19 - Multiple Sclerosis

Question 1

• What is the myelin sheath made of?
• What is its function?
• How is it made?

Answer 1

• Fat & protein
• It wraps around nerves to support nerve function
• It is produced by oligodendrocytes

Question 2

What cells can be lost in MS and via what process?

Answer 2

• Oligodendrocytes
• Autoreactive & inflammatory cells infiltrate the BBB and attack the myelin sheath

Question 3

What are the 3 types of MS?

Answer 3

• Relapsing remitting
• Primary progressive
• Secondary progressive

Question 4

What are symptoms of MS (11)

Answer 4

• Visual impairment ― optic neuritis.
• Nerve tingling and numbness.
• Intestinal and urinary problems.
• Fatigue and weakness.
• Poor co-ordination and balance.
• Speech difficulties.
• Learning and memory issues.
• Difficulty walking.
• Emotional difficulties.
• Muscle spasm or tremors.
• Pain.

Question 5

What role do T cells play in MS?

Answer 5

Shift in T-cell subpopulations away from anti-inflammatory T-regulatory cells (T-regs), towards autoreactive Th17 T cells.

Question 6

What are risk factors for MS? (9)

Answer 6

– Vitamin D deficiency
- Raised BMI.
– Childhood trauma / stress.
– Elevated homocysteine
- Mitochondrial dysfunction.
– Certain autoimmune diseases.
– Infections such as Epstein-Barr virus.
– Cigarette smoke exposure.
– Environmental toxins, e.g. dioxins, air pollution.

Question 7

What supplements are recommended for MS patients? Give doses. (9)

Answer 7

• Vitamin D (optimise levels / 2000 iu).
• Vitamin K (50 - 100 mcg).
• Vitamin B12 (1000 mcg) and methyl folate (500 mcg).
• Omega-3 fatty acids (>1g EPA).
• Quercetin (500 mg).
• Alpha lipoic acid (300 mg).
• Citicoline (250 mg).
• Sulforaphane (250 mg).
• Hesperidin (500 mg).

Question 8

What is the optimum serum Vit D in MS?

Answer 8

75 - 100 nmol/L

Question 9

How does Vitamin D support MS patients? (3)

Answer 9

• MS is more prevalent in countries further away from the equator
• Doubling vitamin D level decreases MS relapse risk by 27%
• Moves the immune system away from autoreactive T-cells towards anti-inflammatory T-regulatory cells.

Question 10

How does Vitamin K support MS patients? (2)

Answer 10

• MS patients are frequently vitamin K deficient (1/3 of expected Vit K levels)
• Gas 6 (growth arrest specific 6) is a vitamin K-dependent anti-inflammatory protein which protects oligodendrocytes and promotes re-myelination.

Question 11

How does Vitamin B12 support MS patients? (3)

Answer 11

• Many MS patients have high homocysteine and low B12.
• B12 supplementation improves neuron growth and survival and regenerates the myelin sheath.
• The phospholipids contained within the myelin sheath are methylated, and so require B12 to support methylation.

Question 12

What is the connection between obesity and MS? (6)

Answer 12

• Obesity (including in childhood) is a risk factors for MS.
• Obese MS patients have a higher level of disability.
• Obesity makes the blood-brain barrier more permeable, leading to inflitration of macrophages and CNS inflammation.
• Leptin (raised during obesity) is associated with CNS inflammation.
• Leptin increases levels of Th17 autoreactive T-cells.
• Obesity leads to an upregulation of M1 and reduction in M2 microglia.
  
  • M1 microglia are proinflammatory and drive oligodendrocyte loss.
  • M2 microglia are anti-inflammatory, support oligodendrocytes and re-myelination.

Question 13

How does early life stress/adversity impact MS development? (3)

Answer 13

Childhood adversity:
* Is linked to MS onset.
* Leads to shrinking of the thymus, increasing the production of autoreactive T-cells.
* Has a negative impact on oligodendrocytes.

Question 14

How does reducing stress and stimulating the Vagus nerve support MS patients? (4)

Answer 14

Stimulating the Vagus nerve:
- Decreases proinflammatory (M1) microglia
- Decreases autoreactive T-cells
- Increases myelination
- Increases anti-inflammatory T-regulatory cells

Question 15

What does the Swank diet for MS involve?

Answer 15

• Low saturated fat (<15g daily)
• No red meat / pork for 1 year
• <50g white meat / fish daily
• High fruit & vegetables

Question 16

What does the Whals diet for MS involve? (give example foods in each category) (6)

Answer 16

• Green leafy vegetables (kale, spinach, rocket)
• Sulphur-rich vegetables (cabbage, onions and asparagus).
• Colourful fruits and vegetables for phytonutrients (beetroot, oranges, berries and carrots).
• Omega-3 fatty acids (Salmon, herring, and sardines)
• Grass-fed meats and organ meats.
• Seaweed.