Functional Support for Multiple Sclerosis

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Multiple sclerosis (MS) is a disease of the central nervous system (CNS) that affects the brain, spinal cord, and optic nerves (1).  Certain inflammatory cells, mainly T cells, macrophages, and B cells, cross the blood-brain barrier where they release cytokines (inflammatory chemical mediators) and free radicals that cause direct damage to myelin sheaths (demyelination) and possibly to neural axons (2).  Antimyelin antibodies "attack" the body's own tissues, causing further damage through complement-mediated demyelination (1).  For these reasons, MS is considered an autoimmune, or immune-mediated, disease.

The onset of MS generally occurs between the ages of 20 and 55 years and occurs mostly in women (60% of cases) (1).  Typically, MS is characterized by symptoms of the disease process that relapse and remit randomly for the first 10 to 15 years after onset. Though progressive worsening of the disease can start at anytime, it typically starts after the relapsing-remitting period.  The remittance of the disease process happens when regulatory T cells enter into the CNS and cause apoptosis of the disease-initiating T cells (1).  Therefore, treatment of MS generally focuses on suppressing the autoimmune and inflammatory mediators, as well as improving fatigue, quality of life (QOL), walking, spasticity, and cognitive impairment.

Conventional Treatment

There are five medications, known as disease-modifying agents (DMAs), approved by the FDA for the treatment of MS.  These drugs decrease relapse rates by 30% to 50%; decrease risk of developing permanent neurologic disability, and decrease new lesion formation in the brain (1).  However, DMAs modestly effect the time to disability, are expensive and ineffective in progressive forms of MS, and have a number of side effects (1).  Thirty-three to 70% of MS patients, therefore, seek alternative treatment measures to optimize conventional treatments, lower costs, and improve QOL (3).

Diet Therapy

Numerous studies based off observations of inland farming communities and coastal dwellers in Norway have found a significant relationship between the prevalence and risk for MS and consumption of animal fat, animal protein, and meat from nonmarine animals (1).  A diet low in saturated-fat and rich in omega-3 fatty acids maintained over a long period of time may slow the disease process, reduce number of relapses, and decrease mortality (2, 3).  A diet rich in omega-3 fatty acids specifically has been shown to have antiinflammatory and immunomodulatory benefits as well as neuroprotective effects that may be especially beneficial to MS patients (1).  

Nutritional and Botanical Supplements

Omega-3 fatty acids.  Evidence strongly supports the efficacy of omega-3 fatty acids to decrease levels of proinflammatory cytokines, inhibit migration of inflammatory cells into the CNS, and increase beneficial immunomodulatory effects (3).  While increasing overall consumption of fatty fish is recommended, supplementing with 3000 mg of EPA and DHA daily may be effective (1).

Vitamin D.  Recent studies have indicated the prevalence of low levels of serum vitamin D in up to 84% of patients with MS (3).  This finding is interesting given the geographic prevalence of MS patients who lived in higher latitudes before the age of 20.  It is possible that a lack of early sunlight exposure may correlate with low serum vitamin D levels and, therefore, increased risk of MS (3).  This hypothesis is supported by knowledge of vitamin D to decrease immune cell-mediated inflammation, decrease ability of inflammatory cells to enter CNS, and a positive correlation between high levels of vitamin D and the antiinflammatory cytokine interleukin-4 (1).  A daily supplementation of 2000 to 8000 IU/day is recommended with the goal of reaching 50 to 80 ng/mL 25-hydroxy D3 (1).

Alpha-lipoic acid.  AHA and its precursor, DHLA, are both potent antioxidants that can catalyze the production of other antioxidants, such as glutathione and vitamin C and E (Yadav et al., 2010).  The combined efforts of antioxidants can scavenge free radicals, repair oxidative damage, and chelate metallic ions involved with oxidative injury (Pizzorno & Murray, 2013; Yadav et al., 2010).  Other positive actions of ALA include preventing inflammatory T cells from entering the CNS, inhibiting T-cell production of MMP-9, and various other immunomodulatory actions (Pizzorno & Murray, 2013).  But the central therapeutic role of ALA in MS is its ability to stimulate production of cAMP, which initiates a cascade of beneficial immunomodulatory effects (Yadav et al., 2010).  Supplementation of 1200 mg can raise serum levels significantly (Pizzorno & Murray, 2013).           

Gingko biloba.  There is limited but promising evidence indicating that standardized extracts of Gingko biloba (120 to 160 mg/day) may benefit MS patients with cognitive impairments (Pizzorno & Murray, 2013).  Though much of this evidence is based on cognitive improvement seen in Alzheimer’s disease, one study did shown cognitive improvement for patients of MS based on several neuropsychological tests (Yadav et al., 2010).  Despite the conflicting data, Gingko biloba has been shown safe and well tolerated in many clinical trials.

Exercise and Stress

Finally, exercise has recently been shown to help with symptoms of fatigue, well-being, walking, and improving QOL for patients of MS, despite earlier recommendations (Pizzorno & Murray, 2013).  Stress has also been shown to induce the onset of MS and worsen and/or increase relapses; therefore, therapies that reduce stress such as mind-body interventions (yoga, meditation, prayer, slow breathing) are highly recommended/encouraged (Pizzorno & Murray, 2013).  Tai Chi and yoga, in particular, may improve MS-related symptoms such as walking speed, flexibility, well-being and quality of life (Pizzorno & Murray, 2013).

In conclusion, incorporating and combing therapeutic strategies such as a low-saturated-fat and omega-3-rich diet, certain dietary and botanical supplements, as well as stress-reducing activities may improve certain disease processes and increase overall well-being and quality of life for those experiencing the debilitating effects of MS.

References

1. Copstead, L.-E. C., & Banasik, J. L. (2013). Pathophysiology (5th ed.). Amsterdam: Elsevier Health Sciences.

2. Mauriz, E., Laliena, A., Vallejo, D., Tunon, M. J., Rodriguez-Lopez, J. M., Rodriguez-Perez, R., & Garcia-Fernandez, M. C. (2013). Effects of low-fat diet with antioxidant supplementation on biochemical markers of multiple sclerosis long-term care residents. Nutricion Hospilitaria, 28(6), 2229-2235. doi:10.3305/nh.2013.28.6.6983

3. Pizzorno, J. E., & Murray, M. T. (2013).  Textbook of natural medicine, (4th ed.). Philadelphia, PA, United States: Elsevier/Churchill Livingstone.

4. Yadav, V., Shinto, L., & Bourdette, D. (2010). Complementary and alternative medicine for the treatment of multiple sclerosis. Expert Review of Clinical Immunology, 6(3), 381–395. http://doi.org/10.1586/eci.10.12

5. Yadav, V., Marracci, G., Kim, E., Spain, R., Cameron, M., Overs, S.,… Bourdette, D. (2016). Low-fat, plant-based diet in multiple sclerosis: A randomized controlled trial. Multiple  Sclerosis and Related Disorders, 9(2016), 80-90. doi:10.1016/j.msard.2016.07.001