Strengthen your immune system – 2 things you can do at home!

Dear all,

I hope you are all Well and Safe and have been managing to enjoy parts of lockdown. OF COURSE follow government advice, and OF COURSE this advice is not going to prevent or cure COVID-19; and I’m sure you already know the basics – eat well, lots of fresh fruit and veg, exercise daily if you can, get good sleep –  but my role has always been to bring you things from outside the box…. so here’s 2 things most people should be able to do at home. One fairly mainstream, and one less so!

  1. Get your vitamin D3!
  2. Acupressure points ‘Elegant Mansion’ !



1. Vitamin D

If you have MS, you should be taking it anyway, right?

The NHS Trust that I work for recently circulated information about vitamin D’s role in immunity, and recommended that clinicians request blood testing for vitamin D3 for their patients, and prescribe vitamin D3 on an individual basis, depending on results, as part of its staff bulletin about COVID-19.

That’s because vitamin D supplementation has been shown, in published research, to enhance the function of the immune system and reduce the risk of developing respiratory infection.  3 studies also show that high levels of Vitamin D reduce the severity of respiratory infection.

It also advised that ‘Vitamin D deficiency has been linked with a large number of conditions from diabetes to depression, and NICE now advise is that all adults in the UK should take a daily supplement containing 400 international units (IU [10 micrograms]) of vitamin D throughout the year. ‘ People with these conditions should take specialist advice before supplementing:
• Hypercalcemia or a history of hypercalcaemia
• History of renal stones
• History of sarcoidosis
• Renal impairment (eGFR<60mls/min) (1, 25 dihydroxy vitamin D may be needed)
•Thyroid/Parathyroid disease
•Paget’s Disease
•Cancer patients

Many people with MS, after looking at the research on vitamin D in MS, take a higher dose, often of 5000IU daily, which is 1000IU higher than the NHS recommended top dose of 4000IU. For more information on vitamin D3 in MS, see

How to get vitamin D3?

Either at least 10 minutes with lots of skin showing in the sun, whilst your shadow is shorter than yourself – ie middle of the day, in the UK, or, by supplementing. In my experience, under the tongue spray is better absorbed than tablets; I have had some patients who took high doses as tablets but whose blood levels only increased minimally; however on switching to the sublingual spray, they picked right up.


2. The ‘Elegant Mansion’!

I made this film as a contribution to an MS Nurses A-Z of getting through coronavirus times, which is why I had to say ‘I’ is for….!

Elegant Mansion. No, that’s not where I live, it’s the Chinese name for the acupressure points K-27s!  Acupressure is a part of Traditional Chinese medicine, and has been used for over 2000 years.  Acupressure (and acupuncture – acupressure with needles)  sends a signal to the body  to “turn on” its own self-healing or balancing mechanisms, by balancing the flow of ‘Qi’, or energy, around meridians ( a subtle circulation system, like the blood and lymphatic systems, but of energy).

The ‘K27’ points, or ‘Elegant Mansion’ are used both to stimulate lung function, boost and strengthen immunity, AND reduce anxiety. Perfect for right now! K 27 points can be stimulated by yourself, or someone can do them for you. You find them right under your collar bones, on either side of the sternum ( breastbone), and they feel like squishy dips, which may feel sore if they are in need of ‘unblocking’ !

  • Use deep, firm pressure to massage and stimulate each point, using finger and thumb of one hand, or the index fingers of both.
  • Relax, and breathe deeply.
  • Repeat the massage as often as you like; 4 or 5 times a day is good

I enjoyed this explanation of stimulating the K27s from acupressure expert Michael Gach… I think he might (!) be Californian

I like to think of the immune system as an army; we need to keep it well nourished, well rested, exercised,  and alert. Coronavirus is a new threat, which our immune systems don’t recognise, and this is why it has had such a devastating effect.  By now, many peoples’ lives have been touched by tragedy, or lost, and many people have been gravely ill. Many people have probably already been exposed without drastic effects. In the end, we will probably all be exposed to the virus at some point, and it is our immune systems that we need to fight it off, or help us to recover, and to help us stay well on a daily basis.

We’re still learning about coronavirus, but supporting our immune system is always going to be a positive, so let’s do whatever we safely can,  and look forward to hopefully seeing each other face to face again soon.

All the best,

Vitamn D References
1. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-RazG, Esposito S, Ganmaa D, Gender AA, Goodall EC. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. bmj. 2017 Feb 15;356: i6583.
2. Gruber-Bzura BM. Vitamin D and Influenza—Prevention or Therapy? International journal of molecular sciences. 2018 Aug;19(8):2419.
3. Grant WB, Giovannucci E. The possible roles of solar ultraviolet-B radiation and vitamin D in reducing case-fatality rates from the 1918–1919 influenza pandemic in the United States. DermatoEndocrinology. 2009 Jul 1;1(4):215-9.
4. Huang F, Zhang C, Liu Q, Zhao Y, Zhang Y, Qin Y, Li X, Li C, Zhou C, Jin N, Jiang C. Identification of amitriptyline HCl, flavin adenine dinucleotide, azacitidine and calcitriol as repurposing drugs for influenza A H5N1 virus-induced lung injury. PLoS Pathogens.2020 Mar 16;16(3):e1008341.

Are your tablets destroying your brain? What to do about anticholinergics

OH NOOO!NOOO! I hate it when a drug that was a useful tool turns out to have really bad side effects!

In an ideal world, we’d all be drug free, of course, but hey – noone is taking this stuff for fun!

You may have seen in the news recently the reports linking drugs with an anticholinergic effect with dementia and cognitive problems. This type of drug includes over the counter anti-histamines for allergies/hayfever.  Many people with MS take anti-cholinergic drugs for bladder overactivity/urgency, which include:

Detrusitol / Tolterodine, Solifenacin / Vesicare, Oxybutnin / Lyrinol XL/Kentera patches, Fesoterodine fumarate / Tovias, or Darifenacin / Emselex

and many take a low dose of tricyclic antidepressants for nerve pain, which include

Amitryptilline, and its less sedating sister, Nortryptilline.

Awareness has been building about the link between anticholinergics and cognitive problems; in fact a review on the subject in 2009 found twenty-seven studies that met their inclusion criteria, of which, all but two  found an association between the anticholinergics  and either delirium, cognitive impairment or dementia. (1)

This month, however, the a new study on 3434 people provides the ‘strongest evidence yet’ that anticholinergic drugs may increase the risk for dementia in older adults.( 2)

All studies done on the effects of anticholinergics have been done in older adults  “There is no data on how these drugs may affect younger people, but I personally will avoid taking anticholinergic agents,” – Shelley Gray, author of the study.

What if you’re only on a low dose?

Unfortunately if that’s a continuous dose, it still counts. Eg 3 years of taking low dose medication with anitcholinergic effect for neuropathic ( nerve) pain counts as high use.

What to do if you’re on one of these meds?

Obviously, full blown dementia in old age is unlikely to be reversible. However, previous studies on people coming off anticholinergics found that the detrimental effects on thinking were reversible(3), so don’t panic!

What are the alternatives?

For the bladder, two of the alternatives I actually mentioned in a recent post: tibial nerve stimulation, and mirabegron,  a selective beta3 adrenoceptor agonist, which works in a different way to anticholinergics.  NICE has recommended mirabegron as an option for treating overactive bladder (OAB) “only for people in whom antimuscarinic drugs are contraindicated or clinically ineffective, or have unacceptable side effects”, which means that you may have to fight for it, or get the help of your continence service to request it, due to the difficulties these days in accessing medicines that are not the cheapest available.

As you will know, if you have urinary urgency with MS, you should never take medications for it before being seen and scanned by a continence nurse, as the problem can sometimes be cause by the bladder not emptying properly, and in this case, the drugs don’t work, they only make it worse!

If however, you’ve been assessed, and found to have a severely overactive bladder, one option, under urology, is to have botox injected into the bladder wall, which completely relaxes the bladder, and lasts for several months. You have to be willing and able to take on intermittent self catheterisation if necessary, and when it works, it can be a real life changer.

Non drug options?

One of the commonest (? rude?)- most common things that people report are being benefitted by hyperbaric oxygen at the Therapy Centre is bladder urgency.I don’t deal in ‘miracles’ but there’s a link in today’s telegraph online about it:

Other little pieces of magic can be reflexology or acupuncture. Small studies have  shown positive effects for treating this problem, and I have had patients reporting good results after seeing our reflexologists, Theresa and Lorna but non are large or robust enough to become very official ( the studies, not Theresa and Lorna! )

Here’s one of the main acupressure points for self help: acupressure for bladder

400-600mg of magnesium can sometimes have a calming enough effect to reduce bladder symptoms, and reducing caffeine and bladder retraining can also have a good effect. (4) Your best source of expertise on the bladder is your continence service nurse, and its a good idea to go back every couple of years to stay one step ahead of any bladder problems in MS.

What about nerve pain?

Luckily, there are other effective medications for distressing neuropathic pain in MS, the most commonly prescribed being Gabapentin, and its updated ( and more expensive) version, Pregabalin. Although there are, as with all drugs, possible side effects, the most common for Gabapentin being weight gain, they are not linked with the dangers to cognition that the anticholinergics are.

At the MS Therapy Centre, we are lucky to be able to offer APS Therapy, which has had a great result for many people, and the therapies Shiatsu and reflexology also have potential to help. So – if you find that you are regularly taking medication with an anticholinergic effect, have a think about the alternatives, and work with your GP to change your prescription, for a clearer head.

1) Clin Interv Aging. 2009; 4: 225–233. Published online 2009 Jun 9. PMCID: PMC2697587

The cognitive impact of anticholinergics: A clinical review


Cumulative Use of Strong Anticholinergics and Incident DementiaA Prospective Cohort Study

Shelly L. Gray, PharmD, MS1; Melissa L. Anderson, MS2; Sascha Dublin, MD, PhD2,3; Joseph T. Hanlon, PharmD, MS4; Rebecca Hubbard, PhD2,5,6; Rod Walker, MS2; Onchee Yu, MS2; Paul K. Crane, MD, MPH7; Eric B. Larson, MD, MPH2,7
JAMA Intern Med. Published online January 26, 2015. doi:10.1001/jamainternmed.2014.7663

4)     Hartmann KE, McPheeters ML, Biller DH, Ward RM et al. Treatment of Overactive Bladder in Women. Evidence Report/Technology Assessment No. 187. Rockville: Agency for Healthcare Research and Quality (AHRQ). August 2009. [Full text] [PubMed]