Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs From our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And joining me today is Dr. Jai S. Perumal. She's an Associate Professor of Clinical Neurology in the Department of Neurology and Neuroscience at Weill Cornell Medicine and an Attending Neurologist at New York-Presbyterian Hospital Weill Cornell Medicine. And she's here to tell us about the benefits of diet, nutrition, and supplements to help manage MS symptoms.

Dr. Perumal, thank you so much for joining us today. I'd like you to speak about what role diet and nutrition even play in managing symptoms and promoting overall wellbeing for patients with MS.

Dr. Jai S. Perumal: Thank you for having me, Melanie. So, diet and lifestyle play a huge role in anybody's, sense of well-being and quality of life. The factor that has greatest data in terms of relevance to MS or any autoimmune disease is vitamin D. Vitamin D, one of the metabolites, has an immune-modulating role. So, it controls the immune system from misbehaving, so to speak. Often, almost everybody's vitamin D level is low. The primary source is sunlight, but we now get it from fortified food.

So, there is data that says that patients who have a low vitamin D have a higher risk of being diagnosed with MS or, in patients who have MS, a higher risk for disability or having a relapse. And the range for vitamin D varies very widely. Usually, it goes from about 30 to 80. So, patients with MS, not only should they be just normal, I would like them to be a high normal. So, usually we do check a vitamin D level on a regular basis. But nowadays, primary doctors are also doing this. So, make sure you're supplementing to get that vitamin D level to a high normal so that you get the benefits of the immune-modulating effect of vitamin D.

With regard to your general diet, patients often tell us they may notice a particular reaction with a particular kind of diet. I've had patients tell me, "Doc, when I ate this particular kind of food or I did this, I noticed that my MS symptoms were worse." As of now, we cannot make a general recommendation as to specific ingredients, but there are patients who mentioned, So many different things and I think everybody's MS is so different. So if you notice that, you know, a particular kind of diet, whether it's some kind of meat or dairy or food product or kind of food is not going well, then that may be triggering inflammation in your body, and you should avoid it. But as a provider, it's hard for us to generalize that to all patients, because the triggers are so different in each individual. So, generally, what we recommend is a healthy diet, more of a Mediterranean kind of diet, more vegetables, less fat. So, that's what we generally recommend to patients. But if an individual patient notices a particular reaction to a certain ingredient or a type of food, then it makes sense to avoid that. But generally, we recommend a overall healthy diet that would apply to any of us.

Regular exercise. Now, when we talk about diet or lifestyle, regular exercise is also important. First of all, when a patient has MS, you don't want to now have another problem to deal with, whether it's diabetes or high blood pressure or high cholesterol or something else. You don't want another trigger to insult the body or injure the body any other way. Plus, especially patients with MS, if they have spasticity or weakness, if you don't engage in some kind of physical activity, spasticity can get worse. Spasms can get worse. The muscles can tend to atrophy. So, I always advise my patients to maintain some level of physical activity. You know, it doesn't have to be strenuous. It doesn't have to be this or that, but just keep doing something. Keep doing something the best you can on a regular basis, because it makes a big difference.

One of the studies that looked at regular exercise, they had two groups. One group was randomized to get this kind of regular physical therapy, another group didn't. And when they looked at the outcome a few months later, it's not that surprising that the patients who had the physical therapy did well in their physical examination or the physical aspects of their disease. But what was surprising is that the impact on cognition was even greater than the impact on the physical status.

So, even regular exercising has an impact on cognition. You know, there is something called green theory. I tell my patients, if they can go out, walk outside, it's not just good for their physical well-being, but for their cognition and for their mental health. So, I cannot emphasize enough how much this kind of lifestyle makes a difference. Because often when a patient comes in, we are so involved in talking about their immune treatments, looking at their MRIs that we don't have time or we don't bring this up, but this plays such an important role in their quality of life and we must make an effort to bring this up every time we see the patient.

Melanie Cole, MS: What great advice you just gave. And it makes so much sense, Dr. Perumal, that following a similar diet to people that don't live with MS is going to make the most sense. And if there are certain foods that are triggering or exacerbate inflammation, I mean, that's good advice for all of us.

Now, for someone living with MS and your exercise advice was spot on as an exercise physiologist, I've worked with so many patients and I see the benefits of just movement, not overheating, but movement, walking, getting involved in any kind of program that keeps them moving is so important. But what about supplements, Dr. Perumal? If they're not getting in their diet, whether they're not following Mediterranean or low-fat plant-based, if they found some foods that are triggering and high inflammation, do you recommend-- obviously, vitamin D we want those levels up-- but what about omega-3s or antioxidants or other supplements? Are there any that you recommend before we wrap up this podcast?

Dr. Jai S. Perumal: In terms of supplement, you know, many patients take vitamin B12. And even if they are normal, if they are low normal, I think supplementing B12 can help. Sometimes patients have mentioned that they feel they have more energy when they take that. And regarding other supplements, I do have some patients who take omega-3. It's not harmful, so it's okay to take it. But the reason we don't specifically advise patients to take certain supplements or not is because there is no data. That doesn't mean they're not helpful. It's just that we don't have solid data to go recommend they do it. Antioxidants, like Turmeric, things like that probably has an impact. But because of lack of data, we don't mention or, you know, advise patients to take these on a regular basis.

Melanie Cole, MS: This is really such an informative episode. As we wrap up, what advice would you offer patients with MS who are interested in incorporating these dietary and nutritional strategies you've discussed here today? In their overall management plan, do you feel that they should be working with a registered dietitian or nutritionist? Give us your best advice here, Dr. Perumal. You are such an expert and what a great guest.

Dr. Jai S. Perumal: Thank you, Melanie. Yes, lifestyle makes a big impact on patients with MS. Patients and providers too are often very much fixated on what immune treatment we are going to do, what the patient's MRI looks like, that we don't set aside time to discuss this with patients. Even having that conversation makes a big difference. Nowadays, I've started making a very conscious effort to discuss this with my patients at every visit. Talk about physical activity, talk about diet, and many of them have come back and said, "You know what, doc? I started doing this." A few steps a day, walk, it doesn't matter, just keep moving. It makes such a big difference.

Now, folks who want to talk to a nutritionist or who don't have an idea of what they should be doing, we do recommend that they see a nutritionist so that they can have a diet plan. You know, there is more and more data looking at probably bacteria in our gut plays a big role in triggering inflammation. The healthier food we eat and the normal bacteria that grow, that is what we need to maintain. When this kind of pathogenic bacteria take over, then they may release all these toxins that are triggering inflammation. So, your overall health makes a big difference in how you will be with regard to dealing with them. So, take care of your body while also doing your immune treatment to control the inflammation. Healthy lifestyle makes a huge impact.

Melanie Cole, MS: Well, it certainly all goes together for that overall health. Doctor, thank you so much again for joining us. And Weill Cornell Medicine continues to see our patients in person, as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to Health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcasts, Spotify, iHeart, and Pandora. For more health tips, please visit weillcornell.Org and search podcasts. And parents, don't forget to check out our kids healthcasts. So many great podcasts there. I'm Melanie Cole. Thanks so much for tuning in today..

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