Exercise training 

•  Vibration training. Vibration training could be an effective alternative training to enhance cognition and quality of life in individuals with MS, according to a small randomized controlled study. 

• Exercise training has a positive influence on MS disease MS by improving the gut flora, according to this new study. I wrote more about the importance of the gut microbiota here and its changes associated with MS here.

• Aerobic exercise seems to have a positive effect -ie improve motor function when compared to conventional physiotherapy. The results are seen after six weeks of exercise, two-three times weekly,suggests this new review of multiple studies.

• Different massage approaches help relieve symptoms of MS. According to this review, fatigue may improve with reflexology,  therapeutic massage, and Swedish massage. Pain, anxiety, and depression can effectively be improved with reflexology, while spasticity may be reduced by Swedish massage and reflexology. 

• Aerobic exercise ( 3 days a week, 25-40 minutes/day at 50-70% of HRMax  for eight weeks, and vitamin D (50000 IU weekly) supplementation for 8 weeks-  help improve BDNF and NGF levels in individuals with MS, according to this new randomized placebo-controlled study. Even better results were seen in the group that combined exercise with vitamin D supplements. Note: BDNF and NGF levels are often impaired in MS, and improving these levels helps promote brain repair, regeneration and maintain proper function. Scientists are looking to target these molecules to treat MS, Alzheimer’s, depression, and other brain conditions. 

Diet and Supplements 

• A review of multiple studies looked at Cordycepin, a key active ingredient from the mushroom Cordyceps for its effects on the immune system and provide symptomatic relief in MS.

• Cannabis. This new study reviews the benefits of cannabis for MS, Alzheimer’s, Parkinson’s, amyotrophic lateral sclerosis, emesis, epilepsy, chronic pain, and cancer. 

• Sativex (cannabis-based prescription drug). A new Belgian study involving 276 participants with MS evaluated the benefits of Sativex to manage spasticity. The study found that more than 60% of the participants who started add-on treatment with Sativex reported a clinically relevant symptomatic effect and continued treatment after 12 weeks. I reviewed Sativex here. 

• Curcumin. This new study looked at the mechanism of action behind the anti-inflammatory, immunomodulating qualities of curcumin and its potential use for MS. Technical: curcumin downregulates NF-κB signaling pathway and its downstream gene targets including cyclooxygenase-2, TNF-α, IL-1, and IL-6. 

• High-dose biotin. Studies regarding the benefits of high-dose biotin for MS have shown mixed results in the last few years.  However, this new systematic review/meta-analysis that included 366 relevant papers and 3 randomized controlled trials involving 889 individuals diagnosed with MS concluded that high dose biotin is beneficial for those with PMS, it has a great safety profile (similar incidence of adverse events in the high dose biotin group compared with the placebo group. However, being aware of lab test interference. High dose biotin mechanism of action (technical): Biotin may activate the acetyl-CoA-, 3-methylcrotonyl-CoA-, propionyl-CoA-, and pyruvate carboxylases→  increased myelin repair and/or synthesis, and may enhance the production of ATP→ potential to prevent neurodegeneration.

• NAC (N-acetyl cysteine) improves cerebral blood flow and may also improve cognition and attention in individuals with MS, suggests this new clinical trial. 

• A second new study reviewed the benefits of NAC for many health concerns, including MS. More details about NAC here. 

  Dr.Wahls diet vs Dr.Swank diet for MS. This new randomized controlled study found that both diets were associated with clinically meaningful reduced fatigue and improvements in the quality of life. More details about Dr. Wahls’s protocol here.

Mindfulness meditation and Tai Chi

• Mindfulness meditation may help with various aspects of MS- including decreased stress levels, improving quality of life quality ( including physical function, social function, mental health, vitality, and general health), and also improving some various emotions like cognitive uncertainty; need to control thoughts and self-awareness, suggests this new study.

• Tai Chi and meditation may help improve balance, posture, fatigue, and disease impact associated with MS suggests this new study. 

Other therapies

• Hyperbaric oxygen therapy (HBOT)  significantly alleviated the progression of MS, suggests this new study conducted in animal models of MS. Note: there are clinical trials that assessed the benefits of HBOT, as well. There had been an increased interest in this therapy after studies done in the late 1980s. One research paper showed that 85% of the participants (40 in total) experienced remarkable improvement in symptoms.

• Rhythmic transcranial magnetic stimulation (rTMS). This new clinical study shows that the use of rTMS has a positive effect on fatigue, both motor and cognitive, in those with MS at all types of course and at different stages of progression.

• Pet therapy, especially dogs- can help improve mood, quality of life, and disease symptoms across multiple neurological disorders, including MS, suggests this new study. 

More news

• The impact of lockdown on individuals with chronic neurological conditions had been evaluated in this new study. The study concluded that lockdown causes posttraumatic stress and deterioration in the quality of life.

• Air pollution and MS. Air pollution has been associated with increased levels of inflammation and degeneration in the brain, possibly linked with the risk of developing MS or having relapses. This new study looked at possible effects of air pollutants like particulate matter (PM10, PM2.5, and ultrafine particles), gaseous pollutants (carbon monoxide, nitrogen oxides, sulfur dioxide, and ozone), and heavy metals, on MS development and relapse.

Vitamins, Herbs & Other  Natural Supplements 

• Milk thistle (silymarin) can help counteract live toxicity associated with MS drug fingolimod, according to this new clinical trial. Another new clinical trial found silymarin has immunomodulating and liver protective qualities in those with MS under treatment with  IFN-β.

• Correcting vitamin D deficiency may help improve numerous autoimmune diseases, including MS. Unfortunately, many people aren’t aware they have vitamin D deficiency. This new study found that 50% of the participants had  D deficiency and almost 25% had vitamin D insufficiency. 

• Cannabis-based drugs (Sativex),  was found to be overall well-tolerated and with a good safety profile, according to this new study that looked at real-world experience ( i.e. observational studies, case reports, etc)with this drug.

• The benefits of riboflavin or vitamin B2 for neurological conditions like MS, stroke, Friedreich’s ataxia, and Parkinson’s disease are reviewed in this new study. 

• CLA-Curcumin combination may help managed MS, particularly by  improving cognitive deficiency and oxidative stress, suggests this new study ( animal models of MS)

• Piperine from black pepper ameliorates brain inflammation, loss of myelin, and other markers associated with MS, according to this new study (animal models of MS). 

• Omega 3 -DHA helps reduce brain inflammation associated with MS  in this new study (an animal model of MS)

• Conjugated linoleic acid ( CLA) may ameliorate symptoms of MS, suggests this new study (animal models of MS). A past study-, a small human trial also showed that using dietary CLA for 6 months improved inflammation associated with MS. 

• The neuroprotective benefits of lactoferrin for MS, other neurological conditions, and managing neurocovid are explored in this new study. It has the ability to cross the blood-brain barrier and  chelate iron can make lactoferrin useful for conditions associated with disturbances of the metabolism of iron- like MS

Exercise, Whole Body Vibration and Acupressure 

• Aerobic training or resistance training – which one is the most effective to improve leg physical function and fatigue in people with MS? According to this new review of multiple studies, both forms of training are effective. 

• Pilates training for MS- which one is more effective-supervised Pilates or home training? In this new trial, the participants in both groups (supervised Pilates or at-home training Pilates) noted significant improvements, however, supervised Pilates training was determined to be more effective than home training in improving strength, postural control, core stability, physical capacity, and fatigue.

• Another new randomized trial found that home-based Pilates significantly improved anxiety, depression, and fatigue symptoms among people with MS. 

• Conditions like MS, Parkinson’s, and stroke can greatly improve with physical exercise, yet many people do not exercise. One of the main obstacles in successful rehabilitation is a person’s fear of movement, a condition called kinesiophobia. This new study found that over 66 % of the participants (who had been diagnosed with a stroke, Parkinson’s, or MS)  had kinesiophobia. 

• Acupressure significantly reduces stress and fatigue associated with MS, according to this new clinical trial. 

• The benefits of whole-body vibration for MS are reviewed in this new study.

Diet & Gut Microbiome 

• The ketogenic diet- a review of the many conditions that could improve with the keto diet. 

-Established applications: obesity, epilepsy, type 2 diabetes, polycystic ovary syndrome,

-Emerging therapeutic applications for cancer, non-alcoholic fatty liver disease, Parkinson’s disease, Alzheimer’s disease, MS, Spinal cord injuries and traumatic brain, 

– Speculative applications: autistic spectrum disorder, amyotrophic lateral sclerosis (ALS), cystic fibrosis, heart failure, COVID-19 (there are two clinical studies in progress as of now)

•  The impact of micronutrients on the immune system and MS. This new study reviewed some of the most promising supplements and their mechanism of action.  Supplementation with Vitamin D, vitamin A, Curcumin, Omega-3, and omega-6 fatty acids improve symptoms,  increase life expectancy and reduce the symptoms of MS, according to researchers.

• Progressive MS shows specific changes in the gut flora, and they also correlated with the clinical symptoms. Unlike other past studies, this new research paper suggests that increased Akkermansia bacteria in MS is not detrimental, but may actually be a compensatory beneficial response in gut flora. 

More News

• Non-drug options for cognitive improvements are reviewed in this new study– from psychotherapy and relaxation training to dietary changes (gluten-free, dairy-free), supplements ( ie vitamin D, selenium, Ginkgo biloba, coenzyme Q10), aerobic training, cryotherapy, and more 

• Mindfulness meditation effectively improves fatigue and sexual satisfaction, associated with MS, is the result of a systematic review of multiple studies.

• Could HIV get MS into complete remission? It was known that HIV infection is associated with decreased risk of MS. However, this new case study described a young woman with active RRMS   who went into the complete resolution of the  MS symptoms following HIV infection and treatment. Researchers believe that the immunosuppression caused by the disease (HIV) and antiviral therapy is likely responsible for these results.

• A  new systematic review and meta-analysis concluded that people with MS expend greater amounts of energy when walking compared to healthy controls. The oxygen cost of walking in people with MS was higher compared with  healthy controls and this increase in oxygen consumption was associated with fatigue 

COVID 19 & MS

This new Brazilian  study (11,560 people with MS) evaluated  the incidence, clinical outcome, and impact of COVID-19. The results:  the incidence of COVID-19 in  participants with MS was not different from those observed for the general population. The majority (87% ) were mild cases. Most of them were on  MS disease-modifying treatment and continued the treatment during the pandemic. 

Diet & Gut Microbiota 

• This new study from Australia assessed the benefits of a healthy diet in participants with MS. The conclusion:  A healthier diet score was associated with better mental, physical and total quality of life, and lower depression, and pain scores, and fewer cognition, vision and bowel symptoms. Higher reported fibre, fruit, vegetable and healthy fat scores were positively associated with most health outcomes. 

• Gut microbiome as a therapeutic target for MS. This study found that  supplementation with  the short fatty acid (SCFA) butyrate has a protective effect against CNS autoimmunity in animal models.  I wrote about gut microbiome and MS here. 

• Obesity, inflammation and autoimmunity. Previous studies found that obesity induces a chronic low‐grade inflammatory state. There is a correlation between obesity and higher prevalence, or worse prognosis, of several autoimmune diseases including: MS, rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel diseases, type‐1‐diabetes and  psoriasis. This new study further supports this idea, showing that  leptin promotes autoreactive T‐cell proliferation and proinflammatory cytokine secretion, while inhibits Treg‐cell proliferation. 

Herbs

• Cinnamon  helps improve inflammatory markers (IL-6 and hs-CRP ) and pain associated with MS, according to this new randomized controlled trial. Daily dose of cinnamon : 4 capsules daily (500 mgs true ceylon cinnamon per capsule) for 8 weeks. A quick  note: while cinnamon has strong anti-inflammatory effects, it is worth mentioning that the placebo group received the “dummy” pill that contained wheat flour. Wheat flour can be pro-inflammatory, and people with autoimmune diseases may have gluten/ other lectin sensitivities. 

• CBD and Medical cannabis. Nabiximols (Cannabis based drug Sativex) improves spasticity and related balance issues and walking – both short and long terms, according to this new study. Furthermore, nabiximols  were well tolerated, with a good safety profile.  This new study is a  review of the benefits of CBD oil for MS. Note: although there is limited research available in humans, worth mentioning some of the CBD effects as  PPAR gamma and serotonin agonists (I wrote about the benefits of PPAR gamma and serotonin HERE and HERE).  The benefits of medical cannabis ( low dose) forMS are reviewed in this study. It was safe and well tolerated;  resulted in a reduction in pain intensity, spasticity and sleep disturbances, with no impairment in ambulation, dexterity or processing speed. Conclusion: medical cannabis can be used as an alternative to treat spasticity and pain in MS.

• Green tea. This new  randomized study suggests that key active ingredients in green tea- may help reduce heart complications in those with MS. Daily dose: 800 mg of EGCG for four months. 

• Black seed. The benefits of thymoquinone, a key active ingredient in black seed (Nigella sativa) forMS and other autoimmune diseases are reviewed in this new study. 

• A new review coving the many benefits of andrographolide, including anti-inflammatory, antioxidant, improvement in  glucose metabolism. Andrographolide The main active ingredient from  Andrographis paniculata, which was tested in previous studies for MS. 

• Flavonoids fight neurodegeneration. This new study is an in depth review of the many benefits of flavonoids (plant compounds found in fruits and medicinal herbs). In addition to protecting the brain against free radicals, flavonoids show anticancer, antioxidant, anti-inflammatory, antiviral, antidiabetic, cardioprotective, anti-aging, and antibacterial activities. These compounds cross easily BBB and reach the brain. Key flavonoids for brain health: quercetin, kaempferol, catechins, rutin, fisetin, baicalein,  luteolin and myricetin. This is the summary for MS   

  https://www.sciencedirect.com/science/article/pii/S075333222100038X

• The herbal extract of Melilotus Officinalis may ameliorate MS severity, suggests this new study (animal model of MS). 

• Resveratrol (in nanoparticle form for enhanced bioavailability and solubility ) may offer neuroprotection, suggests this new study. (animal model of MS) 

More News 

• Vitamin D deficiency and depression are commonly associated with MS. This study shows that the lower is the  serum vitamin D  levels the higher scores for  depression and disability. 

• This new Ducth study suggests  that MS relapses may follow seasonal patterns: relapse rates were significantly lower in the summer vacation month (when there is increased exposure to sunlight and less exposure to infections). EDSS (disability) scores slightly higher in the autumn and lower in the spring. 

• Outdoor air pollution, especially PM (particulate matter ) and nitrogen oxides may be related to the prevalence of relapse of MS, according to this systematic review of multiple studies. 

• Using molecular hydrogen to combat fatigue  related to oxidative stress- is the topic of this new article. Note: other compounds that may help this type of fatigue (seen in MS and other degenerative/age related conditions) include curcumin and N‐acetylcysteine. 

Exercise, Yoga, Electric Stimulation & More 

• Strength training  exercises improve balance variables, functional ability, strength, and quality of life in people with MS, according to this new review of multiple studies. 

• Blood flow restriction (BFR) training ( in which an inflatable cuff partially occludes blood flow around the proximal portion of a limb)  coupled with low-intensity resistance training (LIRT) seems to have similar benefits when compared with   traditional exercises, according to this new case study. BFR is a great way to gain strength without getting fatigued.  More details about BFR, with videos here. 

• Electrical stimulation of the peroneal nerve using the ActiGait® shows improvement in drop foot (due to MS or stroke), according to this new study.

• Cognitive rehabilitation groups show significant improvement in balance skills, according to this new study.  

• Yoga and group psychotherapy based on acceptance and commitment help reduce fatigue and increase the quality of life of people with MS, according to this new study.

Diet, Nutrients,Probiotics -MS News

• A new study (randomized controlled) evaluated the benefits of Mediterranean diet for fatigue and cognitive issues associated with MS. Researchers found higher protective effects of the Mediterranean-like diet against MS-related fatigue than the standard healthy diet. No significant improvement was observed in the cognitive status of following this diet. 

• Optimizing vitamin  D levels is considered a potent strategy for MS prevention. According to this study  from Pakistan,  36.44% had mild or moderate deficiency of vitamin D . In utero and early-life exposure could also be important, but there is strong evidence that levels of vitamin D during the end of adolescence and beginning of adulthood have a major effect in determining the risk of MS.

• Vitamin E. Short-term  therapy (2 weeks)  with vitamin E (alpha tocopherol) showed improvement in motor dysfunction and reduction of demyelination in the animal model of MS, according to this new study (animal models of MS.

• CoQ10  may help increase remyelination and helps manage inflammation, suggests this new study (animal models of MS). 

• “Probiotics  in Autoimmune and Inflammatory Diseases”- this new book offers a review of the benefits of probiotics for MS and other autoimmune and inflammatory conditions. 

Herbs/herbal compounds -MS News

• This new review/ study Convolvulus prostratus-1 evaluated the herb Convolvulus prostratus  aka Sankhpuspi in Ayurveda, and its many benefits for brain health (ie anti-Alzheimer, neuroprotection, cognitive function , anti-stress, anti-depressant, anti-anxiety, anti seizure, alcohol; addition, brain tonic) 

• Moringa. This review  study summarizes the  many benefits of moringa based on research studies. Moringa may benefit 80 diseases, including MS and other autoimmune conditions: rheumatoid arthritis, hyperthyroidism, ulcerative colitis, atopic eczema. Besides autoimmune conditions, morning can be also useful  for diseases associated with oxidative stress/chronic inflammation, altered sugar metabolism, tumors and organ injuries. 

• Oleanolic acid (a natural compound) ameliorates the gut dysfunction (intestinal permeability, inflammation, oxidative stress) found in MS, according to this new study (animal models of MS). Note: the main natural sources of oleanolic acid include: apples, pomegranates, mandarins, lemons, pears,persimmon, grapes, bilberries, jujube, olives. 

• Naringenin attenuates  MS (animal models of MS) by protecting the blood brain barrier and controlling inflammation, suggests this new study. Note: great sources of naringenin include: grapefruit, pummelo hybrid, oranges,  rosemary, oregano,  tomatoes.

• Ellagic acid also may help ameliorate MS, according to this new study (animal model of MS). Good natural sources of ellagic acid are berries, cherries and walnuts. 

Exercise- MS News

• Exercise can be an adjunct therapy for reducing MS severity and progression. Exercise mitigates the MS, not only by reducing symptoms but also by harnessing a neuroprotective  effect, which attenuates the neurodegeneration. Based on a new review of multiple studies,  exercise has a surplus of benefits for those with MS. Overall the most consistent findings have been improvements in gait (with significant effects on motor function), fatigue, cognition and cardiopulmonary function. Studies also found improvements in mood (depression) and cognition,  cholesterol levels and immune health.. Both aerobic and anaerobic exercises are beneficial. Technical: Aerobic activity improves the immune system as evidenced by evaluation of T-cell  (increases CD39 cells and decreases CD31 cells). Anaerobic workouts improve energy metabolism by increasing fatty acid oxidation.  

• Pilates significantly improves the severity of fatigue,  physical disability, balance  and a marker of inflammation  in females with MS, according to this new clinical study. This was a 8 week program, 3 times a week , 40-60 mins each Pilates session. 

• High intensity interval training  (HIIT) seems to protects the brain against autoimmune neuroinflammation (technical: by reducing microglial derived ROS formation, neurotoxicity and pro-inflammatory responses involved in propagation of autoimmune neuroinflammation), suggests this new study (animal model of MS). HIIT_neuroinflammation

Psychological heath- MS News

• Emotional well being matters. This new study  M/E HEALTH_MS showed that irrational beliefs and dysfunctional attitudes have a direct negative effect in individuals with MS , while  spiritual health has a direct positive effect on psychological well-being in patients with MS. Thus,  psychological well-being  can be increased by  educational interventions based on irrational beliefs, dysfunctional attitudes and spiritual health.  

• Group behavioral activation therapy should be used as a complementary therapy along with other treatment methods to improve the psychological status of those with MS, according to this new study. The goal of this study was to find if this  form of therapy depression and identity crisis, and the results showed  significant improvements in both depression and identity crisis.

• The importance of resilience for those living with MS. This new study looked at resilience factors that allow an individual with MS to remain physically active after falling. Protective (personal ) factors personal factors included Locus of Control, Perseverance, Positive Attitude and Optimism, and Flexibility. Resilience processes included Utilizing Support, Problem Based Coping, and Perspective Taking. Finally, the theme of Looking Beyond Oneself was identified as a benefit.

  

More MS News

• Therapies for drop foot. Drop foot is a sign of neuromuscular damage caused by the weakness of the muscles and can be seen in MS and other neurological conditions. This new study (systematic review that included 24 studies) found that two forms of therapy:  robot-based ankle-foot orthosis (RAFO) and Functional Electrical Stimulation (FES) showed considerable improvement in the gait cycle of the participants of the studies.

• Electric stimulation in the form of percutaneous posterior tibial nerve stimulation (PTNS) could help manage  bowel dysfunctions like fecal incontinence and functional constipation, according to this new clinical study. Seven participants (out of 60) of this study actually remained free of symptoms(constipation). 

• Lipid profile ( triglycerides, LDL and cholesterol) correlates with cognitive function, according to this new study conducted in 20 individuals with MS. 

• ECS (endocannabinoid system). Targeting ECS to manage neurological conditions like MS, Parkinson’s and Alzheimer’s disease, is the topic of this new research paper. Great concept,  I wrote in details about ECS here.

  

MS Progression Risk Factors

• Rick factors to transition from relapsing remitting (RRMS) to secondary progressive SPMS. This new study looked at thousands of participants with MS. The most consistent risk factors  for SPMS were an age at onset >40 years, experiencing multiple MS symptoms at onset,  higher baseline disability (EDSS) score and a higher number of relapses.  The most consistent protective factor was the disease-modifying therapy (DMT) exposure was found protective when used during early phase RRMS but did not prevent the disability accumulation after the SP transition.

• A second study looking at the progression of MS in women and its relation with menses and menopause. Conclusion of this study:  A short reproductive period with premature/early menopause and/or low number of pregnancies may be associated with an earlier onset of the progressive multiple sclerosis phase.

Before the COVID-19 pandemic

You couldn’t stop moving. And you had to move fast. This was the mantra of the stressed and distressed North-American lifestyle. The stress levels were increasing in parallel with this fast-paced world, of course. Sitting in traffic for hours to go to work, a jam-packed workday. Running around with the children from school to hockey games to birthday parties. Frustration would kick in when driving in circles to find parking, getting a coffee (damn, they didn’t put enough cream …again!). Where should you book on vacation in the Caribbean? Pool view or ocean view? …awww, so hard to choose. 

During the COVID-19 pandemic

Stay home to save lives. STAY HOME !!!!. The new deadly virus is spreading all around the world. Europe’s desperate doctors shielded by trash bags, as protective equipment was not available. Only patients under 60 are getting ventilators in Italy, reported a newspaper in March. Grocery stores empty amid coronavirus fear, creating a sense of food insecurity. Toilet paper selling on Kijiji for up to $800 per roll! Hand sanitizers in short supply, nowhere to find. Lockdowns. Where is my job? I can’t keep up with the mortgage! Kids have to stay home. Mixed messages from trusted authorities. The second wave is coming and is going to be more dangerous. Record daily jump in COVID-19 cases. Vaccines won’t be available for the next months. By the way, these are headlines from newspapers.

Mindfulness meditation (MM)- one of the best solution to deal with any type of stress 

One of the best gifts you can give your mind, and overall, your health is meditation. Mindfulness meditation effectively lowers your stress level. A recent study found that five to twelve minutes of daily mindfulness meditation is associated with decreased stress and anxiety and increased mindfulness, with more beneficial effects seen following more meditation minutes. People who meditate also seem to have a larger hippocampus, a brain area involved in emotional control, making scientists believe that mindfulness meditation enhances emotional stability.  

Do you feel anxious or depressed? Even one single mindfulness meditation session can reduce anxiety in those highly anxious about experiencing high levels of stress. Practicing mindfulness meditation is linked with lower rates of depression and anxiety and temporary banishes negative emotions.

Why does MM work? This practice raises the levels of certain brain chemicals that play key roles in depression and anxiety, particularly dopamine, serotonin, GABA, acetylcholine, and norepinephrine. 

Meditate regularly, and you’ll get even more benefits. MM makes you sleep better due to its relaxing qualities and by increasing the levels of melatonin. Harvard researchers tell us that MM can reduce the risk of heart diseases. This practice makes you more likely to adopt another healthy lifestyle like a nutritious diet, exercise, and better sleep. MM also improves your high blood pressure and heart variability. A quick note on heart variability. Heart variability tells you how quickly your heart makes small changes between each heartbeat. Higher heart variability means a healthier heart, while low heart variability is linked with heart attacks and strokes. MM helps maintain healthy blood sugar levels. This practice seems to boost longevity by influencing your genes (lengthen the telomers) and increasing anti-aging hormones such as DHEA, and promoting a healthy immune system. 

*****From  Chapter 2 of my latest book “Pandemic Weight Gain” The 4 Step Formula To Lose Those Pounds And De-stress Your Life. 

[wpecpp name=”Ebook weight loss” price=”17.00″]

There is an abundance of recommendations about stopping the spread of COVID-19, flatten the curve, and protecting others. They are essential, and you need to know them. Very few talk about what to do to stay healthy. The purpose of
this book is straightforward. I think it is critical to losing the “quarantine 15,” and I will tell you how to lose those pounds in a matter of 2-4 weeks (depening on your current diet and lifestyle). And it works really well. So well, I’m already back to my prepandemic weight.
The peer-reviewed medical journal, Obesity, highlights that during these times of COVID-19, quarantine is of “great concern because small changes in body weight in relatively short periods can become permanent and lead to substantial weight gain over time.”

I agree with the researchers.Gaining 15 extra pounds in a very short period is unhealthy. These pounds will likely turn into “quarantine 30 or quarantine 40”, as the pandemic will continue into 2021. Quite different from what experts estimate that most adults would gain naturally in an entire year: 0.6 to 1.7 pounds, right?

Here is a little secret: excess weight is a reflection of your state of mind. This “pandemic weight” is different from any other weight gain you have experienced in your entire life. It is also more stubborn and harder to lose because it is packed with superintense emotions. This is a once in century crisis. While diets typically don’t work anyway, guess what? They are less likely to work for the “quarantine 15”.

Luckily, I’ve learned a lot over the years. I know why most diets don’t work and what you need to do to get real, long-lasting results. I spent the last two decades of my life practicing, researching, or teaching medicine in one form or another -conventional and alternative medicine combined. My mission is to help you restore your physical and emotional health, using the power of nutrition, supplements, and healthy lifestyle habits. Because nothing is more important than your health!

My Aha Moment
It is mid-July 2020, in the morning. Coffee was brewing in the pot. I’m in the bathroom. The shower is done, and I’m brushing my teeth. I’m in front of the mirror.
I look once. I look twice, ….and I can’t recognize myself there. What ????
My body was aging faster than I was. As if several years passed by, not a couple of months. My arms were flabby, the
waistline larger, and the natural shape of my body was lost. Did this happen overnight? Nope. This was just a moment of acute self-awareness. Could I blame those weeks of quarantine? Of course, because I used to go 5-6 times a week at the local gym. How about having plenty of food at home and frequent snacking? Sure, this could be another reason for getting out of shape. I couldn’t blame alcohol because I rarely have a glass of wine. Alcohol is another common culprit of a pandemic the quarantine 15, by the way.

I knew at that very moment that I need to get my old self back. Otherwise, the probable scenario would have to look like this: an extra 20 pounds by the end of 2020. Another 20-25 pounds by the end of 2021. This extra weight means increased risk to die prematurely from all causes, increased risk of high blood pressure/heart diseases, high cholesterol, diabetes, arthritis, gallbladder diseases, stroke, depression, anxiety, sleep, apnea, several types of cancers, and overall low quality of life- as per the Centers for Disease Control and Prevention (CDC).
Also, per CDC, excess weight puts you at much greater risk during the COVID-19 pandemic because it increases your chance to develop more severe forms of infection, triple the risk of hospitalization, and more likely to die from it. That’s because obesity impairs the immune function, decreases lung capacity, and overall creates a state of inflammation.

Before the COVID-19 outbreak, we have different stressors.
Sitting in traffic for hours, busy schedules, and tight deadlines.This low-grade, chronic stress was the most common form of stress.

Once Sars-Cov-2 started to spread, all of a sudden, the stress becomes acute, intense, threatening our survival. Fear. Panic. What is expected after a severe, acute episode perceived as life-threatening? A recent research paper on COVID-19 said it very well:” disease itself multiplied by forced quarantine to combat can produce acute panic, anxiety, obsessive behaviors, hoarding, paranoia, and depression, and post-traumatic stress disorder (PTSD) in the long run. These have been fueled by an “infodemic” spread.” Another study looked at the many psychological sequelae related to quarantine. Their results: plenty of negative emotions, including stress, depression, irritability, insomnia, fear, confusion,anger, frustration, boredom, and stigma. Some persisted after the quarantine was lifted. Now it is more important than ever to watch your weight and your emotions.
Do you want to lose the pandemic weight gain and de-stress your life?

This is the first chapter.

Read this book, and you will have the 4- step, researchbased formula to get back in shape physically and emotionally.
Enjoy!

[wpecpp name=”Ebook” price=”17.00″]

Breathing is life, and life is breathing. Your breathing is influenced by your thoughts, and your thoughts and physiology can be affected by your breathing.
You breathe hundred of millions of times throughout your entire life, without thinking.

Deep breathing is an essential part of meditation, yoga, tai chi and responsible for many of these practices’ benefits. The most straightforward explanation is the following: when you breathe deep, you switch from “fight or flight” sympathetic mode to the parasympathetic one, which is deeply relaxing and calming. The vagus nerve, the main component of the parasympathetic system, is activated when you breathe deeply When you practice deep breathing, you engage the abdominal muscles and diaphragm, rather than your neck and chest, bringing more oxygen into your lungs.

Then more oxygen will reach tissues and cells throughout your body. Breathing exercises help improve
V02 max- a marker of cardio-respiratory fitness. These exercises also boost your resting metabolic rate, which is the total number of calories burned when your body is at rest.
Only by bringing awareness to breathing and practicing deep breathing regularly you can stabilize your blood pressure, increase energy levels, reduce anxiety, depression, PTSD, and boost your immunity.

Belly breathe. This is one of the most popular breathing technique is used during yoga.
1. Place one hand on your belly.
2. Take a deep breath in through the nose. Feel the belly
expand and rise during inspiration.
3. Exhale slowly and deeply through the nose. Feel the
belly contract and lower. If you place a hand on your
belly, your writing should more down.
4. Practice 3- 5 minutes several times a day Here is a unique breathing technique to relieve anxiety and
help you fall asleep faster.

The 4 7 8 breathing technique:
1. Close your mouth and inhale quietly through your nose
to a mental count of 4.
2. Hold your breath for a count of 7.
3. Exhale completely through your mouth, making a whoosh sound to a count of 8.
This is one breath. Here is the video with this method, pioneered by Dr Andrew Weill. 

Let’s talk about two special breathing techniques for weight loss.

Japanese breathing. 
You may have heard of the “Japanese breathing” or “the long breath diet,” designed by Miki Ryosuke, a Japanese actor. He claims he lost 28 pounds and almost 5 inches around his waistline in just a few weeks using this technique (which was actually recommended for back pain).

How is it done: Stand up and push one leg forward and the other back. Next, strain your buttocks and transfer your weight to your back foot. You take a three-second breath, then exhale powerfully for seven seconds. You have to do
it for 2 minutes daily. Here is the video.

Vacuum twist. A second technique is called a vacuum twist.

This was a trendy method back in the 1970s and 1980s, and fitness enthusiasts claim that you can lose 2 to 4 inches off the midsection in as little as 3 weeks. Again, it involves deep breathing and targets the inner muscles of the abdomen. How is it done:
1. Exhale completely while standing.
2. Pull in your stomach as hard as you can from the belly
button.
3. Hold as long as you can go without a breath.
4. Start small and work your way up to longer holds.
This should be done 3 times a day. Here is Heidi Powell’ video explaining this technique.

Do these two techniques replace regular exercise, as they are advertised?  No, in my opinion. But they can significantly boost your metabolism, tone your core, and enhance exercise. Based on my experience using these last two techniques, I have to say that they definitely make your core stronger, and your abdominal muscles more defined. When combined with a low carb diet, exercise, and good night sleep, they help you lose unwanted inches around your waistline. Still, it is work looking at how you lose fat through breathing in more detail.

Fat is eliminated through breathing
The connection between breathing and metabolism is wellestablished. Deep breathing brings more oxygen to the body, and this oxygen promotes better absorption of nutrients, helps you flush toxins, and further leads to weight loss.
A 2014 study featured in the BMJ found that the majority of weight loss occurs via breathing. While most medical experts believe that fat is converted to energy or heat, eliminated within feces, or converted to muscles. However, this breakthrough study shows that most fat is eliminated through breathing while exhaling carbon dioxide.

This study tracked down the fat molecules and found that when 10 kilograms of fat are broken down (oxidized), about 8.4 kilograms were converted and eliminated through carbon dioxide. In comparison, the remaining 1.4 kilograms became water. 

ps. this is chapter 3 from my new book :

[wpecpp name=”Ebook” price=”17.00″]

 J Altern Complement Med: Sudarshan Kriya yogic breathing in the treatment of stress, anxiety, and depression: part I-neurophysiologic model; Richard P Brown et al; 2005
 J Trauma Stress: Breathing-Based Meditation Decreases Posttraumatic Stress Disorder Symptoms in U.S. Military Veterans: A Randomized Controlled Longitudinal Study; Emma M Seppälä et al; 2014
 Adv Mind Body Med: Rhythmic breathing: immunological, biochemical, and physiological effects on health; Promila Sharma et al; 2015
 J Altern Complement Med: Immediate effect of slow pace bhastrika pranayama on blood pressure and heart rate; Tapas Pramanik et al; 2009
 BMJ: When somebody loses weight, where does the fat go?; Ruben Meerman et al; 2014
 J Phys Ther Sci: Effects of breathing exercises on resting metabolic rate and maximal oxygen uptake; Min-Sik Yong et al; 2018

Air pollution 

• Air pollution matters to the brain. This new study reviewed past research on this topic. Studies suggest a link between air pollutants and brain development, strokes, headaches,MS (5 studies), cognitive function, brain degeneration. Furthermore, studies found a connection between air pollutants and  nervous (autonomic) function, neuropsychological and neurotoxic effects.  

• A second new study looked specifically at the link between air pollution and MS. This study included the results of  24 studies concerning the relationship of exposure to air pollution (particulate matter, NOx and SOx, CO2, traffic noise, etc. and MS. The results of this review study:  there was a significant relationship between exposure to air pollution and MS development and progression.

• A third new study  tells us that air pollution has an impact on the central nervous system. Particulate matter, especially the ultrafine (nanoparticle) components, can carry numerous metal and trace element contaminants that can reach the brain in utero and after birth. Exposing the brain to these elements had been linked with neurodevelopmental disorders like  autism,  schizophrenia, and  ADHD and neurodegenerative diseases like  Alzheimer’s disease, Parkinson’s disease and MS. Multiple mechanisms of action, leading to the deaths of neurons, oxidative stress and mitochondrial dysfunction. For more info check this new  study.  

New book : 

An naturopathic approach to MS. New Book: There’s No Pill for This: A Naturopathic Physician’s Personal Prescription by Michaël Friedman, ND

Gut Microbiome & Diet

• The gut microbiome suffers certain changes that had been linked with MS in several studies. This new study suggests that changes in the microbiome are not enough, and genetic predispositions are also key players in developing autoimmunity. 

• A second new study suggests that gut microbiota could be a therapeutic target to treat MS, because it has an important impact on disease progression.

•  A third new study is also looking into the  influence of certain microbiota species or compositions of microbiota on the immune system and MS progression.

• Probiotics may be helpful to manage MS because they modulate the immune system and decrease inflammation, according to this study. 

I wrote about gut microbiome here, and changes associated with MS here. 

The benefits of keto diet for MS and other neurodegenerative conditions are reviewed in this new study, including the impact of this diet on the gut microbiome. I wrote about keto diet in detail here. 

Supplements

• Vitamin D. The role of vitamin D in MS disease activity.was investigated in this new clinical study. The conclusion:  Vitamin D in association with other therapies may prevent the progression of MS-related disabilities and  relapses (RRMS). Furthemore, Vitamin D levels may have an impact on several symptoms: depression, anxiety, cognitive deterioration, and fatigue, which are seen in MS. 

• Vitamin D & Omega 3. Taking Omega 3 and vitamin D for 12 weeks has beneficial effects on disability and metabolic status associated with MS, is the conclusion of this new randomized controlled study. Doses used: 2 × 1000 mg/d ω-3 fatty acid and 50,000 IU/biweekly cholecalciferol supplement or placebo for 12 wk.Technical: omega 3- vitamin D combo improved several important markers: C-reactive protein, plasma total antioxidant capacity, total glutathione, malondialdehyde concentrations. In addition, ω-3 fatty acid and vitamin D supplementation lead to  a significant reduction in serum insulin, insulin resistance, total/HDL-cholesterol, and a significant increase in insulin sensitivity and serum HDL-cholesterol concentrations.

• Omega 3. A second study reviews the role omega 3 in managing inflammation, obesity, MS and how this supplement helps modulate the disease progression. You can find a review of the benefits of omega 3 here. 

• Vitamin D. Vitamin D supplementation should be considered in MS, says another new study. Moreover, vitamin D supplementation appears to lower the likelihood of new loss of myelin, changes apparent in MRI examinations.

• Royal jelly. Royal jelly shows improvement in the quality of life of those affected by MS. Researchers used 500 mg royal jelly daily for 90 days in this new randomized controlled study .Caffeic acid phenethyl ester (CAPE), one of the main active compounds of propolis, also show potential benefits to manage MS, suggests this new study (animal model of MS).

• NAC. NAC (N-acetyl cysteine)has a positive effect on brain glucose metabolism in those with MS, helping improve in cognition and attention- according to this new clinical study . I wrote an in depth review of NAC here. 

• Coconut oil. This new study reviewed  the benefits of coconut oil (based on research studies) and found that coconut oil could help to decrease the risk of Parkinson’s disease. Note: according to previous studies, coconut oil has documented activity against obesity, insulin resistance, Alzheimer’s disease and MS. 

• A combination of α-linolenic acid (a supplement) and valproic acid (a drug) are tested for MS treatments, according to this new study

• GJG, a Japanese herbal combination shows promises in this new study (animal models of MS). It appears to reduce brain inflammation (technical: by suppressing glial cell activation, followed by a decrease in the production of TNF-α via p38-TNF signaling). 

• Key components from astragalus helps ameliorate MS, suggests this new study (animal models of MS). 

• Vitamin K. The role of vitamin K in MS management  is explored in this new study. 

• L-carnosine.  A 8-week intervention with L-carnosine (2 g/day) appears “to be a safe and beneficial therapeutic strategy with regard to the reduction of presence and severity of symptoms of MS”, according to this small study which involved 3 participants. L-carnosine improved signs/symptoms like fatigue, waking distance and several markers related to the autonomic nervous system performance and brain metabolism. 

• Medical cannabis and MS. This is not a study, but the powerpoint slides from a webinar on this topic. 

Mindfulness Meditation

• In this new clinical study, there participants with MS were divided into 3 groups: one group practiced mindfulness meditation, the second one solution focused therapy, and the third group served as a control group. The results: the first and second group showed experience reduced stress, the ability to better cope with illness, more resilience and happiness compared with the control group. 

• A second new clinical study concluded that mindfulness meditation helps reduce stress and negative emotions in individuals with MS.

Exercise 

• Aerobic exercise helps improve the quality of life, according to this new study conducted in men with MS. 

• Unlike regular training, low-load resistance exercise with blood flow restriction (LLBFR-RE) requires less muscular effort compared to traditional high-load resistance exercise, but is effective in improving nerve and muscle function. According to this new study, exercise with blood flow restriction is also well tolerated by those with RRMS. More details about this form of exercise here. 

• This new study reviews the impact of exercise on the function and structure of the brain: improved neural connection, protection against degeneration ( neuroprotection), helping the formation of new neurons (neurogenesis), and myelin producing cells (oligodendrogenesis), myelin repair. Many studies support the benefits of exercise for MS management. 

More Therapies & News

• Multiple sessions of tDCS ( transcranial direct current stimulation) paired with aerobic exercise lead to cumulative and persisting improvements in walking and endurance in those with MS, according to this new double blind randomized controlled study. 

• The benefits of UVB therapy used for  early MS are explored  in this study. UVB shows positive impact on the B cells.  

• This study explores the link between MS and  autonomic nervous dysfunction , leading to bladder, sexual, cardiovascular, thermoregulatory, gastrointestinal dysfunction and fatigue. 

• Cooling vests. The lightweight cooling vest improves total walking time and distance in those with MS who have heat sensitivity, suggests this new study.  

• Is there any connection between antibiotic use and MS ? According to this new study, yes. Countries, with high consumption of  penicillin and tetracycline, experience a higher prevalence of MS than other countries.

Most of your  friendly bacteria are  found in the gut. Your gut flora is :

• It is essential for your development and keeps your immune system healthy

• It plays a critical role in digestion and nutrition. For example, without gut microbes, you could not digest many foods, mostly plant compounds.

• Your microbiome has a powerful impact on your mood, your thoughts and emotions. The altered gut microbiome is currently linked with depression and anxiety and how you engage socially. Note: I’m not sure how well your gut microbiome deals with all this stress and social distancing, but future research will tell us. 

• Maintains healthy gut permeability 

• Protects against  “bad” bacteria overgrowth

• Helps make vitamins including some B  and K vitamins 

• Influences gene expressions (related to inflammation and autoimmunity). Therefore, it helps prevent a wide range of chronic diseases- from diabetes to cancer. More details about your gut microbiome here and specific changes associated with MS here.

However, friendly bacteria are  everywhere- in the mouth, nose, vagina, lungs, skin, and even brain!

What is “Mouth Mask”

Wearing the mask is becoming the norm, and we have a new problem called “mask mouth” that causes: skin irritation and redness around the mouth and bad, sour breath. Dentists suspect this condition will lead to all kinds of dental diseases like decaying teeth, receding gum lines, and chronic bad breath.

But we will likely see more complications because the mouth microbiome is connected with the microbiomes from the gut and other organs. Past studies indicate that the mouth microbiome contains over 700 microbial species, including plenty of Streptococcus strains. An unhealthy microbiome is found in periodontal diseases, dental caries, dental implants, weight gain, lupus, diabetes, digestive disorders, Alzheimer’s disease, and various cancers.

Solutions For Mouth Mask

What is the solution?

• Wash your mouth more often. You can use hydrogen peroxide 1.5% as a mouth wash.

• Supplements: Neem and L.salivarius. 

Neem has a strong detox, anti-ulcer, antimicrobial action against harmful bacteria found in the digestive tract, and is incredibly helpful for mouth health. Neem mouth wash was found in research studies to be more effective than the standard mouthwash based on chlorhexidine. 

L.salivarius is a crucial player in mouth health. This probiotic produces antibiotics to fight bacteria in the mouth, helps fight Candida overgrowth, causes the gum’s inflammation, reduces the risk of cavities and strep throat infections, and much more.

Featured News 

• Could those with MS be more resilient during the COVID-19 pandemic? While the rate of stress, anxiety, and depression significantly increased in the general population, this new study we examine the impact of the COVID-19 pandemic on emotional symptoms and quality of life in individuals with progressive MS. Out of 131 participants, 4% reported they had the infection. Overall, little change was noted in symptoms of depression or anxiety or overall quality of life. 

• New Book “Integrative Neurology” looking at the benefits of diet and optimizing the gut microbiome and intestinal permeability and supplements like vitamin D, turmeric, probiotics,  omega 3,  glutathione, alpha-lipoic acid, melatonin, magnesium, l carnitine, coQ10, biotin, hormone replacement therapy (HGH, sex hormones), nootropics, LDN and more. You can read online this section focused on MS here.  

Diet/ Nutrition

• “Treatment of Multiple Sclerosis through Lifestyle Changes: Nutrition, Exercise, Sleep, and Stress Management”, is the title of this new research paper– where the authors emphasize the benefits of nutrition, as well as exercise, sleep, and stress management for MS management.

• The role of the gut microbiome in inflammation of the spinal cord/MS is explored in this new study. I wrote more about changes in the gut microbiome -MS here. 

• Dietary restriction (DR) regimens (either chronic or intermittent reduction of food intake) ameliorate the development of CNS autoimmune diseases like MS, suggests this new study. I wrote about the benefits of fasting/caloric restriction for MS here. 

• What are the benefits of fasting? According to this new study: “  Fasting has shown a similar response to manufactured drugs for the management and treatment of health-related conditions, such as diabetes and obesity, without the adverse effects sometimes caused by medications. Therefore, fasting could potentially ameliorate the health condition of highly motivated adults. However, the effects and safety of fasting cannot be generalized to every patient population, and the practicality of fasting is difficult to accomplish by many people. Continued research on the effects of fasting on the body and mind are needed to obtain a better understanding of this practice and the potential risks and benefits to human health.”

• Dietary fish-risk of developing MS. Here is the conclusion of a  new metanalysis: the consumption of fish decreases the risk of MS. Dietary intake of at least 0.5 servings of fish per week during adolescence and after might reduce the risk of MS. 

Vitamins, Foods, Herbs

• Vitamin D deficiency. This new study found that those with MS are more likely to be vitamin D deficiency compared with the control group. Furthermore. this high prevalence of vitamin D deficiency in those with MS seems to be associated with certain genetic variations ( CYP27B1).

• This new study suggests that kombucha could reduce the severity of MS (an animal model of MS). Technical: through activating  Treg and Th2 cells. 

• MS.Sinomenine, a pure alkaloid extracted from the Chinese medical plant Sinomenium shows potential benefit for the primary progressive MS, by decreasing inflammation and disease severity, according to this new study (an animal model of MS). 

• The benefits of alpha-lipoic acid for MS management are reviewed in this new study, with a focus on the impact on this supplement on certain inflammatory cells and markers. 

• High dose biotin for MS management- a review of studies – some showing positive effects, while others showing negative effects. “Thus, whether high dose biotin is efficacious in PMS and/or whether it causes relapses is uncertain at this time”, is the conclusion of this study. 

• Medical cannabis- this new study looked at the adverse reactions from using cannabinoids. The most common ones were fatigue, weakness, and drowsiness- mostly linked with synthetic cannabinoids like sublingual THC-CBD spray (Sativex), nabilone, and dronabinol. Note: past studies found that synthetic cannabis is linked with more adverse reactions compared with natural cannabis. More about medical cannabis in this section. 

Yoga, Pilates, HIIT & More

• Yoga therapy. This small study show symptom improvement (symptoms of MS) following a 3-month yoga therapy.

• Clinical Pilates and yoga interventions resulted in improvements in respiratory muscle strength and a decrease in perceived walking difficulties in those with MS, suggests this new study. Furthermore, pilates was found superior to yoga in terms of improving balance confidence, walking speed and quality of life, while pilates training was also found effective on mobility, quality of life, and cognition.

• High-intensity interval training (HIIT) improves many symptoms in PwMS and may positively influence disease progression. This new randomized controlled study showed improvement in inflammatory markers over a 3-week training program (HIIT). 

• Kinesio Taping (KT)  could be a solution to muscle spasticity. This new randomized crossover trial conducted in para-athletes suggests that KT can reduce muscle spasticity. Previous studies found KT beneficial for pain relief, edema absorption, and improved muscle performance. 

Other Therapies & More News 

• LDN- according to this new review of scientific literature, low-dose naltrexone (LDN) has shown promise to reduce symptoms related to chronic pain conditions such as fibromyalgia, inflammatory bowel conditions, and multiple sclerosis.

• Ozone therapy may help manage MS. According to this new study. Ozone therapy has anti-oxidant and anti-inflammatory qualities, showing beneficial effects on T17 cell (which play a key role in inflammation/immune response in MS).

• This new study looked at the link between cognitive fatigue and circadian or stress-related cortisol levels in those with MS. Key findings: people with MS have higher cortisol levels during the morning and in the afternoon. The highest level can be found in MS patients that do not experience fatigue. Those who do not experience fatigue seem to suffer from dysregulated circadian patterns of cortisol production.

• Suicide ideation & MS. The prevalence of suicidal ideation in those with multiple sclerosis was estimated at 13%, according to this new study/meta-analysis. Solution: counseling, and psychological support. 

• Practicing gratitude may help you cope with MS and build resilience. This new study found that gratitude uniquely predicted a higher quality of life beyond other predictors  (ie cognitive dysfunction, fatigue, and depression symptoms).