Multiple sclerosis is a significant cause of neurological challenges in young adults, affecting over two million people worldwide and nearly one million people in the United States. Multiple sclerosis is more common in women than men and is typically diagnosed between the ages of 20 and 50. (1, 2)
The development of multiple sclerosis involves various factors, including genetic, geographical, and environmental influences. Functional medicine may play a role in the early identification of multiple sclerosis, helping to recognize key factors that could contribute to the condition. This approach aims to support neurological health and manage disease progression.
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What is Multiple Sclerosis?
Multiple sclerosis (MS) is a condition that affects the central nervous system, including the brain and spinal cord. It involves immune-mediated responses that impact myelin, the protective covering of nerve fibers, and can lead to challenges in nerve signal transmission. (2, 3)
MS affects individuals differently. Based on the disease's progression, the International Advisory Committee on Clinical Trials of MS in 1996 defined four types of MS, outlined below.
Clinically Isolated Syndrome (CIS)
CIS is the first episode of neurological symptoms, lasting at least 24 hours, caused by inflammation and demyelination within the central nervous system (CNS). People with CIS may have a higher risk of experiencing another neurological episode and receiving a diagnosis of MS. (4, 6)
Relapsing-Remitting Multiple Sclerosis (RRMS)
70-80% of MS patients are diagnosed with RRMS. RRMS is characterized by episodes of new or increasing neurological symptoms (relapses) followed by periods of partial or complete recovery (remission). (4, 5)
Primary Progressive Multiple Sclerosis (PPMS)
Up to 20% of people with MS are diagnosed with PPMS. With PPMS, neurological function may gradually worsen from the onset of symptoms, without distinct relapses. (4, 5)
Secondary Progressive Multiple Sclerosis (SPMS)
Some patients with RRMS may eventually progress to SPMS, where neurological function gradually declines, and challenges accumulate over time. (4, 5)
What Causes Multiple Sclerosis?
MS is characterized by an accumulation of immune cells in the CNS. Although the precise cause of MS is unknown, it is believed that multiple factors may contribute to the condition's development and progression. (2, 9)
Genetics
Evidence suggests a genetic influence on the development of MS. Certain populations, such as females, Caucasians, and people of northern European descent, may have an increased risk for MS. The occurrence of MS within families also supports a genetic component in the condition's etiology. (2)
Genetic variations in numerous genes have been associated with MS risk. Changes in the HLA-DRB1 gene, located on chromosome 6p21, are strongly linked to MS. (8)
Environmental Factors
One notable characteristic of MS is its geographic distribution. Areas farther from the equator, such as the northern United States, Canada, Great Britain, and New Zealand, have higher prevalence rates. Some studies suggest that vitamin D deficiency may be a significant factor in MS development, possibly due to reduced sun exposure. (9)
Research indicates that smoking may increase the risk of developing MS and is associated with more severe disease progression. (9)
Theories regarding allergic aspects of MS are evolving. Immune responses to allergens may impact the immune system, potentially leading to immune dysregulation. Food allergens, pollens, and molds have been associated with MS disease severity. (10, 11)
Exposure to heavy metals and chemical solvents may contribute to inflammation and nerve challenges. Accumulation of substances like mercury, lead, and manganese can impact neurological tissues and may stimulate inflammatory processes. (9, 12)
Infection
Research suggests that past infections with viruses like Epstein-Barr virus (EBV) and herpes virus-6 (HHV-6) may contribute to MS risk. These viruses may play a role in activating the immune system, potentially influencing MS symptoms. (9)
Dysbiosis
Changes in the gut microbiome, known as dysbiosis, may affect immune function and inflammation. Increased intestinal permeability, or leaky gut, allows substances to enter the bloodstream, potentially triggering immune responses. This process may contribute to autoimmunity and myelin challenges. (12, 13)
Symptoms of Multiple Sclerosis
Symptoms of MS typically develop in young adults between the ages of 20 and 40. Symptoms vary depending on the disease course and the location of neurological changes. For many with RRMS, relapses may develop over days to weeks, followed by periods of remission lasting months to years. (5, 7)
Common symptoms associated with MS include (7):
- Vision challenges: partial or complete vision loss (often with eye discomfort during movement), double vision, blurred vision
- One-sided numbness, tingling, and weakness
- Lack of coordination, unsteady gait, and difficulty walking
- Bladder and bowel challenges
- Sexual function challenges
- Dizziness
- Fatigue
- Cognitive challenges
- Mood changes
- Challenges with speaking and swallowing
Functional Medicine Labs That Can Help Individualize Support for Patients With Multiple Sclerosis
Functional medicine labs may help practitioners identify factors related to inflammation, immune function, and neurological health. Lab results can aid in personalizing support options and monitoring health outcomes for patients. Below are some common labs considered for individuals with multiple sclerosis.
Autoimmune Markers
Advanced autoimmune panels measure autoantibodies to neurological antigens associated with multiple sclerosis. Detection of specific antibodies may help identify mechanisms behind the condition and inform targeted support strategies.
Infection
Given the potential link between latent EBV and MS, an EBV panel can assess different phases of viral presence.
Cyrex's Array 12 is an alternative screening panel that measures immune responses to various pathogens that may influence immune function.
Gut Analysis
A comprehensive stool analysis assesses the gut microbiome's composition, screens for infections, and measures other gut-specific markers. This test may help identify patterns contributing to inflammation and immune challenges.
Increased blood-brain barrier (BBB) permeability may leave the brain more vulnerable to certain substances. Cyrex panels Array 2 and Array 20 measure markers related to intestinal permeability and BBB integrity, respectively.
Food sensitivities may be related to intestinal permeability and immune responses. Blood tests screening for food sensitivities can guide dietary considerations for managing immune function and gut health.
Environmental Exposures
Environmental toxin tests screen for exposure to and quantify the body's burden of heavy metals and chemicals.
Environmental and food allergies can be assessed by detecting IgE antibodies to specific proteins.
Micronutrient Test
A micronutrient test can identify nutritional needs associated with MS and neurological health, helping to guide dietary and supplemental considerations.
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Evidence-Based Nutrition for Multiple Sclerosis
From a functional medicine perspective, dietary and lifestyle choices may play a role in managing MS. Dietary impacts on MS may include supporting a healthy body weight, enhancing quality of life, and promoting a balanced gut microbiome.
Swank Diet
Beginning in 1949, Dr. Roy Swank started exploring a low-fat diet for MS, later known as the Swank Diet. The recommended dietary guidelines include:
- Avoiding processed foods with saturated fat and hydrogenated oils
- Limiting saturated fat to 15 grams daily
- Consuming 20-50 grams of unsaturated fat daily
- Eating fruits and vegetables without restrictions
- Eliminating red meat and pork for one year, then allowing limited amounts
- Including skinless white-meat poultry and white fish; limiting dark-meat poultry and fatty fish
- Choosing dairy products with 1% or less butterfat
- Eating egg whites but not yolks
- Taking one teaspoon of cod liver oil and a multivitamin daily
- Encouraging whole grains, nuts, and seeds
Dr. Swank's long-term observations suggested potential benefits for those who followed the diet, with differences in health outcomes noted between those who adhered to the guidelines and those who did not. (14)
Wahls Protocol
The Wahls Protocol is a modified Paleolithic (Paleo) diet developed by Dr. Terry Wahls. It focuses on supporting mitochondrial function and myelin health. The WAVES trial indicated potential improvements in fatigue and quality of life for those following the protocol. (12, 15)
The Wahls Protocol is adaptable to individual needs and preferences, with a three-tiered system. The basic level, the Wahls Diet, includes:
- Nine cups of fruits and vegetables daily, divided into leafy greens, deeply colored produce, and sulfur-rich vegetables
- Avoiding gluten and dairy
- Choosing organic, grass-fed, and wild-caught protein sources
Supplements and Herbs for Multiple Sclerosis
Dietary supplements may be considered as part of a comprehensive approach to support individuals with MS. Supplements may help address nutrient needs, support immune function, and enhance quality of life. (16)
Fish Oil for Multiple Sclerosis
Omega-3 fatty acids in fish oil are important for brain health. Some studies suggest that lower levels of omega-3s may be associated with myelin challenges. (16)
A 2021 systematic review suggested that omega-3 and fish oil supplements may offer benefits for individuals with MS, including supporting overall health and well-being.
Vitamin D for Multiple Sclerosis
Vitamin D is considered important for immune health, and some research suggests it may play a role in MS. Studies indicate that at least 400 IU daily of supplemental vitamin D may support overall health. (17, 18)
Alpha-Lipoic Acid (ALA) for Multiple Sclerosis
ALA is an antioxidant that may support the body's natural defenses. Research suggests that ALA supplementation may have potential benefits for individuals with MS, including supporting mobility and reducing inflammation.
L-Carnitine & Acetyl-L-Carnitine (ALC) for Multiple Sclerosis
Carnitine is involved in energy production, and ALC serves as a neurotransmitter precursor. Some clinical trials suggest that supplementation with L-carnitine or ALC may help manage fatigue. (16)
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Summary
Conventional approaches for multiple sclerosis focus on managing symptoms and supporting overall health. Many factors may contribute to the development of MS. Functional medicine practitioners may use specialized labs to identify potential triggers and develop personalized strategies to support neurological health and manage disease progression.
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