General MS Questions

Multiple sclerosis (MS) is an inflammatory, demyelinating disease that affects the central nervous system (brain and spinal cord), and may lead to progressive disability. Myelin sheaths are the insulating coatings around many of the nerves in the body and are responsible for conducting nerve impulses effectively. In people with MS, we think that the immune system attacks the myelin sheaths within the central nervous system, causing inflammation and damage. This means nerve impulses cannot be transmitted normally in the damaged areas. This results in a wide variety of physical and cognitive symptoms, including:

• Visual problems
• Fatigue
• Balance, coordination and dizziness
• Reduced mobility
• Pins and needles, numbness and/or tingling
• Pain
• Slowed thinking and/or memory problems
• Bladder and bowel issues
• Sexual function problems

While the cause of MS is not fully understood, it is clear that both genetic and environmental factors play a role. It has been shown that people who have a close relative with MS are 30-40 times more likely to develop the disease themselves.

Environmental factors such as a lack of vitamin D, smoking and dietary factors, including a high intake of saturated fat, are associated with higher rates of MS. MS is much more common in modern, developed countries that are further from the equator.

There is currently no cure for multiple sclerosis, but researchers now have a much greater understanding of what causes the disease. This is thought to be a combination of underlying genetic traits and environmental factors, such as a diet high in saturated fat and low levels of vitamin D.

Nonetheless, it is possible to significantly improve our quality of life by making long-term lifestyle changes to our diet, levels of exercise, vitamin D and more. These are discussed extensively both on this website and in the book Overcoming Multiple Sclerosis: The Evidence-Based 7 Step Recovery Program by George Jelinek.

Roughly 1/1000 people have multiple sclerosis (MS), although this varies widely by country – for example, places like Northern Europe and Australia have higher rates of MS than regions close to the equator. Official estimates suggest that there are two and a half million people with MS globally, but this is almost certainly an under-estimate.  The rate of MS is increasing by two percent annually

The nervous system, which controls the flow of information from the brain to other parts of the body, is made up of a long chain of neurons. Many of these neurons are covered by ‘myelin sheaths’ – these fatty proteins act to both protect the neurons and make it easier for them to transfer information.

When someone develops multiple sclerosis, we think that these sheaths are mistakenly attacked by the immune system and become damaged. The areas of damage, known as lesions, partially or completely disrupt the nervous system’s flow of information. The symptoms that someone with MS experiences depend on the location and size of these lesions.

Multiple sclerosis is typically categorized into five different types:

• Relapsing-Remitting MS
• Secondary Progressive MS
• Primary Progressive MS
• Progressive Relapsing MS
• Benign MS

The symptoms of MS vary greatly from person to person, as different parts of the brain and spinal cord can be affected by the condition. Common symptom include:

• Numbness,
• Tingling,
• Fatigue,
• Mental health problems such as depression and anxiety,
• Visual problems,
• Muscle spasms, stiffness and weakness,
• Mobility problems,
• Pain,
• Difficulty with memory and other cognitive issues,
• Bowel problems

Pain is a very common symptom of MS. Between 30% and 85% of people with MS experience some form of pain during the course of the disease, which can usually be categorized as either:

1. Nerve-related (neuropathic) pain such as pins and needle, numbness and crawling, pricking or burning sensations.
2. Musculoskeletal pain such as painful joints, limbs and muscles.

Yes. Fatigue is unfortunately a very common problem for people with multiple sclerosis. It can be caused directly by the condition itself or by secondary factors such as heat, infections, physical disability, lack of sleep, diet or as a side effect of medication. Mental health difficulties such as depression and stress are common in people with chronic illnesses and may also exacerbate fatigue. Unlike regular fatigue, people with MS experience a general, ongoing tiredness that cannot necessarily be relieved by rest. This can make daily tasks such as concentration and sleeping difficult. Positive lifestyle factors such as diet, exercise and vitamin D supplementation can reduce fatigue. A diet high in saturated fat may also exacerbate fatigue symptoms.

You can read more here: 

Seven ways for people with MS to manage fatigue

OMS offers the best solution to fatigue

Can a cosy cup of cocoa keep fatigue at bay? 

Your chances of developing MS may be affected by any of the following factors:

• Gender - women are three times more likely to develop MS than men.
• Genetics - close relatives of people with MS are 30-40 times more likely to develop the disease than others.
• Age - although MS can happen at any age, it usually develops in people’s twenties or thirties.
• Ethnicity - Caucasians are more likely to develop multiple sclerosis than any other ethnicity.
• Geography - multiple sclerosis is a lot more common in countries further away from the equator such as the United Kingdom, Northern Europe, the United States and Australia.
• Viruses - numerous studies have found that people with multiple sclerosis are at least twice as likely to have had the Epstein-Barr virus (EBV) as people without MS.
• Smoking - smoking cigarettes doubles the risk of someone developing multiple sclerosis.
• Disease - people with type one diabetes, thyroid disease or inflammatory bowel disease are more likely to develop MS than others.

Multiple sclerosis is not a contagious disease. You cannot catch multiple sclerosis from someone else who has it.

There is a genetic element to MS. If a close relative of yours (father, mother or sibling) has MS, this does not mean that you will develop MS, but you are at an increased risk.

Research has found that close relatives of people with MS are 30-40 times more likely than the general population to develop the disease. Children of someone with MS are at much higher risk - about 1 in 10 - of developing the disease themselves.

However, as multiple sclerosis is not linked to one specific gene, there is no definitive way of calculating one child’s chances of inheriting MS. Lifestyle changes such as vitamin D supplementation and a diet low in saturated fat may reduce the risk of a child developing multiple sclerosis in later life.

Being diagnosed with multiple sclerosis can be a very stressful event in anyone’s life, and this stress can lead to further problems with mental health such as depression.

In fact, at least 50% of people with MS will also experience some level of depression.

This can have a big effect on people’s lives, causing not only low mood but also exacerbating the physical symptoms of MS such as fatigue. 

Some of the core components of the Overcoming MS Recovery Program, such as diet, exercise, meditation and vitamin D exposure have a majorly positive impact on mental health.

Prescribed medication can also be an effective treatment, whilst stopping smoking, taking up therapy, getting a better sleep pattern and drawing support from those around us are all beneficial. A doctor will be able to personally analyse your mood and symptoms.

You can read more here:

Depression and MS

HOLISM meditation results published: meditation has strong associations with better quality of life and less depression

Eating fish is linked to lower risk of depression 

Mind-Body connection and MS 

Optic neuritis is a loss of vision that occurs when the optic nerve that connects the brain and the eye becomes inflamed. It can affect one or both eyes, causing blurred vision, pain or reduced colour vision and even blindness.

Usually, the symptoms of optic neuritis will clear up on their own within a few weeks. Although there is a strong link between optic neuritis and multiple sclerosis, only 40-50% of those who get optic neuritis will be diagnosed with MS.

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.

You can read more here.

In the early stages of MS, the body can repair damaged myelin and nerve damage by ‘re-routing’ information around lesions. That makes it a lot easier for the body to heal and allows for recovery of symptoms.

However, as MS progresses and more lesions develop the recovery ability of the nervous system is overwhelmed. There is also degeneration of the damaged nerves and this contributes to worsening disability.

The focus of the Overcoming MS Recovery Program is to stabilise MS as early as possible and prevent disability from developing.

People with multiple sclerosis tend to die between six and ten years earlier than the general population - one study in 2008 estimated life expectancy to be around 65 years on average. Studies have found that 56-58% of people with MS die from a cause that is directly related to the disease.

Death from infection, suicide and heart disease are all also higher for people with MS than for the general population.

However, it is important to note that these figures were compiled when diagnosis was later and treatments were less effective.

Myelin is a fatty substance that coats part of the nerve cells (neurons) in the body. It protects the nerves and enables signals to be transmitted effectively through the central nervous system to various parts of the body. 

Multiple sclerosis causes demyelination, where the myelin that coats the nerves is damaged. This affects the body's ability to send nerve impulses and can result in a number of symptoms.

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.

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.

Osteoporosis and thinner bone density is a common problem for all people diagnosed with MS. There are many reasons for the increased risk in MS but a major contributor is the 'pro inflammatory' state that occurs with MS. Many of the immune chemicals the body produces in MS actually promote osteoporosis:

• 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

Good summaries can be found on the links below:

1. Osteoporosis and multiple sclerosis: risk factors, pathophysiology, and therapeutic interventions

2. Bone health in chronic neurological diseases: a focus on multiple sclerosis and parkinsonian syndromes

By following the OMS Recovery Program you will already be doing the main things to help yourself.

A vegan diet is not associated with bone loss or fracture but high intake of animal fat and protein are so we would recommend following a vegan diet with some seafood. 

•  Vegetarianism, bone loss, fracture and vitamin D: a longitudinal study in Asian vegans and non-vegans

Exercise can be 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.

No, the flu vaccination appears safe for people with 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.

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.

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 vitamin K2 are also thought to be linked with a higher relapse rate in people with MS

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 1980's. 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.¹ 

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.

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.

Interest in amalgam fillings and MS 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 to indicate that this might be helpful. 

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.

There is no evidence to suggest that dental braces are harmful. 

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 is currently no evidence suggest that bee sting therapy could be of benefit to people with MS.

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

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.

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.