Multiple Sclerosis: Addressing Contributing Factors and Symptoms
Meredith Murray, ND
Multiple sclerosis (MS) is the most common chronic immune-mediated inflammatory demyelinating disease of the central nervous system and affects approximately 100 people out of 100,000.The exact cause of multiple sclerosis is still unknown, but it is strongly accepted that it is a complex combination of immune dysregulation, genetic variants, and environmental factors that all contribute to the development of this disease.
Even though there are multiple factors that can contribute to a person’s development of this condition, which will be reviewed here, ultimately the common denominator for underlying issues relating to MS development is inflammation. It is becoming more accepted that inflammation is thought of as a main factor of many chronic diseases. Multiple sclerosis is a very serious and often a debilitating illness. While the severity of this diagnosis and all its unknowns can be daunting, practitioners can recall back to the foundations of wellness as being supportive for their patients.
Oxidative Stress/Inflammation: Reactive oxygen species and subsequent mitochondrial dysfunction are considered to be playing a role in the demyelination and axonal damage in MS. It stems from inflammation, triggering a cascade of effects ultimately compromising the blood brain barrier and causing an immune response that activates microglia and eventually damage in the nervous system2.
Smoking: One of the strongest lifestyle factors that has been associated with MS risk is smoking. Research has consistently shown that smoking increases risk of developing MS, yet its effect on the progression of the disease is still unknown. Interestingly, the correlation was not found with chewing tobacco, which suggests nicotine is not the responsible agent. Smoking status is something that should be inquired of all patients and appropriate counseling/support for cessation can be given.
Vitamin D: Vitamin D status is generally something of interest to integrative practitioners as it can factor into a variety of different health concerns. Research has shown that there is an inverse relationship with serum vitamin D levels and MS prevalence and/or risk of MS development1 as well as disease activity in diagnosed MS. The Nurses’ Health Study demonstrated that when women took >400IU of vitamin D level daily, their risk of developing MS was reduced. Vitamin D status is thought to be one explanation of why there is an incident of MS at higher latitudes compared to other geographical locations, though this hypothesis was challenged in a 2010 systematic review1.
Viruses: As it is understood that the immune system is involved in the pathogenesis of MS, there are varying hypotheses as to how the immune system becomes activated. One theory, that has been relatively well studied, is that an infectious stimulus such as viral infection may be a trigger for MS, but the evidence of viruses directly linked to MS development has not been shown. Epstein-Barr virus (EBV) has an interesting relationship to MS. There have been several studies that show the risk of MS increased after infectious mononucleosis, including one study that showed that EBV seropositivity in MS patients was 100%, compared to the healthy population where it is 83–90%. More research is warranted to evaluate the connection between EBV and MS, as it is likely complicated. Other viruses, Varicella Zoster virus (VZV) and Cytomegalovirus (CMV), have been studied as possibly being associated with MS. However, the research is limited and not very strong. The research has not supported any connection between MS and vaccination.
Genetics and Immunopathology: As the realm of genetic research expands, the ability to detect variants connected to MS increases. A paper published in 2013 indicated there was over 100 genetic variants associated with immune function that were linked to MS risk with the functional effects being not well understood. The MHC (major histocompatibility complex; also known as the HLA: Human Leukocyte Antigen) class I and II alleles are the most well known as increasing risk of MS development. It appears that modulating the immune system to downregulate TH1 and increase TH2 and TH3 responses can help reduce MS disease activity, which has been shown with various pharmaceuticals1.
GI Dysbiosis: The study of the human microbiome and its role in various diseases has been growing considerably in the last decade. Multiple sclerosis is just another disease that is being researched for the bacterial connection. At this point, the modulation of the bacteria as a treatment mechanism for MS has only been performed in the mouse model of MS. There is now an “MS Microbiome Consortium” looking to evaluate the differences in the microbiome of MS patients and how those differences play a role in the inflammatory process of the disease. This may lead to treatment interventions both at a bacterial level and at a dietary level. One interesting finding of differences in the microbiome of MS patients compared to controls was the increase in Methanobrevibacter and Akkermansia and a decrease in Butyricimonas species.
Environmental factors – BPA and plastics: The exposure to plastics, such as BPA, in our environment is an undeniable influence on disease states, such as obesity and diabetes. It has recently been reported that even BPA exposure during gestation can lower threshold for autoimmunity in a mouse model for MS, indicating that it may be a risk factor for developing MS later in life.
Addressing the Factors:
The above influential factors in the development of MS can be addressed through many primary methods of integrative medicine: optimizing diet, nutrition and lifestyle to lower inflammation and reduce toxic burden.
- Adopting an anti-inflammatory diet. As always, encourage a diet rich in colorful fruits and vegetables, whole grains, lean meats and healthy fats. Not only do these foods contain beneficial anti-inflammatory components, this type of diet encourages a healthy and diverse microbiome.
- Terry Wahl, MD is a pioneer in addressing and treating multiple sclerosis through dietary measures alone. She utilized a specific method on herself, now known as the Wahls protocol, and went from being wheelchair bound with MS to walking and bicycling within a year.
- Evaluate vitamin D status and utilize supplementation to achieve optimal levels. This is especially important in areas of higher latitudes, which tend to have lower vitamin D levels and higher incidences of MS.
- Discuss smoking history with each patient. Without judgement, encourage cessation and offer any supportive methods or resources.
- Educate patients about the exposures of plastics, chemicals and toxins in their environment. Some simple switches could include using a glass reusable water bottle and glass food storage dishes, instead of plastic options, to limit exposure to BPA.
While the above deal with some of the influences in MS development, some integrative modalities can be used to address some of the symptoms that arise during the course of MS.
Yoga has also been researched on its ability to help improve the cognitive issues which occur in MS. Cognitive reserve (CR) and brain reserve (BR) can possibly be an explanation of the discrepancy between cognitive decline and pathophysiological damage in MS. BR is passive and fixed and a result of brain size and brain volume. CR is passive and not fixed and can be affected by brain plasticity as a result of life experiences. One study took the knowledge on CR and BR with MS patients as a way to determine if mind-body techniques could be used therapeutically. There have been multiple studies showing yoga practice and mindfulness meditation (MM) practice to be beneficial in minimizing cognitive decline and improving CR. It has also been shown that an increase in CR can prevent cognitive decline in MS patients. Therefore, it is concluded that the adoption of yoga and MM in early onset of MS may help to attenuate decline as well has help the patient cope with burden of disease, postponing cognitive symptoms that accompany physical neurological decline.
A 2014 review from the American Academy of Neurology rated oral cannabis extract to be safe and effective to deal with the spasticity/pain for MS patients (a recommendation level of A-Effective). This was the only “CAM” intervention with this level of recommendation. Synthetic THC and smoked cannabis were not shown to have the same effect.
Overall, integrative practitioners, with their knowledge and passion about educating people to lead healthy lifestyles, can be a positive resource for addressing some of the factors that can influence a complex condition like MS.
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