Miscellaneous

Vitamin K2 is a fat soluble nutrient, found in meat and plants that plays a role in determining which part(s) of the body to send calcium to. This is important because calcium is thought to both prevent inflammation and help blood clotting.

Research suggests that the level of vitamin K2 is three times lower in people with MS than the general population, with this level decreasing as age increases. Lower levels of VK2 are also thought to be linked with a higher relapse rate in people with MS.

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Those who do shift work before the age of 20, particularly night shifts, have an increased risk of multiple sclerosis in the future. Irregular working and sleeping patterns are thought to disrupt the brain’s day/night sensors, thereby increasing inflammation in the body. This chronic inflammation can also lead to cardiovascular diseases.

Extended shift work can also be linked to negative lifestyle developments like poor diet, lack of vitamin D due to night shifts, and higher rates of smoking and stress. However, these can all be managed by adopting lifestyle changes which the OMS Recovery Program recommends.

Developing a healthier diet, increasing exercise and meditation, and making sure we get adequate vitamin D levels are all effective measures.

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There is little evidence about the long-term safety of vaping itself, but it does have big health benefits due to its role in smoking cessation.

Vaping is a lot safer than cigarette smoking which doubles the risk of developing MS, quadruples the chance of developing progressive MS, and exposes children’s risks of getting MS from secondary smoke. Therefore, vaping can play a very important role for people with MS.

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Smoking doubles your risk of getting MS, making you four times more likely to develop progressive MS, and eight years earlier. Children of people with MS who smoke double their chances of developing the disease themselves due to secondary smoke inhalation.

It is vital that people with MS stop smoking – not only for their benefit but also for those around them.

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Yes. The flu vaccination appears safe in MS. There is the chance of a flare of ‘ghost symptoms’ – that is symptoms from areas of old damage. This can also occur with changes in temperature and with infections. It does not represent a new relapse rather represents abnormal nerve conduction in nerves that have previously been damaged, covered here.

Osteoporosis and thinner bone density is a common problem for all people diagnosed with MS. The cause for the increased risk in MS is multifactorial: a major contributor is the ‘pro inflammatory’ state that occurs with MS. Many of the Cytokines (immune chemicals) the body produces in MS actually promote Osteoporosis:

  • Ambulatory newly diagnosed People with MS (PwMS) or with CIS (Clinically Isolated Syndrome) have reduced Bone Mineral Density (BMD)
  • 80% of young men diagnosed with MS have a reduced BMD

In addition, treatments such as the interferons and steroids are also known to cause thinning of the bones. These combined with likely historically low levels of Vitamin D, reduced sun exposure, reduced physical activity/mechanical load on bones means that there are multiple potential contributors for the development of Osteoporosis. Good summaries can be found on the links below:
Osteoporosis and multiple sclerosis: risk factors, pathophysiology, and therapeutic interventions
Bone health in chronic neurological diseases: a focus on multiple sclerosis and parkinsonian syndromes

By following the OMS Program you will already be doing the main things to help yourself. By moving to a less ‘inflammatory’ state – you will be stopping the inflammatory cause of bone thinning and promote bone formation. A vegan diet is not associated with bone loss or fracture but high intakes of animal fat and protein are so we would not recommend the consumption or dairy.
Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans

Exercise, particularly high intensity, weight bearing, high impact and resistance training looks helpful. Very recently an interesting study of the effect of Yoga on Osteoporosis was studied. In this study women diagnosed with Osteoporosis did four hours of Yoga/week for six months. Their BMD was measured before and after the intervention and shown to significantly improve. Here are the links to read more on this:
Effects of Yogasanas on osteoporosis in postmenopausal women
Risk of Nonspine Fractures in Older Adults with Sarcopenia, Low Bone Mass, or Both
Sarcopenia and fragility fractures

In line with the OMS program moderate alcohol (2-4 standard drinks / week) appears beneficial. A study from France showed that Women drinking this amount had a higher BMD. You can read more on this here.

By maintaining Vitamin D in the range of 150-225nmol/L you will have optimum Calcium absorption (for example those with a Vitamin D level of 86.5nmol/L absorb 2/3 times more calcium than those with 50nmol/L) and do not need to talk calcium supplements.

Smoking is associated with decreased BMD and increased fracture risk, so smoking cessation is of course essential.

There is no evidence to suggest this. There has been a case report questioning a link with dental amalgams and MS – but there is no solid link and other reviews have found against this. One recent review of adverse issues with Orthodontics did not mention any neurological symptoms.

Bladder issues occur in up to 75% of people with MS. There are a number of potential reasons for this, one is due to the effect of MS on the bladder and another possible reason is suppression of the immune system – an effect of some of the disease-modifying medications, meaning infections are more likely. There is a lot that can be done to help with this and your treating doctor should be able to address this.

CCSVI (chronic cerebrospinal venous insufficiency) is thought to be a vascular condition in which an obstructed flow of blood from the brain and spinal cord back to the heart may cause damage to the nervous system and lead to MS.

Professor Paolo Zamboni, a vascular surgeon from the University of Ferrara, Italy, first observed and named CCSVI. His 2008 paper suggested that reflux pressure in the cerebral veins might induce leakage of blood around the small veins in the brain, and subsequently inflammation which causes MS and other diseases.

Multiple publications on CCSVI have appeared since then, and Zamboni has continued his own research, but the findings remain inconclusive. Studies are ongoing, but for now, the evidence that CCSVI causes MS is not strong.

For a more detailed discussion of CCSVI and MS, with sources, see the MS Encyclopedia.

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The term “lesion” is a non-specific one; from Wikipedia you can see that it is “any abnormality in the tissue of an organism; usually caused by disease or trauma,” and that is essentially correct. Scanning the brains of people without illness randomly, particularly in old age, is bound to turn up lesions in many of them, as abnormalities of the brain increase with age.

It is important not to confuse these “lesions” that occur in people who are otherwise well with the “lesions” that occur in MS. Because MRI images are just a pictorial representation of the anatomy of various tissues, and while they’re more sensitive than CT scan images, these MRI images are not particularly sensitive. So brain lesions look much the same on MRI no matter what causes them.

The Rotterdam Scan Study found about 95% of older people who are randomly scanned have lesions in their brains. These lesions mostly represented the small areas of brain that die as blood vessels age and fail over time. In MS however, these lesions usually represent areas of demyelination, and the lesions are usually distributed in the brain in a very typical pattern, enabling radiologists to say that the lesions are typical of demyelinating disease.

People with MS often wonder why radiologists don’t just say the patient has MS, but it is not that easy, because lesions are non-specific. So, in a person with symptoms suggestive of MS, and lesions in the typical MS pattern on MRI, a clinician may say the diagnosis is likely to be MS. But that is why the neurologists often do other tests and wait until a second episode with new MRI lesions before they make a definitive diagnosis.

In the OMS book, on page 61, you’ll read about the Italian imaging study that found 10% of relatives of people with familial MS (families with a history of MS), 4% of relatives of people with sporadic MS (no other MS in the family), and 0% of the general population had lesions suggestive of MS on MRI scanning. This is more relevant to people with MS than the Rotterdam Scan Study is.

Interest in this area stemmed from an early observation about the geographical distribution of MS. Ingalls, a doctor in Massachusetts, noted that the incidence of MS seemed to follow the incidence of dental tooth decay.1 Knowing that mercury (which forms part of dental amalgam in fillings) has been implicated in neurological disease, the theory was formed that perhaps the amalgam in fillings was causing MS.

One of the difficulties with this theory is that the incidence of dental caries (or cavities in the US) may just be a marker for some other factor that is really contributing to the development of MS. An interesting case control study from Leicester found that people with MS had more dental caries than those without.2 It also found that people with more mercury amalgam fillings had higher mercury levels in their bodies, but it found no higher incidence of MS in those with fillings. So the association of dental caries with MS may just be a reflection of some other variable that is also related to dental caries, and not dental amalgam.

Although the issue remains contentious, a major 2001 review concluded there was no significant health risk from dental amalgam.3 A subsequent review in 2005 concluded that there was no evidence of any association of amalgam with neurodegenerative diseases or autoimmune diseases, but that more research is needed with regard to MS.4 A further systematic review in 2007 reported that there was a slight increase in the risk of developing MS for people with amalgam fillings, which was consistent across studies but did not reach statistical significance.5

Although many people with MS have had their fillings removed as a result, there is as yet no evidence of any sort that I can find to indicate that this might be helpful. Critics of the technique will point out that MS has developed in many, many people who have no fillings or have dentures. On the other hand, many people approach their recovery from serious illness in a very holistic way, and feel that removing all possible toxic substances from their bodies and environment is essential. Removing their dental fillings may be part of this process. It certainly seems that people with many amalgam fillings have higher levels of mercury in their bodies.

If a person is doing all the other things recommended here, I wouldn’t advise getting fillings replaced as a trial just to see if it will help. Like asbestos roofs in houses, the hazardous material is probably safer left in place, where it will release much less of its toxicity than if it is drilled and removed. A reasonable approach would be to leave current amalgam fillings in place, but to get any new ones (if needed) made from a different material.

References:

  1. Ingalls TH. Epidemiology, etiology, and prevention of multiple sclerosis. Am J Forensic Med Pathol 1983; 4:55-61
  2. McGrother CW, Dugmore C, Phillips MJ, et al. Multiple sclerosis, dental caries and fillings: a case-control study. Br Dent J 1999; 187:261-264.
  3. Wahl MJ. Amalgam–resurrection and redemption. Part 2: The medical mythology of anti-amalgam. Quintessence Int 2001; 32:696-710.
  4. Mitchell RJ, Osborne PB, Haubenreich JE. Dental amalgam restorations: daily mercury dose and biocompatibility. J Long Term Eff Med Implants 2005; 15:709-721
  5. Aminzadeh KK, Etminan M. Dental amalgam and multiple sclerosis: a systematic review and meta-analysis. J Public Health Dent 2007; 67:64-66

There has been a lot of conjecture about whether getting immunized against hepatitis B increases the risk of getting MS. Hepatitis B vaccine is genetically engineered and has been available since the 1980s. It is considered to be well tolerated by people, although there have been many reports of increased risk of MS associated with the immunization. A large case-control study from the US tested whether this was by chance, and it found an alarming increase in the risk for several major autoimmune diseases, including MS. People getting hepatitis B vaccination were 5.2 times more likely to be diagnosed with MS than controls who were not vaccinated.This is supported by a US case-control study which showed that people with MS were 3.1 times more likely to have been vaccinated in the 3 years prior to onset of symptoms than controls who did not have MS.2 To confirm that this was a real effect specific to hepatitis vaccination, they checked whether tetanus or influenza vaccination resulted in any similar effect, and found none.

It seems likely that MS is not the only autoimmune disease that may be precipitated by hepatitis B vaccination. US researchers found significant numbers of people with other autoimmune diseases after hepatitis B vaccination in a Vaccine Adverse Event Reporting System and the general medical literature.3 They concluded that it should be considered that there is causal relationship between hepatitis B vaccination and serious autoimmune disorders among certain susceptible people.

For people already vaccinated for hepatitis B, there is nothing that can be done about it. But it may be worth considering this information if the question comes up of having close family members or children vaccinated for hepatitis B, given that they already have a much higher risk of developing MS than the general community.

References:

  1. Geier DA, Geier MR. A case-control study of serious autoimmune adverse events following hepatitis B immunization. Autoimmunity 2005; 38:295-301
  2. Hernan MA, Jick SS, Olek MJ, et al. Recombinant hepatitis B vaccine and the risk of multiple sclerosis: A prospective study. Neurology 2004; 63:838-842
  3. Geier MR, Geier DA. A case-series of adverse events, positive re-challenge of symptoms, and events in identical twins following hepatitis B vaccination: analysis of the Vaccine Adverse Event Reporting System (VAERS) database and literature review. Clin Exp Rheumatol 2004; 22:749-755.

Another therapy that has had its proponents over the years has been bee-sting therapy. A 2005 study of 26 patients used live bees stinging patients with relapsing-remitting MS three times a week.1 The researchers found no reduction in disease activity, disability, or fatigue, and no improvement in quality of life, so this therapy is difficult to recommend. Others have tried immunizing people with MS with bee venom extract. In a small study of 9 patients, researchers found it to be safe — but it did not seem to produce any benefit.2

References:

  1. Wesselius T, Heersema DJ, Mostert JP, et al. A randomized crossover study of bee sting therapy for multiple sclerosis. Neurology 2005
  2. Castro HJ, Mendez-Lnocencio JI, Omidvar B, et al. A phase I study of the safety of honeybee venom extract as a possible treatment for patients with progressive forms of multiple sclerosis. Allergy Asthma Proc 2005; 26:470-47