Demyelinating disease

Characterized by demyelinating lesions in the central nervous system (CNS), the symptoms of multiple sclerosis (MS) include weakness, balance problems, impaired vision, numbness, bladder dysfunction, and changes in psychological status. A chronic disease, MS presents with variable signs and symptoms, and is considered a relapsing/remitting disease, meaning symptoms come and go with periodicity. The name of the disease, multiple sclerosis, exemplifies the disease process as it occurs in the CNS (comprised of the brain and spinal cord), characterized by multiple sclerosed, or scarred, areas throughout the brain and spinal cord. Involved in this process are various components of the immune system that attack and destroy the insulating material surrounding nerve cells (myelin), and in some cases destroy the nerves themselves.

Often initially appearing in young adults, MS symptoms may occur in attacks that are separated by months or years, however actual diagnosis cannot be unequivocally made until symptoms have occurred in different parts of the nervous system. Affecting 2.5 million people worldwide, and 300,000 people in the United States, MS is far from being understood completely, and the true cause of the disease is yet to be discovered.

Standard pharmaceutical treatment for MS was not initiated until 1993, when the first approved medication was made available to patients. Since then, another 3 drugs have been approved and marketed for MS. These medications are designed to prevent relapses and slow the progression of the disease, by inhibiting components of the immune system that are implicated in the disease. Some of the drugs are agents that are very similar to a chemical produced by the body's own immune system (beta-interferon), and another is designed to mimic a component of myelin known as myelin basic protein. Not without side effects and administered via injection, these medications encompass the standard medical approach to treating MS, which is comprised of suppressing the indicted component of the immune system which researchers believe to be responsible for producing symptoms of the disease.

Of course, suppression of the disease rarely leads to cure, and does not offer any other type of healing from the process that initiated the illness, nor does it assist the body in doing what it does best, healing itself when supplied with the appropriate sources of vitality and energy.

Causes of Multiple Sclerosis

No single causative factor has been identified in the development of MS. An incredible amount of information and research has implicated a few key factors thought to play a major role in the development of this disease. Women are more affected than men, and a familial pattern does exist, but no solitary genetic anomaly has been identified. As mentioned earlier, MS changes constantly throughout the patient's life, and these fluctuations in disease symptomology can be related to various external triggers. (1) Known triggers include emotional and physical stress, excessive heat, viral infections, food allergies, and environmental pollutant exposure.

It should also be acknowledged that A + B probably does not, in this case, equal C. A disease process that involves the body literally destroying a part of itself probably has its origins in a number of sources, and the equation probably more accurately resembles 1 + 2 + 3 = 4, manifested from multiple genetic, environmental, and possibly psycho-social factors. The body can work in amazing ways, both for our benefit and against us. Mental stressors can be the main causes of illness, without a doubt. People with less than adequate coping or stress resolution skills are often more ill than those with more efficient means for coping. Dealing with one's stressors in a healthy way (externalizing them rather than internalizing) is an important part of health, as we are often our own worst enemy when it comes to allowing our bodies to function fully. Major causes implicated in the pathogenesis of MS include infectious agents, environmental exposures, individual susceptibility, and possibly, dietary factors. (2)

Infectious Agents

Viral infections have long been implicated in the pathogenesis of MS due to their known ability to cause demyelination of nerve cells in human and animal models and because of the comparatively similar symptom picture seen in other human demyelinating diseases, conclusively demonstrated to be of viral origin when compared to MS. (3) It is postulated that viral infections may directly affect the cells of the nervous system, or may cause damage through the formation of antibodies which then destroy the myelin sheaths. Other than these non-specific postulations, two newer theories, named the "Hit-Hit" and "Hit-Run" hypotheses, have recently been proposed. (4) In the "Hit-Hit" hypothesis, a viral agent remains viable and/or is reactivated in the CNS, and damage is caused directly by the virus and by the immune response to destroy it. In the "Hit-Run" hypothesis, the viral agent infects the peripheral nervous system (located outside of the brain and spinal cord), never entering into the CNS. Damage is caused by the immunologic reaction to this virus, establishing a propensity for subsequent autoimmunity due to a virally-induced aberration in the immunologic milieu. Identification and eradication of the viral agent presents one challenge, while reversing viral and immunologic damage presents quite another challenge.

Geographic Link?

Other supportive factors for the role of infection in the development of MS include a demonstrated variation in geographic location, specifically among Caucasians. There is a relationship between where a person lived as a child and their risk of developing MS later in life, suggesting an environmental link at work in the disease. The incidence of MS is greater in persons living (as children) in more northern areas of Europe and North America. (5) Other evidence suggests that when people move from a high-risk area to a low-risk area, or the reverse prior to the age of 15, they may acquire the risk associated with the new area, and if they are older than age 15, they retain the same risk associated with the old area. (6) Otherwise, the geographic hypothesis is weakened by the lack of an identifiable infectious agent and weak analysis testing the association between MS and any previous infection in subjects. (7)

However, some interesting research has been done in the area of vitamin D and autoimmune disease. Researchers have hypothesized that a form of vitamin D, known as 1,25-dihydroxyvitamin D3, exerts protective effects against MS due to the following: 1) Vitamin D3 fully protects animals from an experimentally induced form of MS, which is widely used as a research model for human MS. 2) Because of the environmental relationship between latitude and MS, it is hypothesized that a crucial factor is lack of ultraviolet light-induced vitamin D3 synthesis in the skin, and that vitamin D3 acts as a selective immune system regulator that works to inhibit autoimmune disease; therefore in low sunlight conditions, insufficient protective amounts of D3 are manufactured. 3) Despite the circumstantial nature, this theory may explain the geographical distribution of MS, and two especially interesting geographic examples: MS rates in Switzerland are elevated in low altitudes and depressed at high altitudes, where UV light is more intense, and in Norway, where MS rates are higher inland, but much lower near the coast where vitamin D3-rich fish is regularly consumed. (8) The authors of this work suggest that further research in this area may suggest the possibility that MS could be prevented in genetically susceptible people through the use of supplemental vitamin D3.

Treatment Options

As mentioned previously, the causative factors for MS are many. It is beyond the scope of this paper to address each suspected cause, especially when no single, or for that matter, several direct links are yet to be established. Natural therapeutics provide several forms of treatment with established benefits in people with MS, and can help reduce the symptoms of this disease. Long-term effects of natural therapeutics are not known at this time, however this does not imply that these therapies should not be employed. Again, MS is a disease with probably several causes, one of them being biological individuality, and what may provide some benefit in one patient may provide great or little benefit in another.

Diet

Food allergy, a common culprit in many conditions, should be strongly considered in the treatment of MS. Although clinical evidence for removal of food allergens is difficult to come by, anecdotal evidence does suggest that this approach can help to relieve MS symptoms. Additionally, evidence is accumulating that reflects the intricate relationship between food proteins and human immunity gone awry. (9) We strongly emphasize that all persons, regardless of condition, identify foods that may cause negative interactions in their bodies. Food allergies and sensitivities, when identified and removed, result in the alleviation of many patients' symptoms in other conditions. By removing these foods, the body is able to perform its regular functions with less energy directed at combating or dealing with foods that it does not agree with. Again, if one is ill, it is most important to identify all factors that distract the body from focusing on complete health and healing.

One of the most proven (and therefore most popular) dietary approaches to MS is that of the Swank diet. Although it is not our intention to recreate the information about this diet here (the internet is awash with Swank diet information), it is important to highlight this approach. Dr. Swank established the evidence that long-term diets which maintained an extremely low amount of saturated fats tended to slow the progression of the disease, as well as decrease the number of symptom attacks. MS patients on the Swank diet were followed for 34 years. Patients that adhered to the dietary guidelines were divided into three groups of neurological disability (minimum, moderate, severe), and those who followed the diet most closely displayed "significantly" less disease deterioration and death rates than controls. Additionally, the greatest benefits were seen in the "minimum" neurologic disability group, with a 95% survival rate (excluding other causes of death) and retainment of high levels of physical activity. (10) Swank recommends the following dietary guidelines:

* 20-50 grams of unsaturated fat per day

* No more than 15 grams saturated fat per day; none from processed foods

* Avoidance of red meat for one year, then 3 ounces once per week thereafter

* 1 teaspoon cod liver oil per day

* Daily supplementation with a multivitamin and mineral

Antioxidative Therapy

The role of antioxidant status in MS patients has been explored from both a causative and treatment standpoint. Oxidative stress has been implicated in many disease processes, not only MS. (11) Oxidation is a damaging biologic process that occurs basically as a side effect of normal metabolism. Unfortunately, the environment is full of other oxidants (namely pollution and chemicals) that are ingested along with the air we breathe and food we eat. Oxidation damages DNA molecules and fatty acids in the body, making it difficult for genes, and therefore cells to repair themselves adequately. Continuous damage at these microscopic levels is widely considered to be the root cause of age-related decline. (12)

One study demonstrated low levels of 4 standard antioxidant vitamins (vitamin C, beta-carotene, retinol, alpha tocopherol) in a group of MS patients compared to control subjects, and significantly elevated indicators of lipid peroxidation (an end-measure of oxidation of fats in the body) during an exacerbation of MS. (13) In a separate study, a significant increase in the amount of plasma lipid oxidizability, autoantibodies against oxidized lowdensity lipoproteins, and a measurable decrease in antioxidant capacity of patient plasma were measured in persons experiencing a flare-up of MS symptoms. (14) These findings highlight the importance of antioxidants in the prevention and treatment of disease conditions, including MS. By supplementing with adequate amounts, one may possibly mitigate the effects of oxidation on lipids, an important step in the prevention of MS.

Supplementation with vitamins C, A, E and the minerals zinc and selenium provide a good antioxidative base therapy. All of these nutrients have proven antioxidative effects, and have been widely studied for their efficacy in preventing oxidative damage in the body and restoring antioxidant status in disease states. (15) Recent research has revealed a group of even more powerful antioxidant compounds derived from plant sources. These compounds, known as oligomeric proanthocyanidins, can be found in many plant foods, however the most abundant sources include green tea, bilberry, grape seed, buckwheat, and red wine. Supplying adequate amounts of these foods in the diet may greatly decrease one's oxidative burden. Providing large amounts (studies of the protective effects of green tea revealed that those who consumed the equivalent of 10 or more cups per day experienced the greatest preventative effect) of these compounds (with the exception of red wine) in food or supplement form (supplements will allow for greater consumption) can provide a proactive and preventative strategy for lessening the severity of the MS disease process.

Prokarin

Prokarin is a proprietary formula comprised of histamine, which is a type of neurotransmitter, caffeine, and other components. Developed by Elaine Delack, RN, Prokarin is available only through compounding pharmacies with a doctor's prescription. As a treatment for MS, Prokarin is not intended as a cure. However, many practitioners and their patients are seeing positive results with this medication, which is applied topically on the skin, and absorbed into the body. A recent study comparing this product to placebo in several objective areas measuring symptoms of MS revealed that Prokarin exerted a modest improvement in fatigue symptoms, was well tolerated by patients, and caused no physical or laboratory data abnormalities. (16) Additionally, laboratory analysis determined that despite caffeine being included in the drug, it exerted no independent effect on performance. Proponents of Prokarin also advise some different dietary guidelines than those suggested earlier, for example advocating consumption of dietary fats quite different from those suggested in the Swank diet.

Other Lifestyle Modifications

Maintenance of physical fitness is important in people with MS. Although becoming fatigued is contraindicated in MS, getting regular, stimulative exercise can be beneficial for preventative maintenance as regular exercise and physical activity can minimize states of decondition and help people with MS to maintain optimal physical function. A study designed to determine the relationship between physical activity and social, mental and physical health and well being in people with MS, revealed that persons with MS who reported participating in regular exercise scored higher on physical functioning and general health measurements than those who did not exercise at all. (17)

A disease with many unknowns, MS has many potential treatment options. Newer pharmaceuticals offer some relief of symptoms, however they come with side effects, and do not contribute any curative effect. Natural therapies for MS are plentiful, with results varying from individual to individual. These therapies work to alleviate the symptoms, while at the same time providing the body with adequate sources of the materials it needs to stay healthy, and avoid further disease progression. The key, of course, is to begin therapy early in the disease process, as the further the progression, the more recalcitrant it can be. Despite the numerous natural therapies available, people with MS are encouraged to try any therapies that may provide some benefit. It is difficult to determine whether a therapy will slow or even halt the disease process until it has been used for some time. However, it is the authors' opinion that whether trying to stay healthy, or preventing the continuation of disease, it is important to give those therapies with clinical backing a chance to work in treating this disease.

References

1. Weinshenker BG. The natural history of multiple sclerosis. Neurologic Clinics 1995; 13: 119-146.

2. Kidd, PM. Multiple Sclerosis, An Autoimmune Inflammatory Disease: Prospects for its Integrative Management. Alt Med Review, 2001; 6: 540-566.

3. Stratton CW, Mitchell WM, Sriram S. Does chlamydia pneumoniae play a role in the pathogenesis of multiple sclerosis? J Med Microbiol 2000; 49: 1-3.

4. Scarisbrick IA, Rodriguez M. Hit-Hit and Hit-Run: viruses in the playing field of multiple sclerosis. Curr Neurol Neurosci Rep. 2003 May; 3(3): 265-71.

5. Victor M, Ropper AH (2001). Multiple sclerosis and allied demyelinative diseases. In Adams and Victor's Principles of Neurology, 7th ed., pp. 954-982. New York: McGraw-Hill.

6. McDonald WI, et al. Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the Diagnosis of Multiple Sclerosis. Annals of Neurology, 2001, 50: 121-127.

7. Granieri E, Casetta I, Tola MR, Ferrante P. Multiple sclerosis: infectious hypothesis. Neurol Sci. 2001 Apr; 22(2): 179-85.

8. Hayes CE, Cantorna MT, DeLuca HF. Vitamin D and multiple sclerosis. Proc Soc Exp Biol Med. 1997 Oct; 216(1): 21-7.

9. Barbeau WE. Interactions between dietary proteins and the human system: implications for oral tolerance and food-related diseases. Adv Exp Med Biol. 1997; 415: 183-93.

10. Swank RL, Dugan BB. Effect of low saturated fat diet in early and late cases of multiple sclerosis. Lancet. 1990 Jul 7; 336(8706): 37-9.

11. Konig D, Wagner KH, Elmadfa I, Berg A. Exercise and oxidative stress: significance of antioxidants with reference to inflammatory, muscular, and systemic stress. Exerc Immunol Rev 2001; 7: 108-33.

12. Golden TR, Hinerfeld DA, Melov S. Oxidative stress and aging: beyond correlation. Aging Cell. 2002 Dec; 1(2): 117-23.

13. Besler HT, Comoglu S, Okcu Z. Serum levels of antioxidant vitamins and lipid peroxidation in multiple sclerosis. Nutr Neurosci. 2002 Jun; 5(3): 215-20.

14. Besler HT, Comoglu S. Lipoprotein oxidation, plasma total antioxidant capacity and homocysteine level in patients with multiple sclerosis. Nutr Neurosci. 2003 Jun; 6(3): 189-96.

15. Gueguen S, Pirollet P, Leroy P, Guilland JC, Arnaud J, Paille F, Siest G, Visvikis S, Hercberg S, Herbeth B. Changes in serum retinol, alpha-tocopherol, vitamin C, carotenoids, zinc and selenium after micronutrient supplementation during alcohol rehabilitation. J Am Coll Nutr. 2003 Aug; 22(4): 303-10.

16. Hayes CE, Cantorna MT, DeLuca HF. Vitamin D and multiple sclerosis. Proc Soc Exp Biol Med. 1997 Oct; 216(1): 21-7.

17. Stuifbergen AK. Physical activity and perceived health status in persons with multiple sclerosis. J Neurosci Nurs. 1997 Aug; 29(4): 238-43.

by Jason Barker, ND and Chris D. Meletis, ND

Dr. Barker specializes in sports medicine and is a consultant to the exercise and nutraceutical industry, and is in private practice in Portland, Oregon www.pearlclinic.com; Dr. Meletis is an international author and educator and is in an integrated private practice at the Pearl Clinic in Portland, Oregon www.pearlclinic.com

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