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Dr. Obeidat:
Hello, this is CME on ReachMD. I'm Dr. Ahmed Obeidat. Joining me today is Dr. Mark Freedman.
Mark, how can we preserve brain health in multiple sclerosis? A big question.
Dr. Freedman:
Yes, it is. But what it really points to is the patient is more than just the disease that's attacking the brain. There’s this overall concept of brain health, and it's something that is very vital to just the benefit of treatment in MS as a whole. I'm up in Canada, and one of my colleagues in Canada has really done a lot of work in this regard and she has published studies where we've looked at things such as comorbidities. And we knew that comorbidities, things like hypertension and respiratory disease and diabetes, all of these things may impact MS, but in fact, her studies have shown that it does impact MS. Not only does it make MS faster in terms of progression, there are more, even, relapses in these patients who have more comorbidities that are untreated.
But not only that, but the medicines that we're using are not as effective in these individuals. So if we look just at the MS, we're missing a lot about the patient, and there's a lot of other things we can do for them. So you have to address these comorbidities. It’s not something that our neurology field teaches us about, but their ability to get them to stop smoking and control their blood pressure and lose weight, because obesity is another factor that comes in there.
Many of these things need to be addressed. We need to partner with perhaps other colleagues, internists, and certainly the family practice physician who's going to be looking after them to address these. This is not incumbent on us as the neurologist to address all of that. But in general, all of that with MS is affecting brain health as a whole. And dealing with this holistically as best that we can with our colleagues is probably going to be able to reduce the morbidity and slow progression of the disease in these individuals.
Dr. Obeidat:
Yeah, excellent points. These are things that we can talk to patients about, we can educate, but that's also something that we educate the whole community, right, whether MS or not, about the importance of preserving brain health.
You touched on diet, and one of the things that people ask me in clinic all the time is what is the best diet for MS? And I always say, well, eating healthy. Whatever the best diet for your brain is the best diet for your heart in a way, right, for your overall health. So I don’t typically recommend a specific diet. I’m a little bit biased because I'm Mediterranean, Middle Eastern, so I actually tell them the Mediterranean diet is a good one because I like it. But any healthy diet is something that people can adopt. And of course, stopping smoking, limiting alcohol intake, and managing comorbidities, as you mentioned, is a very, very, very important thing.
If they come in clinic and a blood pressure is 180 over 100, right? That’s a problem. Like, oh, we need to take care of that. Right? And this is where we talk to the primary care colleagues in trying to optimize all these functions surrounding the brain because the brain is a very sensitive organ to how the environment of the body is. And I think these are great points that you’re bringing on exercise and even wellness. Just feeling well and not stressing much about the disease is another thing that I tell my patients do.
Dr. Freedman:
So mental health, depression, that sort of thing can play a role. So preserving brain health, this also brings into the concept of preserving reserve. And as we age and the disease goes on, you call upon your ability to have that reserve function in the brain.
And all these things early on, they eat away at your reserve, and you lose that capacity as you get older to be able to compensate. And so it's very important to stress to individuals it’s not about today, but what you’re doing today is preserving that for the future so that you can call upon that reserve and it'll be there for you 10, 20, 30 years down the road.
Dr. Obeidat:
Yeah. I agree. Kind of preserving the brain reserve. And I think this is a great concept. All of us should be thinking about it for our lives.
So this has been a great discussion. That’s all the time we have, but thank you to our listeners for tuning in and thank you so much, Dr. Freedman, for all the advice you gave us.
Dr. Freedman:
Thanks, Ahmed.
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