Understanding Multiple Sclerosis

by John G. Connor, M.Ac., LAc.,  edited by Barbara Connor, M.Ac., L.Ac.

TABLE  OF  CONTENTS
Introduction
What is Multiple Sclerosis?
What causes Multiple Sclerosis?
Chinese Medical view of Multiple Sclerosis
Acupuncture, Craniosacral Therapy, Botanicals and Nutrients in treating MS symptoms
Recommended foods
Swank’s Dietary Protocol
Foods to Avoid
Botanical and Nutritional Support
Herbal and Nutritional Supplement Safety Issues
Lifestyle Recommendations
References

INTRODUCTION
In our treatment of multiple sclerosis (MS) Barbara and I use a combination of acupuncture, craniosacral therapy, botanicals, nutrients, dietary and lifestyle recommendations.  None of the treatment modalities we employ can cure MS but we believe our treatments can help with symptom management and with some of the side effects of the conventional drugs used for MS.  

People with MS are widely using complementary and alternative medicine (CAM) treatments. Internationally, study results indicate that the prevalence of CAM use among people with MS ranges from 41% in Spain to 70% in Canada and 82% in Australia. The reasons for CAM use vary from treatment of concrete symptoms to bodily exploration and development of coping strategies, and CAM treatments are most often used in combination with conventional treatment. (Skovgaard et al 2012)

Over the last few decades medications, such as Betaseron, Avonex and Copaxone, have been developed that favorably alter the disease process in MS.  In recent years the scenario of therapies for MS has widened with the advent of new drugs. The majority of people with MS are probably using one of these medications under the supervision of a physician with expertise in treating MS.  We realize that MS is a very complicated disease and we sincerely hope the following article helps clarify the role that integrative treatments can play in helping people with multiple sclerosis to have a better quality of life. 

The increasing number of first-line and second-line treatment options, together with the variable course of the disease and patient lifestyles and expectations, makes the therapeutic decision a real challenge. There is no single best treatment strategy, but therapy has to be tailored to the patient. This is a time-consuming task, rich in complexity, and influenced by the attitude towards risk on the parts of both the patient and the clinical team. (Lugaresi et al 2013) It is now established that anti-inflammatory and immunomodulatory treatment is beneficial in the early relapsing stage of MS, but these treatments are ineffective in secondary progressive and particularly in primary progressive MS. (Losy J 2013)
 
WHAT  IS  MULTIPLE  SCLEROSIS?
Multiple sclerosis is a disease of the central nervous system (CNS), including the brain, the optic nerve and the spinal cord.  It affects various parts of the nervous system by destroying the myelin sheaths that cover the nerves and leaving scar tissue called plaques, ultimately resulting in destruction of the nerves.  This process is known as sclerosis.  Because the sclerotic lesions can heal, this disease goes through characteristic phases of remission and relapse.

Multiple sclerosis is a neurodegenerative disease characterized by chronic inflammation accompanied by demyelination of neurons in brain. MS is characterized by symptoms like mood disorder, fatigue, vision changes, muscle weakness, and motor changes. Chemokines like IL-17, chemokine (C-C motif) ligand 17 (CCL17), and CCL20 are suggested as major mediators in MS neuroinflammation and pathology. (Bhullar & Rupsainghe 2013)

Multiple sclerosis is an autoimmune disease characterized by recurrent episodes of demyelination and axonal lesion mediated by CD4+ T cells with a proinflammatory T helper (Th)1 and Th17 phenotypes, macrophages, and soluble inflammatory mediators. The overactive pro-inflammatory Th1 cells and clonal expansion of B cells initiate an inflammatory cascade with several cellular and molecular immune components participating in MS pathogenic mechanisms. (Mirshafiey & Kianiaslani 2013)

MS involves autoimmune inflammatory attack against the myelin insulation of neurons.  Thymus derived (T) cells sensitized against myelin self-antigens secrete tumor necrosis factor, cytokines, prostaglandins and other inflammatory mediators that strip away the myelin and sometimes destroy the axons.

 Symptoms vary from person to person.  They usually begin with fatigue followed by visual problems (double vision and blind spots), numbness and tingling, speech disturbances, dizziness, bowel and bladder disorders, weakness, lack of coordination (difficulty walking, foot dragging), paralysis, loss of balance and emotional instability.

Multiple sclerosis (MS) has traditionally been considered an autoimmune inflammatory disorder leading to demyelination and clinical debilitation as evidenced by our current standard anti-inflammatory and immunosuppressive treatment regimens. While these approaches do control the frequency of clinical relapses, they do not prevent the progressive functional decline that plagues many people with MS. Many avenues of research indicate that a neurodegenerative process may also play a significant role in MS from the early stages of disease, and one of the current hypotheses identifies mitochondrial dysfunction as a key contributing mechanism. We have hypothesized that pathological permeability transition pore (PTP) opening mediated by reactive oxygen species (ROS) and calcium dysregulation is central to mitochondrial dysfunction and neurodegeneration in MS. (Su et al 2013)

According to Dr. Andrew Weil although many of us associate MS with eventual paralysis, the course of MS is extremely individual, ranging from periodic, mild flare-ups in some people to severe progression of symptoms in others.  In fact more than 75% of people with MS will never need to use a wheelchair.

WHAT  CAUSES  MULTIPLE  SCLEROSIS?
The cause of MS is still unknown, although it is widely believed to be an autoimmune disease in which white blood cells attack the myelin-producing cells in the CNS as if they were a foreign substance.  T-cells reactive to the major constituents of myelin, such as myelin basic protein (MBP) and proteolipid protein, migrate from the peripheral circulation, across the blood-brain barrier, and into the brain.  There they proceed to attack myelin-ensheathed axons and myelin-producing cells, initiating an inflammatory cascade that eventuates in the white matter lesion or plaque of MS. 

Myelin-reactive T-cells in the peripheral circulation may become activated by microbes. Structural similarities between the foreign antigens on the microbes, and the self-antigens of myelin may lead to inadvertent auto-sensitization of the T-cell against self.  Cytokines, which are small peptide substances that act as cell-to-cell messengers to regulate immune cell activity, may also play a role.  Cytokine production can set the immune system into one of two major modes: T-helper types 1 (Th1) or 2 (Th2).  Th1 activation features mainly cell-mediated cytotoxicity, and inflammatory and hypersensitivity reactions.  In MS the Th1 pattern dominates.  Therapeutics are being pursued that down-regulate Th1 cytokines, with the goal of systemically turning off the autoimmunity of MS.

Some experts suggest that an as-yet-unidentified virus may be involved.  Heredity may also be a factor.  Another theory is that it is caused by food intolerances or allergies, especially allergies to dairy products and to gluten.  It has been seen to follow malnutrition, emotional stress, and infections.

The cerebrospinal fluid (CSF) of most MS patients contains an elevated level of antibodies, which is characteristic of an infectious process. One hypothesis states that this is in fact due to an unrecognized infectious agent that causes MS.  Epidemiological studies suggest MS is initiated by a primary encounter with an environmental agent during childhood or early adulthood.  Viruses are obvious candidates for the infectious agents in MS because several cause demyelination in humans and animals.  The demyelination of MS may result from direct viral damage to brain cells, or from viral infection leading to the formation of antibodies, which then attack the myelin.

Some studies suggest that oxidative stress may be one of the sources, or a consequence of the disease, from loss of oxidant/antioxidant balance. Clarification of the mechanisms involved in oxidative stress, in different forms of multiple sclerosis, could result in improvements in the monitoring and prognosis of the disease, with subsequent increases in a patient’s quality of life. (Ferreira et al 2013)

Chemokine Receptors in MS:

According to an article published by R&D Systems entitled “Chemokine Receptors and Multiple Sclerosis Pathogenesis” (Fall 2003) – as a result of the myelin reactive T cells crossing the blood brain barrier into the CNS an inflammation cascade is initiated with release of inflammatory mediators that damage or destroy oligodendrocyte-formed myelin sheaths and underlying axons. Several lines of evidence suggest that chemokines, small secreted proteins important for regulating leukocyte trafficking, play a role in directing or maintaining T cells in regions where myelin destruction takes place.

The article goes on to say that several studies show that T cells isolated from the blood and CSF of MS patients exhibit increased levels of chemokine receptors including CCR5 and CXCR3.  In addition, some studies show that elevated levels of CCR2, CCR5, CXCR3 on cells in blood and CSF are associated with relapse in individual patients, while treatment of MS with IFN-β results in down regulation of CXCR3 and CCR5.  Chemokines undoubtedly play critical roles in directing lymphocytes to regions of inflammation.  Further studies will be needed to determine whether chemokines and their receptors might represent effective targets for future MS therapies.

 According to an article by Parris M. Kidd, PhD, on multiple sclerosis published in Alternative Medicine Review (2001) agents that can trigger MS exacerbations include viral infections, emotional stress, pregnancy, heat exposure, allergic reactions to foods and irritation or provocation by environmental agents.  The major etiological factors best supported by the available evidence are inherited susceptibility, microbial infections and environmental toxin exposure.  Diet has been less studied but undoubtedly makes important contributions.

Some of the factors that may contribute to the causation, exacerbation or progression of MS as outlined in Dr. Kidd’s article are as follows:

Viruses Linked to MS:
Human Herpesvirus Type 6 (HHV-6)
Chlamydia
Mycoplasmas
Varicella zoster
Retroviruses
Nidoviruses

Toxins and other Environmental Factors which may be Linked to MS
Solvents and pesticides
 X-rays
Exposure to cats, dogs and caged birds
Mercury

Dietary Factors Contributing to the Worsening of MS:
High animal fat diet
Diets high in gluten and milk (T-lymphocytes reactive with milk proteins are very common in persons with MS, and small proteins from milk have been found to be molecular mimics of self-antigens in myelin.)
Allergies to tobacco, house dust, etc.
Sulfite food additives

CHINESE  MEDICAL  VIEW  OF  MULTIPLE  SCLEROSIS
In Chinese Medicine MS is considered a type of Atrophy or Flaccidity (Wei) Syndrome.  Demyelination – a loss of fatty substance surrounding the nerve fibers – corresponds to a description in Chinese Medicine involving the loss of vital fluid Essence or Jing.  The quality of the myelin sheath is similar to the Chinese Medicine quality of Essence.  In Chinese Medicine the brain and spinal cord are understood to be an extension of the Kidney system, the storehouse of Essence.  Kidney yin and yang are the key factors in the regulation and balancing of yin, yang, qi, blood and all the body’s immune mechanisms.  Proper regulation of the normal immune response is achieved through balance.  Therefore the focus in treating the autoimmune aspect of MS in Chinese Medicine is to nourish the Kidney Essence and establish a balance in physical, emotional, mental and spiritual energy as well as in life style.

The most common Chinese Medical patterns seen in multiple sclerosis are:
Damp-Phlegm with Spleen Deficiency which manifests as numbness, feeling heaviness of the legs, tingling, dizziness and tiredness.
Liver and Kidney Deficiency
which manifests as progressive weakness of the legs, weak back and knees, dizziness, poor memory, blurred vision, hesitancy or urgency of urination.
Liver Yang Rising which manifests as stiffness of the legs, vertigo and vomiting.
Liver Wind which manifests as tremors, spasms and paraplegia.

ACUPUNCTURE, CRANIOSACRAL THERAPY, BOTANICALS AND NUTRIENTS IN  TREATING  MS  SYMPTOMS
Barbara and I believe that acupuncture, especially when it is combined with craniosacral therapy may help with MS related symptoms by releasing not only energy blockages in the meridians and energy centers but also restrictions in the fascia which surrounds muscles and organs as well as blood vessels and nerves.  The focus of these treatment strategies is to promote the flow of nutrients and energy throughout the body especially to the muscles, nervous system and immune system and encourage the balancing of these vital systems so that people with MS can lead a healthier life. The botanicals and nutrients work together to help enhance the vitality and life force, increase efficiency, restore harmony and rhythm, correct nutritional deficiencies and excesses, as well as remove toxins.

RECOMMENDED  FOODS
Eat only organically grown foods with no chemical treatments or additives, including eggs, fruits, gluten free grains, raw nuts and seeds, vegetables, soaked raw oats, sprouted wheat (if there is no gluten sensitivity), rice, raw goats milk, fresh wheat germ and GLA rich oils. (MS patients have a severe deficiency in various fatty acids, particularly linoleic acid).

Also recommended are tofu, tempeh, soy sprouts, soy milk, cabbage and cauliflower which are all rich lecithin sources. (Lecithin is often deficient in MS.)

Liver Yin tonics such as leafy green vegetables, mung beans, mung bean sprouts, millet, seaweeds, cereal grass concentrates, micro-algae, and in cases of severe deficiency gelatin or animal liver.
 
Cold-water fish – are rich in omega-3 oils which are important in maintaining normal nerve cell function and myelin production. They are incorporated into the myelin sheath where they may increase fluidity and improve neural transmission.
 
Maintain a low fat diet because a high fat diet impairs the conversion of linoleic acid to prostaglandin E1 (PGE1).  (PGE1 regulates brain function and nerve impulses, is required for proper functioning of the immune system, is a vasodilator, controls blood pressure and inhibits blood clotting.)
 
Eat plenty of raw sprouts and alfalfa, plus foods that contain lactic acid such as sauerkraut and dill pickles. Also good are drinks that contain lots of chlorophyll.
 
Drink at least eight 8 oz. glasses of quality water each day to prevent toxic buildup in the muscles.
 
Take a fiber supplement. Fiber is important for avoiding constipation.
 
Never consume saturated fats, processed oils, oils that have been subjected to heat (either in processing or in cooking), or oils that have been stored without refrigeration.

SWANK’S  DIETARY  PROTOCOL
Devised by Dr. Roy Swank, Professor of Neurology, Univ. of Oregon Medical School, this diet may help MS symptoms.  Swank’s diet recommends:
Fresh whole foods should be emphasized and animal foods (with the exception of fish) should be reduced, if not completely eliminated.
 
Fish should be eaten three or more times a week.
 
Saturated fat intake should be no more than 10 grams per day.
 
Daily intake of polyunsaturated oils should be 40-50 grams (margarine, shortening and hydrogenated oils are not allowed).
 
Normal amounts of protein are recommended.
 
Swank’s diet significantly reduces the platelet adhesiveness and aggregation which is observed in atherosclerotic processes as well as in MS.  Excessive platelet aggregation and micro-emboli are thought to result in damage to the blood-brain barrier, alterations in the micro-circulation of the brain and spinal cord and lack of oxygen to the brain. 
 
In addition to reducing platelet stickiness Swanks diet probably benefits MS in several other ways: 
1)   It would be expected to lower cholesterol. 
2)   Polyunsaturated oils appear to help prevent MS deterioration (cod-liver oil inhibits autoimmunity in experimental animals)
3)   Keeping the “bad” fatty acids low reduces their competition with the “good” ones such as omega-6 GLA and omega-3 ALA, EPA and DHA.

FOODS  TO  AVOID
Avoid saturated fats, cholesterol and alcohol because they lead to the production of PGE2 which promotes the inflammatory response and worsens MS symptoms.  Alcohol also interferes with unsaturated fatty acid conversion, increases the saturated-fat blood count and destroys various B vitamins.

Avoid red meat.  Animal source fats have a significant content of saturated fats; a low content of the anti-inflammatory omega-3 fatty acids DHA and EPA; and a high proportion of their omega-6 fatty acids are in the form of long-chain omega-6 arachidonic acid.  Arachidonic acid is a precursor to pro-inflammatory prostaglandins.  The delicate endothelial linings of the blood vessels are vulnerable to pro-inflammatory attack, and inflammation of blood vessels in the brain is characteristic of MS.  Plaques frequently arise around a vein or venule.  Omega-3 fatty acids help maintain anti-inflammatory balance in the circulation, while supporting myelination and nerve cell membrane renewal.
 
Avoid cow’s milk.  Cow’s milk contains only 1/5 the linoleic acid of human milk.  According to a study appearing in Lancet in 1974 people who were fed cow’s milk as children were found to be more susceptible to MS as adults than people who were breast-fed. 
 
Also avoid tobacco, chocolate, sugar, (eating sweets has been linked to increased MS risk), coffee, fried foods, highly seasoned foods, meat, refined foods, salt, processed, canned or frozen foods and nitrates (found in certain smoked sausages).  

Try avoiding gluten. In case you may be allergic to gluten you may wish to try eliminating gluten from your diet and see if it helps.

BOTANICAL AND NUTRITIONAL  SUPPORT
  • Antioxidants – Oxidative stress is a crucial factor in MS pathogenesis by ameliorating leukocyte migration, contributing to oligodendrocyte damage and axonal injury. Reactive oxygen species (ROS) and reactive nitrogen species (RNS) are created in the CNS of MS patients mainly by activated macrophages and microglia structures responsible for demyelinisation and axons disruption. Activated microglia secrete different inflammatory and oxidative stress mediators such as cytokines (TNF and IL- 1b and IL- 6) and chemokines (macrophage inflammatory protein MIP- 1a, monocyte chemoattractant protein, MCP- 1 and interferon (IFN) inducible protein IP- 10). The inflammatory state is promoted by that. MS in chronic stages is dominated by neurogenerative processes involving axon and neuron loss probably resulting from oxidative stress and excitotoxicity. Therefore, consideration of the treatment engaging antioxidants and dietary supplementation is needed. (Miller et al 2013)
Fruits highest in antioxidants include amla, bilberries (dried), black currants, wild strawberries, cranberries, dried apples, dried plums, dried apricots and prunes.  Grains highest in antioxidants are buckwheat, millet and barley.  Nuts high in antioxidants include walnuts, pecans and sunflower seeds. Beverages high in antioxidants include espresso, coffee and pomegranate juice. Spices highest in antioxidants include clove, peppermint, allspice, cinnamon, oregano, and thyme.  Artichokes are antioxidant rich vegetables. Fruits and vegetables in the medium antioxidant range are dried dates, dried mango, black and green olives, red cabbage, red beets, paprika, guava and plums. (Carlsen et al 2010) Other powerful antioxidants include alpha-lipoic acid, N-acetylcysteine, coenzyme Q10, vitamin C & vitamin E. 
  • CoQ10 – The present study suggests that CoQ10 supplements at a dose of 500 mg/day can decrease oxidative stress and increase antioxidant enzyme activity in patients with relapsing-remitting MS. (Sanoobar et al 2013) CoQ10 is needed for improved circulation and tissue oxygenation. It strengthens the immune system. Food sources include mackerel, salmon, sardines, beef, peanuts and spinach.
  • Curcumin is a polyphenolic compound isolated from the rhizome of the plant Curcuma longa that has traditionally been used for pain and wound-healing. Recent studies have shown that curcumin ameliorates multiple sclerosis, rheumatoid arthritis, psoriasis, and inflammatory bowel disease in human or animal models. Curcumin inhibits these autoimmune diseases by regulating inflammatory cytokines such as IL-1beta, IL-6, IL-12, TNF-alpha and IFN-gamma and associated JAK-STAT, AP-1, and NF-kappaB signaling pathways in immune cells. Although the beneficial effects of nutraceuticals are traditionally achieved through dietary consumption at low levels for long periods of time, the use of purified active compounds such as curcumin at higher doses for therapeutic purposes needs extreme caution. A precise understanding of effective dose, safe regiment, and mechanism of action is required for the use of curcumin in the treatment of human autoimmune diseases. (Bright JJ 2007)
  • DHEA (dehydroepiandrosterone) – Fatigue in progressive MS could be related to low serum levels of DHEA and DHEAS. Our results suggest that these hormones should be considered as biological markers of fatigue in MS patients and that hormone replacement may thus be tested as an option to treat fatigue in MS patients. (Tellez et al 2006)
  • Eicosapentaenoic acid (EPA) and docosahexanoicacid (DHA) – EPA greatly inhibits platelet aggregation and DHA is present in large concentrations in lipids in the brain. Supplementation may be helpful in areas where cold-water fish are not available as both EFA & DHA are found in cold-water fish oils.  A small clinical trial published by Cendrowski in Br J Clin Practice 1986;40: 365-367 with no patient control group suggested that omega-3 fatty acid supplements from fish oil might reduce MS exacerbations. 
  • Epigallocatechin-3-gallate (EGCG) exhibited neuroprotective effects by modulating neuroinflammation and attenuating neural damage. Quercetin, apple polyphenols, myricetin, and piceatannol have also activated SIRT1, thus exhibiting potential in MS treatment. Earlier studies have also shown  that flavonoids limit demyelination in MS suggesting their potential against neuro-inflammation and related disorders. Preclinical data has shown that polyphenols exhibit potential to block neural inflammation and damage by activation of SIRT1 pathway along with modulation of inflammatory cytokines. The potential of polyphenols on limiting demyelination makes them prospective therapeutics in age-related MS and amyotrophic lateral sclerosis (ALS). (Bhullar & Rupsainghe 2013)
  • Essential Fatty Acids (EFA) – The omega-6 EFA, linoleic acid, has an inhibitory effect on the inflammatory response and the omega-3 EFA, alpha-linolenic acid, has a greater effect on platelets (interferes with blood clotting) and is required for normal CNS composition. Both omega-3 and omega-6 EFAs are found in flaxseed oil.  A study published by Homa et al in J Neurol Neurosurg Psychiatr 1980;43:106-110 found abnormally low levels of linoleic acid in the red cells of 14% of their MS patients. Small clinical trials suggest a modest reduction in the severity and duration of relapses in patients with MS receiving PUFA supplements. (von Geldern & Mowry 2012)
  • Evening Primrose Oil – may be helpful in the event that there is a block in the conversion of linoleic acid to GLA (gamma-linolenic acid) as evening primrose oil has a high concentration of GLA. A non-controlled study done by Simpson et al published in New Zealand Med J 1985;98: 1053-1054 concluded that GLA from primrose oil improved peripheral blood flow characteristics and consequently, hand-grip strength.
  • Gamma-linolenic acid (GLA) – is produced in the healthy body from omega-6 EFAs and is also found in spirulina, borage seed oil, evening primrose oil and black currant seed oil. GLA is converted into PGE1 by the body.  PGE1 regulates brain function and nerve impulses, is required for proper functioning of the immune system, is a vasodilator, controls blood pressure and inhibits blood clotting. GLA contributes to anti-inflammatory balance by competing with the pro-inflammatory arachidonic acid.  Avoid non-steroidal anti-inflammatory agents such as aspirin, ibuprofen and indomethacin as they not only block the production of PGE2 but also PGE1.
  • Ginseng The purpose of this study was to evaluate the efficacy and safety of ginseng in the treatment of fatigue and the quality of life of multiple sclerosis (MS) patients. Of 60 patients who were enrolled in the study, 52 (86%) subjects completed the trial with good drug tolerance. Statistical analysis showed better effects for ginseng than the placebo as regards MFIS (p = 0.046) and MSQOL (p ≤ 0.0001) after 3 months. No serious adverse events were observed during follow-up. This study indicates that 3-month ginseng treatment can reduce fatigue and has a significant positive effect on quality of life. Ginseng is probably a good candidate for the relief of MS-related fatigue. Further studies are needed to shed light on the efficacy of ginseng in this field. (Etdemadifar et al 2013)
  • Oleanolic acidMultiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE), are inflammatory demyelinating diseases that develop as a result of deregulated immune responses causing glial activation and destruction of CNS tissues. Oleanolic acid and erythrodiol are natural triterpenes that display strong anti-inflammatory and immunomodulatory activities. These triterpenes protected against EAE by restricting infiltration of inflammatory cells into the CNS and by preventing blood-brain barrier disruption. Triterpene-pretreated EAE-mice exhibited less leptin secretion, and switched cytokine production towards a Th2/regulatory profile, with lower levels of Th1 and Th17 cytokines and higher expression of Th2 cytokines in both serum and spinal cord. Triterpenes also affected the humoral response causing auto-antibody production inhibition. In vitro, triterpenes inhibited ERK and rS6 phosphorylation and reduced the proliferative response, phagocytic properties and synthesis of proinflammatory mediators induced by the addition of inflammatory stimuli to microglia. Both triterpenes restricted the development of the characteristic features of EAE. We envision these natural products as novel helpful tools for intervention in autoimmune and neurodegenerative diseases including multiple sclerosis. (Martin et al 2012)
  • Polyphenols are naturally occurring phytochemicals found in fruits and vegetables, exhibiting strong neuroprotective properties. Important dietary sources of polyphenols include apples, berries, cocoa, herbs, red wines, seeds, onions, and tea. Dietary polyphenols have also been implicated in prevention of oxidative damage and LDL oxidation. (Bhullar & Rupsainghe 2013)
  • Quercetin was found to control immune response via modulation of IL-1β and TNF-α and reduced the proliferation of peripheral blood mononuclear cells isolated from multiple sclerosis patients. (Bhullar & Rupsainghe 2013)
  • Resveratrol, a silent mating type information regulation 2 homolog1 (SIRT1) activator, has exhibited prevention of neural loss without immunosuppression in experimental autoimmune encephalomyelitis (EAE) model of MS. Pharmaceutical grade formulation of resveratrol SRT501 was found to attenuate neural damage in EAE through SIRT1 activation. Cell culture studies have also shown SIRT1-mediated neuroprotection by resveratrol. (Bhullar & Rupsainghe 2013)
  • Scutellaria baicalensis Georgi is one of the important medicinal herbs widely used for the treatment of various inflammatory diseases in Asia. Baicalin (BA) is a bioactive anti-inflammatory flavone found abundantly in Scutellaria baicalensis Georgi. To explore the therapeutic potential of BA, we examined the effects of systemic administration of the flavone (5 and 10 mg/kg, ip) on relapsing/remitting experimental autoimmune encephalomyelitis (EAE) induced by proteolipid protein 139-151 in SJL/J mice, an experimental model of multiple sclerosis. The results suggest that BA might be effective in the treatment of multiple sclerosis.(Zeng et al 2007)
  • Low vitamin B(12) levels and raised homocysteine levels  – A meta-analysis was conducted to assess the relationship between serum homocysteine, vitamin B(12), and folate levels in patients with multiple sclerosis (MS). Both  homocysteine and vitamin B(12) were statistically significant, but the standardized mean difference for folate was not. Patients with MS were found to have raised homocysteine levels but low B(12) levels, which might contribute to the pathogenesis of MS. (Zhu et al 2011) Vitamin B12 aids in cellular longevity and helps prevent nerve damage by maintaining the protective myelin sheaths. Use a lozenge or sublingual form. Food sources include: Brewer’s yeast, clams, eggs, herring, mackerel, dairy products, meat and fish; also dulse, kelp, kombu, nori, soybeans and soy products.
Hyperhomocysteinemia (elevated homocysteine) is associated with cognitive impairment in multiple sclerosis. The authors of this study concluded that plasma total homocysteine levels are increased in MS and that hyperhomocysteinemia is associated with cognitive impairment in this disease. (Russo et al 2008)  

  • Vitamin A – is an important antioxidant.  Oxidative stress is increased in MS.  Food sources include liver, fish liver oils, green and yellow fruits and vegetables, apricots, asparagus, beet greens, broccoli, cantaloupe, carrots, collards, dandelion greens, dulse, garlic, kale, mustard greens, papayas, peaches, pumpkin, red peppers, spirulina, spinach, sweet potatoes, Swiss chard, watercress and yellow squash.
  • Vitamin C – promotes production of the antiviral protein interferon in the body. It is also an antioxidant and immune stimulant.  Consuming foods rich in vitamin C has been correlated with decreased MS risk. Food sources include berries, citrus fruits, green vegetables, asparagus, avocados, broccoli, Brussel sprouts, cantaloupe, collards, kale, mangos, onions, papayas, green peas, persimmons, pineapple, spinach, strawberries and tomatoes.
  • Vitamin Dstatus has been shown to influence both the incidence and the course of MS. High vitamin D levels are probably protective against the development of MS, although the efficacy of vitamin D supplementation in slowing progression of MS remains to be established. (von Geldern & Mowry 2012) Vitamin D aids in calcium absorption.  Food sources include fish liver oils, fatty saltwater fish, eggs, dandelion greens, liver, sweet potatoes, salmon, tuna and vegetable oils.
  • Low Vitamin E and higher Homocysteine levels – We compared the blood levels of uric acid, folic acid, vitamins B12, A, and E, tHcy, CHL, HDL-cholesterol, and triglycerides in forty MS patients during a phase of clinical inactivity with those of eighty healthy controls, matched for age and sex. We found higher levels of tHcy (p = 0.032) and of HDL-cholesterol (p = 0.001) and lower levels of vitamin E (p = 0.001) and the ratio vitamin E/CHL (p = 0.001) in MS patients. (Sqlemi et al 2010) Vitamin E protects the nervous system, is important for circulation and is also a powerful antioxidant.  Food sources include cold pressed vegetable oils, dark green leafy vegetables, legumes, nuts, seeds and whole grains; also brown rice, dulse, eggs, kelp, flaxseed, oatmeal, cornmeal, soybeans, sweet potatoes, watercress, wheat and wheat germ.
  • Vitamin B1 (Thiamine) acts as a coenzyme participating in the complex process of glucose conversion into energy and is vital in certain metabolic reactions.  It is involved in the maintenance of the heart and nervous system, and acts as an antioxidant, protecting the body form the degenerative effects of aging.  Consumption of foods rich in thiamine is correlated with a decreased MS risk.  Food sources include brown rice, fish, legumes, peanuts, peas, poultry, rice bran, wheat germ and whole grains.
  • Vitamin B2 (Riboflavin) is necessary for cell respiration because it works with enzymes that take the oxygen from the cells.  It is part of a group of enzymes that are involved in the production of bodily energy, which utilizes carbohydrates, fats and proteins. Consumption of riboflavin rich foods is correlated with decreased MS risk. Food sources include cheese, egg yolks, fish, legumes, meat, milk, poultry, spinach, whole grains and yogurt; asparagus, avocados, broccoli, Brussels sprouts, currants, dandelion greens, dulse, kelp, leafy greens, mushrooms, molasses, nuts and watercress.
  • Vitamin B6 (Pyridoxine) – is required by the nervous system and is needed for normal brain function. It aids immune function and is involved in more bodily functions than almost any other single nutrient. Deficiency may cause MS in susceptible persons. Food sources include: brewer’s yeast, carrots, chicken, eggs, fish, peas, spinach, sunflower seeds, walnuts, and wheat germ.
  • Vitamin B complex – aids immune system function and maintains healthy nerves.
  • High copper and low zinc levels – The serum levels of zinc (Zn) and copper (Cu) were measured in sixty Iranian patients with MS and compared with sixty age-, gender- and socioeconomic status-matched healthy subjects without any neurological disorders as controls from the same geographical area. Significantly lower serum Zn and higher serum Cu levels were found in the MS patients compared with the controls (p < 0.0001 and p = 0.002, respectively). The serum Zn level of the secondary-progressive MS patients was significantly lower compared with the relapsing-remitting MS patients (p = 0.009). There was no significant difference between the serum Cu levels of the two subgroup of MS patients (p = 0.42). (Ghazavi et al 2012)
  • Sulfur – protects against toxic substances.  Garlic is an excellent source of sulfur.
  • Manganese – is needed for healthy nerves and a healthy immune system. It is an important mineral often deficient in people with MS.  Food sources include: avocados, nuts and seeds, seaweed and whole grains as well as in blueberries, egg yolks, legumes, dried peas, pineapples and green leafy vegetables.
  • Potassium – is needed for normal muscle function. Consuming foods rich in potassium has been correlated with decreased MS risk.  Food sources include: fish, fruit, legumes, poultry, vegetables and whole grains.  It is specifically found in apricots, avocados, bananas, blackstrap molasses, brewer’s yeast, brown rice, dates, dulse, figs, dried fruit, garlic nuts, potatoes, raisins, winter squash, torula yeast, wheat bran and yams.
  • Choline and Inositol – stimulate the central nervous system and aid in protecting the myelin sheaths from damage. Food sources of choline include: egg yolks, lecithin, legumes, soybeans and whole grain cereals.  Food sources of inositol include: brewer’s yeast, fruits, lecithin, legumes, unrefined molasses, raisins, vegetables and whole grains.  Caution:  The consumption of large amounts of caffeine may cause a shortage of inositol in the body.
  • L-glycine – aids in supporting the myelin sheaths. Glycine has been recommended for persons with MS since it counteracts aldehyde accumulation and has antispasmodic properties (daily dosage is about 3 grams per day).
  • Calcium – deficiency may create a predisposition to developing MS. Calcium is needed for prevention of muscle cramps, prevents bone loss associated with osteoporosis, helps to keep the skin healthy and aids in neuromuscular activity.  Foods high in calcium include kelp, cheddar cheese, collard leaves, kale, turnip greens, almonds, brewer’s yeast, parsley, dandelion greens, hazel nuts, Brazil nuts, watercress, goat’s milk, tofu, dried figs, buttermilk, sunflower seeds, yogurt, whole milk, olives, broccoli, clams and spinach. If supplementing use supplements consisting of calcium citrate and/or calcium malate. Use chelate form for best assimilation.  Caution: Calcium supplements should not be taken by persons with a history of kidney stones or kidney disease.
  • Magnesium – is needed for calcium absorption and for proper muscular coordination. A deficiency of magnesium interferes with the transmission of nerve and muscle impulses, causing irritability and nervousness. Food sources include dairy products, fish, meat, seafood, apples, apricots, avocados, bananas, brown rice, dulse, figs, garlic grapefruit, green leafy vegetables, kelp, lemons, peaches, soybeans, tofu, wheat and whole grains.
  • Valine, Isoleucine and Leucine – work together to protect muscle.
  • Lecithin (granules or capsules) – needed for normal brain function.
  • Acidophilus – helps to detoxify harmful substances, enhances absorption of nutrients and aids digestion.
  • Milk thistle – Numerous controlled studies in Germany have demonstrated that milk thistle can benefit the health of the liver. Conventional drug management of MS through interferon β-1a (Avonex) and glatiramer acetate (Copaxone) and most of the other injectable treatments tax the liver as can chronic use of medications such as Ibuprofen and Imodium. 
HERBAL  AND  NUTRITIONAL  SUPPLEMENT  SAFETY  ISSUES
On the question of enhancing immune system function with tonic herbs in MS: 
According to a review on herbal safety published in an article on the Rocky Mountain MS Center website, people with MS should be aware of individual herbs or mixtures of herbs that may activate the immune system.  The article asserts that since MS is characterized generally by excessive immune system activity, these herbs pose theoretical risks.  That these herbs may be immune-stimulating does not necessarily imply that they are “bad” for people with MS.  Instead, it means that there is a theoretical risk to be considered before using these herbs that are poorly studied in MS. 

The question of glutamine supplementation in MS: 
In an article by Subhuti Dharmananda on the dangers of excess glutamine in MS, he notes that in some neurological diseases, it is found that glutamate levels in the central nervous system become unusually high at sites of pathology.  In one of these processes that takes place glutamate is excreted by immune cells that take part in inflammatory processes, the result is high local concentrations at the neurons in progressive neurological diseases such as MS and ALS.  The excess glutamate at the neuron acts as a poison; at high enough levels, the nerves exposed to glutamate can be completely and permanently damaged, so that they are no longer capable of transmitting signals.  Thus, while glutamate is a major component of the body, and an essential part of the nervous system, high levels localized in the nerve cells can be quite toxic.
The role of glutamate in ALS and MS has raised the question as to whether persons with these diseases might have to be careful not to get high levels of either glutamine or glutamate via their diet and/or by taking glutamine supplements.  Until more is known about glutamine supplementation in relation to ALS and MS, it is recommended that patients who have these diseases limit their intake of supplemental glutamine.  One can avoid excessive intake of glutamate by minimizing ingestion of foods containing MSG and hydrolyzed vegetable protein, and by limiting the dosage of glutamine supplementation.  A modest glutamine supplement level of about 5-10 grams/day is likely to have some benefit in relation to muscle wasting, immune responsiveness, or intestinal disorders, without promoting increased glutamate levels in the blood. 

Use of Chinese herbs in the treatment of MS: 
 According to a study done by Xi and Yaohua entitled “Thirty-five cases of multiple sclerosis treated by traditional Chinese medical principles using differential diagnosis” published in the Chinese Journal of Integrated Traditional and Western Medicine1990; 10(3): 174-175 thirty patients received specific herbal decoctions over a period of 3-13 years and relapses were prevented except for two patients who each experienced only one minor exacerbation, each event following a viral infection (common cold).  Two of the cases were deemed basically cured after taking 45 – 68 doses, 15 were markedly improved and another 15 somewhat improved, most of them taking 20-40 doses.  Unfortunately this study was not a double-blind placebo controlled study and, therefore, such controlled studies will be needed to determine if, in fact, Chinese herbs are effective in treating MS.


LIFESTYLE RECOMMENDATIONS
  • Avoid stress and anxiety.  They often precipitate attacks of MS.
  • Avoid exposure to heat such as hot baths, showers, sunbathing and overly warm surroundings; avoid becoming overheated when working or exercising; and avoid exhaustion and viral infections. They all may trigger an attack or worsen symptoms.
  • Get regular exercise and keep mentally active.  These are extremely helpful in maintaining muscle function and bring about remission of symptoms. Exercises that increase body temperature can make the symptoms worse. Swimming is the best exercise. Stretching exercises are helpful.
  • When an exacerbation begins, take at least two days of complete bed rest. This can often stop a mild attack.
  • Maintain a strong immune system to avoid infections which often proceed the onset of MS.  Avoid being around persons who have viral infections.  Avoid getting chilled.  Treat all infections promptly.
  • Treatments to reduce Candida activity have been found to reduce the fatigue experienced by many people with MS.
  • Utilize practices that evoke spiritual rejuvenation such as meditation, yoga, qi gong, tai chi and prayer.
REFERENCES
Abbate. Skya, DOM, “The Management of Multiple Sclerosis with the Extraordinary Vessels”, Acupuncture Today, Dec. 2003 38-39
 
Balch, James F, M.D. & Phyllis A. Balch, C.N.C, Prescription for Nutritional Healing New York: Avery Publishing Group. 1997
 
Bensky, Dan & Randall Barolet, Chinese Herbal Medicine Formulas & Strategies, Seattle: Eastland Press, 1990
 
Berkow, Robert, MD, Editor, The Merck Manual, Rahway, NJ: Merck & Co., Inc., 1992
 
Blackstone, Margaret, The First Year – Multiple Sclerosis, New York: Marlowe & Co. 2003
 
Dharmananda, Subhuti, PhD, “Amino Acid Supplements I: Glutamine” Portland, OR: Institute for Traditional Medicine, Sept. 1997
 
Dharmananda, Subhuti, PhD, “Chinese Herbal Treatment for Multiple Sclerosis and other Flaccidity Syndromes, including Myasthenia Gravis and Amyotrophic Lateral Sclerosis” Portland, OR: Institute for Traditional Medicine, Nov. 1996
 
Dharmananda, Subhuti, PhD, “Evaluation of DHEA levels in Multiple Sclerosis” Portland, OR: Institute for Traditional Medicine, Sept. 1997
 
Dharmananda, Subhuti, PhD, “Modern Chinese Medical Methods for MS: Clinical Setting and Patient Reports” Portland, OR: Institute for Traditional Medicine, Sept. 1997
 
Dharmananda, Subhuti, PhD, “Preliminary Report on Second Year Study: Chinese Medical Treatment for Multiple Sclerosis” Portland, OR: Institute for Traditional Medicine, Oct. 1995
 
Dharmananda, Subhuti, PhD, “Report on Three Years of Clinical Study: Chinese Medical Treatment for Multiple Sclerosis” Portland, OR: Institute for Traditional Medicine, Oct. 1996
 
Harkness, Richard, Pharm., FASCP & Steven Bratman, M.D., Drug-Herb-Vitamin Interactions Bible, Rocklin, CA: Prima Publishing, 2000
 
Kidd, Parris M., PhD, “Multiple Sclerosis, An Autoimmune Inflammatory Disease: Prospects for its Integrative Management”, Alternative Medicine Review,
Dec. 2001, Vol 6, No. 6, 540-566
 
Kirschmann, Gayla, J, Kirschmann, John D, Nutrition Almanac, New York: McGraw- Hill, 1996
 
Kozovska, M.E., MD et al, “Interferon beta induces T-helper 2 immune deviation in MS”, Neurology, 1999;53:1692-1697
 
Jones, Cindy L.A., Ph.D., The Antibiotic Alternative, Rochester, VT: Healing Arts 2000
 
Lininger, Schuyler W., Jr., DC, The Natural Pharmacy, Rocklin, CA: Healthnotes, Inc. 1999
 
Maciocia, Giovanni, The Practice of Chinese Medicine, Edinburgh: Churchill Livingstone, 1994
 
Martino, G. et al, “Inflammation in multiple sclerosis: the good, the bad, and the complex”, Lancet Neurol 2002 Dec;1(8):499-509
 
Mindell, Earl, R.Ph, Ph.D., & Virginia Hopkins, Prescription Alternatives, New Canaan, CT: Keats Publ, 1998
 
Murray, Michael, N.D., & Joseph Pizzorno, N.D., Encyclopedia of Natural Medicine, Rocklin, CA: Prima Publishing, 1991
 
Pitchford, Paul, Healing with Whole Foods, Berkeley: North Atlantic Books, 1993
 
Rocky Mountain MS Center website www.MS-CAM.org “Traditional Chinese Medicine: Acupuncture, Asian Herbal Medicine and Asian Proprietary Medicine” Englewood, CO, 2003
 
Tortora, Gerard J, Grabowski, Sandra Reynolds. Principles of Anatomy and Physiology, New York: Harper Coffins, 1993
 
Vanderhaeghe, Lorna R. & Patrick J. D. Bouic, Ph.D., The Immune System Cure, New York: Kensington Publishing Co. 1999
 
Vickers, Edythe, N.D., L.Ac. and Subhuti Dharmananda, Ph.D., “Traditional Chinese Medicine and Multiple Sclerosis”, Portland, OR: Institute for Traditional Medicine, July 1996
 
Weil, Andrew, “Natural Help for Multiple Sclerosis” Self Healing, June 2000
Werbach, Melvyn R., MD, Nutritional Influences on Illness, Tarzana, CA Third Line Press, 1996


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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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One Response to Understanding Multiple Sclerosis

  1. Everything is very open with a precise clarification of the challenges.
    It was truly informative. Your website is extremely helpful.
    Thank you for sharing!

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