Kalina Sanders, MD, EMHA: NMSEAM: Complementing Your Immune System: March 2024
Wonderful hi everyone I’m your host Aaron fine and I’m the social media marketing coordinator for Ms Focus before we start the webinar I’d like to introduce this year’s National Ms education and awareness month booklet toolkit the theme for 2024 is Ms Warriors battling autoimmunity we wrote
This toolkit with the aim to provide a deeper awareness of the immune system benefits of and advances in treatment and how you can advocate for autoimmune research in your community if you’re currently subscribed to our MS Focus Magazine then please be on the lookout to receive your 2024 toolkit in the next
Few weeks if not please respond to your registration email of this webinar and we can add you to our mailing list to make this toolkit in today’s webinar possible I would like to thank our wonderful sponsors Jen Tech Sandos beatric EMD serono and to noi thank you
Everyone for your time and we hope you enjoy this webinar now I’m thrilled to introduce our speaker Dr Kina Sanders is a board certified neurologist with Baptist Neurology in Jacksonville Beach Florida she received her doctorate medicine degree from the University of Texas HSC San Antonio she completed her Internal Medicine internship and
Neurology residency at the University of Florida Jacksonville she subse ly M completed a master of health administration at the University of North Florida she is currently the director of the comprehensive multiple scosa Center at Baptist Health and she serves on a number of executive committees for her practice and the
Hospital she is also the chair of the Florida healthc care provider council with the national Emma Society she is a passion for clinical care medical research and patient education DR Sanders we are so pleased to have you join us today and thank you for taking time out of your busy schedule to
Educate us all so I’m going to turn it over to you thank you so much awesome thank you for that wonderful introduction how did you know all of that about me it was all Wikipedia it was on Wikipedia awesome all right I’m gonna bear with me
One second while I share my screen here so we can get started tonight all right hopefully everyone can see that nice and clearly good evening everyone it is a privilege to be online with all of you tonight thank you for sharing your afternoons and your evenings with me um I am always excited
To be able to share information about multiple sclerosis especially during National Ms awareness month so tonight I am going to be discussing complementing the immune system and particularly how our lifestyle choices play a role I would like to add lots and many thanks to Megan wo who I have the pleasure of
Working with and learning from on a daily basis she provided most of this presentation and I hope I can do it justice so this is what we are going to be talking about today our objectives are I’m going to provide an overview of the immune system and how it impacts
Multiple sclerosis briefly describe how our disease modifying therapies affect the immune system but would really like to spend a lot of time discussing lifestyle changes that complement our immune system particularly nutrition movement mindfulness and overall Ms care and then I will touch briefly on some um common supplements and vitamins that I
Hear about in my practice and uh supplement safety so what is our immune system let’s jump in and talk about it the purpose of our immune system is really to provide a defense to fight bacteria and viruses and keeps our bodies safe and healthy our immune system is really made
Up of many types of cells as you can see here on the slide and our immune system is made up of really two distinct Parts one part is called the innate immune system and as you can see on this slide it has things like macras nutrifil uh natural killer cells um and
Then we have our adaptive immune system which is made up of our te- cells and B cells that we kind of commonly think about in multiple sclerosis I like to think of our innate immune system as our First Responders so if you think about your paramedics or
Your fire rescue people they go and they attend to any emergency that there is they don’t care what it is who it is or whether or not they know what’s wrong with them they go and attack anything our adaptive immune system I kind of like to describe as our hospital this is
House with our our doctors and our nurses who have gone through special education and have a specific knowledge in what care that they provide so they are very particular about what they see and what they um treat and so when we think about kind of our rapid response
Response and our slow response we have to think about them differently and so as I move through the slides I want you to kind of remember what these different cells do and we will though uh spend a lot of time talking about the Adaptive immune system which is really made up of
Our t- cells and our B cells so what happens in multiple sclerosis this happens there is a lot of things going on in this picture that you can see but really what happens is that our adaptive immune system which was supposed to learn that it should fight a
Bacteria or virus kind of fails itself and it starts to see your central nervous system which is made up of your brain and spinal cord and optic nerve they see it as foreign and they attack it and this is what we call an a auto immune response so your immune system
Cells which are meant to fight external things are now fighting internal things and as I mentioned before these cells are your adaptive immune system the slow responders the doctors and nurses in the emergency room and they are made up again of our t- cells and B cells um but
We also know that there are other players in in the game they are supposed to be outside of the central nervous system in our lymphatic system and our blood cells but they do get across into the central nervous system where they wre their habit so let’s break it down a little
Bit further with our immune system so I talked about our te cells not all tea cells are bad there are really three main types of tea cells um and these are our TH or our te- helper cells there’s a th1 these are primarily our inflammatory cells these are the ones that are
Confused and going into the central nervous system and creating uh destruction or demyelination we also have our th7 cells which are also inflammatory and also considered our misguided or our bad tea cells but we do have th2 cells and these are our our truly helper cells they are anti-inflammatory cells they are there
To help to protect uh our our nervous system now when we talk about B cells B cells as you may know um create antibodies and it is part the antibodies that are going in and attacking the demy or the myin in the covering around our nerve cells these cells are often times
Though activated by our te helper cells so they not only work independently but they work together to wreak the Havoc that we see uh in multiple sclerosis so all of them are important but I do want to focus on our t cells and our B cells now I mentioned
That there are other players enroll in involved in the the MS process I think one of the main things are our dendritic cells which are helped to present the wrong information to our te- cells and our B cells our micras are kind of like our garbage men they are there to go and
Help clean up um um bad areas and then we have our microa which are our immune cells that actually reside or live inside of our central nervous system now in Ms they are also doing the wrong thing so often times they will clean up things when it’s not needed or they go
And they uh precipitate or make the inflammatory process uh worse and so all of these though are part of the immune system when it comes to Multiple Sclerosis so how do our disease modifying therapies affect the uh the immune system as you can see here in the
Chart and as you’re aware we have almost 20 different uh disease modifying therapies some of them are in the same class and they have the same mechanism of actions but you can see here that they exert their primary effect on our either our t- cells or our B cells when
We if you’re still on an interferon therapy that might be rebith beta seron avenex these actually decrease te- Cell Activation and they don’t allow them to grow or proliferate and they also prevent the tea cells from Crossing into the blood brain barrier so they work peripherally but also prevents them from
Going in glitterer acetate is an interesting one in which that it actually causes a shift from our pro-inflammatory te- cells if you remember it was our th1 our th17 and it actually tricks the the body to create more helper or anti-inflammatory cells th2 two cells and so it doesn’t necessarily decreases
B cells I’m sorry t- cells but it causes them to shift from a pro-inflammatory te- cell to an anti-inflammatory te- cells if any of you are on our s1p modulators that’s like galenia uh inside of your lymph nodes when they are sequestered inside of your lymph nodes
They are not circulating in the blood if they’re not circulating in the blood they can’t cross the blood brain barrier and that reduces the amount of inflammatory attacks to the central nervous system are fummer rates also kind of help with that th1 to th2 shift but they also serve and and by
Activating an antioxidative pathway so we know that oxidative stress can cause our cells to die and cause a dysfunction within our central nervous system and so the ferates like Tech federa or uh vumerity they help to quiet down that oxidative stress that occurs within our central nervous system ter flutamide is another
One and it helps it works by preventing our tea cells from dividing and proliferating so they’re not our t- cells and our B cells so they’re not um again attacking the nervous system and then many of you may know about our B cell depleters that’s ok our okris um and brium
Kempa they work primarily on our B cells so they prevent our B cells or they cause a decrease in the number of B cells that we have in our bodies and so the B cells aren’t talking to the te- cells and they’re not creating antibodies to attack our nervous system
Tabri or natalism AB um it works by preventing your tea cells from crossing the bloodb brain barrier so that’s another way in which it’s not necessarily taking away cells but preventing their migration um if any of you have heard of Maven clad or cladribine it also works
By decreasing our t- cells and our B cells um and then it is allowed they are allowed to repopulate and then they are uh depleted again um and again when the when the te- cells and the B cells come back it’s felt that they are smarter than they were
Before on this slide are BTK Inhibitors those are currently still in clinical trials they are looking at BTK inhibitors for people that have both relapsing Ms um but they also looking at it in secondary Progressive and primary progressive MS um but I think it’s it’s a good opportunity to talk about the
Impact of microa so many of you may have heard some recent buzzword of smoldering Ms or slowly expanding lesions and part of the process of uh smoldering Ms is the activation of microa um and so BTK Inhibitors are felt to decrease B cell um numbers as well as
Decrease the activation of micro Gia within the central nervous system and so there’s some optimism um the clinical trials are still on going and so we don’t have full data or much data yet but there may be some impact of BTK on the process of smoldering Ms so as you
Can tell our all of our disease modifying therapies work on the immune system they’re there to prevent relapses to preent prent MRI changes and to hopefully prevent or have some impact on disability progression but as you noticed in the the title we’re talking about complementing the immune system and so
When we think about a complimentary medicine a lot of people start to think about alternative medicine or integrative medicine or functional medicine and kind of use those words interchangeably and so this slide really just highlights the difference between what we consider as conventional medicine uh which is disease Focus it’s
Treating the symptoms it’s using our disease modifying therapies as I just went through on the previous slide um and it’s kind of based on Western medicine but then we have alternative medicine which is kind of uses um a combination of um of our conventional medicine as well as some of our complimentary
Medicine uh the complimentary medicine approach is kind of more of a modern approach um and again it also uses both conventional and alternative medicines and then integrative kind of puts it all together um and and really though focuses on data driven solution so they really focus on um what the evidence
Supports um and then there is functional medicine as well which kind of maybe tries to figure out how the to treat the patient holistically and not just the disease all right so lifestyle changes and the immune system it is it’s no longer a myth that that physical and psychological stress causes lowgrade
Inflammation in the body um and this low-grade inflammation can result from various disease States so if you have comorbid um hypertension or high blood pressure or high cholesterol or chronic stress it can create lowgrade inflam uh inflammation and that lowgrade inflammation can result in other disease States um such as autoimmune diseases
Like multiple sclerosis or cancers um now this lowgrade inflammation can be modified by things like nutrition mindfulness and and movement so we all know the rhyme Humpty Dumpty right in the rhyme Humpty dumpy is on a wall and he has a great fall it doesn’t tell us though how he fell off
The wall I have read many theories on the internet um about how Humpty Dumpty fell off the wall either he uh slipped and fell there is some reports that it’s in reference to a war and a cannon hit the wall and Humpty fell off off the
Wall but ultimately in my mind he fell off due to bad choices whether it was the choice to get up there to begin with because maybe it didn’t fit his his body um or maybe he would he chose to bend over to reach for something um and that
Led to his fall so when it comes to our health let’s see here when it comes to our health there are really things that are come into play there are our genes which we really have very little control over it’s our environment and then there are some things that are interactive or
Part of our biochemistry and the way these things kind of line up together integrate either result in Wellness or illness now like Humpty Dumpty who had a choice to either get on the wall or not we also have choices based on our environment what we where we where we
Are what we choose to maximize or minimize and then we have choices regarding our biochemistry and that is primarily with our nutrients our detoxifications our energy levels that really determines whether or not we will end up with Wellness or illness because of it so let’s talk about some of those
Choices we’ll start kind of with nutrition which I think is very important and ultimately as I go through the slides I want you to keep this quote in mind when it comes to nutrition eat food not too much mostly plants oops wrong button we go so when we think about our
Our Foods there are the good and the bad so some of our foods are really there to help to stimulate anti-inflammatory effects so there are receptors um from foods that are high in fiber and omega3 that help to reduce the amount of inflammation some of our flavonoids activate also anti
Anti-inflammatory effects some of our short chain fatty acids that are made in the gut from high-fiber foods produce anti-inflammatory cyto Sines sorry about that and then foods that are high in U polyunsaturated fats and oils are also anti-inflammatory and this is kind of really an animal models have been shown
To maybe have some neuroprotective effects and then higher levels of intake of fruits and vegetables that’s going to be key are also associated with reducing relapses and disability and then foods that are high in fiber from whole grains and and again our fruits and vegetables decrease the recruitment of inflammatory cells and
Protein so there are definitely foods that can have a a good benefit for us now how about the bad so saturated fats and oils um our Butters um and our creams are increase pro-inflammatory and increase some of our um inter lucans which are also molecules that create inflammation
Are longchain fatty acids things that are found in processed foods foods that are high in Omega 6 actually stimulate our inflammatory tea cells so if you remember from the beginning of the presentation our th1 and our th17 cells those pro-inflammatory cells are actually activated by our processed
Foods and then our saturated fat and oils again those that are high in Omega 6 and sugars also increase our risk for vascular disease and so we know that the vascular changes that occur in our brain um also impact how our nerve cells function and impacts how our MS
Progresses and changes over time and so those patients that have comorbid high blood pressure high cholesterol diabetes those are primarily the the vascular comorbidities actually have a progression in their edss or their disability status sooner than those who don’t so what we eat definitely has an
Impact not just on our immune system as well but our brain health so there are a number of diets that are available um there is really no best diet but if you’re like me and you struggle with making choices and like to follow a plan there are a number of
Different um diets that are available uh many of you may be aware of the uh walls Elimination Diet and this is kind of based off of a Paleo type of diet and so there um are really somewhat restrictive or confined to uh Meats fish nuts vegetables and fruits uh the paleo diet
Limits Dairy and Grains and and definitely limits processed foods the Swank diet is out there as well the Swank diet is kind of one of the oldest diets and it was uh created by a physician back in the 1940s and 1950s uh where he really limited the amount of red meats oily
Fishes um and limited the amount of saturated fats um and unsaturated fats for uh the patients and then he uh followed them or he followed up with them 15 years later and he found that in patients who adhere to his diet they generally were doing better
Than those who partly adhere to his diet um or did not adhere to his diet there are others overcoming Ms and they all um the McDougall diet the Mediterranean diet many of us are doing ketogenic diets and then there are like the fasting mimicking diets and and really
All of the um diets really have very similar recommendations particularly with cutting out Dairy certain Meats uh eating less fats and then supplementing uh with things like omega-3 um and vitamin D supplementation um the McDougall diet is a a lowfat vegan diet so if that’s something that you’re more interested in
You may consider looking into that as well and then the Mediterranean and really the the goal of all of them is to decrease the inflammatory impact of our immune system so let’s switch gears to exercise many of us hate to get up and go and do it but glad we did once we’re
Done movement is definitely key um an exercise for an individual person is different from others and so what I might consider as a hard workout you might think it was pretty easy but exercise is important to know that it is um uh associated with the production of
Uh brain uh neurotropic factors um which are felt to be neuroprotective particularly during the inflammatory response the other thing that EX exercise can do is it can decrease our risk or improve vascular disease so it’s not just helpful for the immune system but again the high blood pressure the diabetes the high
Cholesterol and then for some it actually helps to improve our mood it helps to upregulate some of our serotonin receptors and give us a little bit of a lift in our energy um when it comes to movement you choose moderate exercise or movement um
The goal is to aim for 150 M minutes per week of movement and again that may not all be exercise that may be just taking a walk around your your your kitchen island you don’t have to do it all in one big trunk consider small chunks uh
Maybe sitting or splitting it up to like 22 minutes a day even even if it’s five or 10 minutes any type of movement is good and then you choose really the best time of day for that you want to make sure that your fatigue level allows you to participate in the activities you
Want to make sure that you’re staying cool and really choosing something you like to do and if you like me you need an accountability partner en list some help get someone else to work out with you that keeps you motivated and keeps you moving now let’s switch gears to
Mindfulness um when we think about the impact of of stress and really the role it it plays when we when we look back over time and the evolution of humans stress and our fight ORF flight response was beneficial it’s saved Our Lives it kept us from being captured uh by
Animals who were trying to eat us but over time we have kind of evolved into really a constant state of stress and that may be our electronic devices that may be the uh amount of coffee that we are taking the amount of money we’re spending the traffic we’re sitting in on
A daily basis um and maybe the lack of exercise that kind of gives our body kind of this fight or flight feeling all of the time and that generally is detrimental or harmful for us so when we when we look at kind of how our body responds to stress and there are really
A lot of things that come into play um within our our nervous system so if we are kind of mellow and calm and we are socially engaged we are mentally engaged in things that we enjoy our um our digestion increases are we are resistant to infections we are have the ability to
Relate and connect to other people and our bodies are really in a kind of a steady state but as we kind of start to increase our um our stress we kind of get into that fight or flight our blood pressure starts to increase our heart rate goes up our adrenaline hormones get
Going that might result in worsening of our MS symptoms when those adrenaline hormones get going and so when we get beyond that into the freeze standpoint that’s like you in front of that tiger and it’s about to eat you you can’t move right and so when we are in that freeze
Part of our our bodies and our stress we become depressed we become feeling of helplessness we shut down we dissociate or we and we don’t engage and our bodies struggle be because of that and so really I think our goal is to remain in the green zone so in that social
Engagement with using our flight or flight AS life gives us because we all know that life isn’t always uh peaches and cream and and cherries um and so we want to though do our best to kind of stay in the yellow to mostly Green Way uh phases so how do we do
That um if my screen Works it’ll be there we go mindfulness so meditation improves our immune response without increasing in inflammation so we get a boost of our immune system um but it does not cause our MS to to to get worse um it stimulates activities and areas of
The brain that help to control our emotions particularly our our frontal loobe so it kind of gives us more of our serotonin um that’s available in our brains which is our our kind of our Feelgood uh hormone and so mindfulness decreases that fight or flight that yellow zone it definitely helps to ward
Off the freeze the Red Zone and it decreases our inflammatory factors um that I’ve mentioned before and increases our anti-inflammatory factors as well so mindfulness is again like exercise very different from person to person um that that meditation may be spiritually based or it just may be mindful based where
You are centering your your thoughts um or you are praying and so whatever is uh uh befitting for you is what you should focus on doing and that mindfulness like our exercise should occur every day all right so let’s switch gears in our in our final few
Minutes uh of the dactic part of it because I do want to make sure that we have enough time for questions I will touch briefly on the role of supplements um in our uh for our immune system and so when it comes to overall symptoms of multiple sclerosis is there
Are a number of supplements that have uh been evaluated to some point many of them uh on this list um help to support the nervous system and not specifically the immune system but I would like to highlight in the next few slides uh some that are kind of specific to
Complimenting the immune system so helping with that and that’s going to be primarily vitamin D uh vitamin A and other antioxidants and I will uh touch on biotin as well so our probably our most studied vitamin um and the impact on the immune system is vitamin D vitamin D definitely has
Immunomodulatory properties there are actual vitamin D receptors on our um immune cell so T cells and our B cells and really the the presence of vitamin D helps to reduce the expression of some of those inflammatory uh chemicals and hormones that are released um it helps to support our
Maccrage maturation so remember our macro phases are the cleanup people so we want to make sure that they are cleaning up appropriately and and not doing it at inappropriate times um it enhances our innate immune system so it helps our First Responders to be more effective and maybe help to take care of
Our our bodies and where our adaptive immune system doesn’t have to take the full load um and it does help to regulate the production of those pro-inflammatory cyto kindes um and so vitamin D is extremely important for our immune Health uh when it comes to vitamin D supplementation um you really should
Talk with your health care provider um the recommended daily allowance is around 600 to 800 international units uh for adults and that’s the general population but when you talk with your healthcare provider knowing what your levels are and having the appropriate dose um can be uh the
The the decision for the correct dose for you um vitamin D3 is preferred rather than D2 um because vitamin D3 is what our B’s naturally make um and so we want to uh simulate what our bodies are normally doing I think it’s extremely important to note that doses greater
Than 4,000 in international units daily may cause toxic effects so you can definitely have too much vitamin D um and so you want to make sure that you’re monitoring your levels as you are doing your supplements and what about antioxidants so antioxidants tend to decrease the damage caused by free radicals and
Oxidants in our bodies um main antioxidants include vitamin A but vitamin C and E are also considered antioxidant and they are um helped by our vitamin b6 and b12 and they’re also very important um but I would like to talk specifically about vitamin A because there is some uh small amount of
Data that shows its uh potential benefit in reducing the inflammatory process so again it helps by modulating and regulating the uh th1 to th2 shift that we talked about previously and it also helps to modulate your B cells and some of your dendritic cells um and so the uh increasing an autoimmunity and
Regeneration tolerance in the central nervous system is reduc used um when um someone is taking vitamin A and the other antioxidants there was a clinical study U that sh that supported the evidence of using vitamin A um and and clinical symptoms it improved the total um multiple sclerosis functional composite
Score and patients who had relapsing remitting Ms um but unfortunately the study it did not uh show any uh impact on disability progression relapse rates um and patients still had new brain active lesions um on their MRI and so it’s really um important to note that there is no well document published
Studies and people that show a true clinical benefit of using them and so there should be some caution because sometimes the antioxidants can stimulate the immune system now how can we get the antioxidant effect without using the vitamins if anyone was paying attention before you know that fruits and
Vegetables are extremely helpful um and they can provide us with uh the antioxidant effect without using the supplements and so eating two to four servings a day of fruit three to four servings a day of vegetables can help us get and accomplish that goal all right how about biotin many
People um have been using Biotin and there was a a study published in 2015 um that was a pilot study looking at high doses of of biotin um over the course of a I think a three-year period um in primary and secondary progressive MS um and and
Those patients in that in that cohort had that used high doses of biotin which was about 100 to 300 milligrams um had a positive effect on their disability progression um and their time 25t walk um but other Studies have been mixed that did not show a potential uh any
Benefit for relapsing disease and so biotin I think is important to highlight that it can interfere with other laboratory results um and so we have to be cautious particularly if we are looking for things like thyroid issues uh cardiac enzymes and some cancer markers can uh testing can be uh
Erroneous or um off because of the use of high does biotin so you definitely want to talk with your health care provider about those risks and benefits um I think it’s interesting to note that Americans spent uh a lot of money 227 billion dollars on uh nauticals in
2020 um and so there are some benefits for some of them some we can consider them fruits and vegetables and a pill um there’s some evidence that certain supplements can be helpful um for some things and not others but I think we should um remember some of the dangers
Uh in our supplement and safety um there’s uh very low regulation um and consistency among them so quality is a concern um it definitely cannot replicate the benefits of our Natural Foods that we put in um and then we do have to remember that there can sometimes be interaction between
Different supplements or some of our medications and supplements and some of our diseases and supplements and so really you know approach uh any interest or desire in supplementations with your health care provider so that they can help make you help that decision so Optimal Health is not complicated again we want to maximize
What um we need for our individual selves we want to minimize what is harmful to ourselves and then we want to prioritize the environment um that we put ourself in particularly with our stress level so with that hopefully you’ve um gleaned some information and knowledge on how and what things can help
Complement our immune system and we want to make sure that we do it simply and safely so with that that concludes the presentation I want to thank uh everyone for sharing your evening and afternoon with me hopefully you’re eating dinner if you’re on the East Coast um and I
Definitely want to give another uh huge thanks to Megan for helping me put this together so with that I am going to end my presentation and we are going to I think open up for some questions yes absolutely DR Sanders thank you so much that was deeply insightful and
Informative and I truly appreciate you presenting this info for me and our audience that was that was really incredible um as DR Sanders said we are now ready for the Q&A if you have a question you can ask goodby using the Q&A button in the app or ask it live of
Raising your hand using the raising hand button or press star nine if you’re on on the phone and I will call on you uh we’ll start off with uh use uh attendee who uh says hi diagnosed 1997 RR uh now seem to be entering secondary Progressive I’m in my 70s and was taken
Off DMT coxon several years ago and was told dmts not recommended for senior citizens but still have not received a reason why would you please comment on why are not recommended for dmts thank you that is a that is a a great question um when when I first starting started
Treating patients with multiple sclerosis um you know I was telling my patients this is your disease modifying therapy you’re on it for uh your entire life and and we’ll just kind of go from there but as our knowledge has evolved as we’ve learned a little bit more about
The immune system and the impact it has on multiple sclerosis we know that as the rest of our body ages so does our immune system and so the data suggests that as a person gets older their immune system becomes ccent it becomes quiet it is less likely to be active and less
Likely to um cause relapses or MRI changes so we see kind of a fairly steep decline in um in the risk for relapses over time and so at a point and I I there is not necessarily a specific age but at a point we have to start to begin
To look at the risk benefit ratio or balance of our therapies and so if we start to see that the potential risk outweigh the benefit that is waning then there may be a choice to stop the medication but in my practice it is it’s not necessarily A one-size fitall
Approach and we I have to take each person individually so that there may be something that your health care provider felt about your profile that maybe made that risk benefit less um desirable thank you so much um got a couple of just couple comments from uh our audience Katherine just
Wanted to thank you for your valuable information and Tammy says excellent info relevant and presented in a clear and easy to understand way so thank you guys for those really nice words uh Peggy would like to know is there a supplement and recommendation for nutrition that can help bolster low IGG
Levels that are impacted by Emma’s treatments unfortunately there isn’t so your IGG levels are antibodies um and your antibodies are a direct effect of production by your B cells um and so they are if you don’t have B cells because you’re on a B cell depleting medication that result is a low or
Decrease in your immunoglobulins and unfortunately there isn’t anything natural or from a supplement standpoint that can build those back up okay uh somebody wants to know what effect do dmts have on the absorption of vitamins and minerals whether by food or supplementation at this point I don’t
Think there’s really any data um that um tells us whether or not that they um prevent absorption um but I do think it’s important that we have to understand and look at potential drug to supplement interactions um and I know um with uh certain disease modifying therapies that
We have to be mindful of that and so it is important that you talk you tell your health care provider all of the supplements that you are on um so that we can make sure that there isn’t an interaction we can check our little machine our program to make make sure um
But to answer your question I don’t think that there is any impact of our disease modifying therapy on the absorption uh or metabolism of our vitamins um we have a question from Facebook this is from Linda and she’s asking thoughts on LDN immunomodulator yes so lowd do
Nxone um has historically uh been um compounded and available for the treatment of of multiple sclerosis I will say though that the the data and the studies behind its utility in Ms is still and remains very limited um but there are some patients that feel that there is they get
Symptomatic Improvement or relief from the use of LDN um but it is not there’s no clear evidence that it actually truly has immunomodulatory effect okay Nicole asks I’m on 50,000 IU vitamin D2 weekly and alternating with 100,000 IU every other week due to deficiency without it without it my
Vitamin D levels go into to the teens I’ve been doing this for years is this not good for me so when you when you break down the the the 50,000 units um over the course of um a 7day period I do feel like you are still
Within your uh um safety range of the medication obviously your doctor would be um should be monitoring your levels um I’ve talked a lot about supplements but I think it’s important to know that we do our body makes vitamin D um we absorb the UVB rays from the Sun um and
So that is another key way to increase your vitamin D without supplementation um but if your provider has put you on that regimen I would assume that they are checking your levels to make sure they’re not elevated um if you aren’t familiar the range for
Vitamin D in most Labs is 30 to about 100 generally I like vitamin D levels around 50 I do get concerned when they get to the the higher level um or definitely above 100 and those adjustments will need to be made at that time so if you’re on vitamin D
Supplementation your vitamin D level should be checked periodically is there something you can do for high liver values from dmts nothing from a a a kind of a natural standpoint um obviously depending on the level of your liver enzymes it may mean that you are not a candidate for that disease
Modifying therapy um and so it depends on the level it depends on the medication and it depends on if you’re having any uh negative uh effects from that so having that discussion again with your healthcare provider to kind of see where you are is good I wanted to First say iel
Presentation thank you I was diagnosed with rrms 15 months ago and started arus in December of 2022 I had to talk to my neurologist in the starting do you have any suggestions for whether it might help to for help me to search out an MS Clinic for someone who specializes in Ms
For a second opinion yes I would direct you to the National MS Society website they have a directory of all all Ms focused providers whether it’s Physicians or physical therapists um and you can put in your zip code and it’ll tell you who is within a certain mile radius from you
Um and that will kind of take you in the right direction Karen from Facebook ask what do you recommend for smoldering him we’re still trying to figure out smoldering Ms um and and so for any of you who are unfamiliar with smoldering Ms it’s it’s really kind of a new
Understanding of what we were seeing uh secondary progressive MS and it’s a kind of a lowgrade inflammation that’s occurring in chronic lesions so people are not necessarily accumulating new lesions but their chronic lesions are still kind of festering kind of like a a a fire that’s dying um and so we haven’t
Quite figured out the true treatment for smoldering Ms um there is some some evidence to suggest that high efficacy medications um are are helpful in maybe preventing smoldering Ms as I mentioned earlier there is some optimism about BTK Inhibitors that may have an impact on microgo uh which could have an impact on
Smoldering Ms and then I think looping back to the the lifestyle um the medit the exercising the the healthy eating the anti-inflammatory approach can have some benefit of um smoldering a mass okay um I’m going to transition this over to um our audience member who has their hand up I’m going to allow
Robin to talk Robin would you like to say the DR Sanders Robin I’m so sorry we cannot hear you hello there we are oh there we go Robin sorry about that I was diagnosed with thems in uh 2014 and so in March of 2014 so it’s exactly 10 years and
Um I wanted to know if you could comment on why there aren’t any changes in my um MRI but yet I see changes in my um ability to walk that’s that’s a very common question that I get and and part of that kind of speaks to that smoldering Ms uh
My my my theory or my understanding of it really why is there a discrepancy between MRI and I’m getting worse is the one thing is that the MRI is uh correlates very highly with inflammatory activity right new uh immune res immune attack to the nervous system and so when we see that people
Are kind of slowly getting worse secondary progressive MS smoldering Ms that disease processes much different and so we will see stable MRIs because you’re not having relapses but what you’re having is what we now are thinking is smoldering Ms which we’re still trying to figure out
How to impact it so the MRI is only one feature of the disease and then two it really correlates much more with um relapses than it does with progression thank you so much Robin you’re talking uh Adelia asks I’m on my 38th year of Ms mon Ginia I have osteoarthritis and pain
In my knees is pain in knees and legs common pain in Ms so pain uh is very variable with multiple sclerosis and I think it is important to highlight that pain does exist with Ms um there is unfortunately not a particular type of pain that we can attribute to Multiple
Sclerosis um and unfortunately having Ms does not prevent you from having other disease processes like osteoarthritis and so sometimes it is very difficult to tease them out um but working with our orthopedic doctors or rheumatologist that can look for other objective features of arthritis can be helpful to distinguish the two but yes
Uh pain can come from multiple sclerosis it can also become because of secondary factors due to Ms not specifically the disease but let’s say you have weakness across your um your knee joint and so the weakness subsequently results in um uh into that joint pain so there are a lot of
Different features but kind of talking with your healthc care provider engaging in the other Specialists uh can help to treat you appropriately okay so I want to let our audience know uh DR Sanders has been very uh very very uh she’s been very good with her time uh she is going to be
Able to answer questions for just a few more minutes so uh if I’m unable to get to your question I’m very sorry but I’m gonna try to get these out as soon as quick as I can so uh Andrea or Andrea asks what are the side effects of too
Much vitamin D yes um I think the biggest side effect that we have to be mindful of is kidney stones um but it can also contribute to weakness confusion um frequent urination constipation so some of the symptoms that we kind commonly think of with Ms but I think the biggest one is
Uh kidney stones okay uh sh from Facebook asked any thoughts about the ti ti out I’m so sorry TI sabur infusion is there a specific question about Ty sabur it was just a general question what your thoughts on on on the infusion itself I guess so so tabri is
Is really considered one of our high efficacy uh therapies when it comes to Multiple Sclerosis um it has been around for a very long time um we have to balance the the benefits it has at of reducing relapses with the the risk for PML uh though so for those patients that
Are JC virus negative and which the risk for PML is lower uh it may be a good option to treat highly active disease um this question comes up a lot um in our presentations uh Dana uh first want to congratulate you on a great presentation but she want to know can
You get a copy of these slides um I will have to check with with Megan who’s the original owner of most of the slides before I can agree to to share itely fair enough uh someone would like to know in your professional career do you see a lot of physical progression
Even when MRIs are stable I do I do particularly as as patients uh go along in their disease Journey uh the longer you’ve had uh Ms the more likely we are to see a transition into secondary progressive MS um also age uh is a predi um a predictor of having disability
Progression even when the MRIs are stable and that might again go towards that smoldering Ms um I talked about the lowgrade inflammation that we can see uh pathologically or underneath the microscope and on high build MRIs unfortunately and our regular practices and our normal care we aren’t able to have those tools to
Really truly see uh smoldering Ms um but we have to assume that it is going on um and so it is unfortunately a fairly common thing that I see is stable MRIs with progression of the disease okay um DR Sanders you just have one last question for you okay
All right this is from Tammy and she says can you comment on hearing loss with Ms any connection with miners man maners yeah maners is she even wrote there probably SP yeah hearing loss is less common uh symptom of multiple sclerosis but there are areas in the brain particularly in the temporal loobe
That help with processing of of of what we here we also know that as the nerves leave from the inner ear and insert into the brain stem there can be lesions there that can impact hearing I don’t think that there’s any correlation though between multiple sclerosis and maners disease
Maners disease is more of a a structural problem with the inner ear and the amount of fluid that’s there okay DR Sanders thank you so much for being so generous with your time um so we let the audience know that that brings us to the end of this event if
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Eastern with Dr Brad Willingham to to discuss the importance of exercise and how it affects the immune system thank you once more to DR Sanders our attendees and our wonderful sponsors Jen Tech Sandos the address DMV serono and sopi uh have a wonderful night everyone thank you so much for joining it’s been
Uh it’s been a real pleasure thank you
