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Diet and Nutrition for NMO – Breakout Session – 2018 NMO Patient Day

Erin Fromm:

Hi, it’s cold in here isn’t it? That is smart. I need a blanket. I need a blankie. Well welcome. I think this is the last breakout session of the day. I hope you’ve enjoyed visiting the other ones today. My name is Erin Fromm. I work at the University of California, Irvine. I work with Dr. Ardith Courtney, who I believe was on the panel this morning, answering some questions.

Erin Fromm:

And we’re going to talk about dietary modifications today for NMO symptom management. When we look at other chronic diseases, sometimes there’s a template. There’s a diet for that disease. There’s a cardiac disease. There’s a template, a thing to follow low-sodium diets, to help reduce congestive heart failure, that type of thing. Diabetes, there’s a diabetic plan that you follow. You need to keep your insulin in check, so you are really measuring your macronutrients, which are protein, carbs, and fats. And you have to have a very balanced diet.

Erin Fromm:

For epilepsy, the ketogenic diet has been studied to reduce seizures and ketogenic diet is very high fat. Primarily all fat and moderate protein and very low carbohydrates. But what about for NMO? Is there a diet for NMO that we know of? There’s a lot of theories and a lot of different clinicians have different viewpoints, but we can all agree that an antiinflammatory approach seems to make a big difference in an inflammatory disease.

Erin Fromm:

We need to look at what has been studied in the past to make sense of these things, the Swank Diet we will review first, the McDougal Diet and then a probiotic research study. The Swank Diet was actually developed back in the 40s by Dr. Roy Swank. Now, he’s following multiple sclerosis patients, because that’s what we had back in that time. And that’s the research that we have available, and it does follow the same pathogenicity for NMO, so that’s why we’re looking at this.

Erin Fromm:

And he had a large cohort. I think he had about 1500 patients that he followed for 35 years. Unfortunately, his results were criticized by other scientists, because it lacked a control group. We didn’t have comparison for scientific validation. The diet was strict, or is strict. Saturated fat is anything like animal fat, coconut oils, butter. And basically you had to limit it to 15 grams per day. And to put that into perspective, a chicken thigh is 10 grams. So you’re already nearly at your max for the day. A pat of butter is 12 grams.

Erin Fromm:

Unsaturated fats are considered to be your healthy fats, like avocados, salmon and olive oils, nuts, seeds, that type of thing. And you’re allowed 20 to 50 grams per day of this type of unsaturated fat. Sitting down to a salmon dinner, puts you halfway to your goal on that. So what did it show? And over the years, over 35 years, the patients that adhered to the les than 20 grams per day, actually had slight deterioration in their disease process. And the death rate was 31%. Whereas the people that ate a higher fat diet had serious disability progression over the years and 79 to 81% death rate. That seems pretty significant to me.

Erin Fromm:

Dr. McDougal came along. He studied under dr. Swank and he wanted validation. He wanted to prove that this type of diet actually does improve disease process and demyelination. And so he wanted to look at MRI data. He wanted to use actual images, MRI images, to see if it made a difference in disease progression. He also wanted to look at fatigue. And he used fatigue scores, different questionnaires. And this diet went on for one year. Unfortunately it was limited, because he only had $700,000 to run the study for a year. And so the MRI data was not helpful, because one year is not enough to look at MRI results and disease progression. But it did show improved fatigue, which is significant.

Erin Fromm:

Probiotics are getting a lot of buzz these days. I’m sure everyone’s heard about probiotics, but Dr. Kouchaki did a randomized, double-blind, placebo controlled trial, which is the gold standard. Basically it was two groups. One’s getting placebo and one is not. And they did a 12 week study design and they use VSL3 probiotic, which is a common probiotics sold at Costco, CVS.

Erin Fromm:

And what they wanted to measure for their end points were disability, mental health and metabolic indicators. Metabolic indicators are things like insulin levels, cholesterol levels, that type of thing. And it did have favorable outcomes on disability. They used the EDSS score, which is a zero to 10 score your neurologist uses to measure your level of disability. And if it moved greater than one point, that was considered statistically significant. Mental health improved, all the inflammatory markers in the body improved. And it turns out having an antiinflammatory environment actually shortens the duration of relapses. And again, they measured this in MS. We need NMO studies, but given the similarities in demyelination, it may be something helpful.

Erin Fromm:

We want to talk a little bit about NMO symptoms, and then what we can do to try and manage them, because this is just a few of the symptoms that people suffer with NMO. Neurogenic bowel, neurogenic bladder, fatigue, alters your sleep cycle, your quality of life is affected, and a lot of people suffer depression and anxiety. A neurogenic bowel is a manifestation of constipation, fecal incontinence, and evacuation difficulty. It’s due to the lesion location on your spinal cord and affects a lot of people. And we want to know, is there anything you can do to manage this with nutrition?

Erin Fromm:

On the top of the pyramid is fiber, and the American diet is lacking fiber and fiber 25, grams is actually pretty hard to reach. Does anyone know how much is in a cup of broccoli? How many grams of fiber? Okay. No one seems to know the answer, and I was totally surprised to learn it’s only four grams in a cup of broccoli. And you think fiber, you think broccoli, right? That’s always what people think. Raspberries actually have eight grams of fiber in a cup and lentils are probably one of the highest fiber foods that you can have at 16 grams. Nuts have fiber, sprouted grains have fiber, coffee has fiber in it too, surprisingly.

Erin Fromm:

But it’s important, because fiber bulks the stool. It’s a nondigestible nutrient. With fiber, though, you need water. You need a lot of water. And that’s why hydration is included in this, because it helps ease past passage of stool. And the fiber absorbs water, so you want to have a lot of water along with your increased fiber intake, otherwise you’ll be very uncomfortable.

Erin Fromm:

Again, probiotics come up here, because probiotics create an anti-inflammatory state. Your gut is made up of a microbiome. I think that most people are familiar with that term these days. But the bugs in your gut actually change with what you eat. They have studied patients who ate anti-inflammatory diets, the microbiome was different than when they ate like crap. Essentially when you have a good diet, you have good bugs. And then when you didn’t eat very well, you didn’t have enough of the good bugs in there, which sets off your digestion.

Erin Fromm:

And that goes along with processed foods as well. Processed are not real food, unfortunately, but the American diet, we can’t avoid it. It’s part of our culture. But if you can try to eliminate processed foods, because they really wreak havoc on your digestive system. It’s very hard to digest.

Erin Fromm:

Neurogenic bladder is a manifestation of urinary frequency, incomplete emptying, urinary incontinence, nocturia, getting up frequently during the night having to go to the bathroom, and then UTI’s. Urinary tract infections. What can you do? Well, we know what you should avoid. And those are bladder irritants. Caffeine is a known bladder irritant, alcohol, spicy food, capsaicin, that’s the chemical compound in spicy food is known to be a bladder irritant and then soda.

Erin Fromm:

For bladder health, it’s good to consume a lot of water, flushing out your system and berries are really good for bladder health. They have a lot of antioxidant, anti-inflammatory properties to them. Most people are familiar with drinking cranberry juice when you have a bladder infection, I think that’s common, but they’re strong. The berries have a lot of powerful properties to them, which make a big difference with bladder health, and also in your system.

Erin Fromm:

One of the biggest complaints I hear from patients is fatigue. It’s one of the worst and most debilitating, it effects quality of life. And there are some things that you can do to manage fatigue with nutrition. Again, that low fat diet comes back up. And by low fat, we’re talking about The same parameters that the Swank diet followed, but trying to focus more on healthy fats like salmon and nuts and seeds. And it shows that your insulin levels and your lipid levels, when they’re normalized, fatigue levels improve in people. A healthy BMI also improves fatigue levels.

Erin Fromm:

Vitamin D. Vitamin D deficiency, it’s very common in NMO, and it actually is responsible for the aggressiveness of your disease. Vitamin D supplementation is hugely important and I hope everyone’s taking it. Does everyone know their levels? No. Okay. The takeaway today is, at our clinic and it’s up to your clinician and whoever you see, but my physician recommends 5,000 international units per day. Most people are taking 400. it’s nowhere near where you need to be at your levels.

Audience Question:

Is vitamin D one of those ones you can’t take too much of?

Erin Fromm:

Vitamin D is toxic because it’s fat soluble, but it’s toxic in a normal person, not a person with an inflammatory demyelinating disease. It’s really actually hard to get levels for our MS patients and our NMO patients up to the level that we want them at.

Erin Fromm:

That being said, you need to monitor your levels every four to six months while you’re supplementing, because you don’t want to become toxic. I think we have about a thousand patients.I’ve never seen anybody get to a toxic level.

Audience Question:

Do you have kids in your study?

Erin Fromm:

Pediatrics?

Audience Question:

Yeah.

Erin Fromm:

No, no. That’s a good question though.

Audience Question:

[inaudible]

Erin Fromm:

Yeah, that’s a good question.

Audience Question:

Okay.

Erin Fromm:

Yeah. And kids are actually more inflammatory in disease states than adults are. But that’s a really good question to think about that.

Erin Fromm:

Yes?

Audience Question:

Is there a standard dose that should be taken?

Erin Fromm:

Our recommendation is 5,000 international units per day, but again, your clinician might not agree with that. That’s just what we practice. And we monitor levels every four months on everyone. Yes?

Audience Question:

My question is, I live in Massachusets so…

Erin Fromm:

No sun?

Audience Question:

Yeah. I’m not much of a pill taker, so I try to tan.

Erin Fromm:

Yeah. Is it the same?

Audience Question:

I don’t know, but whenever there’s sun, I’m running towards it, because I never see the sun.

Erin Fromm:

I can’t endorse tanning, because it’s a carcinogenic. It can cause cancer, but there’s high vitamin D foods like fortified foods, like fish and that type of thing. Or if you can drink milk, milk has a lot of Vitamin D in it. Oh, sorry, I think you were first.

Audience Question:

I just wanted to mention other than [inaudible] you guys are in California. And I don’t know where everyone from, but they recommend 10,000 IU’s a day. That might answer your…

Erin Fromm:

And that’s true, because people look at us like 5,000 is just hugely… It’s a big dose, but I grew up in Seattle, so I know that the sun doesn’t shine very often. And when it does, it’s a glorious day. So 10,000 might make sense for someone who doesn’t have the sun. In Southern California, we have a lot of sun, but a lot of sunscreen. That’s part of the problem because we’re blocking that the good effects from the sun.

Audience Question

I’m from Florida where there’s a lot of sun and I wear a lot of sunscreen. I do take 5,000 of vitamin D daily, now only because now I’ve been diagnosed at the very start of osteoporosis, with all the steroids I’ve used over 10 years, that I’ve been diagnosed. With that being said, I do get my numbers checked because I had a potassium and sodium issue too, so I’m now not a potassium pill to increase my potassium. But with the vitamin, the 5,000, my doctors also recommended that I take a calcium.

Erin Fromm:

Yes.

Audience Question:

And also magnesium.

Erin Fromm:

Yes. Yep.

Audience Question:

Okay.

Erin Fromm:

You are on track because one without the other doesn’t absorb in your body, so they do sell those together. At least vitamin D3 and calcium. And Puritan’s Pride is a company that, that I will endorse because…

Audience Question:

I’ve heard of them. Yeah.

Erin Fromm:

… they make a good quality product and they combine the two. Puritan like P-U-R-I-T-A-N, Puritan’s Pride.

Audience Question:

As long as I am getting the vitamin D levels checked, the 5,000 is something fine to stay on forever.

Erin Fromm:

Absolutely.

Audience Question:

Okay. Okay.

Erin Fromm:

And recommended.

Audience Question:

Okay. Thank you.

Erin Fromm:

Yes.

Audience Question:

Just real quick. My doctor has me taking the one pill a week, and I think that’s 50,000 and it’s supposedly 50,000. But on following test, it showed that that was not high enough for me, because he said I was still low on vitamin D. Is there a higher dosage that I need to take?

Erin Fromm:

I’m surprised you’re taking it just weekly. Most people I know and correct me if I’m wrong, take a daily dose. They also have a liquid form that sometimes is more highly absorbed in the body. But again, it ranges from five to even 10,000 per day. You might want to discuss with them. Do what your level is?

Audience Question:

I don’t remember at the moment. I have it at home.

Erin Fromm:

Right. It’s mostly your neurologist who really cares what your levels are. And that gets us…

Audience Question:

Well, it’s my general doctor that gave me that…

Erin Fromm:

Okay.

Audience Question:

He was surprised that it was low, but he didn’t really up the dosage or anything. Should I take it more like on a daily?

Erin Fromm:

Yeah, I definitely can’t speak for your clinician.

Audience Question:

Right.

Erin Fromm:

But in our practice, we have our patients take 5,000 per day if you have a demyelinating disease, because you’re deficient in it and it affects your disease. It makes your disease more aggressive if you’re not getting adequate amounts.

Audience Question:

Okay, so just turning my question around a little bit, would it be better to take a daily dosage instead of a weekly dosage then?

Erin Fromm:

I would think so considering that your number hasn’t popped up.

Audience Question:

Okay. All right. Thank you.

Erin Fromm:

You’re welcome.

Audience Question:

Again, probiotics comes up here too with fatigue, because those studies that they did on probiotics also showed a decrease in fatigue, which made a big difference. And that anti-inflammatory foods, again, antioxidants, such things like carotenoids and flavonoids, the things that are found in whole, natural foods and fruits and berries and that type of thing, make a really big difference in your environment, decreasing inflammation.

Erin Fromm:

Depression is another very common problem with NMO. And there are some studies that show Omega-3, which you can supplement with Omega-3’s, but it’s also in again, fish. I think salmon must be like the most glorious food here today. But it’s also in flax seeds, walnuts and soybeans. Flax seeds and chia seeds are actually sold at places like Trader Joe’s now where they weren’t always available and can be thrown into food, or smoothies. That type of things that easily can be incorporated in your diet.

Audience Question:

It’s also an important component of myelin. And as we all know, myelin is that protective sheath around your brain and your spinal cord. And that’s exactly what is being chomped away in NMO, so it’s an important component. And also, a healthier lifestyle leads to decreased depression.

Erin Fromm:

This little apple icon right here is for this word, and I’m sorry it’s not bigger. This is an app, it’s called Cronometer. We can use technology to make life a little more doable with chronic disease. Cronometer, you entering your food and it actually breaks down every single nutrient of the foods that you eat. If you enter in your meals for the day, it breaks down your calories and all your carbs, your saturated mono and saturated fats, your proteins, all your vitamins and your fiber. And then you hover over that value. And it will tell you, let’s say for fiber, you hover over that, it tells you exactly what foods you ate that day that had fiber in it. And then you know where to really reach your goals, your nutrient goals. You can open it up on your computer, or tech savvy people on the phone. MyFitnessPal, people like to use as well, for food journaling.

Audience Question:

Sometimes food allergies are triggers and it’s a little bit different in NMO because a lot of patients are on prednisone. And when you’re getting tested for food allergies, it can make a difference on those Ig levels that they’re testing, so it might not be accurate. Let’s say you think you’re a gluten intolerant and you go get tested, your gluten test might be inaccurate based off of if you’re taking glucocorticoids and Solu-Medrol and that type of thing.

Erin Fromm:

But someone brought up a good point, like an elimination diet makes a big difference. An elimination diet would mean 21 to 30 days of eliminating all food triggers that you think are making life hard, and then slowly add one food back three days at a time to see if that indeed is a food trigger for you. Those who are not on steroids, they actually can have food allergy tests, and it might be beneficial.

Erin Fromm:

Processed foods, I can’t stress enough that it creates inflammation in the body. While we have children and goldfish in our pantry and all the things that we do to survive and get by in life, if you can strive for 80 to 90% of eating anti-inflammatory foods, create a good environment in your body, and 10% of the time you have the birthday cake, enjoy your life. But we really strive to make a difference with disease management.

Erin Fromm:

Okay. Q&A. Go ahead.

Audience Question:

You mentioned supplementing calcium and magnesium as well. I know that magnesium always comes with a combination, like magnesium oxide, or sulfate, what’s the best combo to get?

Erin Fromm:

I don’t know the answer to that. I’m trying to think back when I used to work in the hospitals back in the day, like an ICU, and we had different magnesium’s, like SlowMag and that type of thing. But I don’t have a good answer for you on that. I’ll have to look it up, but I do know at least with vitamin D and calcium, it should be taken together and it should be a D3.

Erin Fromm:

Yes? She’s right behind you.

Audience Question:

I have been looking into a all added sugars free diet and possibly gluten free diet. I have NMO. Do you think that’s a good idea?

Erin Fromm:

Yes. You know why? Because sugar causes inflammation. It just does. And if you look at, or if you talk to other people who have cut sugar out, except for fruits, fruits are important because fruits contain not just glucose that you need for healthy function in your body, but also contains fiber. And bananas have fat, other things that you need other nutrients. But sugar, just white, plain sugar alone is highly inflammatory.

Erin Fromm:

Not everyone’s gluten-intolerant. But if you notice for you it’s making a difference, then it’s worth it, whether or not you have an allergy to it.

Audience Question:

I’m not gluten intolerant as far as I know, but I have heard that it helps reduce inflammation.

Erin Fromm:

There’s a lot of buzz, but the research is shortcoming so far. But onward and upward with research trials we go, so we might find out something later in life that it makes a difference.

Audience Question:

Awesome. Thank you.

Erin Fromm:

Yeah.

Audience Question:

I just recently started taking probiotics and I think it’s really helping me, but I can’t quantify that. I don’t know much about them. Is there an amount, or a brand or a type?

Erin Fromm:

The brand that I can endorse was the one that was in the research trial, which is the VSL3. And again, that is VSL3 V like Victor, and that’s sold at Costco, or CVS, so it’s easy to get. If you go on Amazon and you type in probiotics, my God. And 40 billion and 90 million. Yeah.

Erin Fromm:

Yes, yes. And it has eight strains of bacteria, good gut bacteria. Don’t get looped into the 40 million strains that type of thing. It’s completely overwhelming. And typing in diet, even on Pinterest, if you go on Pinterest, there’s a diet for everything. It’s overwhelming. Yes?

Audience Question:

I take probiotics as well, [inaudible 00:24:52] was a very good brand too. But thank you. As far as acidophilus, can that be combined with a probiotic?

Erin Fromm:

Yes. And acidophilus I believe has good enzyme in the system. I think it helps digest food easier.

Audience Question:

Okay.

Erin Fromm:

And taking a combination is not harmful and it’s completely allowed.

Audience Question:

Because someone had told me to add that, but I wasn’t sure. And I wanted to wait till I got here to… And then the other thing, what do you feel about dairy? Because we all know it causes inflammation. And I feel better because I have gone dairy free.

Erin Fromm:

And that’s my case in point. Every single person, if you had milk and you had milk, you might have two different reactions to it and how your body tolerates it. The big problem with milk is the hormones and antibiotics that have been infiltrated into our cows. And that’s really the big issue. I suppose, that if it were just back in the olden days and it was just straight cow milk, I don’t think we would have the same allergic responses to it.

Erin Fromm:

So the takeaway is, if it works for you and it makes you feel better than, than you do not need that. You need to find your calcium sources elsewhere though. I think spinach, because spinach tastes just like milk, right? Blend it with a little water. But unsweetened almond milk is a really healthy alternative too. Yes.

Audience Question:

Another question.

Erin Fromm:

Sure.

Audience Question:

I have slow gastric emptying and it comes and goes. Is there something to keep in mind when I’m having a bad, slow gastric emptying day?

Erin Fromm:

These questions, boy, because I know that even your neurologist can’t answer that question for you, right?

Audience Question:

Right, but I’m wondering if a high fiber something could contribute to in the stomach if it sits too long.

Erin Fromm:

Well, and this is the thing with fiber too. You have to have enough hydration to handle the fiber. And a lot of people don’t stick to high fiber, diet because it’s uncomfortable at first until your body gets used to it. Most people have like a lot of gassiness and bloatedness with it, especially with slow gastric emptying. You feel like you can’t win.

Erin Fromm:

And that’s where I find that adding slowly into your diet, those foods that you can tolerate, those are the foods that you need to eat, but also the probiotics should affect and make a difference in how you tolerate that fiber.

Audience Question:

Does the probiotic instantly help? Can you take it one day and then you’re fine. Or does it have to build up over time?

Erin Fromm:

I think most people don’t take them regularly because they don’t notice a difference. Because it’s one of those things, even like vitamin D, even though you should take it, you don’t feel a big difference. But you should take it because it is making a difference. And same with the probiotics and all of these things are not one thing alone. It’s not a lovely magic pill. It’s combination of things.

Audience Question:

Thank you.

Erin Fromm:

You’re welcome. Yes.

Audience Question:

My question has to do with hydration. Considering the fact that most of us have bladder issues, I’m not going to take a whole gallon of water in the morning to go to work to then have accidents all day. Is there any other type of liquid food, or any other combination that we can take to hydrate that’s not water? That’s not making us have accidents all day.

Erin Fromm:

Absolutely. And I do suggest drinking your water in the morning, but not a gallon of it. And I would suggest melons, like watermelon and honeydew and cantaloupe and cucumbers and that type of thing. Those are all high water content, which hydrate you. And those count towards your water consumption for the day. If you can sit at your desk and have a couple slices of watermelon, not only are you getting your fiber and your hydration, but it’s also antioxidants as well. It’s a win, win, win. Yes?

Audience Question:

There’s been a lot of buzz about vegan diets, too, and what is your thought about that? And like eating meat and a lot of protein through meats.

Erin Fromm:

Yeah. I was talking about Pinterest, if you go on Pinterest, you type in diets, you’re going to get just the whole world of diets. There’s a lot of validity to eating clean and eating vegan. It’s just that not everyone can adhere to it. So I would suggest, for what feels right and feels good for you. If it’s a good quality diet, vegan diet is well recognized in the health community, it’s well supported. You get your protein. It’s still a very healthy diet.

Erin Fromm:

Let’s say you feel an infinity to it, then it would be something worth trying. If it’s something where you feel like you’re just constantly torturing yourself by not having a piece of chicken, or an egg, then it’s not going to work for you. And some people, they have an affinity towards a certain food group. The only food group, you shouldn’t have an affinity to is sugar. And we do, because we get addicted to it. So once you clean it out and you clear it out, you don’t have that same addiction. It goes away.

Audience Question:

Just a quick question. So out of the three, dairy, gluten, and sugar, you would say sugar is the biggest one to cut out?

Erin Fromm:

It’s the most inflammatory.

Audience Question:

Okay.

Erin Fromm:

Yeah. Yes?

Audience Question:

Earlier you were talking about eating for your gut, so my question would be, is there a resource that you suggest for people to look into, like a book or something like that that guides you to the best foods to eat that are going to give you the good bugs that you were talking about to keep propelling you forward?

Erin Fromm:

That’s a good question. I think that what you’re trying to ask is, what is the best diet for that? And essentially it’s cutting out the crap, to simplify things. It really is. It’s not all what you put in your gut, but it’s what you take away. And when they looked at the two groups, even then the same person, a person who ate a bunch of processed foods and like saturated fats that were added, food preservatives and that type of thing, it altered that whole leaky gut syndrome. It did make a difference in the gut flora.

Erin Fromm:

Think of your intestine as a garden and you want your garden to flourish and be beautiful, but you throw a bunch of crap on there and then all the flower’s dies. And so when you put in all good food, it had flourishing garden flowers, and then your bowel is functioning. Your bowel is never going to be perfect in NMO, but you still can do some things to help manage it, manage your symptoms. Yes?

Audience Question:

I’m just curious. I think I might’ve even asked this last year, but is there a specific…

Audience Question:

Hi, my question, is there a specific anti inflammatory diet that someone could follow?

Erin Fromm:

If you Google that you’ll find 500, but I can tell you there are anti-inflammatory foods. And you can actually pull up a list of anti-inflammatory foods on a trusted, reputable website. I think even the MS Society has… Which is useful for NMO information too. But you can pull up their information on nutrition and pull up an entire list of anti-inflammatory foods.

Audience Question:

Okay.

Erin Fromm:

Yeah.

Audience Question:

No, I consciously, even before I got sick, I tried to eat healthy. We do the colors.

Erin Fromm:

Yeah.

Audience Question:

But some people say, “Oh, you’ve got to eat the antiinflammatory diet. That’s why you’ve got this. And that’s why you got the transverse myelitis and the NMO, if you just changed to an anti… It would all go away.”

Audience Question:

And it’s really hard, because I’m trying my best.

Erin Fromm:

Right.

Audience Question:

And it gets a little bit frustrating. And so I just thought, I’d ask you again, if there’s some magic thing? I’m sure we’d all be on it.

Erin Fromm:

I think people make judgements based off of their Google searches. And they’re not scientists, they’re not practicing clinicians and they don’t have a foot to stand on. If you can try to put the noise behind you as much as possible, because clearly you’re doing the right thing by eating pretty healthy, even prior to your disease process. Nothing causes NMO that we have found, nothing causes MS that we have found. And so all you can do is work with what you can, but the noise needs to go away. It’ll make life easier.

Audience Question:

I’ve done the whole trying to go organic and seeing the difference. if you buy an organic Apple and a regular Apple at the supermarket…

Erin Fromm:

Good question.

Audience Question:

… Is that going to make a difference?

Erin Fromm:

It’s a good question. And unfortunately, I would love to say you don’t need to buy organic, because organic food is expensive. The problem is, is that all the pesticides… You really can’t win. The pesticides and everything that’s in our soil. And even from the rain and the acid that comes down from there can affect the quality of your food. And so there is something called a dirty dozen, look it up online, and it will tell you which foods you need to buy organic.

Erin Fromm:

It’s the dirty dozen, because it’s the highly penetrable, where the pesticides get into the fruit itself. And then the rest of the fruits and vegetables, you can just hand wash and you should be fine.

Erin Fromm:

I think we’re supposed to wrap it up unless there’s one last question. Anyone? Nope. Sure, okay.

Audience Question:

… probiotics. Have you heard of the Saccharomyces boulardii? It’s a yeast. It’s not a bacteria, but it is specific for C. diff, if anyone knows what C. diff is.

Erin Fromm:

Yes.

Audience Question:

C. diff is just treated with antibiotics and then it goes on and on and on.

Erin Fromm:

Yeah. So C. diff occurs when you disrupt your gut and that bug takes over and causes a horrifying nasty illness that leaves you in the hospital, or death. Yeah. I worked with a lot of patients that died from C. diff toxicity. On that bright note, thank you. Enjoy the rest of your day. Thank you. Thank you.

 

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Update: NMO Clinical Trials – 2018 NMO Patient Day

2018 NMO Patient DayThe Guthy-Jackson Charitable FoundationHilton LAX Los Angeles

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