New study on neurotransmitter deficiencies : Dopamine and norepinephrine deficiencies associated with MS. Both neurotransmitters appear to have an inhibitory effect on T17 cells (which are abnormally high in MS) [1]. I wrote about norepinephrine and dopamine deficiencies in MS, along with ways to boost dopamine and norepinephrine levels.

The link between hepatitis B vaccine and MS is not new.

This study looked into the database and the cases reported to the Vaccine Adverse Event Reporting System (VAERS). According to this study, MS cases were up to five times more likely to be reported after a hepatitis B vaccination than after any other vaccination. Another finding: the development of MS following hepatitis B vaccination were more likely to occur from outside the USA and to be reported before 2000 than those associated with other immunizations [2].

Is it safe to discontinue MS therapy after age 60? It looks that is very safe to discontinue MS therapy as you get older. This study evaluated 600 individuals with MS on DMT (disease-modifying therapy- immunomodulators). Almost 30% (178) of them discontinued MS therapy, and only one MS relapse had been recorded [3].

I do have a question this study didn’t look at- if it’s so safe to discontinue MS therapy after age 60……how about after 50, or a couple of years after the therapy started ?

Diet, Supplements & Alternative Therapies

  • Diet has an impact on function and quality of life in people with MS, according to a pilot study. Specifically this study shows better ambulation, improved daily function and quality of life with increased fat intake, decreased carbohydrate intake, and increased intake of the micronutrients cholesterol, folate, iron, and magnesium [4].

 

  • Targeting mast cells to treat MS is an indeed a smart approach- some scientists believe that this is the future of MS therapy. I wrote about it in this article . Current drugs target the suppression of B cells, which make these drugs more effective but also more risky- a lot more (and serious side effects).How about linking these two- how mast cells influence regulatory B cells, and how UV induced immunosuppression can help MS? This is a great research paper exploring this topic (the entire document available in pdf) [5].

 

  • A new review of herbal medicines used for managing MS found that the following herbs are most commonly used: Andrographis paniculata (King of bitters), Boswellia papyrifera (Bitter frankincense), Cannabis sativa (Hemp), Ginkgo biloba (Ginkgo), Aloysia citrodora (Lemon verbena), Ruta graveolens (Rue) and Panax ginseng (Korean ginseng). Cannabis had the highest level of clinical evidence, supporting its efficacy in managing MS symptoms. The above mentioned herbs were mostly used for muscle spasticity, fatigue, vision problems,urinary symptoms, tremor and improving memory and function [6].  

 

  • The amino acid D-Aspartate shows serious therapeutic potential- it stimulates differentiation of oligodendrocyte (the myelin producing cells) precursors, prevents demyelination and accelerates remyelinationin animla models of MS. Technical: D-Aspartic acid is a newly discovered agonist for NMDA receptors, play a role in NMDA receptor-dependent processes (ie synaptic plasticity and memory) [7].

 

  • Melatonin vs glatiramer acetate or interferon beta- which one works best for MS? This was a study in animal models and melatonin (known to modulate immune response) was compared with the standard drugs glatiramer acetate and interferon beta. The prescription drugs seem to work better from a clinical perspective. Both melatonin and interferon beta were able to decrease TNF-a, a very important marker of inflammation (higher than normal levels of TNF-a are seen in MS and many other autoimmune conditions) [8].

 

  • Another study on melatonin. Melatonin plus baclofen helps manage muscle spasticity and promote myelination (in animal models of MS) [10]. Quick note here: I know some people are unable to take melatonin- either can t tolerate it, or feel no effects (for sleep). On easy solution is to try 5HTP, the precursor of melatonin (tryptophan would not be a good choice as it can go down and follow kynurenine pathway rather than serotono-melatonin pathway)- I covered this topic here.

 

  • Cannabis can help with a few symptoms, not just spasticity (as it is currently recommended) Cannabidiol- shows multiple benefits for people with MS, and can be used to reduce spasticity, pain, inflammation, fatigue, and depression. Furthermore, it can reduce the need of other prescription pills- especially drugs prescribed for sleep, anxiety, depression and pain (opioids), according to this study [9].

 

  • Iron and copper metabolism  in MS : MS, Parkinson’s and many other conditions are linked with impaired metabolism of iron. This is a main cause of neuron/other cells’ death. This study reviews this topic, along with inflammation and dysbiosis as key problems in autoimmune diseases, neurodegeneration, metabolic conditions and cancer [11]. 

 

  •  Besides problems with iron metabolism, there are issues with another mineral- cooper. The metabolism of the mineral copper is altered in MS, and appears to play a role in the development of this condition [12].

 

  • Vitamin K 2 significantly lower in people with MS. Possible causes: due to depletion, lower production of this nutrient in the gut, decreased absorption reduced intake of precursor vitamin K1 [13].  Quick note here: supplementation with high doses of vitamin D3 can cause magnesium and K2 deficiency, as these 3 nutrients work together. Make sure you take magnesium and K2 along with vitamin D.

 

  • One more study to support the consumption of non-GMO foods, and avoidance of pesticides: Exposure to pesticides is associated with chronic diseases, including MS, cancer, Parkinson, Alzheimer, diabetes, aging, cardiovascular, chemical sensitivity, and chronic kidney disease [14].

 

  • Training programs that incorporate balance and eye movement exercises are helpful for people with MS. This randomized trial shows improvement in balance in those who followed the program [24].


The Best ways to treat MS related spasticity? Based on a review study (including 23 randomized controlled trials and 2720 patients) found that Cannabis based treatments (Cannabinoids) and botulinum toxin are effective (significantly better efficacy than placebo) for managing spasticity. Other treatments included tizanidine, baclofen and transcutaneous electric nerve stimulation (TENS). The researchers suggest botulinum toxin as a first choice, followed by cannabinoids and TENS [15].

Quick note: be aware that botulinum toxin may be effective, but is not the safest option- it is one of the most potent neurotoxin out there. Even the purified form (as in prescription drug) has serious side effects. More serious side effects are recorded from used it therapeutically (as in MS) compared with cosmetic botox injections, and include: swallowing problems, breathing problems, generalized muscle weakness, necrotizing fasciitis (rapid spreading infection, can be lethal), sarcoidal granuloma (a form of tissue inflammation), a form of gangrene called Fournier gangrene and also death [16].


A phase I clinical study evaluated the stem cell therapy for treating MS (autologous, bone marrow-derived mesenchymal stem cells) [17]. We will see more research on stem cells for MS in the next decade. I think the treatments will get safer in the future. However, at this point I see more risks than benefits for using these therapies.


The Importance Of Gut Microbiome in MS

Obesity, leptin levels, gut flora and MS: Higher levels of leptin are found in individuals with MS compared with healthy controls, based on a systematic review and meta-analysis [18].

A second study shows that impaired gut microbiota and elevated leptin levels seem to correlate with an increased risk of developing MS in obese individuals [19]. Quick note: Leptin is a hormone produced by fat cells and other cells in the body. It has many beneficial effects, the problem occurs when leptin levels are higher than normal.  Increased leptin levels correlate with inflammation, increased body weight, fatigue and much more. Luckily, there are natural ways to decrease leptin levels- for example fasting, exercise, or correcting some neurotransmitter deficiencies (ie dopamine, norepinephrine). 

Gut flora (microbiome) play a key role in MS- another study supporting this idea. Impaired gut microbiome is more often seen in MS than healthy people. In those genetically predispose to MS, the alteration of gut microbiome leads to inflammation and demyelination in the brain/spinal cord. Bacterial products can directly influence the blood brain barrier, the neurons and other cells can activate T cells [20]. 

Note: Let’s remember Dr. Fasano’s research and how autoimmune diseases develop.  There must be 1. A genetic predisposition 2. Certain triggers (ie infections, stress) and 3. Increased intestinal permeability aka leaky gut (which correlates with altered gut microbiome). By reducing the triggers and address gut inflammation, one can reduce the symptoms and even reverse the autoimmune condition. Intestinal inflammation activates the kynurenine pathway causing serotonin deficiency; serotonin is the precursor of melatonin and a down-regulation of serotonin-melatonin pathways may contribute to several symptoms of MS, including depression [21].

More details about tyrptophan -serotonin-melatonin and kynurenine pathways in my article and how to correct serotonin deficiency here.

Great research papers discussing the changes in MS gut microbiome, along with solutions such as dietary changes and probiotics [DIET_MS MICROBIOME_2018],  [22]-more details about this research paper and MS microbiome in this article. 

Fecal incontinence associated with MS could be treated by stimulating a nerve that controls certain muscles in the leg (posterior tibial nerve) [23].

It is worth getting a sleep test to see if you have restless leg syndrome (RLS). RLS is common in MS, and correlates with sleep quality, fatigue, and overall quality of life. It appears that individuals with more adipose tissue (fat) are more likely to have RLS [25].