Multiple Sclerosis - can diet help?

Multiple Sclerosis is an autoimmune disease in which the body's defences attack the nerve cells in the brain and spinal column. The disease progresses due to the breakdown of the fatty myelin sheaths that surround the axons of our nerves. This impairs the nerve signalling leading to a wide range of symptoms from tingling, visual disturbances, speech problems, problems swallowing to loss of movement and becoming bound to a wheelchair. In a typical case, symptoms are episodic, manifest themselves during relapses which occur 1-2 times per year. These relapses can be triggered by viral illness or stress and symptoms can sometimes be made worse by heat (Urthoff's phenomenon).

There are a number of different ways in which the disease manifests itself, but most commonly it starts as a relapsing-remitting form, which after a few decades often turns into a more progressive form.

Who does MS affect?

It most typically affects women more than men with about twice as many women contracting it. This is quite typical of a number of autoimmune diseases. MS is also found most often in latitudes further from the equator where there is less sunlight, suggesting a possible role for ultraviolet radiation and vitamin D. It is also more prevalent in the western world, which could point to either genetic factors, dietary factors or the activity of regional viruses. It could easily be that some or all these factors are involved as the patterns of disease prevalence are complex, and indicate multiple causative agents.

Why have I got MS?

There is no single identified cause for MS, however there are a number of things associated with an increased risk of MS. The three main risk factors are:

  • Genetics is thought to play a role, with people in the same family as a sufferer being at increased risk. For instance identical twins have a risk of 30% of getting MS if their twin has it, while the risk is less than 5% for a sibling. This compares to a risk as low as 0.15% for the general public in the UK (That's about one in every 800 people). These genetic associations result from the fact that people in the same family have similar DNA. DNA is found in every cell in our body in 23 paired chromosomes. It is chromosome number 6 that is thought to be most involved with MS. Chromosome number 6 produces special proteins that are used on the surface of all our cells to mark them as being our own 'self' cells. Without these proteins our immune system attacks our cells in what is called an autoimmune disease.
  • Environmental factors that affect risk of MS include sun exposure which decreases the risk. There are aspects of diet which are likely to also affect risk. Omega 3 fats as found in fish oils, vitamin D have been suggested as foods that may help, while junk food and dairy foods have been put forward as foods that don't help. Smoking has been shown to increase risk of MS, increasing your chance of getting it by about 50%1There is also a theory that having too hygienic a childhood, especially in the first 5 years, can increase risk of contracting MS.
  • Previous infections that have been associated with MS include glandular fever, especially if caught when a teenager. Glandular fever otherwise known as Epstein Barr virus is a type of herpes virus and to a lesser extent other herpes viruses have been associated with MS risk. Herpes is a funny virus in that it can lay low in the body without ever producing any symptoms. In some people certain environmental triggers may activate the virus. Our immune systems learn to recognise particular viruses and develop ways of recognising them, so that they can attack and destroy them. However, it is possible that the surface feature that our immune system recognises on a herpes virus is similar to surface features on our myelin sheaths around our nerve cells. This then can lead to an autoimmune response where our immune system attacks the myelin, giving rise to MS. 

Natural remedies for MS

There are a number of non-drug based approaches that offer some promise in slowing the progression of MS. Two of them reflect the fact that MS is concentrated in latitudes that don't get a great deal of sunlight, namely ultraviolet radiation and vitamin D. These non-drug based remedies are:

Natural sunlight and vitamin D

Although Vitamin D is produced by natural sunlight and is thought to play a protective role also, there is something else about sunlight that seems to have the potential to slow MS down. A recent study with mice with EAE (an animal disease similar to MS), suggested that a protective effect against MS could be due to some other aspect of the ultraviolet light found in sunlight and not just down to the increased production of vitamin D2. This suggests that getting out into sunlight regularly and perhaps using a sunlamp could be beneficial.

The active form of vitamin D called calcitriol is produced indirectly after exposure to the sun and also comes from dietary vitamin D. It is also available from vitamin D3 supplements. There is evidence that vitamin D supplementation can help reduce the progression of MS3.

Fat levels in the diet

There is a very low fat diet kinown as the 'Swank Diet' that originated in the US in 1949. This is based on some early research with very low fat diets outperforming low fat diets in terms of the symptoms recorded by MS patients. The original research had several flaws in it that invalidate the results. This diet also does not have a credible scientific explanation for how it would work. Far from helping, low levels of essential fats are likely to impair the balance of the immune system and to potentially worsen symptoms over the long term. When it comes to fats most evidence points to a beneficial effect from the types of fats found in oily fish, while fats found in junk food (trans-fats) are likely to be harmful. There is some suggestion that components of dairy food may not be helpful, but this is more likely due to proteins in the dairy than the fats it contains.

Exercise and relaxation

These are likely to reduce symptoms of MS. Long term exercise will keep the muscles as well conditioned as they can be. Exercises to concentrate on include:

  • Cardiovascular exercise, which helps us relax and can improve bowel health, which is often affected in those with MS.
  • Balance challenges which will work the key muscles and neuronal circuits that keep us mobile.
  • Strength work, which will strengthen your muscle fibres, reducing the impact of losing the use of one or more fibres as the disease progresses.

Drug remedies for MS

Most drugs used in the treatment of MS have potentially serious side effects. Such drugs as beta-interferon, glatiramer, fingolimod, natalizumab and mitoxantrone (used in cancer chemotherapy) all try and stop some elements of the immune system in their tracks. Mitoxantrone is modestly effective at reducing attacks as to a lesser extent is natalizumab. However side effects are potentially severe when this approach is used. For instance Mitoxantrone cannot be used long term due to its severe side effects. Prescriptions for some of these drugs come with cautionary messages from some of the medical authorities.

Cannabis

An understandably contentious topic, but one that hits the news fairly regularly. Can cannabis help MS sufferers, does it reduce symptoms and what effect does it have on the long term prognosis of patients? There is some evidence that excessive muscle stiffness, spasticity can be improved for some MS patients. However it should be remembered that obtaining cannabis via smoking has at least as many harmful effects as ordinary smoking.

So what should the diet be like for someone with MS?

A normal healthy diet is your starting point. That is, avoid processed food and try to eat plenty of fresh vegetables and fruit along with some quality meat, fish, eggs, nuts, legumes (beans and lentils) and a little dairy produce. It would be wise to ensure you get plenty of omega 3 oils as these help dampen the inflammation caused by your immune system attacking the neurons in your brain and spine. Omega 3 oils are found in the oily fish: mackerel, sardines, pilchards, salmon and trout. They can also be had from fish oil supplements.

Vitamin D supplements may be worth trying, especially if you can establish that your blood vitamin D levels are low(4). A normal range for blood vitamin D levels (25-hydroxy D) is from 75-200 nmol/L (30-80 ug/L). These levels fluctuate naturally between winter and summer in temperate latitudes. Vitamin D tests are available from private testing labs for around £50.

While such things as vitamin D and omega 3 oils may help slow down disease progression, it is also the case that the many symptoms of MS may be reduced by specific dietary intervention. What changes are made would depend on what the problem was. For instance bowel disturbance in MS may be reduced by the use of probiotics, which can be commonly found in probiotic yoghurts or supplements.

References:

1) http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0016149

2) http://www.pnas.org/content/107/14/6119.full?sid=9f6ae16b-e55a-467d-88b5...

3) http://jcem.endojournals.org/content/96/9/2826.abstract

4) http://vitamindtest.org.uk/