OCTOBER 2018 MS NEWS- Marijuana, Valerian, Vitamin D and Other Supplements/ Therapies For MS
dr.vanta
Herbs/Natural Supplements For Managing MS Symptoms
Medical Marijuana: Cannabis extracts and cannabidiol as efficient as Copaxone, according to this new study (animal model of MS)
Another new study. An extensive review of the therapeutic potential of cannabis for various conditions- from MS and other neurological conditions to IBS, nausea and vomiting, various cancers, eye diseases, pain, addictions, anxiety and more. Why so many health benefits? Because the endocannabinoid system is involved in important physiological processes ie. energy balance, appetite stimulation, blood pressure, pain modulation, nausea and vomiting control, memory, learning, immune response and more.
Marijuana became legal for recreational use in Canada this month. It will become legal in Michigan US as well. I think this is a step forward in bringing awareness about marijuana and the fact that this herb is not as bad as previously thought. I also have big hopes that doctors will be more open to explore this therapeutic option. While I do not recommend it for recreational purposes, I do see a lot of value in using medical marijuana under doctor’s supervision.
Valerian. Valerian can improve sleep and could be used as a complementary therapy in MS related sleep issues, according to this double-blind randomized clinical trial.
Grape seed. Grape seed supplement can improve fatigue, physical and mental activity in patients with MS, according to this double-blind study.
Vitamin D levels- MS link. A new study supporting the importance of vitamin D. The main findings of this study: 1.Vitamin D intake is inversely associated with disability in those with RRMS. 2. Sunlight exposure is inversely related to disability and fatigue in those with PPMS and RRMS. 3. Increased risk of relapse in MS is related to low serum levels of vitamin D.
Another study on vitamin D. Did you know …? Without vitamin D, just 10–15% of dietary calcium is absorbed ?Full-body exposure to 10–15 minutes of sunlight by a light-skinned individual in the summer months provides 10,000–20,000 IU of vitamin D? Vitamin D deficiency is associated with an increased risk for colorectal, prostate, ovary, and breast cancers and increased mortality?
One more new study on protective roles of vitamin D related to MS and other conditions.
Adding vitamin D to the regular MS treatment was associated with a decrease in relapse rate by 2.6 times, according to this new study. Vitamin D dosage used in this study: 4,000 IU / day in the fall and winter at and 500-1500 IU / day in the spring and summer.
A word of caution: there is also a case study of vitamin D intoxication reported in an individual with MS who was taking very high doses (50000 UI daily) for several months.
Alpha lipoic acid. Lipoic acid might be a promising candidate for MS. treatment, based on its antioxidant anti-inflammatory and immunomodulatory effects found in this study (animal models of MS).
D-aspartate shows neuroprotective effects in animal models of MS, according to this new study. Note: this finding should not be a surprise. The amino acid d-aspartate is also a neurotransmitter, known for its importance in brain development. D-aspartate also improves hormone levels ie testosterone, progesterone and HGH.
Panax Ginseng. A nice review of panax ginseng as a candidate herbal medicine for autoimmune diseases- including MS. Note: While I agree that panax ginseng has great therapeutic potential, I do not recommend it for two reasons:1. Can overstimulate the immune system and 2. The supplement may be contaminated with various unhealthy substances. I recommend Ashwagandha (the Indian ginseng instead- from reputable source- more details on Ashwagandha here).
Icariin (key active ingredient in Epimedium, aka Horny Goat Weed). A review of its many benefits for MS and other brain conditions, as well as heart diseases and cancer.
Pien Tze Huang (PZH), a Chinese medicine formula shows potential to treat MS. (animal study). Technical: Mechanism of actions: lowers Th1 and Th17 cells, suppresses the production of ROR-γt and T-bet as well as the mRNA levels of their downstream pro-inflammatory cytokines (ie IFN-γ and IL-17A. PZH may also inhibit the phosphorylation of some key proteins in the STAT and NF-κB signaling pathways.
The Gut Microbiome. Diet, Exercise & Other Natural Therapies That Work
The role of gut microbiome in MS in this new studyI wrote about the importance of gut flora for MS here.
Ketogenic diet and calorie restriction may help improve MS, according to this new study .Technical: Ketogenic diets attenuate cyclooxygenase and lipoxygenase gene expression in MS. More about Keto diet here.
Exercise, A new book “Recent Researches in Health Science”.This book emphasizes the importance of physical activity- which had been shown to slow the progression of MS symptoms — particularly improved mobility, functional abilities and overall quality of life. — yet, most people with MS (about 80%) do not exercise regularly. Current recommendations for MS: aerobic (moderate intensity) 30 minutes 2-3 days a week. and resistance training for major group muscles 2-3 times a week.
Neuro Physiotherapy works to improve pain, mobility and quality of life- according to this new study conducted in individuals with MS (14 days program).
Tibial and sacral neuromodulation appear safe and offer significant improvements in urinary tract symptoms and quality of life in those with MS who have failed standard medication/therapies, according to this new study.What does this procedure involve? This is not surgery. The doctor will insert a thin needle under the skin of your ankle, near the tibial nerve (in case of tibial neuromodulation. A stimulator will send electrical impulses through the needle to the nerve, and on to other nerves of the spine that control the bladder.
Light therapy (photobiomodulation with visible or near infrared light) helps improve MS, and generally speaking chronic inflammation and degeneration. This study aims to investigate how this therapy works. It appears that B cells are key players. Technical: Data presented here suggest that 670nm light induces B cells to produce IL-10 which is important to the improvement of clinical disease in the EAE.
Combining conventional therapy with Traditional Chinese Medicine treatments is more effective than conventional medicine alone in treating neurological autoimmune diseases (ie MS, Guillain–Barre syndrome), according to this new meta-analysis.
More MS News & Potential New Therapies.
How common is truly benign MS? This study from UK evaluated over 1000 participants with MS who received the diagnosis of MS for over 15 years. Scientists further evaluated a representative sample from this group.According to the researchers, only 15% of them had benign MS. There was a huge discrepancy between patient’s perception and doctor’s assessment: 69% of them considered they have a benign form of MS. Note: Of course, I would like to see that the opinions of doctors and persons with MS would match … However, at the end of the day, what a person feels about his/her condition is more important than the medical records.
Heavy metals linked with increased blood brain barrier (BBB) and MS risk, according to this study. Arsenic seem to the biggest problem. Cadmium and lead also tested.
MS misdiagnosed- a case report.The person presented in this case study was diagnosed with RRMS when in fact had Moyamoya (cerebral angiopathy)
The link: tryptophan metabolism-MS risk/relapse rate.We may see in the future new therapies aiming to improve tryptophan metabolism I wrote in details about tryptophan pathways and its importance for MS here. A quick recap: tryptophan—> 5 HTP—> serotonin—>melatonin. I also wrote here how to improve serotonin levels naturally, and why I prefer 5 HTP over tryptophan as a supplement. This new study conducted in children found a few interesting connections between tryptophan levels and MS- for example: high levels of tryptophan (in the serum) were associated with reduced risk of MS. Based on stool samples, scientists suggest that more abundant the microbial genes involved in tryptophan metabolism, the lower risk for relapses. They also mention that Conclusion: tryptophan metabolism is associated with MS risk and disease severity.
Targeting bile metabolism to treat MS. Another brilliant concept. I will cover this topic in this blog in the future. Some studies done, more in progress. I have no doubt that will show positive results and support the idea that improving bile metabolism is crucial for brain (and overall) health. As the authors note in this study, bile acids act on various receptors that are found on cells throughout the body, including the brain. They have significant effects on the immune system.
Sex hormones could be useful for MS treatment. Not a new idea, but a new study ( actually a review of multiple studies) showing the protective role of sex hormones (ie estriol) in remyelination. Note: I do see a lot of value in improving sex hormones (naturally rather than taking hormone replacement therapy). Technical: This study still focuses on the immuno protective effect of sex hormones in TH1-driven autoimmunity diseases. It is true that MS was seen as a TH1 driven autoimmune disease in the past. The TH1 theory is a bit outdated. The Th17 became more recognized after, and now MS appears to be more TH9 driven autoimmune disease. Research still in progress in the field of immunology….
Abnormal cortisol levels (either too high or too low) linked with MS. Both higher and lower cortisol levels were associated with MS in this new study. Higher cortisol levels were associated with depression and anxiety, and also may be linked with the progression and severity of MS. On the other hand, lower levels were associated with depression, fatigue and urinary dysfunction.
How to decrease the risk of pediatric MS. This study looks at lifestyle changes that can decrease the risk of MS in children. Diet, weight management, regular fitness and good sleep are all important. Diet, particularly vitamin D and vegetable intake, was associated with reduced relapse rate. Obesity was linked to increased risk of MS, and physical activity was associated with reduced relapse rate and fatigue.
Immune-cell crosstalk in MS. Interactions between the B and T cells of the human immune system are implicated in the brain disease multiple sclerosis, suggests this study. It emerges that B cells make a protein that is also made in the brain, and that T cells recognize this protein.
Less Known Symptoms/ Conditions Linked With MS
Headaches can be a sign of early MS. Headaches had never been considered a classical symptom of MS, yet this new study shows that it is worth investigating it, as many cases of MS during early stages manifest with headaches and migraines.
Sleep apnea linked with MS- occurring in 29% of people with this condition, according to this new study. Sleep apnea was also linked with day time fatigue, depression.
Psoriasis. Individuals with MS are at higher risk to develop psoriasis compared with healthy population, according to this review of multiple studies.
Systemic venous thrombosis linked with MS (MS confers 1.91 increased risk of this condition), according to this new systematic review.
Altered fat metabolism. Dyslipidemia seems to be associated with MS progression, particularly in women with relapsing-remitting form of MS, according to this new study. Scientists found a correlation between abnormal cholesterol (total cholesterol and LDL) with disability score in those with RRMS
Genetics
SNP rs1929992 in IL-33 gene may be associated with different pattern of MS susceptibility, suggests this new study.
Apal (rs7975232) gene polymorphism (related to vitamin D receptors) may be associated with MS risk, says this study.
A rare mutation in the purinergic receptor 7 (P2RX7) may represent a putative high-risk gene for MS, according to this study.
HLA-A*03 allele has a significant association with MS, which is in line with other studies, and also confirmed that the presence of this allele could increase the risk of MS, suggests this new study.
The gene polymorphisms at the loci of IL2RA rs2104286 and rs12722489 are closely associated with susceptibility to MS (in Han and Hui nationalities, Chinese study).
The correlation between the methylation status of CpG site of the BDNF gene and the progression of disability in MS patients explored in this study.
MS Therapies & Drugs (Including Side Effects)
Cladribine is gaining popularity for treating RRMS, at least in Europe. The CLARITY trial showed a significant reduction in relapse rate for cladribine in RRMS (compared with placebo).
A new drug (monoclonal antibody drug) will be soon on the market, I guess. Satralizumab. The results of the phase III study just got published. Evaluated for MS like condition called neuromyelitis optica spectrum disorder. Note: I do not recommend any monoclonal antibody drugs (in the same class: Ocrelizumab, Alemtuzumab, natalizumab or rituximab), as I see more risks than benefits.. Daclizumab was withdrawn from the markets earlier this year, details here.
Serious Adverse Reactions from MS drugs.
Alemtuzumab. One one hand, alemtuzumab is praised for its efficacy in a new study (CARE-MS II trial) looking at the follow up results- 8 year period. On the other hand, you may have notice in my monthly news review that this drug has more case reports of serious adverse reactions than any other MS drug. This month: Three cases of sarcoidosis following alemtuzumab treatment of MS reported in this study. Off note, about 50% of individuals will develop a new autoimmune disease following treatment with this drug (in many cases the thyroid gland is affected).
Alemtuzumab. Another case of sarcoidosis due to this drug described in this study.
Alemtuzumab. Neutropenia caused by this drug (case study)
Alemtuzumab.Lambert–Eaton myasthenic syndrome. Linked with alemtuzumab use in MS (and this syndrome can mimic progression of MS)-case report.
Alemtuzumab. Liver injury (acute severe hepatitis) from alemtuzumab use in MS — a case report
Alemtuzumab. Haemophilia A developed from using alemtuzumab for MS- a case study.
Fingolimod linked with heart rate and abnormal lymphocytes (a type of white blood cells) levels. This study also found a correlation between these two side effects.
Teriflunomide causes digestive symptoms, and this study suggests that these symptoms may be due to the fact that the tablets contain lactose. I have two comments here. 1. It is great to see more awareness regarding the inactive ingredients. Most prescription drugs contain fillers that can cause symptoms. Lactose is one, but we should also consider artificial flavors, artificial colors and many other unhealthy chemicals used as fillers. 2.Lactose may only in part explain those side effects affecting the digestion. The drug itself has an impact on the gut flora, which may translate into digestive symptoms.
