Method is specifically helpful for people with MS. But you know, our bodies, we are human beings, doesn't matter whether you have MS or not, you know, we still should pursue for the same therapies that has got some emerging evidence that is going to help you and again, you know, being mindful and exploring things you know, some you know, there are some side effects like going to the sauna for example if you're pregnant is not recommended. You know, if you have a cardiovascular disease you know, high blood pressure issues, low blood pressure issues, going to the sauna can affect that cardiovascular condition you know, you may feel even worse respiratory conditions like you know, having asthma, bronchitis, emphysema, high temperature humidity in the sauna can cause a lot of discomfort and can be dangerous you know, if you have infection fever, again you know, you need to take time to recover from the infection, don't overdo things to yourself that might be you know, harmful because it may prolong the healing process, when you have infection if you apply yourself with a heat and cold probably is going to worsen your recovery rate. And be careful with a dehydration you know, any exercise you do, any diet that you follow, and so on are called applications make sure that you are well hydrated you drink a lot of a lot of water throughout the day.. still water is preferable, bubbles of water causes a bit of indigestion so just be mindful and care for your body. And mind and body and mind has got good connection. So that's something to pursue, to feel better. Be yourself better. And when you are better. You will notice that your whole environment, your friends, your family, they start feeling better because you are setting that vibe, you know setting that sort of a whole theme and emotion you know, around you it's something that is having a almost a chain reaction, you know, and then you sort of start getting more positivity from your surroundings and environment and friends and family and they start sharing on the only positive vibes too. So it's reciprocal sharing type attitude that is always going to nourish your body and mind.
Nick:
Wow, amazing such good information, such rich information. Thank you so much. I feel like we've covered lots of different topics today. If there was just one or two things that you could say to someone with MS to maybe help with their brain health to take away from today. What would you recommend?
Dr Agne:
Well, we covered a lot of things today and I cannot strike the importance of exerciseing regularly has been shown numerous benefits for people with MS. You know, physical mood, cognitive function improves, promote the neuroplasticity and brain ability adapts to reorganise itself to respond to the new experiences, new challenges, new stresses, reduces inflammation, improves the immune system, you know, and mindfulness. Mindfulness is something to go for and is a practice that involves your attention in the present moment without judging without judgmental type attitude and a lot of emerging evidence to suggest that it improves your mood, your stress and anxiety, cognitive function for people living with MS. So these are two things.
Nick:
Thank you so much. Again, amazing information. And I'm sure lots of people have taken so much from the interview today. So thank you so much. I was just wondering, you've mentioned a few times your podcast if people wanted to find you online, where are the best places?
Dr Agne
Well, Bee Well With MS is placed on the multiple well known podcast platforms. So just use the platform that you normally use for listening to the podcast. Mainly, it's the most popular place that people find me is on the Spreaker platform, or Spotify. So yes, please tune in and listen to the Bee Well with MS…the uniqueness to this podcast is that I interview my peers and colleagues and patients and I share science and science based tools with a wide audience as well as you can find some pre recorded guided meditation tracks for any events and clinical situations in your life. And please do share your comments with me and share your ideas, anything that you would like me to record for my Bee Well with MS podcast. And I read every single comment, so please don't hesitate, just let me know. And I will make sure that I follow your comments and criticism and recommendations. So just tune in and listen to the Bee Well with MS. Thanks for having me today, Nick. And it was a great pleasure talking to you. And I hope that your audience will be happy to listen to all these evidence based and less evidence based approaches that every other person would follow. And I'm sure that listeners to your podcast, people who are very active patients generally new in this life, and they will take some bits and pieces into account to pursue for better living and better quality of the brain health. If you follow all these recommendations that I just told you today, you will be spot on…believe it or not your symptoms will be milder, milder, your MS will be behaving a bit better. And you will feel better yourself. I promise you. Thanks for listening.
Nick:
Thank you so much. Yeah, can't wait to listen to your next podcast
Dr Agne:
Bye Nick
Helena:
Now, if this was commercial podcast, here's where there would be an advert. But as we're charity, we don't do that. So instead, we'd like to take the opportunity to tell you all about our fantastic resources for people with MS.
Nick:
Yeah, and you can find lots on our website. That's MStrust.org.uk. There's so many different resources and pieces of information on there for anyone who's affected by MS. So do you head to our website and hit that MS information support tab and in there there's a section dedicated to wellbeing and health.
Helena:
And also if you look in our big A-Z of MS, you can find it on MStrust.org.uk/A-Z you can read a lot about the topics that Agne and Nick spoke about so like brain health, sleep and exercise. Well I'm sure all the other bits as well. So check that out as well.
Nick:
And we are back. How's it going? Helena?
Helena:
What did you make lots of notes through that, gosh, it was a lot of information. Agne is so great and so enthusiastic about all these things. And I bet it will be very interesting to have her as your neurologist, really impressed by the fact that she sort of her MS patients seems to be doing a little bit better than average, compared to other patients out there. That's obviously something to give her sort of big plus points for working on your brain health.
Nick:
Yeah, maybe that's definitely something that we can all take away from this, isn't it? It's that there's this, there's places to start, and there's those small steps that you can start to do. Whether you know, it's exercise or finding something that works for you, we can all make those steps early on.
Helena:
Yeah, I saw what she's talked about with the different supplements was really interesting, because that's something that I don't really know that much about. And I know that some people are feeling very, very, very passionate about, oh, you should take this or you should take that. So it was quite interesting to sort of hear the research that's been done into things and what's out there and what works and what doesn't work, really, I think the info and inquiry line quite often suggest to people when they're thinking about starting anything like this, to maybe in the same way, as we often talk about doing a symptom diary, and maybe you can almost do a little experiment diaries. For instance, if you wanted to start taking, I don't know, lion's mane or vitamin D, start by doing it, and then just sort of writing down how you're feeling and how it's going. And then say, maybe after a month, do a stocktake. And sort of has it made any difference, what's going on and, and almost, like, get it so your own little clinical trial on yourself. Because the main problems with a lot of supplements is maybe not that they would be dangerous for you, but they are actually very expensive. And if they're not doing much, then you might just be spending a lot of money on nothing. So I think it's good to sort of actually see if it makes any difference for you, just because it works for some person might not work for you. So, but I've certainly thought Agne gave a lot of interesting points about it.
Nick:
Yeah, definitely. And I think that's one thing we often say, Isn't it on our social media channels and inquiry services? People potentially saying they've got some kind of miracle cure miracle supplement to take, it was actually it was good to just hear about the research that was out there. And actually, that is such an individual process, isn't it for each person. So along with all of the wealth of knowledge that Agne talked about, you know, there's take that away as well as is, yeah, maybe try things that might work for you. And, and keep going and try out different approaches.
Helena:
Yeah. And I guess it goes with the same with like exercise or sleep or anything really kind of try different things and see what works and then note it down. And, and see, I do feel like you more I talk about it, like actually keeping a bit of a diary to see how things are going and trying different things. I certainly know. I've talked a lot about exercise on the podcast, because I feel like that really helps with my fatigue. But yesterday, I was trying to do a bit of cardio when I was feeling really tired. And my fatigue just got so bad afterwards. So I'm sort of thinking, well, actually, that type of cardio that I was trying yesterday, I probably wont try that again, when I'm having a bad day. So you know, you kind of live and learn with these things, don't you?
Nick:
Yeah, no, I wonder about this. And you were saying that was like I don't know, just like if you were taking, like diary entries about things that you are doing, as well, where you could look back on, you know, on your journey. If you're anything like me, and you think of you know, there's exercise, there's mindfulness, there's diet, but actually, if you do just change some of those things, actually documenting them, and then maybe in a few months, just looking back and thinking, Oh, actually, you know, on some days, I've been able to, exercise for this amount of time. On some days, I've been able to have this particular diet and actually just seeing that bit of sort of progress, I guess. Yeah, as you say, you know, if you're having difficult experiences, difficult days, then it might not be the best time to go back through that and look through that. But actually, if you know, if you wanted to start making that kind of changes to your lifestyle, you know, having that positive journey document is quite nice, isn't it?
Helena:
Yeah. And I guess, that could be sort of on paper. I do my stuff on Instagram quite often because then I could just kind of scroll back through posts and go oh, yeah, that was that was good day or that was a bad day
Nick:
Ive seen you on there.
Helena:
Looking red faced and exhausted most of the time. Yeah, I have no shame. I have, I think, you know, we've discussed and heard some lots of different things. So maybe we could do just do like a quick summary of things that can sort of help you with a brain healthy lifestyle. These are mostly the things that Agne discussed. But I think there's a few things that we also put up on our website. So the first thing which was also I think the first thing that Agne said was keeping as fit and active as you can through regular exercise, and maintaining a healthy weight and eat a healthy diet and make sure you get all the vitamins you need. Make sure you get a good night's sleep. That's a tricky one for most of us. And keeping your mind active through reading, learning new skills, things like puzzles and Sudoku and crosswords, and there are loads of apps and things. Try out mindfulness. We had a great video during MS Awareness Week, that's up on our YouTube channel that you could try with a chap called Justin, which is great for mindfulness is a big one, avoid smoking, we're gonna do a podcast on this in the future. It's a bit of a tricky topic if you are doing it. But it's one of those things that just comes back time and time again on how much it can affect MS and MS progression. Limit how much alcohol you drink. And also another things that are quite important is that you continue to take medications that your doctor has prescribed. So not kind of thinking that I'm going to do this instead of it because you still need to talk to your health, health professionals with what you're doing when it comes to medication. And making sure other conditions such as diabetes or heart disease are well controlled because they also impact these things, but like I said, smoking is going to be a topic for a future podcast as well as sleep, I believe. So we can learn some more then can't we Nick? But you know what, looking at that listing, it can feel quite daunting, because I think it's important to feel that you're not pressured to do all at once or ever feel pressured or bad about how your life is currently. Because you might think oh my goodness, me, I'm not doing any exercise. I'm mostly eating takeaways, I don't sleep, I smoke, you know, it's, you know that shaming people into things, it's not a great way to get you started. So I would say like, maybe try and pick one thing that you would like to change. I know, for instance, my sleep is really bad. And I am really bad with things like mindfulness, my mind goes all the time, I do too much things, like just crash and burn. So I really know. And my MS nurse has said it to me as well, you should really try mindfulness. So I think I'm going to adapt that idea of doing a little bit of journaling over that, I think, maybe next month. I'm thinking of trying to do a bit of mindfulness every day and see if that has an effect that maybe as a bright byproduct, I'll get better sleep. But if not, then maybe that will be the next thing to work on. And if you have got any strategies when it comes to brain health, we would love to hear from you.
Nick:
Yeah. And speaking of hearing from you, if you have any other questions about MS. Be they about brain health or any other aspects of life of MS. We are always here for you. So our inquiry service is available from Monday to Friday except to UK bank holidays. And that's from 9am to 5pm. Outside of those hours you can of course leave us a message and we'll get back to you as soon as we can. The number is 08000323839
Helena:
And you can also find us on Facebook, YouTube, Twitter and Instagram.
