Gut Check: Community Questions (Bonus Video)

But I still enjoy the moment. Food is emotional and communal — like, it’s joy. When it’s just me, I stick to simple plans. But I wonder what you have to say about that. Also, algae nutrition like spirulina and chlorella and how they fit into giving the mitochondria the energy that they need to energize the rest of your body. I’d also love your thoughts on water fasting — like how many days is safe and what’s the best way to ease in and ease out. Thanks.

Payrovi: All right. Thank you, Damien. That was great. And I think I heard three different questions there. The first one was around what do you do when you’re out with friends — especially for some of our younger patients. Is it okay to stray off your good diet? What do you think, Dr. Mirla?

Mirla Avila, MD: I like that, and I think that’s applicable to all of us, because it’s hard to be 100% strict all the time. So I like to tell my patients — and I do the same thing myself — it’s the 80/20. So 80% of the time, you’re very focused on what you’re eating and making sure, but when you go out and there are not a lot of options on the menu, well, you can choose the one that you feel is the best and just think, like, nothing will happen.

Whenever I go home, I’m just going to focus again on that 80% and choosing the good thing. I think that’s a really good practice. And it makes it easier because it is true — as I was mentioning, I live in Texas. So that’s what I do. I try to choose my fish and vegetables throughout the week, because I know that if I go to a restaurant, likely that will be the day that I will eat meat. And you don’t feel that you’re missing out.

Payrovi: Absolutely. And no one’s perfect — not even the integrative functional medicine doctor. I actually tell my patients, if you can aim to be 90% perfect, that’s a really good place to be. So there’s room for error, for sure.
Damien’s second question was about spirulina and chlorella, which I actually consider superfoods. They can have a really potent detox activity.

They can actually be a decent source of protein. So it’s like a superfood that you can add to smoothies — that’s the way I would use it. I don’t really know of other ways to use it, but it doesn’t feel like a supplement. It feels a little bit more like food.

Avila: I agree. And then regarding the fasting — there have been a lot of studies in fasting in different disorders and diseases, including multiple sclerosis. But I think it’s important to know that this is going to vary from one patient to another. If somebody has diabetes, they may not be able to fast, for example. And also, I think you have to listen to your body. You have to see what works for you. And if you feel that the fasting is bringing more stress than benefit, then maybe you don’t need that long of a fast. I think this is going to be very dependent on each person.

And I would say consult your doctor before you do anything prolonged, because depending on your other comorbidities, you want to make sure you’re okay to be fasting. But it can be something good. Depending on each person, you may be able to do like 12 or 18 hours. But again, it depends. So consult your doctor.

Ben Hofmeister: Hi, Doctors Payrovi and Avila. My name is Ben. And what I know about MS and gut health is mostly that I don’t know enough about MS and gut health. I think I may have been in that camp that thought resetting your gut biome was all it took. I am just now grasping the importance of maintaining that biome, and it turns out that’s a lot harder than the initial reset.

I’m trying to eat better by cutting out processed foods and sugars and taking a probiotic supplement, eating yogurt, drinking kefir — that sort of thing. But I don’t know if that’s really enough. So thank you for doing this segment and for your emphasis on the importance of maintenance.

Avila: What would you say, Susan, on maintenance?

Payrovi: Yeah. So the maintenance piece is key. Because you can reset the gut, but if you don’t hold that environment, you’re going to just revert right back to where you were. And so this is why it really just becomes a lifestyle — where at least hopefully 80% of the time you’re putting in the good stuff and keeping out the bad stuff.

There are actually gut restoration programs that patients can follow to start getting their gut to move in the right direction. In fact, I do a 12-week program with patients in my clinical practice where we basically try to give the gut what it needs — the right foods, helpful behaviors — and then remove what’s damaging. A lot of this can actually be accomplished through diet and behaviors. You don’t need fancy supplements to accomplish that.

Avila: Yeah. And I think that a way also is to add things little by little and focus on adding good things. And while you’re adding, you’re going to start taking away the bad things because you start realizing that by eating healthier, you’re also feeling better. Rather than making a dramatic change and taking away things that you enjoy suddenly — that can sometimes feel more like a punishment.

So I say that if you start adding things, like leafy vegetables to your diet, and then next week you add more antioxidants — once you realize you’re already eating more nutritionally, you just start to enjoy it more and slowly make that change. I feel that it’s easier to sustain.

Payrovi: Ben actually had a great start by cutting out sugar and processed foods and adding in some of the fermented foods — that actually makes a profound difference. So great job on that. Yes.

Jennifer Powell: Hi, Dr. Payrovi and Dr. Avila. My name is Jen, and I have secondary progressive multiple sclerosis. I was diagnosed in 2010 with relapsing-remitting and told about a healthy diet and healthy gut microbiome. I really didn’t understand the gravity of it, because I thought MS was such a big diagnosis — how could anything I do possibly affect it? So I stayed on my diet, which was not very healthy, not giving any consideration to modifying it.

Once I did — about, gosh, only four years ago — seriously consider modifying my diet for weight loss, I began to feed my body healthy foods: fewer carbohydrates, low sugar, no sugar, leafy greens, more plant-based diet. And I noticed a difference. My cog fog was less and my clarity was more. How I carried myself was different. The weight of the foot drop lessened. Well, it certainly isn’t every day that I see these things — but the overarching theme to healthy eating for MS has been beneficial, and I will continue to do so. So thank you.

Avila: I think it’s never too late to focus on good health and eating. I think as a culture, none of us learned this as kids — I didn’t myself. So as an adult, I have put a purpose on focusing and making my family also understand why it is important.
I wish this was taught in even elementary schools, in high schools — to understand the power of nutrition so you make your own selection.

But I think this is something that many patients face, Jen. And it’s never too late to start focusing on things that are going to be beneficial in the long term.

Payrovi: What really struck me was her comment around, “MS is such a big diagnosis — how can anything I do make an impact?” And it certainly feels that way as a patient. I’ve experienced that.

But also what I know now is that there’s a lot we can do. And it’s so helpful to hear that simple changes she’s made slowly over time have helped with her cognitive function and energy. Even the foot drop may feel different on certain days. So I think that really speaks to the power of food and its impact on the gut environment and the gut microbiome — and how it can influence MS symptoms and the future course of MS.

Avila: Thank you all for the videos.

Payrovi: Yeah. I love hearing from our community. So thank you, everybody, for watching. Don’t forget to check the show notes below for our free download: the MS Gut Microbiome Tracker.

Avila: Yes, and remember to always talk to your healthcare providers for any decision on diet changes or supplements for your multiple sclerosis.
Payrovi: All right — and don’t forget to check out our next episode coming out soon for more useful information for MS.

Avila: Thank you.