Dietary salt associated with MS activity(07/10/13)
Sodium intake was positively correlated with risk of increased disease activity in patients with multiple sclerosis, according to a small study reported here.
Each gram of estimated daily sodium intake above the average in a 52-patient sample was associated with an increase of 3.65 in MRI lesion counts, said Mauricio Farez, MD, PhD, of Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia in Buenos Aires.
Also, patients with estimated salt intake classified as high -- more than 4.8 g daily -- showed relapse rates that were 3.95 times greater (95% CI 1.39-11.21) than those with intakes less than 2 g/day, he told attendees at the European Committee for Treatment and Research in Multiple Sclerosis annual meeting.
Farez emphasized repeatedly that the findings did not prove that high salt intake caused the increased disease activity. He acknowledged that, if there is a causal relationship, it possibly could go in the reverse direction -- that patients with highly active MS may increase their salt intake as a result. But he said he did not view that as very likely.
The study in a total of 122 patients with relapsing-remitting MS grew out of previous research connecting salt intake with vitamin D levels and body mass index, he said. Numerous studies have indicated an association between vitamin D status and MS risk -- including one reported minutes earlier at the Copenhagen meeting -- and it seemed logical to examine whether sodium may share a similar association, Farez explained.
He and colleagues initially recruited 70 patients for a first phase of the observational study. They underwent a baseline MRI scan in November 2010, followed by MRI scans and analysis of urinary sodium excretion as a means of estimating sodium intake 1 year later. Finally, in November 2013, relapse rates for the preceding 2 years were calculated.
During this first phase, the MRI analyses included "combined unique activity" counts -- the total of new T2 lesions and new gadolinium-enhancing T1 lesions since the baseline scan.
A second group of 52 patients was examined in June 2013 with MRI scans and urinary sodium testing to provide replication data for the association between sodium intake and MRI lesion activity. Because this group had only a single scan and no follow-up, Farez and colleagues could only calculate T2 lesion loads, not the combined unique activity lesion counts nor relapse rates.
Farez acknowledged that an important limitation of the study was that it did not measure urinary sodium excretion with 24-hour urine collections, which he said were impractical since they require participants to carry a large container to capture all their urine for a whole day and night.
Instead, his team relied on spot urine collections and a published formula to estimate daily sodium excretion and, from that, daily sodium intake.
He reported that, in the first group of patients, not only those with high sodium intake (more than 4.8 g/day) but also those with "average" consumption showed increased risk of relapse. Participants with estimated daily intake of 2.0 to 4.8 g/day had relapse rates that were 2.75 times that of the low-intake group (95% CI 1.30-5.81).
Comparing both the average- and high-intake groups, the trend was significant at P=0.001, he reported.
Also in the first group, combined unique activity lesion counts were approximately three times greater in both the average- and high-intake groups compared with the low-intake group (P not reported), Farez said.
And, T2 lesion counts were similar in the first cohort's low- and average-intake groups at an average of about 6, but they reached a mean of approximately 14 in the high-intake group (P<0.05).
In the replication set of 52 patients, similar results were seen, Farez said. He and his colleagues calculated that each increment in intake of 1 g above the cohort average was associated with 3.65-lesion increase in T2 count (SD 0.77, P<0.001).
He did not specify the cohort average, but he said that the national average in Argentina has been measured at nearly 5 g/day, well above the U.S. mean of 3.4 g/day.
The World Health Organization has recommended a maximum daily intake of 2 g/day. In the U.S., several government agencies have jointly called for a maximum of 1.5 g/day -- but earlier this year, the Institute of Medicine complained that the scientific evidence did not a support such a low figure, instead backing an older standard of 2.3 g/day.
Farez and colleagues also measured serum sodium but found no relationship between it and clinical or MRI activity. It was also not significantly associated with estimated sodium intake, with an R2 value of just 0.0082.
Asked by the session moderator what a causal mechanism might be, Farez said previous studies had suggested that high salt levels can promote increased inflammatory activity throughout the body. Also, he said, it may increase permeability in the blood-brain barrier, which could contribute to inflammation in the central nervous system.
Whatever such a mechanism may be, he said, "it does not seem to occur in peripheral blood."
The study had no commercial funding.
Farez reported a relationship with Merck Serono. Other investigators reported relationships with this firm and with Biogen Idec, Novartis, and Teva.
Primary source: European Committee for Treatment and Research in Multiple Sclerosis
Source reference: Farez M, et al "Sodium intake is associated with increased disease activity in multiple sclerosis" ECTRIMS 2013; Abstract 119.
Source: MedPage Today © 2013 MedPage Today, LLC (07/10/13)
Dr. Ikuo Tsunoda, Assistant Professor in the Department of Microbiology and Immunology at the Center for Molecular and Tumor Virology of the Louisiana State University Health Sciences Center, and colleagues reported that resveratrol, the polyphenol compound produced by the skin of red grapes and peanuts, worsened neuropathology and inflammation and had no neuroprotective effects in multiple sclerosis (MS) in the Oct. 1, 2013, issue of The American Journal of Pathology.
The researchers advise people that have MS or anticipate the development of MS to avoid resveratrol supplements as well as red grapes, peanuts, and red wine as a precautionary measure until further research defines the action of resveratrol in MS.
The researchers induced MS into test mice in two different forms. The diets of the test mice were compared with normal mice. One group of test mice ate a diet high in resveratrol. The other group of mice with MS ate a diet free of resveratrol.
The test mice that had MS and ate a diet high in resveratrol developed symptoms of MS earlier, had higher levels of inflammation, lost more myelin, and demonstrated slower recovery or no recovery from MS than mice that ate a diet free of resveratrol.
Resveratrol demonstrated no anti-viral effects in mice infected with Theiler's murine encephalomyelitis virus the virus used to induce MS like symptoms in test mice.
Source: examiner.com © 2006-2013 Clarity Digital Group LLC (03/10/13)
When I have diagnosed patients with multiple sclerosis (MS) to be gluten intolerant, the results of implementing a gluten-free diet are often an improvement of their MS and nervous system related symptoms. When they related their improvement to their neurologist, it was frequently met with disbelief or a comment that implied some type of ‘placebo’ effect. Understandably, patients would be very frustrated at the dismissal of what they felt was a significant factor in their health.
While in the past, I’ve only had my clinical experience as a clinical nutritionist to stand on in support of how gluten affects M.S., we now have a wonderful study that reveals the strong correlation between gluten intolerance and MS.
BMC Neurology published a study entitled “Prevalence of Celiac Disease in Multiple Sclerosis” where they reported that the population of individuals suffering from MS appeared to be 5 to 10 times more likely to develop celiac disease than the general population. Interestingly, their first degree relatives were 16 to 32 times more likely to develop celiac disease.
Celiac disease is understood to be associated with different autoimmune and neurological diseases. To see how this potentially related to MS, the researchers examined 72 patients suffering with MS along with their 125 first-degree relatives and compared them to 123 healthy controls.
10% of the MS patients were found to have positive blood tests for celiac disease as compared to 2% of the healthy controls. [Note: this study found 2% of the ‘general population’ to have celiac disease. This is significant for we have used the figure of 1% incidence for quite some time. It is my belief that it IS higher and this study certainly gives merit to that supposition.]
Examining the same individuals through biopsy, 11% of the MS patients had celiac disease. Additionally, an astounding 32% of their first-degree relatives were also found to have celiac disease. No comment was made as to reasons why first-degree relatives would have such a marked increase, but it is quite fascinating.
Could it be that those with neurological illnesses, especially of the autoimmune variety should not only be tested themselves for celiac disease, but should also ensure that their family members be screened?
Conditions known to be associated with celiac disease, including dermatitis and iron deficiency anemia, were found in 57% and 39% of the MS patients respectively. Not surprisingly, considering that MS and celiac disease are both autoimmune diseases and where there is one autoimmune condition there is usually more, the researchers also found indications of other autoimmune conditions present in these affected individuals. Specifically, autoimmune thyroid disease was found in 26% and rheumatoid arthritis in 15% of the MS patients.
When a gluten free diet was instituted, all of the MS patients with celiac disease improved ‘considerably’. Not only did their digestive complaints improve but so did their nervous system symptoms.
Dr. Rodrigo, the main researcher stated that: “So the main message that we want to [get out] to doctors who attend MS patients is to perform clinical, serological [blood], genetic, and histologic [biopsy] studies directed to find a possible associated [celiac disease]“.
Copyright © Health Now Medical. All Rights Reserved. 2013 (02/10/13)
Every year, more than 2,500 Britons are told they have multiple sclerosis. If they ask what it means, they’re likely to be given the textbook definition: it’s a progressively disabling, incurable, neurological illness.
They’ll be told that pain, disability and a range of distressing symptoms are in their future. How bad it gets, how quickly it happens it’s not possible to predict. But there’s not a lot they can do, except take the drugs available.
That was the experience of my husband, Jon, when he was diagnosed ten years ago. He has relapsing-remitting MS, which means symptoms appear during a relapse, then fade partially or completely.
We were 24, boyfriend and girlfriend, and the shock we felt at hearing the news became, over time, a kind of self-preservatory denial of its possible implications.
There is almost no end to the list of symptoms MS can cause, but in Jon’s case it manifests as general, sometimes debilitating, fatigue, spasms and pain in his arms and legs, and numbness in hands and feet. That could change at any time to include problems with his vision, balance and speech, bowel and bladder function, among other things.
His neurologist advised him to take a daily injection of Copaxone, thought to reduce the rate of relapse by up to 30 per cent, and to ignore anyone who told him it could be controlled any other way.
As anyone who has ever Googled it will know, there is an extraordinary array of alternative theories on the treatment of the illness.
If expensive and experimental treatments such as stem cell injections or vascular brain surgery could be proven to work, Jon would do them all, at any cost. And when time is ticking and hope is hard to find elsewhere, it is easy to see why some put their faith in the shakiest of logic. But the proof is elusive.
Jon thinks that until he sees the evidence something can alter the course of this unpredictable disease, it is better to live, as far as possible, as if nothing has changed. He works hard, eats what he likes and tries to think about MS as little as possible. It’s a decision I have always supported and respected.
So, ten years after his diagnosis, we are nervous at the prospect of meeting Professor George Jelinek when he gives a talk in Brighton next Sunday.
A widely published and well-respected doctor from Australia, he was diagnosed with MS 14 years ago and believes it is possible to recover from it.
He says he has helped hundreds control their disease with his methods, and some of their stories make up the persuasive testimonials on his website and in his latest book, Recovering From Multiple Sclerosis: Real Life Stories Of Hope And Inspiration.
More importantly, he has done what few complimentary therapists do: research to back up his work.
Jelinek’s own diagnosis, on top of the fact his mother suffered terribly with it before taking her own life in 1981, motivated him to use his expertise in scientific and medical research to devise ‘an evidence-based guide to recovery’.
He tells me on the phone: ‘The preventive approach is very mainstream when it comes to the treatment of other chronic illnesses such as heart disease or diabetes. 'For some reason, neurologists have been very slow to embrace this.
'Drugs are prescribed – I don’t exclude these, my approach is to do whatever it takes to be well, and for a lot of people that involves taking a drug – but the importance of helping patients change their lifestyles is not so well accepted.’
At its core, Jelinek’s programme is a very low saturated fat diet, excluding meat and dairy, as a diet high in saturated fat diet makes MS more likely to progress.
There is also regular exercise, meditation and exposure to sunlight, all based on his interpretation of widely accepted medical studies.
Last year he published a paper after patients with MS attended a residential retreat promoting his method. The majority of them reported a significant improvement in physical and mental wellbeing.
Professor Leslie Findley, consultant neurologist at Queen’s Hospital Romford, is cautiously optimistic.
‘A sensible approach to disease management, including changes to diet, and increased exercise, relaxation and Vitamin D, are likely to improve outcomes for many people with MS,’ he says.
‘We know high stress levels adversely affect the relapse rate, and the way this programme addresses that through meditation alone could explain the perceived improvement in health.’
Living as Prof Jelinek suggests would take hard work and commitment and critics claim he may be giving people false hope.
But Jon and I have a baby now, and if there was a way to give my husband a chance of living a longer and healthier life, we would do whatever it took.
‘Isn’t it so much worse to tell people there is no hope, when clearly there is? There is clear evidence that shows there are things you can do to improve your situation,’ says Prof Jelinek.
It is empowering to think we could seize greater control over Jon’s disease and his future but it means overhauling our lives.
Prof Jelinek says: ‘It takes significant commitment. But I needed no greater incentive than seeing my mother becoming progressively disabled by this disease, so I wouldn’t deviate for one minute from this lifestyle.’
I fear putting too much faith in such a strict regimen would make every relapse more disappointing, and every chocolate biscuit an unbearable source of guilt. 'It is hard enough to live with a chronic illness, without adding to that burden. But knowing those are not reasons to ignore advice that could help us in the long run, we’re keeping our minds open.
THE STRICT DAILY REGIME THAT CLAIMS TO OVERCOME MS
- Follow a diet that is meat/poultry and dairy-free. Eat only wholefoods (no processed/ready-made foods) so your diet is low in saturated fat and rich in seafood, vegetables, fruits, nuts, legumes, seeds, pulses and grains.
- Take omega-3 fatty acid supplements. Start the diet by taking 20ml a day of standard-strength fish oil and some flaxseed oil on your food.
- Gradually replace the fish oil with flaxseed oil over nine months. On days when oily fish is eaten, omit fish oil supplement.
- After nine months you should be taking 20 to 40ml of flaxseed oil every day.
- Optional. Take B group vitamins or B12 supplement if needed.
- Expose as much of your body as possible to sunlight for 15 minutes daily, three to five times a week to gain Vitamin D, deficiency of which is linked to development of MS.
- Take Vitamin D3 supplement of at least 5,000IU daily.
- Meditate for 30 minutes every day.
- Do 20 to 30 minutes of exercise that elevates the heart rate, about five times a week, preferably outdoors.
- Walking, running and swimming are good examples of this type of exercise.
Prof George Jelinek is speaking at the American Express Community Stadium, Brighton, on July 7.
Source: The Daily Mail © Associated Newspapers Ltd 2013 (01/07/13)
Multiple sclerosis is a challenging disease on many fronts, including the search for effective ways to treat and manage symptoms and relapse. Results of a novel trial using omega-3 and omega-6 fatty acids, as well as vitamins, have shown some promise for people with multiple sclerosis.
Can a natural supplement help MS patients?
Multiple sclerosis (MS) attacks the central nervous system, damaging and destroying the myelin sheaths that protect the nerves and causing a wide array of symptoms that can range from mild (e.g., numbness in the limbs) to severe (e.g., paralysis, blindness). Among the estimated 400,000 people in the United States and 2.5 million individuals around the world who have MS, one challenge is reducing and managing relapses.
Relapsing-remitting MS is the most common form of the disease. It is characterized by attacks—when symptoms flare—followed by remission, when patients have few or no symptoms. Remissions can last for weeks or months, and the disease does not progress.
After 10 to 20 years, people with relapsing-remitting MS typically develop a progressive form of the disease. Known as secondary progressive MS, patients experience a decline in relapses but the disease gets worse.
Researchers in Cyprus conducted a 30-month randomized, placebo-controlled, double-blind, proof-of-concept clinical trial in which they tested three different new, natural treatments to determine if they might reduce disease activity among patients with relapsing-remitting MS who were or were not receiving disease-modifying treatment.
Eighty patients were randomly assigned to one of four groups: (1) omega-3 and omega-6 fatty acids on a 1:1 ratio, plus vitamin A and vitamin E as alpha-tocopherol; (2) the same as (1) plus the addition of gamma-tocopherol; (3) gamma-tocopherol alone; and (4) placebo. The supplements were taken once a day. A total of 41 patients completed the study.
After two years, there were eight relapses reported by the 10 patients in the (2) group compared with 25 relapses reported by the 12 patients in the placebo group. This represented a 64 percent reduction in risk.
The nutrients used in the supplement combination included the following:
Omega-3 fatty acids in the form of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) at 3:1 weight/weight. Both DHA and EPA are available in fish oil supplements. Omega-6 fatty acids in the form of linoleic acid and gamma-linolenic acid at 2:1 weight/weight. Linoleic acid is found in many vegetables oils. Gamma-linolenic acid is found in plant oils such as evening primrose and black currant and has anti-inflammatory properties.
Vitamin A, a group of fat-soluble retinoids that are involved in immune system function, vision, and cell communication Alpha-tocopherol, one of eight types of vitamin E, a fat-soluble vitamin. It is a potent antioxidant and works with gamma-tocopherol, another form of vitamin E. Gamma-tocopherol is another form of vitamin E that reportedly has more anti-inflammatory powers than alpha-tocopherol and is the form found naturally in the diet. The authors noted that minor amounts of other nutrients (i.e., polyunsaturated, monounsaturated, and saturated fatty acids) were also in the supplement combination. Overall, this small study demonstrated that a nutritional supplement combination significantly reduced the occurrence of relapse in patients with MS.
More evidence that supplements help MS
In another new study, appearing in Acta Neurologica Scandinavica Supplementum, the authors conducted an analysis of studies involving the use of fat-soluble vitamins (A, D, E, and K) in the management of multiple sclerosis. They concluded that “there is comprehensive evidence from epidemiological, observational, and experimental studies that vitamin D may be beneficial in MS.”
Indeed, previous investigations have indicated that low levels of vitamin D may worsen MS symptoms and increase the risk of relapse. More research is needed in this area.
The authors of the Scandinavian study also pointed out, however, that the other fat-soluble vitamins had shown some beneficial effects in animals. Thus far, however, too little is known about their impact in humans.
People with multiple sclerosis frequently turn to alternative medicine to find relief for their symptoms. This new study and others indicate multiple sclerosis patients may find some help in the use of natural supplements.
Pantazaris MC et al. A novel oral nutraceutical formula of omega-3 and omega-6 fatty acid with vitamins (PLP10) in relapsing remitting multiple sclerosis: a randomized, double-blind, placebo-controlled proof-of-concept clinical trial. BMJ Open 2013 Apr 17; 3(4). Pii:3002170
Torkildsen O et al. Fat-soluble vitamins as disease modulators in multiple sclerosis. Acta Neurologica Scandinavica Supplementum 2013; (196): 16-23
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