Barts-MS rose-tinted-odometer: ★★
How brain-healthy is your lifestyle?
Someone asked yesterday why did I give George Jelinek’s book ‘Overcoming MS’ a positive review and yet we don’t promote it openly 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? I am still pissed off with myself for not making it clear that I don’t support the OMS diet. Yes, I support the principles of OMS in terms of lifestyle interventions, but I simply can’t support the OMS diet. The diet is simply not evidence-based. In fact, there is no ‘MS diet’ that is evidence-based so anyone who claims their diet needs to be followed to treat MS can’t be doing this from any position of authority.
So why did I give OMS a positive review?
The principles that underpin OMS are scientifically sound, but a lot of them are not evidence-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 aspects 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 the 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 are very poor. This is a conundrum that challenges HCPs and behavioural psychologists but is not an insurmountable obstacle. There are examples that when politicians, HCPs and the general public get behind a national lifestyle and wellness programme it can work. A good example of this is what Finland has done at a population level over the last 20 years.
- Lifestyle-wellness interventions should be adopted by everyone regardless of whether, or not, you have MS. This is why we set up the Barts-MS Brain Health challenge and why I started the Think Brain Health initiative. 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 the advice seriously from a Brain Healthy HCP than from an HCP who is unhealthy. If you smoke, are unfit, overweight and eat badly how can you tell your patients to stop smoking, to start exercising, change their diet and lose weight? Unless you walk the talk you are not credible.
- 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? Plant-based diet? Etc? 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 and ultra-processed foods are in the dog house and justifiably so. I am adamant that what you eat needs to be compatible with your culture which is why I wrote a piece on Medium about Diet as a Philosophy.
- Please let common sense rule the day and if you find you like, and enjoy, walking or running 1 km or 5 km, who knows you may gradually extend your walks and runs to 10 km, 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.
So I yes I have gone lukewarm on OMS because it is not the be-all and end-all of MS management. I have also heard from many independent sources that George Jelinek promotes it openly as an alternative option for the management of MS. I have seen many tragic examples of patients under my care who are now very disabled as a result of using lifestyle and wellness programmes as an alternative option to DMTs to manage their MS. OMS should only ever be used as a complementary MS management tool.
Disclaimer: Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the position of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust.