Multiple Sclerosis (MS) is a chronic, inflammatory disease of the central nervous system (CNS), presenting with a variety of symptoms. While conventional treatment focuses on disease management using medical drugs, newer thinking and research is identifying contributory underlying pathologies and dietary strategies capable of improving symptoms and prognosis.
MS is thought to affect around 100,000 people in the UK, typically diagnosed between the ages of 20 and 40, with more women affected than men. While the mechanisms behind MS have been debated in the medical community, it is generally agreed to be autoimmune in nature, whereby the immune system attacks the fatty myelin sheaths that protect nerves, especially in the white-matter area of the brain where there is a higher concentration of fatty acids. Under normal circumstances a healthy, in-tact blood brain barrier should protect brain tissue from immune attack, but if it becomes inappropriately permeable then immune cells, such as T cells, can enter the brain where they may tag and attack nervous system tissue causing damage and further inflammation. This damage leaves scars, or lesions, known as plaques. The damage to the myelin and nerve fibres means that messages communicated throughout the CNS either don’t get through at all, or they become slower or distorted.
Symptoms are varied and far-reaching, including:
- Numbness and tingling in the extremities
- Dizziness and balance problems
- Muscle weakness, stiffness or spasms
- Vision problems
- Difficulties swallowing
- Speech impairment
- Bowel and bladder irritability and incontinence
- Memory problems and difficulty concentrating
- Depression, stress and anxiety
Conventional medicine has classified the different types of MS as follows:
- Relapsing/remitting MS – this is the most common type, and involves flare-ups, which can be mild to severe, during which new symptoms appear or old symptoms return. These relapses can last for days, weeks or months, with most experiencing complete remission between relapses while some are left with a few lingering symptoms. Relapses may be triggered by stress, infection, or the period post-pregnancy. Conventional medicine will typically use immune suppressive drugs in an attempt to prevent relapses, plus high dose steroids to manage active relapses when they occur.
- Secondary progressive MS – most people with relapsing/remitting MS will go on to develop secondary progressive MS eventually, typically around 15 years after diagnosis. This usually presents with a gradual progression and worsening of the condition and a failure to recover completely between relapses. This stage tends to be treated with steroids, immune suppressive medication.
- Primary progressive MS – this type tends to be diagnosed at a slightly older age than the other types of MS, between ages 40 and 50, and is characterised by a gradual worsening of the condition with possible periods of stabilization, rather than the appearance of sudden relapses with remission in between. Treatment involves immune suppressive medication, and physical therapy may be recommended for mobility issues.
- Benign MS – considered a milder form of the condition with longer periods of remission, and presenting with minimal or no disability. The disease may still eventually progress over time.
- Childhood MS – occasionally, MS can develop in children and teenagers, and commonly features problems with memory, thinking, tremor and poor coordination. Some immune suppressive drugs may be prescribed to children.
Unlike the conventional medicine approach, functional medicine experts suggest that there are many possible underlying pathologies linked to MS, and indeed all autoimmune conditions, including infectious agents such as Lyme disease, Chlamydia Pneumoniae and Epstein Barr (1), plus nutrient deficiencies and heavy metal toxicity. Detecting and addressing these underlying conditions using a systems-based, whole body approach, and employing specific dietary strategies, are important tools in the treatment and management of the condition.
Lyme disease (LD) may be associated with or even mistaken for MS due to a similar set of symptoms, including a possible relapsing/remitting pattern, weakness, fatigue, pins and needles and cognitive dysfunction. There may also be similar plaques in the white matter in the brain (2), although plaques caused by MS would not be expected to recede with antibiotic treatment in the way that those caused by LD would.
MS has also been shown to parallel the distribution and incidence of the LD pathogen Borrelia burgdorferi (3), a member of the Spirochete family of bacteria carried by deer ticks. Research has found a statistically significant correlation between those with both MS and anti-Borrelia antibodies (4) and additionally, the pathologist Alan B. MacDonald MD has found that the autopsies of brain tissue taken from 19 patients with MS featured Borrelia pathogens living within parasitic worms, eggs and larvae inside the brain tissue (5). LD diagnosis is controversial (6) and MacDonald goes on to argue that current testing does not adequately detect the presence of Borrelia bacteria and it can therefore be missed as important underlying pathology that could be treated if discovered early enough. Conventional treatment for LD tends to focus on antibiotics, which has little backing in scientific research (7, 8). Click here for more information about LD, including diagnosis and treatment.
Chlamydia Pneumoniae (CP) is another pathogen capable of causing latent disease in humans. Researchers have examined whether any connection exists between MS and chronic persistent CNS infection with CP, with findings suggesting an association does indeed exist between the two (9, 10), but it is not clear whether CP represents a causative factor or secondary infection of a damaged CNS.
Epstein Barr (EBV) is a common virus repeatedly linked to MS in research, with numerous studies suggesting that EBV plays an important role in the pathogenesis of MS (12, 13), in children as well as adults (14). Results suggest that EB antibodies are elevated before MS onset, that EBV titers are higher in MS patients than in controls, and there is an increased risk of developing MS after EBV has been observed, with one study stating the risk ‘increases sharply’ after infection (15). Vitamin D status has been linked to EBV, with research suggesting that vitamin D modulates the immune response to EBV (16) as well as being linked to MS, with optimal levels showing a protective effect (17). Recent research has also found high dose vitamin C to be a promising natural treatment option for EBV (18).
Vitamin B12 status may also be linked to MS, in that they share common inflammatory and neurodegenerative characteristics, making distinguishing between the two difficult in some cases (19). One study found that participants suffering from MS had reduced B12 binding capacity compared to others, and large dose B12 injections brought improvement in several key areas compared to the pre-treatment period (20).
Heavy metal toxicity is another area linked to MS, and all autoimmunity, having the potential to increase inflammation and compromise detoxification and neurological function. (21). While data linking the two conditions is more limited, one case study has suggested beneficial changes to symptoms after the treatment of elevated heavy metals via chelation therapy (22).
The health of the gut, or the microbiome, is a key factor in immune function and may therefore have a considerable impact on MS incidence and progression. Research has found alterations in gut bacteria in the small intestine of MS sufferers (23), as well as quite a distinct balance of flora in the large intestine compared to healthy subjects (24). Although it’s currently unclear whether these changes are a causative factor or a consequence of the condition, it is understood that the integrity of the digestive system plays an important role in the risk of inflammatory conditions, and therefore optimising the structure and function of the digestive tract should be instrumental in the prevention or treatment of MS.
There are a number of specialised diets that research suggests may help to improve the progression of MS. The first of these diets is The Swank Diet (25), a low-fat diet devised by Dr Roy L. Swank, who spent 50 years researching MS relating to different populations and their intake of fat, leading him to write the book The Multiple Sclerosis Diet Book: A low fat diet for the treatment of MS. The diet is not only low in fat generally, but also free from hydrogenated fats, processed foods, red meat and dark-meat poultry, and actively encourages the intake of cereal grains, fish, fruit and vegetables. The diet stipulates only no-fat dairy should be consumed, and includes guidelines on the quantity of eggs, nuts and seeds that can be eaten. Dr Swank’s research and the positive findings he reported were purely observational, and a more recent and scientifically robust one-year study (26) of Dr Swank’s approach failed to find any changes to the MRI results of the participants.
While The Swank diet reported symptom improvement due to its low fat content, another dietary approach has been found to be beneficial because it is very high in fat and low in carbohydrates, namely the ketogenic diet. The ketogenic diet encourages a state called ketosis in which the body makes a metabolic shift and efficiently burns fat for energy instead of glucose. This dietary approach has been gaining ground in the treatment of neurodegenerative conditions including MS, epilepsy, Alzheimer’s disease and Parkinson’s. Ketone bodies have been found to have a protective effect against neurodegeneration and cognitive decline in those with Multiple Sclerosis (27, 28).
The Wahls Protocol is another dietary approach put forward by Dr. Terry Wahls (29), researcher and clinical professor of medicine at the University of Iowa, who gave an inspiring TED talk about her own MS diagnosis and the importance of mitochondrial health (30). Her subsequent book, The Wahls Protocol, explains her ‘paleo style’ protocol in detail, and stresses the importance of using food as medicine to improve mitochondrial function. Very large quantities of colourful antioxidant-rich fruits and vegetables are recommended plus healthy fats from natural sources, wild fish, grass fed and wild muscle and organ meats, and healing foods such as fermented foods and bone broths; while completely avoiding refined fats, gluten and dairy, and minimising other foods often thought of as healthy such as non-gluten grains, legumes and eggs that can aggravate the lining of the gut, promoting inflammation and interfering with nutrient absorption. Wahls has created The Wahls Foundation (31) to carry out research aimed at promoting and developing the use of diet and lifestyle intervention in the treatment of MS. Research is still emerging but has so far been promising (32).
As well as addressing diet, it should be noted that positive lifestyle factors including mindfulness, meditation, exercise and social contact should be considered in the management of MS. Research suggests that those suffering from emotional stress are more at risk of the condition than controls (33), and meditation has been found to reduce perceived stress (34) and pain (35) in chronically ill patients with MS (34), plus regular yoga helped improved fatigue (36).
Written by Emma Rushe
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- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2649682/ – ketogenic diets and MS