For now and for the future: how a Functional Medicine approach to MS can change your life starting today
If you’ve reached this page, it might be that you’re here because you have MS, you think you may have MS, or you have a relative of loved one who has MS.
We understand that a diagnosis of multiple sclerosis for you or for a loved one can be really worrying, and that you may be concerned not only for what it means for your quality of life right now, but also what the future could hold in store.
The good news is that while there is no ‘cure’, a Functional Medicine approach to MS can help to protect your health right now, and help to ensure a great quality of life for the future.
Our approach relies on understanding the unique factors at play in your MS, so we can work to bring them under control and put your MS into remission long term.
Table of Contents
Multiple sclerosis statistics
Multiple Sclerosis (MS) is an autoimmune condition that affects around 2.8 million people worldwide (1).
The Multiple Sclerosis Society estimates that around 110,000 people are living with MS in the UK, with 5,200 new cases diagnosed each year (2).
These estimates are based on data up to 2010 and so there is uncertainty as to the true size of the current MS population (3), but it is very likely to be larger today than it was in 2010.
MS causes fatigue, pain, and mobility problems and can significantly impact everyday quality of life.
It is two to three times more common in females than males, and diagnoses are most common in the 20-40 age group.
The prevalence of MS has increased in every world region since 2013 (4).
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What is MS?
Multiple sclerosis (MS) is a chronic disease affecting the central nervous system (the brain and spinal cord), and like other autoimmune diseases, it occurs because the immune system starts to attack your body’s own tissues.
In this case, the body attacks the nerves, brain, and spinal cord – specifically the myelin sheath (a fatty substance which protects and insulates healthy nerve fibres) (5).
This immune attack causes inflammation which affects electrical impulses that pass along the sheath and nerves, affecting communication between the central nervous system and the body.
Over time this inflammation damages the myelin sheath and can lead to scarring of the nerve within the sheath.
This is what can cause “progression”, where symptoms gradually worsen, without any relapse (6).
MS is unpredictable and affects each person differently.
What are the different types of MS?
Information regarding the different types of multiple sclerosis may slightly defer depending on the source of your information (7,8,9).
There are four stages (or types) of MS and the symptoms associated with MS increase as stages progress.
However, not all MS patients progress through all the stages.
Most MS patients are first diagnosed with relapsing-remitting MS and for some, the symptoms may increase, progressing to Secondary Progressive MS.
Around 10-20% of MS patients may not progress to develop major disabilities even 20 years after diagnosis (10).
A small percentage of patients (less than 10%) suffer progressive disability from the outset (Primary Progressive MS) (11).
So we can see that it’s not a given that a patient diagnosed with relapsing-remitting MS, will proceed to secondary and then primary progressive MS.
And therefore, slowing down or halting disease progression (as we do in our Functional Medicine approach to MS) becomes an important clinical goal, as well as restoring function throughout the body.
Clinically Isolated Syndrome (CIU)
This is the first sign of MS symptoms and is due to inflammation and loss of myelin sheath.
It may be one symptom (monofocal) or several symptoms (multifocal).
This could be a single episode or go on to progress to full-blown MS.
Relapsing-Remitting Multiple Sclerosis (RRMS)
This type of MS is characterised by the onset, over a period of hours to days, of neurological symptoms, and these symptoms may persist for days or weeks, i.e. a series of relapses (or exacerbations or attacks).
These symptoms then disappear partially or completely, on their own or with treatment -‘remission‘.
Sufferers may then remain symptom-free for weeks, months, or even years.
At the time of diagnosis, 85-90% of patients will have a relapsing-remitting course of multiple sclerosis (12).
Secondary Progressive Multiple Sclerosis (SPMS)
Secondary Progressive Multiple Sclerosis follows relapsing-remitting MS.
Due to worsening nerve function, progression to RRMS means that there hasn’t been full recovery after any relapses, and this results in disability.
Primary Progressive Multiple Sclerosis (PPMS)
Primary Progressive Multiple Sclerosis is so called because from the first (Primary) symptom, symptoms have been progressive.
There is no relapse and remission, but a consistent, gradual progression over time.
PMMS doesn’t develop from relapsing-remitting MS because there are no, or too few, relapses to progress.
Other types of MS
Radiological Isolated Syndrome
A diagnosis of radiologically isolated syndrome (RIS) is made if an MRI scan of the brain or spinal cord shows damage that looks like MS, but you haven’t noticed any MS-like symptoms.
Benign Multiple Sclerosis (MS)
Benign MS cannot be predicted at the time of diagnosis, or even after a few years with MS.
It is identified by the fact that someone has had the diagnosis of MS for at least 15 years and yet has had no evidence of worsening (both in functional ability and as evidenced on the MRI).
This occurs in about 5-10% of patients.
What are the signs & symptoms of multiple sclerosis?
The symptoms and severity of multiple sclerosis can vary greatly between individuals; from being only mildly affected to severe: losing the ability to write, speak, swallow, speech, or walk.
Some common symptoms of multiple sclerosis include:
Central nervous system symptoms
Mouth and speech
and many more.
What’s the conventional medicine approach to multiple sclerosis?
In conventional medicine, your doctors will aim to diagnose the condition using a variety of tests:
and then will treat the symptoms with medications and perhaps make referrals to various therapists.
Medications to suppress the immune system and treat symptoms include:
2/ Disease Modifying Therapies e.g., Beta Interferon (Extavia) and Siponimod (Mayzent)
3/ Haematopoietic stem cells (HSCT) in certain individuals.
HSCT uses chemotherapy to remove the harmful immune cells and then aims to rebuild the immune system using a type of stem cell found in the bone marrow.
A multidisciplinary team is often employed to support all aspects of MS, for instance:
These interventions work to manage the symptoms of MS, but do not address why you have those symptoms, which in the Functional Medicine approach to MS, is what we aim to do.
What’s the Functional Medicine approach to MS?
Let’s go back to the ‘types of MS’ discussed earlier and specifically the clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS).
These conditions can present many years before a clinical diagnosis of MS.
Many people are diagnosed with these types, and never go on to develop full blown MS.
But for some, they are an early sign that they will later develop other more progressive stages of MS.
So, what makes one individual more susceptible to going on to develop MS, and can we do anything to prevent it?
Can it be due to their genes or their environment?
Well, what we do know is that in autoimmune diseases like MS, there are a TRIAD of factors present:
and in all likelihood, an imbalanced microbiome.
To take a deeper dive into this triad of factors, head over to our article on autoimmune disease.
For those with an ‘active relapse’ in MS, the immune system is still attacking the myelin around the nerves.
This causes inflammation and in our Functional Medicine approach to Ms, we want to know why this is happening.
In our clinical practice working with those who have MS, we help to optimise nutrient status, environment and lifestyle factors to help improve symptoms, and identify and address underlying risk factors or imbalances.
Read on to understand some of the common risk factors associated with MS that we consider, assess and then address if required, through a scientific evidence-based, natural approach.
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Causes and risk factors for MS
There are many triggers that may be driving this inflammation and causing the immune system to misfire, and attack the myelin sheath and nerves.
The list below are some examples of research-proven factors that can contribute to disease onset or are pertinent drivers of MS:
Genetics and Race
MS disproportionately affects Caucasians (13), while Asians are significantly less likely to develop MS.
Northern latitudes have the highest prevalence of MS (14) and for this reason, daylight hours and vitamin D levels have been areas of huge interest in MS (more on this later).
However, there are new trends being noted globally, suggesting environmental and genetic changes are at play.
For example, in recent years, in the US, there has been an increase in MS rates in African Americans and Hispanics, whereas in the past, African Americans were at low risk of developing MS (15).
Additionally, a Canadian study reported an increase in MS in females of Asian background, with the incidence doubling in the period 1986-2010 (16).
The MS rate in the non-Asian white population remained unchanged.
Age and gender
MS is most commonly diagnosed in people in the 20 to 40 years old age group, although it can develop at any age.
The mean age of diagnosis is 32 (4).
MS is about 2 to 3 times more common in women than men.
The evidence is clear that smoking can worsen MS.
Smoking can escalate the progression of the disease, increasing the risk of disability.
It can also mean more and larger lesions and more frequent relapses (17,18)
Smoking has been shown to have a significant effect on the number of symptoms experienced by patients with MS. Studies clearly suggest that smoking correlates with an increased number of symptoms (19).
Low vitamin D has been associated with an increased risk of a MS diagnosis for many years.
The data hasn’t always been clear or definitive, but low vitamin D does appear to be a strong environmental risk factor for developing MS and for the severity of MS (20, 21, 22).
In fact, in 2018, health professionals in Canada were advised to check vitamin D status for those at risk of developing MS, and treat with a dose that helps maintain a blood vitamin D level of 50-125nmol/L.
Interestingly, sunlight exposure during childhood and adolescence also interferes with the risk of developing MS in adulthood (23).
It is very well documented that vitamin D is critical for healthy immune function and immune modulation (23), thereby reducing autoimmunity risk.
Vitamin D receptors are found in many different tissues and cells in the body, including neurons, where it can regulate the function of over a 1000 genes (24).
Low vitamin D has also been associated with depression, in those with MS (25).
All of our cells rely on mitochondria to produce cellular energy.
They are tiny, super powerful, energy producing factories inside our cells.
Optimal neuronal health depends on good mitochondria function (26).
But it is also relatively easy to damage our mitochondria and reduce their efficiency.
Smoking, environmental chemicals, high stress, poor diet, low antioxidant status, nutrient deficiencies, dehydration, infections, are some reasons why our mitochondria may not be working at full capacity.
Like any busy factory, the mitochondria also produce a lot of waste, in the form of free radicals that can lead to ‘oxidative stress’.
Some people with MS can trace back their symptoms to have started after a traumatic event or period of very high stress yet results from studies exploring whether stress can cause MS, have been mixed.
Studies have however, demonstrated that there is a strong correlation between periods of high stress, and exacerbation of MS or MS relapse (27, 28), in people who already have an MS diagnosis.
For example, a study performed in 2002, following fifty women with MS for one year, noted that some high stress events such as a death in the family or a divorce, were associated with MS exacerbations in the subsequent 6 weeks (29).
But the good news is that stress reduction techniques have been shown to significantly reduce the development of new MS lesions on MRI scans (30), although the benefit was not maintained once the stress management therapy stopped.
Consistent, long term, stress reduction techniques may prove to be extremely helpful.
Oxidative stress & inflammation
Inflammation can be caused by many factors, such as smoking, infections, environmental factors, or other causes, and can result in an immune reaction that in turn triggers the production of reactive oxygen (or nitrogen) species.
Reactive oxygen species (ROS) then drive neuronal damage and neurodegeneration (31).
The more ROS we produce, the more likely we are to create ‘oxidative stress’, a state where there is insufficient antioxidant capacity to compensate for the level of reactive oxygen species (ROS) being produced.
Oxidative stress is a significant contributor in neurodegeneration. But it is also relatively straight forward to improve.
In Functional Medicine, we luckily have a huge range of nutritional and lifestyle strategies that can effectively lower oxidative stress, thereby protecting neuronal health.
Numerous chronic infections have been proposed to be causative factors of MS, or contributors to the progression of MS.
In our experience at Coho Health, we definitely find chronic infections, upon testing, in those with MS.
A number of potential mechanisms are believed to be involved whereby an infection contributes to immune system dysregulation and autoimmunity.
These include processes called ‘molecular mimicry’, ‘epitope spreading’, and ‘bystander activation’ (32):
Viruses like Epstein–Barr virus (EBV) seem to be the strongest candidates as a risk factor (33), and subclinical EBV infections are often found in people with MS (34).
There are also links with Human Herpes Virus 6 (35).
These viruses can lie dormant and become reactivated many years later, perhaps when the body is undergoing another viral attack like COVID, or a bacterial infection, for example bacterial overgrowth in our gut (SIBO) or mouth (periodontal disease).
Bacteria that are linked with MS include Mycobacteria, Chlamydia pneumoniae, and Helicobacter pylori (36).
Research shows that Chlamydia pneumoniae, a sexually transmitted disease, was more prevalent in the biological liquids of patients with MS than in healthy volunteers (37) and Mycoplasma pneumoniae may be associated with demyelination (38).
Since there are many pathogens to consider in MS (39), it is important to understand which, if any, are relevant in your case.
Advanced testing can help us to explore viral load for an individual.
An example of such a test is the Viral Screens by Immunosciences Lab, (for UK and EU clients, available from Regenerus Labs, through your Coho Health practitioner).
Or looking more broadly, an immune response to various pathogens, not only viruses, can be screened by using the Cyrex Array 12 test – Pathogen-Associated Immune Reactivity Screen.
If you’re working with a Coho Health practitioner, then we will make the best functional testing recommendations for your specific case after an initial consultation and full review of your health history, family history, and signs and symptoms.
Increased intestinal permeability (‘leaky gut’)
Or for a more specific, in depth version of how a leaky gut / increased intestinal permeability can cause autoimmune conditions, take a look at the graphic below:
Increased intestinal permeability can be normalised through mucosal barrier supportive nutrients, these include:
while also looking to understand and address the drivers of a ‘leaky gut’ for each person.
‘Leaky gut’ is often a physiological state that develops as a consequence of other imbalances.
Causes of a ‘leaky gut’, could be:
The gut-brain axis
The gut-brain axis can be considered as a bi-directional multi-crosstalk pathway between the gut microbiota and the brain.
In the presence of increased intestinal permeability, the gut-brain axis can lead to immune responses, not just locally in the gut, but also in other areas of the body such as the Central Nervous System (CNS).
Research indicates that the gut-brain axis likely plays a crucial role in neurological diseases, including multiple sclerosis (40).
This article proposes two possible consequences of gut-brain axis dysfunction in MS:
1/ A pro-inflammatory intestinal environment and ‘leaky gut’, induced by dysbiosis, could lead to altered communication with the CNS via the vagus nerve, thereby contributing to CNS inflammation and disease pathogenesis.
2/ Neuroinflammation affecting signal transmission could result in intestinal inflammation as the disease progresses (41).
This pro-inflammatory environment is often due to a dysbiotic microbiome.
The microbiome comprises of trillions of organisms; bacteria, viruses, fungi, and protozoa.
However they are not all equal.
Some exert positive benefits on the body, and others exert negative effects, so having balance within the microbiome (an imbalance is called dysbiosis), is key.
We already know that dysbiosis in the microbiome can contribute to systemic diseases like obesity, diabetes, autoimmunity, and rheumatoid arthritis.
Research has shown significant differences in the microbiome of MS sufferers compared to those without the condition (42).
This is important as studies suggest certain gut microbes can make the immune system turn against nerve cells.
Akkermansia is a bacteria normally associated with having a positive anti-inflammatory effect on the gut mucosa.
But in MS it is found to be four times higher than it should be (43).
The bacteria Acinetobacter was also four times more abundant in MS patients than in individuals with no disease (44).
And a recent study in the journal Cell, also showed higher amounts of Akkermansia, Ruthenibacterium lactatiformans, Hungatella hathewayi, plus Eisenbergiella tayi, and decreased levels of Faecalibacterium prausnitzii and Blautia species in MS (45).
Clinically, we can explore these infections using advanced comprehensive stool analysis tests such as the GI MAP by Diagnostics Solutions, the GI Effects Comprehensive Stool test by Genova Diagnostics, or the GI Ecologix test by Invivo Clinical.
But how does this lead to MS?
It is thought that the molecules produced by certain gut bacteria alter the MS patients’ immune system.
For example, in the presence of Acinetobacter and Akkermansia, the immune cells that come into contact with these bacteria then become a particular type of T helper cell, which triggers inflammation.
Additionally, some gut bacteria from MS patients seems to block the production of molecules, like the cytokine IL-10, that reduce inflammation (46) while other bacteria influence cellular energy.
A study including 1,349 participants, showed that those with food allergies had more relapses, and were twice as likely to show more lesions on an MRI scan (47).
Dr Terry Wahls, who herself is in remission with MS, strongly advocates a no gluten and no dairy diet.
This is partly because these foods are common food sensitivities and can cause increased intestinal permeability (increasing immune cells and inflammation), but also because the proteins in gluten and dairy, resemble self-proteins in the myelin.
The immune system can mistakenly launch an attack on myelin when its aim was to remove the food proteins.
This can increase demyelination.
Other food reactions should also be assessed in MS, as any food triggering a negative immune response is a risk factor for more inflammation and immune system problems.
The Functional Medicine approach to MS: remyelination
Remyelination (the repair of the damaged myelin sheath) already occurs in MS naturally.
When the myelin sheath is repaired, the nerve can regain full function, which is obviously a pretty big deal in MS.
In a Functional Medicine approach to MS, we therefore want to do everything possible to promote remyelination.
Remylination is usually quite an active process in the early stages of the disease, but the remyelinated sheath may not be as functional as the original myelin.
Over time, remyelination reduces, this could be due to several hypothesised causes; the ageing process itself, the inflammation in MS, and /or the scarring that might make this process more difficult.
There are medications which can help reduce disease activity and relapses during the RRMS phase of the disease.
But so far, we are lacking successful treatments to prevent disability progression, which is due to nerve damage and loss.
If we can enhance myelin regeneration, we can support the axon and restore nerve function.
And this is exactly what has been demonstrated in a number animal studies (48), which have led to some early human studies that are currently underway.
This research will hopefully make it possible to develop medicines that can promote myelin regeneration.
Stem cell therapy research continues in MS, for example using stem cells for myelin-producing oligodendrocytes (ODCs).
Mitochondrial transplant, where live mitochondria are transplanted into damaged cells to support remyelination, is another area of interest.
Cordycepin, originally from Cordyceps militaris (a mushroom) was studied in animal models where it was found to support remyelination (49).
Cordycepin has since been synthetically produced and patented, and research in this area continues.
Cobalamin (from vitamin B12) is critical in myelination and enhances nerve repair and function (50).
Optimising levels of active B12 in MS patients, may improve remyelination.
The Functional Medicine approach to MS: nutrition strategies
There are many beneficial diets proposed for MS:
In fact, a couple of these dietary models are about to be put to the test in what will be the largest and longest dietary intervention study performed in the setting of MS.
At time of writing, Dr Wahls is currently recruiting those with relapsing remitting MS (and will do so throughout 2023) for her new research study where 156 people will be included in a trial assessing whether (and by how much), brain volume loss rate can be reduced in MS.
Brain volume loss naturally occurs with ageing; however this rate is increased in MS.
The trial aims to prove that dietary interventions can reverse brain volume loss in MS sufferers.
Participants will be divided into three dietary intervention groups, the Wahls elimination diet, the Ketogenic diet, or the control group (who will also receive guidance, around e.g. reducing sugar and increasing vegetables).
We are super excited to follow the outcome of this trial which is set to demonstrate the power of nutritional interventions in MS (what we already see with MS patients!).
You can find out more about the trial here: https://wahls.lab.uiowa.edu/join-study
It’s interesting to note, that actually there are some common nutritional interventions in all the above mentioned dietary models, such as the elimination of inflammatory foods like trans fats, sugars and refined carbohydrates.
Some of the diets also avoid foods that can frequently cause an immune response in autoimmunity, like grains, gluten, legumes, dairy, nightshades and eggs.
But equally (or perhaps even more) importantly, the dietary interventions focus on what to include, not just what to avoid.
We want to include nutrient-dense foods that can:
and particularly important in MS, foods that can help support:
Which brings us on to thinking about dietary fats.
Dietary fat is a highly debated area in nutrition, particularly when it comes to saturated fats (found, for example in, meat, skin on meat or poultry, dairy, and coconut oil).
Saturated fats in MS: yes or no?
Healthy fats are required for many functions in MS.
Healthy fats are essential for myelin formation which is composed of about 70-85% of fat, for hormone production, reducing LDL-cholesterol, and keeping cell membranes fluid (improves cell to cell communication).
Diets like the SWANK and OMS suggest limiting saturated fats to 15 grams a day (51, 52), whereas The Wahls Protocol advocates saturated fat.
One type of fat, called polyunsaturated fatty acids (PUFA), is essential for the optimal structure and function of cell membranes, and for the production of an anti-inflammatory molecules called eicosanoids.
This same outcome is not achieved with saturated fats.
Different types of fats have different functions in the body, but interestingly, when there insufficient PUFAs available, the cell membranes instead will use available saturated fats.
Unfortunately, this isn’t a healthy ‘swap’ and leads to dysfunction, since the saturated fats affect cell membrane function and are not able to produce anti-inflammatory eicosanoids.
Hence in a Functional Medicine approach to MS, we assess the balance of the different types of fats in your body.
Then, armed with this information, we can make the necessary recommendations around how much fat to include, which type of fats you might need more of and which to avoid.
Levels of polyunsaturated fatty acids (such as omega 3, 6, and 9), saturated fats, monounsaturated fats, and trans fats, can be easily measured through a simple finger-prick blood sample.
Examples of these tests, include the Genova Diagnostic Essential and Metabolic Fatty Acids test (although most functional labs provide a similar test).
A sample report can be viewed here.
In short no one diet fits all, and in our Functional Medicine approach to MS, we look at your individual needs and plan a personal nutritional protocol accordingly.
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Although being diagnosed with and living with MS can be really worrying, overwhelming, painful, frustrating, and can feel hopeless at times, you can live a great quality life free of MS flares.
We can’t promise it’ll be easy, but we can promise it’ll be worth it.
As you’ll have seen from reading this article, getting to the root cause of MS in each unique case involves the assessment of many different factors.
With so many potential causes and contributing factors, our Functional Medicine approach to MS looks to first identify those factors, then reduce or eliminate them where possible.
We’ll aim to restore health by bringing the body back into balance with reduced levels of inflammation, better immune system balance, and reduce or eliminate the stimuli that are causing autoimmune attacks.
At the same time, we’ll also optimise all the factors that support myelin sheath repair.
If you’re ready to change your life, we’d love to help you take control of your MS journey, and feel better.
To your optimised, healthy future,
Lulu & the Coho Health team
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