Mona Bostick, RDN, LDN, on Nutrition Care in Multiple Sclerosis
Mona Bostick, RDN, LDN, discusses nutrition and the role of multidisciplinary nutrition care for patients with multiple sclerosis. She recently gave the talk, “The Importance of Assessing Nutritional Health in Patients with MS” at the 2020 Consortium of Multiple Sclerosis Centers (CMSC) Virtual Meeting.
Bostick M. The importance of assessing nutritional health in patients with MS. Presented at: 2020 CMSC Virtual Meeting; May 27, 2020.
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Mona Bostick, RDN, LDN, is a registered dietitian nutritionist in private practice in Greensboro, North Carolina. Find out more about her practice at MSBITES.com.
Neurology Consultant: Hello everyone, and welcome back to another podcast. I’m Christina Vogt, associate editor of the Consultant360 Specialty Network. Today, I’m joined by Mona Bostick, who is a registered dietitian nutritionist in private practice in Greensboro, North Carolina. Today, we’ll be discussing nutrition and the role of multidisciplinary nutrition care for patients with multiple sclerosis. She recently gave the talk, “The Importance of Assessing Nutritional Health in Patients with MS” at the 2020 Consortium of Multiple Sclerosis Centers Virtual Meeting.
So first, could you discuss the role of nutrition in the care of multiple sclerosis? What are some key nutritional needs in this patient population?
Mona Bostick: I think it's really important to know that MS is a complex disease with a complex manifestation. Some people refer to it as a snowflake disease because, if you have 10 people with multiple sclerosis standing in a row together, each person is going to have a different experience with that disease process, and each person may have nutrition impact symptoms, or things that impact their wellness, that others will not experience, or a matter of degrees.
So, clinically speaking, MS is a chronic inflammatory demyelinating disease of the central nervous system, but the important thing to know is that it remains a disease with no known cause and no known cure. But in spite of that fact, there are a lot of people out on the internet putting misinformation out there, using vague, almost pseudoscience, language promising that one nutrition intervention or another, or a group of supplements can, and I'm air quoting here, “heal, beat, reverse or sometimes even cure” the MS disease. And they refer to diet often as the root cause of multiple sclerosis, but I want to remind you that it's a disease with no known cause, which means diet isn't the cause of multiple sclerosis.
I guess when it comes to the nutritional needs, folks with MS, first and foremost, it would be to be heard. They have a number of questions, and they need to be answered in an evidence-based way. And then, the next important thing would be to be appropriately and adequately clinically assessed by a dietitian, and that's because while there's no evidence to support that diet will heal, beat, reverse, cure, or in any way impact the disease process, health-related quality of life has an enormous impact, and what that means is that if a person with multiple sclerosis has one or more comorbid chronic health conditions like diabetes, hypertension, cardiovascular disease, folks in this situation are going to seem to go more quickly to disability and have a lower quality of life.
So, while the role of nutrition isn't to heal, beat, reverse, or cure the disease, there is a place for nutrition to help maintain and optimize overall health and wellness while living with the disease, and a registered dietitian has an important role in in making sure that that is addressed.
Neurology Consultant: Why is it important to have multidisciplinary collaboration between neurologists and RDNs to address the nutritional needs of patients with MS?
Mona Bostick: This is really important because, as I said, patients have questions and they want answers. And it's been my experience–when you go to a doctor, when you go to a neurologist, you generally have questions for the neurologist that are within their scope of practice.
And so, physicians and other allied health providers don't have the time, they have limited time, to address what they're there to address with the patient, and then in addition, provide nutrition information. Add to that the fact that most of these either physicians or allied health professionals have no training or education in nutrition. Many actually have biases or opinions, just like we all have opinions, but that's not really the way to get that information to a patient. That's probably not going to be appropriate, and often it's very oversimplified. In other words, “Gluten free! It worked for my friend, or it worked for, you know, another patient. They said they've had good results with that.” So, I'm not really sure how quality that information is, and it may not be within their ethical scope of practice, much like it would not be within my scope of practice as a dietitian to give advice on how one should proceed with physical therapy or swallowing. We all have clinical boundaries for a reason.
And nutrition is a clinical practice, and dietitians can help to provide that information, not just to the patient, but to the whole healthcare team and put the patient experience with nutrition in context for the other health care team members.
Neurology Consultant: What key takeaways on this topic do you hope to leave with neurologists, RDNs, and related clinicians on this topic?
Mona Bostick: In my presentation, I made a distinction between conventional and unconventional modalities. I am conventionally trained, I went to, you know, college. I got a degree in nutrition. I went through a dietetic internship, worked in a clinical setting for, you know, inpatient clinical setting. Now, I'm in private practice. But I am conventionally trained, and I practice in a conventional medicine approach to health. And I feel it's really incumbent, especially in this day of blossoming field of integrative functional and other unconventional modalities being practiced by other people who've been conventionally trained, much like myself, I feel that it's really important to provide context around the language that you're using with your patients. Don't use words like heal, beat, reverse, or cure, because these are things that are not possible with a disease like MS, but patients are vulnerable and they want to hear that. So, it's our role as healthcare providers, whose first role is to do no harm, to just make sure we provide context and clarity around the words we’re using.
And, for those who are in conventional settings practicing conventional medicine, it's important to know that there are benchmarks of health beyond BMI. So, telling a patient who's newly diagnosed with multiple sclerosis, maybe they're overweight or obese, but maybe they've got multiple other comorbid health conditions, but I hear a lot from patients and physicians as well that the advice they give or receive is to just simply lose weight. That's a problem. It's easier said than done, and it may or may not be the best approach, and it's also important to remember, whether you are a physician or a nurse or an intake person, nutrition is one of the most emotionally charged topics. And we all have opinions around that, and we all potentially have biases, but it's really important to check that at the door, because nutrition is, in addition to being an opinion, it's also an area of clinical practice, and registered dietitians are uniquely qualified to provide that information in those assessments.
And lastly, patients really want this information. They need this information, and if we as credentialed qualified providers are not giving them the information, “Dr Google” is going to be really happy to fill that void, and I don't believe “Dr Google” has our patients’ best interest at heart.
Neurology Consultant: Thanks again for discussing this topic with me today. For more podcasts like this, visit Consultant360.com.