Multiple sclerosis - the environmental approach to treating
To make sense of how to go about managing MS it is helpful to have some idea about the different mechanisms which are believed to come into play to cause it. We know multiple sclerosis is an auto-immune disorder where the immune system attacks its own myelin sheath within the central nervous system. This causes damage to cells in the CNS and further activation of the immune system as the immune system clears away cellular debris created. As a result of this immune activity free radicals are produced and if antioxidant status is poor then this will cause further damage. Having identified the mechanism, one can now put in place some of the things to ameliorate them.
Why does the immune system attack its own myelin?
The possibilities are:
- Molecular mimicry. If a patient develops leaky gut, this would mean large antigenically interesting molecules getting from the gut into the blood stream where they elicit an antibody response. For some people it just so happens that these antibodies can cross react with self and that self may be myelin sheath. So the first aspect to consider here are gut problems. See Fermentation in the gut and CFS
- Toxic stress. As a result of living in an increasingly polluted world we are increasingly exposed to toxins. Many of these get in to the brain where they stick on to components in the brain and change how they look. If the immune system doesn't recognize this new look then it will make antibodies against them, ie auto-antibodies disease is triggered. However toxins may be toxic in their own right. For example mercury inhibits the normal assembly of microtubulin proteins. Organophosphates upset neurotransmitter levels and interfere with oxidative phosphorylation.
- Infection driven chronic inflammation.
So the tool kits to be employed for the treatment of multiple sclerosis are as follows:
- Reduce the likelihood of gut problems - eat a Ketogenic diet - the practical details. Please see also My book The PK Cookbook - Go Paleo-ketogenic and get the best of both worlds.
- Consider the possibility of poor digestion (Hypochlorhydria and pancreatic enzymes), tackle probable fermenting gut as above.
- Tackle Antioxidants status - measure glutathione peroxidase, superoxidase dismutase and Co-Enzyme Q10. Consider high dose Vitamin B12 injections.
- Moderate the immune system - with Vitamin D and Essential Fatty Acids.
- Do a Detoxing - Far Infrared Sauna (FIRS). regime which address heavy metals and pesticides, (especially if there is evidence of exposure). Consider lymphocyte sensitivity tests to heavy metals such as mercury.
- Look for a chronic infection which may be fungal (so measure urinary mycotoxins) or chronic viral (the most useful tests are the EliSpot test at Armin labs for herpes viruses).
So in order of importance one must:
- Take vitamin D as a supplement or as sunshine. The further away from the equator one lives, the greater the risk of multiple sclerosis. Furthermore, mice which have been genetically modified to develop MS can have the progression of the disease blocked by taking 1:25 dihydroxycholecalciferol. Anybody living in a northern climate is probably vitamin D deficient or at least has sub-optimal levels and this certainly contributes to the load of not just MS, but also heart disease, osteoporosis and cancer. Either one should use a sun bed regularly so that you are lightly tanned or take a vitamin D supplement 5,000iu daily.
- Take my standard regime of nutritional supplements (see my Nutritional Supplements handout) and extra essential fatty acids - evening primrose oil (at least 2 grams) and fish oil (as least two grams) daily.
- Low dose Naltrexone is used by a great many MS sufferers throughout the world and seems to slow progression of the disease. Naltrexone is a natural opiate antagonist. Its usual therapeutic dose would be 50mg and this is largely used as an antidote in a case of opiate poisoning. The idea is to give a very tiny dose, namely 4mg at 10 o'clock at night. The idea is to slightly inhibit endogenous opiates, which will result in a rebound hyper-effect the next day. For further information see Low dose naltrexone. To achieve such a small dose, take a 50mg capsule of Naltrexone (available on prescription only) and dissolve it in 25mls of water. This produces a solution of 2mg per ml. Keep it in the fridge. The daily dose is 2mls (i.e. 4mg) at bed time.
- Paleo Ketogenic Diet. A diet which seems to be of established benefit in multiple sclerosis is that which increases the proportion of vegetable and fish oils and cuts out dairy products. Fat from meat is a good source of energy to the brain - see Brain fog - poor memory, difficulty thinking clearly etc The dietary aspect is explored in depth in Judy Graham's excellent book "Understanding MS". Take probiotics such as Kefir.
- Look at antioxidant status. Any auto-immune reaction against myelin sheaths will be amplified by free radicals and poor antioxidant status. I think it is well worth measuring three key antioxidants, namely superoxide dismutase, glutathione peroxidase and Co-Q10.
- High dose vitamin B12 is of proven benefit in multiple sclerosis. I use this routinely in my MS patients and many report improvements in energy levels and well being and improvement of their neurological symptoms. The joy of B12 is that it has no known toxicity. It probably works because it is a very efficient scavenger of peroxynitrite, which is a free radical produced when superoxides combine with nitric oxide. I suggest initial injections of 0.5mg (500mcgms) daily subcutaneously and adjust according to clinical response. B12 provides "instant" antioxidant cover.
- Mercury. The problem with dental amalgam fillings is that the amalgam is a liquid, albeit a very stiff one. This means that as the fillings erode, mercury is released into the mouth where it is inhaled and deposited in bone, kidneys and the brain. There is some very good evidence which now links mercury from dental amalgams to Alzheimer's disease, but it may well be that it has the potential to trigger MS because heavy metals act as immune adjuvants (this is, of course, the reason why mercury as thimerosal is used in vaccinations). My personal view is that nobody should be walking around with dental amalgam in their teeth, but we can measure to see if this is a problem - firstly by doing a Kelmer test which measures urinary mercury levels before and after a chelating agent and secondly doing mercury sensitivity tests to see to what extent the immune system is activated by the presence of mercury. If these tests were very abnormal then there would be a clear indication for going ahead and getting rid of the mercury fillings, but if done then this should be carried out by a dentist who understands the problems of mercury because the process of extraction can temporarily increase its absorption.
- Reduce the toxic load generally - actually this applies to all of us all of the time! This means avoiding 'chemicals' as much as possible. This means chemicals in: the air - the rule is "if you can smell it, it can cause problems". I am suspicious that small particulate matter (PM10 and below, there is virtually no monitoring of PM2.5s) produced by polluting industry may cause MS. Avoid perfumes, sprays, fumes, solvents, industrial chemicals as much as reasonably possible.
- water - use filtered or bottled water for drinking.
- Food - Avoid packaged/tinned foods, eat as much fresh vegetables, fruit as reasonable possible. Organic is ideal but often not practical.
- Get your thyroid checked. I would check a free T4, free T3 and TSH in almost any disease! If there is one autoimmune disease present then you are more likely to get others.
- Sleep is vital for good health - it is during sleep that healing and repair take place - aim for 9 hours sleep between 9.30pm and 6.30am.
- "If you don't use it, you lose it". Nerves can heal and repair and make new connections. In the central nervous system the brain is good at finding alternative pathways to make things work. Remember that throughout life the brain makes one million new connections every second! A mind boggling statistic! But there is the potential to create other new routes when one has been damaged. The more you exercise your brain and body, the better. Take advantage of any physiotherapy on offer.
- Leaky gut. It would be very easy to look for a problem with leaky gut by doing a PEG test which measures molecules which spill over into urine and from measuring the size of the molecules and the amount leaky gut can be diagnosed. This could be caused by allergy (consider a PK diet") and/or a gut dysbiosis (see DIY probiotics). NB The PEG test is temporarily suspended by Biolab but they hope to be able to offer it again later in 2008.
- See my DETOX handout (linked earlier in this article) - there is much that can be done to reduce the load. Essentially sweating regimes are the most physiological way to detox. - if you have the energy to exercise and sweat - fine. If not, consider getting a far infra red sauna to sweat out toxins - see "FIR sauna".
- If fatigue is a major problem, or you are not improving on the above regime, also do my standard work up for CFS - possibly do mitochondrial function tests. Not only are mitochondria important for energy levels, but many neurodegenerative diseases are caused by mitochondrial failures.
- Mercury - Kelmer test
- Lymphocyte sensitivity to metals and chemicals
- SODase (superoxide dismutase) studies
- Co-enzyme Q10
- Thyroid profile: free T3, free T4 and TSH
- Mitochondrial Function Profile
"Best Bet Diet Group" The web pages of the MS-Diet Support Group, who see diet and nutrition as pivotal for understanding and treating MS.
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