Nov
02
2013

MS Is A Multifaceted Disease

By | Allergies, Multiple sclerosis, Nutrition, Prevention

A new study was recently released that showed that MS is a multifaceted disease. A significant number of people without multiple sclerosis have narrowing of their neck veins. There is a new theory that chronic cerebrospinal venous insufficiency due to narrowing of veins outside the skull may be responsible in causing MS in a significant percentage of patients. Using venograms in MS patients and in controls without MS a recent study from the University of British Columbia, Vancouver, BC showed that normal controls also had narrowing of neck veins and the authors felt that this invalidated the vascular theory of MS. This story is based on this Lancet publication.

Brain oxygenation is what counts

What was not mentioned in this publication was that venous blood flow on the surface of the brain can get obstructed inside the skull. It’s all about brain tissue oxygenation; if the brain gets enough oxygen, all is well. If there were a lack of perfusion due to venous congestion inside or outside the skull, the patient would be in trouble.  I will discuss this further below.

In this blog I will discuss first how to diagnose MS, then mention some newer studies about neck vein circulation with SPECT scanning. I will then review various causes of MS and return to a discussion of the Vancouver study from above.

How MS is diagnosed

The physician can combine a number of tests to diagnose MS. This includes the patient’s symptoms such as balancing problems, double vision, memory problems, fatigue etc. Neurological examination, imaging studies like MRI scanning, lumbar puncture to examine the cerebrospinal fluid and evoked potential studies is what a neurologist orders. The physician requires all of these findings to decide whether the criteria for making a diagnosis are in keeping with all the symptoms of MS. In 2001 an international neurological panel developed the McDonald criteria for diagnosing MS, which were revised in 2010.

MS Is A Multifaceted Disease

MS Is A Multifaceted Disease

Newer ways diagnosing perfusion problems in MS patients (SPECT scan)

One of the newer functional scans is a SPECT scan. It shows areas where there is a lack of blood supply to the brain, but can also identify areas where too much blood circulates. Here is a site where the technique of the SPECT scan is reviewed in more detail.

SPECT scan results in MS patients

SPECT scans in MS patients showed a significant reduction in blood flow to the frontal lobes and to the left temporal lobe. Reduced activity of the left temporal lobe on SPECT scans correlated with MS patients having a deficit in verbal fluency and having a problem with verbal memory. This indicates that a reduction in blood flow to these areas of the brain associates with developing MS.

Perhaps a SPECT scan of the brain (which is where the action of MS is) may be a better indicator for MS than looking for veins in the neck by ultrasound or venograms, as SPECT scans look directly at brain perfusion. The question is whether these blood circulation problems in MS patients may cause deficiencies in the brain of oxygen, nutrients and possibly of other internal mediators.

Known causes of MS

There are a number of known causes of MS, which I will review below.

Autoimmune disease

As this link shows, MS is a disease due to inflammation of the brain. The area where there is inflammation leads to demyelination from loss of the myelin sheaths, which causes the white lesions visible on MRI scans of the brain. One such cause is an allergy to wheat and wheat products. Gliadin antibodies and anti-tissue transglutaminase antibodies were positive in a significant number of MS patients, but not in controls. This suggests at least in part that immunological causes are at play. I agree with this blog that describes that there is significant evidence that gluten intolerance can lead to MS and the positive tests that were found by researchers are likely just the tip of the iceberg.

Overlap of celiac disease and MS

Dr. William Davis describes in Ref. 1 and 2 that you can have celiac disease with no gut symptoms, in other words a person can develop autoimmune symptoms from gliadin and gluten sensitivity without diarrhea or bowel cramps. Dietary lectins, particularly the ones found in wheat lead to leaky gut syndrome and subsequently to autoimmune diseases. One of these autoantibodies can cause MS by destroying the myelin sheath. In a mouse model Mayo Clinic researchers have shown that an antibody injection can be used to block autoantibodies against the myelin sheath. Investigations are ongoing with regard to whether this type of treatment would work in humans as well.

Genetic factors

It is known that a human leukocyte antigen (HLA -DRB1) shows an association with the risk for developing MS. Caucasians have a higher risk of developing MS and they also carry the HLA-DRB1 antigen more often. Another genetic factor is a variation of the IL7R gene. You can read about it under the HLA-DRB1 link. On average the risk of getting MS in the general population is about 10 to 20%.

Nutrition and dietary factors

It has been described that vitamin D3 levels when obtained from in MS patients are low. Vitamin D3 can prevent against MS to a certain degree, so does sun exposure. In countries where malnutrition is common, MS occurs more often.

According to Dr. Terry Wahls who is a clinical professor of medicine at the University of Iowa Carver College of Medicine, a diet of vegetables, fruit, meat, no grain, no dairy, no sugar, no corn and no potatoes can cure MS. Dr. Wahls herself had severe MS in the past and cured it with the help of this diet!

Infections

Certain infections can cause MS. Probably the best correlation was found between the mononucleosis virus (Epstein Barr virus) and the later development of MS.

Chronic cerebrospinal venous insufficiency

According to Dr. Zamboni from Italy clogged veins in the neck can cause MS. Dr. Zamboni placed stents into neck veins that showed narrowing.  He found that about 50% of MS patients had improvement with the placement of stents. This allows the blood from veins around the brain to drain normally. This could improve brain circulation in the areas described above where SPECT scans detected a lack of blood supply to certain parts of the brain.

Discussion of the Vancouver publication

It is important to note that certain areas of the brain were not circulating blood as well as others. SPECT scans depicted the blood circulation of the brain. 50% of patients with chronic cerebrospinal venous insufficiency experienced a cure from MS with simple venous stent procedures. This is remarkable. Sure, the Vancouver researchers found that normal controls also have a significant amount of venous abnormalities in their necks. But this does not explain the successes in those MS patients who got better with a simple venous stunt procedure. We also need to be cognizant that Big Pharma sponsored the Vancouver study researchers.

Measuring brain circulation in MS patients

SPECT scans on both the control groups and the experimental MS groups before and after stent procedures need to be done. This way we know whether the brain circulation following stent procedures improved or not. However, this is what I would have expected to see. In other words more research is necessary by other investigators. The question they need to answer is whether or not the surgical stents provided help. Did the surgical procedure help to normalize their brain circulation or not?

Conclusion

Our knowledge regarding MS is getting more multifaceted as new research is emerging. Diet appears to be a major contributing factor, as vitamin D3 is essential for normal brain function and for a normal immune system. At the same time researchers identified grains and wheat as a cause of MS in a subgroup of patients. Leaky gut syndrome can cause autoimmune antibodies, which subsequently can bring on MS. Avoid the foods Dr. Wahls described as being causative in developing MS and you can improve MS remarkably or get cured. The same is true for avoidance of wheat and wheat products as Dr. Davis described.

Multifaceted causes of MS

In my opinion not every MS patient benefits from a stent, but vitamin D3 deficiency or a history of mononucleosis infection in the past does not explain the causation of every MS case. We simply do not have all of the answers yet. But we do have enough information to thoroughly investigate MS patients;  the treating physician will then use clinical judgment to decide which treatment would be the most suitable one for an individual MS patient.

More information on multiple sclerosis: http://nethealthbook.com/neurology-neurological-disease/multiple-sclerosis/

References

1. Stern: Massachusetts General Hospital Comprehensive Clinical Psychiatry, 1st ed. “DSM-IV SUBTYPES OF MDD”. Copyright © 2008 Mosby

2.  William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.

3.  William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.

Last edited Nov. 7, 2014

Sep
01
2007

MS Vaccine Breakthrough

By | Multiple sclerosis, Prevention

One of the great hopes associated with genetic research is the goal to combat disease. With the human genome project completed it is now possible to look at new therapies. The work remains large and seems to be overwhelming, but a new vaccine for MS represents a major triumph. MS has been an illness that has devastated individuals and their families. It also has vexed and frustrated researchers and health professionals. Immunomodulating therapy with interferon has been able to make a difference in the quality of life for many patients, but so far it has been a seemingly impossible dream to find a vaccine that is safe and effective.

Montreal research, which has been published in August, confirms that the vaccine works by reducing the numbers of the immune system cells attacking the nerve fiber sheath. MS belongs to the groups of autoimmune diseases, meaning that cells of the own immune system turn against other body cells and destroy them. The challenge has been to stop these cells. So far immunomodulators have been looked at as an answer to this problem. This breakthrough represents a first in the history of medicine where a DNA vaccine will be used in the treatment of an autoimmune disease, which is MS.

MS Vaccine Breakthrough

MS Vaccine Breakthrough

Other autoimmune diseases are lupus or rheumatoid arthritis. No vaccine is available for these diseases, but the first DNA vaccine represents hope for many, that more therapies will become available.

As this review shows, the DNA vaccine experiment against MS failed, because in clinical trials it did not stop MS lesions from growing: http://multiple-sclerosis-research.blogspot.com/2012/01/research-myelin-dna-vaccination-and.html

More information about MS: http://nethealthbook.com/neurology-neurological-disease/multiple-sclerosis/

Reference: National Review of Medicine, August 30, 2007, page 10

Last edited November 3, 2014

Jun
01
2005

Epstein-Barr Virus Responsible For Multiple Sclerosis

By | Multiple sclerosis

Multiple Sclerosis (MS) is a chronic disease, which is dreaded by patients and a puzzle to researchers. While there are MS treatments that control the disease, it remains crucial to treat the early onset. So far the triggering factors have been an unsolved puzzle. Genetic traits and poor nutrition have been implied, yet there has been no conclusive evidence. For a long time there has been the suspicion amongst researchers, that a “multiple sclerosis virus” could be the culprit.

New research, which has been published in the Journal of the American Medical Association shows that the truth is not far off.

Between 1988 and 2000 blood samples have been taken in a study among medical personnel of the United States. Special attention was paid to the group that was granted a permanent disability due to chronic illness. Amongst those who had Multiple Sclerosis, positive blood tests for Epstein Barr virus titers were prominent. The affected individuals were young adults, and the infection with the Epstein-Barr virus had occurred several years before the onset of the illness (the average time between the collection of the blood specimen and the onset of MS was 4 years.) There was also a correlation between the age of the patient and the occurrence of illness. The risk at age 25 was three-fold higher than at age 20 to contract Epstein Barr viral infection. Another strong indicator was an elevated serum level of IgG antibodies to EBNA complex or EBNA-1. This finding was associated with a three-fold risk for the development of MS.

Epstein-Barr Virus Responsible For Multiple Sclerosis

Epstein-Barr Virus Responsible For Multiple Sclerosis

This result would be of interest to young adults who were infected with mononucleosis, as the Epstein-Barr virus, which triggers the seemingly harmless and self-limiting “kissing disease”, seems to entail a higher risk for the development of MS in a younger adult population.

More information on MS:  http://nethealthbook.com/neurology-neurological-disease/multiple-sclerosis/

Reference: JAMA Vol293, Nr.20, 2496-2501, May 25,2005

Last edited October 28, 2014

Jan
01
2005

Relapse Of MS Reduced By New Drug

By | Multiple sclerosis

The effects of MS have been devastating to people afflicted by the disease. New research has brought treatments to combat the progression of the illness, yet relapses after remission have remained perplexing and frustrating to physicians and patients alike. Interferon has been a tremendous help, but patients often experienced flu-like symptoms after receiving interferon. Treatment with steroids has been problematical as well.

The results with Natalizumab (Antegren) are showing impressive results: relapses of MS are reduced by two-thirds (compared to placebo) The drug mechanism works by inhibiting the migration of aggressive auto-immune cells into such tissues as the brain, where they would cause inflammation, which in turn would cause MS lesions. Dr. Paul O’Connor is the lead investigator of the trial and chief of the MS clinic at St. Michael’s Hospital in Toronto, and he reports that this new medication gives double the effect compared to previous drugs against MS. MRI scans also showed 90% less new lesions compared to patients who took placebo (ineffective “fake” medication). Compared to previous MS drugs the medication is safe and well tolerated. The administration of the drug has to be done intravenously, so the patient would need to make a trip to a clinic or hospital once a month.

Relapse Of MS Reduced By New Drug (Approved, Then Not Approved, Now Approved Again)

Relapse Of MS Reduced By New Drug (Approved, Then Not Approved, Now Approved Again)

On the strength of the excellent results the approval process of the drug is carried out only after one year of the study. A second study involving approximately 1,200 patients is ongoing, and the manufacturers of natazulinab (Elan Corp. and Biogen Idec Inc.) are anticipating regulatory approval in the United States. They are also seeking the approval of the drug with Health Canada.

Addendum: This drug was withdrawn from the market due to unacceptable side-effects as can be seen from this link. Here is a review of multiple sclerosis treatments that offers an alternative approach.

Reference: The Medical Post, November 30, 2004, page 49

Last edited October 27, 2014

Sep
01
2004

Epstein-Barr Virus Linked With MS

By | Infectious Disease, Multiple sclerosis

MS, the debilitating and at times fatal disease which affects about 50,000 Canadians continues to be a puzzle to medical researchers. New findings are shedding new light on this illness and may help to unravel its complexities and bring more effective treatment to patients.

Dr.Brenda Banwell from the Department of Pediatrics and the Pediatric MS Clinic at The Hospital For Sick Children in Toronto found that 83 % of children with a diagnosis of MS showed evidence of a previous Epstein-Barr virus infection. (Healthy controls only showed a rate of 42 %). No differences were found for other viruses (like herpes, parvovirus, chicken pox). Researchers have yet to determine, whether there is a link between Epstein-Barr virus infections and MS, or whether MS patients are more susceptible to Epstein-Barr infections.

With regard to MS treatment amazing improvement has been demonstrated on MS patients who were treated with the cholesterol-lowering drug simvastatin. A reduction of MS induced brain lesions by 44 % was achieved in patients treated with the drug, and animal experiments show similar results. Researchers are cautioning MS patients that more investigations will be needed, till this treatment will become a new standard in the treatment of MS.

Epstein-Barr Virus Linked With MS

Epstein-Barr Virus Linked With MS

Link to more information on multiple sclerosis.

Reference: Parkhurst Exchange, Vol.12, Nr.8, August 2004,page26

Last edited December 8, 2012

Feb
01
2004

Less Multiple Sclerosis (MS) With Vitamin D Supplement

By | Multiple sclerosis, Uncategorized

In multiple sclerosis (MS) the body’s immune system appears to attack the insulation material of nerve cells (called “demyelination”) leading to areas of focal inflammation. These areas can be depicted with MRI scans (see white MS lesions, compared to a normal brain). A new study showed that vitamin D supplementation (as part of a multivitamin supplement) was reducing the risk of developing MS in women when compared to women who did not take supplements. This study was published by Munger et al. from the Department of Nutrition, Harvard School of Public Health, Boston/MA, in the Jan. 13, 2004 edition of Neurology.

The study is based on data from two large nurses health studies (NHS with 92,253 women followed from 1980 to 2000 and NHSII with 95,310 women followed from 1991 to 2001). The study material was pooled into one database. Among these 187,563 women 173 developed MS during the course of the original studies. When the group of women who took 400 IU or more of Vit.D supplements (as multivitamins) were compared to the group who took less than 400 IU or none, the investigators found that they were 40% less likely to develop MS. Other factors that can lead to higher frequencies of MS such as smoking or latitude at birth had been adjusted for. There has not been a change in the results of the protective effect of Vit.D. With food being the only source for vitamin D (skim milk, fish) the protective effect against MS was not demonstrable. However, when food vitamin D was combined with additional multiple vitamin tablets (with vitamin D) the protective effect against MS was observed.

Less Multiple Sclerosis (MS) With Vitamin D Supplement

Less Multiple Sclerosis (MS) With Vitamin D Supplement

In the introduction the authors pointed out that Vit. D has been shown in other studies to be an immune response modulator weakening autoimmune reactions. This effect has been shown clearly in a mouse model of MS, called experimental autoimmune encephalopathy. There are also data available from human research, which showed that certain cytokines are released in the presence of vitamin D so that the immune cells are less likely to attack the brain tissue. There were also seasonal variations that could be demonstrated in this study, which indicated that MS lesions were progressing at times when vitamin D levels were low and that they were regressing when vitamin D levels were high.

The authors of this study stressed that this is the first study to suggest a protective effect of vitamin D against MS, which would have to be confirmed in other studies that preferably would also include males. It shows a very strong statistical connection, but cannot conclusively prove causation. The investigators said that further studies will also be needed to confirm the notion that vitamin D may be beneficial as part of the treatment in MS patients.

Link regarding vitamins and minerals: http://www.nethealthbook.com/articles/vitaminsmineralsandsupplements.php#vitaminsandminerals

Last edited December 8, 2012