Multiple Sclerosis

Multiple Sclerosis: Totally avoid mammal meat, animal fat, dairy, new potatoes; take vitamin D, K, B-12, fish oil, and acetyl-L-carnitine.

Many autoimmune diseases are more likely to occur in meat eaters and are more likely to do better if patients stop consuming animal products. Multiple sclerosis fall under this category. If becoming a seafood vegan is more than you can handle, at least stop eating mammals ("red meat") and don't eat the skin or fat of chickens or turkey. Definitely, don't use dairy products of any type. In MS, patients become allergic to their own nerve fiber myelin. Some of these same proteins are present in animal meat and fat, since these animals have nerves protected by myelin, just like humans. Avoiding meat and dairy products has been found to be of considerable help for MS, reducing disability and the rate of death, although this was not a randomized study. Animal fats and smoked meat are especially bad. Fish or fish oil is very good (See Fish). I recommend 10 capsules of fish oil per day.

Acetyl-L-carnitine is an inexpensive amino acid derivative proven helpful for multiple sclerosis fatigue as will as chronic fatigue syndrome. B-12 helped in one study. Vitamin D helps prevent MS and is a very important idea as a part of treatment. At 2000 IU per day, it's cost of $22/yr is a super health bargain since it has many other health benefits. Melatonin might be helpful and is worthwhile in view of its low costs and other health benefits. Vitamin K is great for osteoporosis (which is common in MS), inexpensive, has very few side-effects, and helped prevent but not treat MS in a study of an animal model. Simvastin (Zocor) and presumably any of the other statins may also be of benefit. For individuals who would have to pay for their own medications and/or for whom the physician is unwilling to prescribe a statin, or side-effects are a problem, policosanol is worth given a try ($100 vs. $5/month), although there is no research on policosanol for MS. Doxycycline, a very inexpensive long-acting tetracycline, also appears likely to be of benefit. Acyclovir also may be a worthwhile intervention with probable minor benefits.

Steroids, such as methylprednisolone, are often used in acute attacks. Unfortunately, steroids provide no long term benefit.

Some new treatments have come out for MS, but they are extremely expensive for the benefit they give. This includes glatiramer (Copaxone)($15,900/yr), interferon Beta-1a (Avonex ($16,300/yr), Rebif($19,300/yr)), interferon Beta-1b (Betaseron)($16,600/yr), and mitoxantrone. These medicines reduce relapse by 0%-40% compared to placebo. This means that five or six must take the medicines for one to benefit or $80,000-$100,000 per relapse year obtained. These extremely expensive medications do not stop the progression of disability and may not lower the death rate. Their benefit is definitely limited. Harvard researchers estimate that it costs $2,000,000 per quality life year added!

The new anti-inflammatory natalizumab (Tysabri)($28,100/yr) was withdrawn from the market March 1st, 2005, after resulting in the death of one patient and serious consequences to a second. Natalizumab is an antibody against activated lymphocytes that play a role in the inflammatory process of MS. In the 13-month SENTINEL study of 1,171 patients given Tysabri plus Avonex, 67% were relapse-free vs. 46% on placebo or roughly $200,000 for each additional patient kept relapse-free for 1 year. In the 13-month AFFIRM study of 942 patients given only Tysabri, 76% vs. 53% on placebo were relapse-free. Mitoxantrone damages the heart, so probably should not be taken for more than two years.

These new treatments are all budget-buster drugs. Before the public is forced to foot such incredible costs, patients should first be taken off red meat and dairy and put on vitamins D, B-12, and fish oil.

Older, usually less expensive treatments for MS might be of some value. These include immunosuppressive drugs azathioprine, methotrexate, cyclophosphamide, cyclosporine, cladribine, total lymphoid radiation, and bone marrow transplants.

Acyclovir: Multiple Sclerosis May Be Helped: A 60-patient DB PC study of acyclovir 800 mg t.i.d. for two years found 34% fewer exacerbations with acyclovir (p=.08) with patients with illnesses of greater than two years in duration being significantly benefited and significant difference by grouping patients by frequency. Acyclovir treatment of relapsing-remitting multiple sclerosis. A randomized, placebo-controlled, double-blind study. Lycke J, Svennerholm B, et al. University of Gothenburg, Sweden. J Neurol. 1996 Mar;243(3):214-24

Acyclovir: Valacyclovir May Help: In a 24-week DB PC study of 70 patients with two or more MS relapses in the 2-year period before enrollment, those on 1 gram of valacyclovir three times daily for 24 weeks showed fewer new active lesions per patient: 11.9 vs. 14.5; patients with high levels of disease activity in the valacyclovir treatment group (n = 17) developed fewer new active lesions per scan than did those in the placebo treatment group (n = 11). The median number of active lesions was 2.0 in the valacyclovir treatment group and 6.5 in the placebo. Because of the small number of patients, most differences were not statistically significant. A randomized, double-blind, placebo-controlled MRI study of anti-herpes virus therapy in MS. Bech E, Lycke J, et al. Aarhus University Hospital, Denmark. Neurology. 2002 Jan 8;58(1):31-6. Ed: Valacyclovir is much more expensive than acyclovir, but has no advantages over acyclovir.

A Anti-Viral Might Help MS Somewhat: MRI evaluation showed no significant drug effect. A randomized clinical trial of valacyclovir in multiple sclerosis. Friedman JE, et al. New York University. [email protected]. Mult Scler. 2005 Jun;11(3):286-95.

Antiinflammatory Natalizumab Helped: Binds to immune cells and keeps them from leaving the bloodstream. Up to 90% decrease in lesions. NEJM 1/2/03. Ed: This medicine has been pulled off the market in 2005 due to side-effects, including death.

Autoimmune Antibodies Predict Full Episodes: 103 patients with early symptoms were given blood tests. Those positive for 2 particular antibodies were 76 times more likely develop full MS. This could be used to institute early interferon or other treatments. The antibodies are positive in 5% of normals. Author suspects the antibodies attack myelin. Tom Berger, U Innsbruck, New England Journal of Medicine 349: 139-145.

B-12 Appears to Help MS: In a 24-week DB PC study of 138 patients given vitamin B-12, 1 mg intramuscularly weekly, and either lofepramine 70 mg and L-phenylalanine 500 mg twice daily, or matching placebo tablets, all improved by 2 GNDS points after starting vitamin B-12 injections. The addition of lofepramine and L-phenylalanine added a further 0.6 points benefit. Maximum benefit occurred in 5 weeks. More research is needed to confirm and explore the significance of this clinically small difference. A randomised placebo controlled exploratory study of vitamin B-12, lofepramine, and L-phenylalanine (the "Cari Loder regime") in the treatment of multiple sclerosis. Wade DT, et al. Oxford, UK. . J Neurol Neurosurg Psychiatry. 2002 Sep;73(3):246-9.

Baclofen Intrathecal Pump Increases Disability: In a 5-year follow-up of 21 MS patients on an intrathecal baclofen pump for spasticity, there was a significant improvement in clinical efficacy (Ashworth spasm score, p<0.05) but a small yet significant worsening of disability (p<0.05). Comparing pretreatment with 26 weeks after pump implantation, a worsening was observed in disability (EDSS and ISS, p<0.05) and perceived health status (p<0.05). Zahavi A, Geertzen JH, et al. University Groningen, Netherlands. J Neurol Neurosurg Psychiatry. 2004 Nov;75(11):1553-7.

Bee Sting Therapy Didn’t Help MS: In a DB PC crossover study of 26 patients with relapsing-remitting or relapsing secondary progressive MS of 24 weeks of medically supervised bee sting therapy or 24 weeks of no treatment. Live bees (up to a maximum of 20) were used to administer bee venom three times per week. New gadolinium-enhancing lesions on MRI of the brain were not reduced, and there was no significant reduction in relapse rate. There was no improvement of disability, fatigue, and quality of life. A randomized crossover study of bee sting therapy for multiple sclerosis. Wesselius T, et al. The Netherlands. Neurology. 2005 Oct 12

Carbamazepine (Tegretol) Worsens Multiple Sclerosis: In a large group of MS patients followed for 3 years, the 36 on carbamazepine had 12 periods "mimicking" a relapse; the 94 of gabapentin had only one case mimicking a relapse and the 22 on lamotrigine had none. The high rate of worsening of neurological functioning on carbamazepine suggests it should be avoided in MS. Antiepileptic medications in multiple sclerosis: adverse effects in a three-year follow-up study. Solaro C, Brichetto G, et al. Genoa, Italy. Neurol Sci. 2005 Feb;25(6):307-10

Cyclophosphamide Helped MS Added to Steroid and IFN: In a PC, single-blind study of 59 MS patients with active disease during IFNbeta treatment, patients received either cyclophosphamide 800 mg/m2 plus methylprednisolone 1 g IV (CY/MP) or methylprednisolone once a month for six months and then followed for an additional 18 months. All received three days of methylprednisolone 1 g IV at screening and 30 mcg IFNbeta-Ia IM weekly for the entire 24 months. The number of Gd+ lesions was less for CY/MP at three (P =0.01), six (P =0.04) and 12 months (P =0.02). The cumulative rate of treatment failure was significantly lower in the CY/MP (rate ratio =0.30; P =0.011). Combination therapy with CY/MP and IFNbeta-Ia decreased the number of Gd+ lesions and slowed clinical activity in patients with previously active disease on IFNbeta alone. A randomized blinded trial of combination therapy with cyclophosphamide in patients-with active multiple sclerosis on interferon beta. Smith DR, et al. Harvard. Mult Scler. 2005 Oct;11(5):573-82. Ed: Whether IFN is cost effective is another issue. It’s not.

Depression is Common and Due to Disability: Evaluated 84 Brazilian relapsing-remitting MS patients using the Beck Scale (BS), the Hospital Anxiety and Depression scale (HAD) and the Expanded Disability Status Scale (EDSS). The depression was presented at 17.9% and the anxiety at 34.5% of the RRMS patients. There is a correlation between depression and functional disability (p=0.0002), but there is no relation between depression and sex, age or duration of the illness. Mendes MF, Tilbery CP, Balsimelli S, Moreira MA, Bar o-Cruz AM Arq Neuropsiquiatr. 2003 Sep;61(3A):591-5

Depression and Other Psychiatric Difficulty Much Higher in MS: In a controlled epidemiological study of 50 outpatients with clinically definite relapsing-remitting MS and 50 healthy matched controls, MS patients reported a 217% higher prevalence of psychiatric disorders with 46% suffering from major depressive disorder. The risk of suffering from any non-mood psychiatric disorder was also higher in MS patients than in controls (odds ratio 2.67). Risk factors for depression were female sex and severity of disability, but not therapy with interferon beta or longer duration of illness. Psychiatric disorders and depression in multiple sclerosis outpatients: impact of disability and interferon beta therapy. Galeazzi GM, et al. University of Modena and Reggio Emilia, Italy. . Neurol Sci. 2005 Oct;26(4):255-62.

Depression: Suicide Increased 112% in MS: In a linkage study using the Danish Multiple Sclerosis Registry and the Cause of Death Registry of all 10,174 persons with multiple sclerosis from 1953 to 1996 with follow up to January 1999, 115 adults had taken their own lives, whereas the expected number of suicides was only 54.2. The increased risk was particularly high during the first year after diagnosis (SMR = 3.15). The excess suicide risk has not declined since 1953. Suicide among Danes with multiple sclerosis. Bronnum-Hansen H, et al. Copenhagen K, Denmark. . J Neurol Neurosurg Psychiatry. 2005 Oct;76(10):1457-9.

Dental: Amalgam Fillings Very Weakly Linked to MS: In a study of 20,000 new New Zealand soldiers, there was a non-significant link between the number of amalgam fillings and multiple sclerosis (adjusted hazard ratio (HR) of 1.24 (P = 0.06), but there was no association with chronic fatigue syndrome (HR = 0.98), or kidney diseases. Further follow-up of the cohort will permit investigation of diseases more common in the elderly. Health effects of dental amalgam exposure: a retrospective cohort study. Bates MN, Fawcett J, et al. Porirua, New Zealand. Int J Epidemiol. 2004 Aug;33(4):894-902.

Dental: Amalgam Fillings Not Linked to MS: In a case-control study of 132 MS patients and 423 controls, researchers found only a trend toward a higher number of dental fillings in cases than controls. The odds ratios for exposures of different duration and with different numbers of amalgam fillings were not statistically significant. Multiple sclerosis and dental amalgam: case-control study in Ferrara, Italy. Casetta I, Invernizzi M, et al. University of Ferrara, Italy. Neuroepidemiology. 2001 May;20(2):134-7

Dental: Bad Teeth, Not Amalgam Fillings Linked to MS: In a case-control study of 39 female MS victims and 62 controls, the odds of being a MS case increased by 9% for every additional unit of DMFT index of dental caries. This represents a 21% increase in risk of MS in relation to dental caries in this population. There was no difference between cases and controls in the number of amalgam fillings or in body mercury or lead levels. There was a significant correlation between body mercury levels and the number of teeth filled with amalgam Multiple sclerosis, dental caries and fillings: a case-control study. McGrother CW, Dugmore C, et al. University of Leicester. Br Dent J. 1999 Sep 11;187(5):261-4

Dental: Amalgam Non-Significant Link to MS Probably Just Bad Teeth: In a case-control study of 143 MS patients and 128 controls, neither the number nor the duration of exposure to amalgams supported an increased risk of MS. After adjustment for age, sex, smoking, and education those who had more than 15 fillings had an odds ratio (OR) of 2.57 compared to those who had none; for individuals whose first amalgam was inserted more than 15 years prior to the study, we found an OR of 1.34. Although a suggestive elevated risk was found for those individuals with a large number of dental amalgams, and for a long period of time, the difference between cases and controls was not statistically significant. Dental amalgam and multiple sclerosis: a case-control study in Montreal, Canada. Bangsi D, Ghadirian P, et al Hotel-Dieu Pavilion, CHUM, Montreal, Quebec, Canada. Int J Epidemiol. 1998 Aug;27(4):667-71

Dental: Campaign Against Amalgam Fillings: Opponents of mercury fillings compared 47 multiple sclerosis patients with silver/mercury tooth fillings (amalgams) to that of 50 patients with their fillings removed. Those with amalgams suffered significantly more depression on a BDI while their scores on the State-Trait Anger Expression Inventory indicated more anger. On the SCL-90 Revised, subjects with amalgam fillings had more depression, hostility, psychotism, and were more obsessive-compulsive. A comparison of mental health of multiple sclerosis patients with silver/mercury dental fillings and those with fillings removed. Siblerud RL. Rocky Mountain Research Institute, Inc., Colorado. Psychol Rep. 1992 Jun;70(3 Pt 2):1139-51. Ed: People worrying about their fillings for years might be expected to feel relieved after spending money to have them removed. Advocates make biased researchers.

Dental Cavities Strongly Linked to MS; Maybe a Vitamin D Deficiency Effect: Comparing the geographical distribution of MS to those of dental caries found that the rates of death due to MS in Australian states are linearly related to the numbers of decayed, missing, and filled (DMF) teeth found in individuals from those states (P < 0.002). In the U.S., a strong positive correlation (P < 0.001) also exists. The prevalence of MS in 45 countries or areas correlates well with the frequencies of DMF teeth among children of school age in those locations (P < 0.001). The prevalence of MS also correlates well with the percentage of people with no teeth in certain countries (P < 0.001). The risk for dental caries is lower among the following groups: the lower socioeconomic classes in the United States of America; Chinese immigrants to England compared with natives; blacks compared with whites; and males compared with females. The dental caries risk is higher during pregnancy and lactation. All these trends have been described for MS as well. It suggests that MS and dental caries might both be caused in part by a dietary excess of certain fats and by vitamin D deficiency. Comparative epidemiology of multiple sclerosis and dental caries. Craelius W. J Epidemiol Community Health. 1978 Sep;32(3):155-65

Donepezil (Aricept) Helped Memory a Little at High Cost: In a 24-week DB PC study of 69 MS patients with cognitive impairment, those on donepezil (10 mg daily) showed some improvement in memory performance compared to placebo (p = 0.043), but not on other cognitive tests. Donepezil improved memory in multiple sclerosis in a randomized clinical trial. Krupp LB, Christodoulou C, et al. State University of New York at Stony Brook, NY. Neurology. 2004 Nov 9;63(9):1579-85. Ed: Donezezil is very inexpensive for the drug company to make, but expensive to buy. This study suggests that other, much less expensive Alzheimer's treatment might help a little, e.g. sage, fish oil, lemon balm, vinpocetine, gingko, melatonin, quercetin, etc.

EB Virus May Cause Some MS: In a case-control study of 3,000,000 US military of whom 83 developed MS and two controls for each case, researchers found that blood collected an average of 4 years before MS showed the risk of MS increased with antibody titers with an risk ratio RR of 19.7 for highest vs. lowest for capsid antigen and 33.9 for nuclear antigens. This was true even for those whose samples were collected 5 or more years before disease. There was no association with CMV antibodies. EBV probably causes Burkitt lymphoma, nasopharyngeal carcinoma, and Hodgkins, too. JAMA 3/26/03

EB Virus Probably a Cause of MS: In the health region of central southern England, the rate of MS developing in people admitted to hospital with infectious mononucleosis was a non-significant 117% increase of risk of MS (RR 2.17). At the interval of 10 years or more, there was a significant 300% increase in risk (RR 4.01). The mean time from infectious mononucleosis to first admission with MS was 14 years. Multiple sclerosis after infectious mononucleosis: record linkage study. Goldacre MJ, Wotton CJ, et al. University of Oxford, UK. J Epidemiol Community Health. 2004 Dec;58(12):1032-5

Estriol Helps Relapsing MS: UCLA study of 6 with relapsing MS and 6 with unremitting MS found decrease in lesions with estriol. Estriol only in pregnant women and used widely in Europe for menopause, but not in US because no effect on osteoporosis. Annals Neurol 10/02.

Fatigue Sign of On-Going Brain Atrophy: In a study of 134 patients previously enrolled in a 2-year clinical trial of interferon beta-1a and re-evaluated 8 years after randomization into the trial, there was a clear relationship between fatigue and brain atrophy which was independent of changes in disability, mood, or other MRI characteristics. Fatigue appears linked to destructive pathologic processes in RRMS patients. Association of fatigue and brain atrophy in multiple sclerosis. Marrie RA, Fisher E, et al. Cleveland Clinic. J Neurol Sci. 2005 Feb 15;228(2):161-6.

Fatigue: Acetyl L-Carnitine Helped Fatigue in Multiple Sclerosis: Acetyl L-carnitine (ALCAR) has been shown to improve fatigue in patients with chronic fatigue syndrome. In a 36-patient DB crossover study of 3 months each of amantadine (100 mg twice daily) or ALCAR (1 g twice daily). Beck Depression Inventory didn’t change. Six withdrew because of adverse reactions (5 amantadine and 1 ALCAR). ALCAR was better for the Fatigue Severity Scale (p = 0.039). Comparison of the effects of acetyl L-carnitine and amantadine for the treatment of fatigue in multiple sclerosis: results of a pilot, randomised, double-blind, crossover trial. Tomassini V, Pozzilli C, Onesti E, Pasqualetti P, Marinelli F, Pisani A, Fieschi C., University of Rome, Italy. J Neurol Sci. 2004 Mar 15;218(1-2):103-8. Ed: ALCAR has also been proven to help diabetic peripheral neuropathy and neuropathy from HIV medications in humans as well as help nerve regrowth in rats. Therefore, it appears to me that ALCAR may actually help heal MS. For more, see the Carnitines. This costs less than 27 cents per day or $8.00 per month if purchased as the powder for in bulk.

Fatigue: Mitochondrial Dysfunction plays a key role in Progressive Brain Axonal Loss in Multiple Sclerosis. Andrews HE, Nichols PP, et al. University of Newcastle upon Tyne, UK. Hypotheses. 2005;64(4):669-77. ALCAR works mainly in the mitochondria.

Gingko Might Help MS: In a DB PC study of 39 MS patients matching in the areas of gender, education, type of MS, years since onset, and baseline performance on a battery of neuropsychological tests, those in the ginkgo group were four seconds or 13% faster than the placebo group on a Stroop timed color and word test that measures attention and such "executive functions" as planning, decision making, and controlling goal-directed behavior and execution of deliberate actions. In a recent survey of 1,913 patients in Oregon, 20% reported using the supplement and 39% thought it to be beneficial. However, until now, there was no evidence the supplement had any effect on memory. Jesus Lovera, Oregon Health Science Univ., American Academy of Neurology's 57th Annual Meeting in Miami Beach, Fla., 4/05.

Glatiramer Still Relapsing After Eight Years: In open-label extension followed a randomized, placebo-controlled, double-blind study of GA of approximately 30 months duration. Patients originally randomized to GA continued on it (group A) and those randomized to placebo switched to GA (group B). Of 251 original patients, 142 (56.6%) remained in the study after 8 years. Annual relapse rate for both groups declined to approximately 0.2 (one relapse every 5 years). Neurologic consequence of delaying glatiramer acetate therapy for multiple sclerosis: 8-year data. Johnson KP, Ford CC, et al. Baltimore, MD. Acta Neurol Scand. 2005 Jan;111(1):42-7.

Gluten-free Diet: Exacerbation of Protracted-Relapsing Experimental Allergic Encephalomyelitis in DA Rats by Gluten-free Diet. Di Marco R, et al. University of Catania, Italy. APMIS. 2004 Oct;112(10):651-5. Ed: Many in the herbal community promote a gluten-free diet for MS. There appears to be no evidence supporting the idea.

Hepatitis B Vaccine Linked to Small Increase in MS: In a case-control study of 163 MS victims in Britain and 1,604 carefully matched controls, 6.7% of MS patients vs. 2.4% of controls had had a recent hepatitis B vaccination. 93% of MS patients had not had hepatitis B vaccinations at all. Miguel Hernan, Harvard, Neurol 9/04. Hepatitis B infects 350 million worldwide vs. 2.5 million for MS. Thus, the authors consider the risk to be reasonable.

Hepatitis B Vaccine Causes Increase in MS, Lupus, Rheumatoid Arthritis, and Other Autoimmune Diseases: In a case-control epidemiological study, adults receiving HBV vaccine had significantly increased odds ratios (OR) for multiple sclerosis (OR = 5.2, p < 0.0003), optic neuritis (OR = 14, p < 0.0002), vasculitis (OR = 2.6, p < 0.04), arthritis (OR = 2.01, p < 0.0003), alopecia (OR = 7.2, p < 0.0001), lupus erythematosus (OR = 9.1, p < 0.0001), rheumatoid arthritis (OR = 18, p < 0.0001), and thrombocytopenia (OR = 2.3, p < 0.04) in comparison to the tetanus vaccine group. The chances of exposure to hepatitis B virus in adults is largely life-style dependent. A case-control study of serious autoimmune adverse events following hepatitis B immunization. Geier DA, Geier MR. Silver Spring, MD.. 2005 Jun;38(4):295-301.

Hygiene: Exposure to Infants in Early Life Lowers MS Risk: The "hygiene hypothesis" has implicated sibship as a marker of infection load during early life and suggests that exposure or reexposure to infections can influence the developing immune system. In a case-control study in Tasmania, Australia, of 136 MS cases and 272 community controls, increasing duration of contact with a younger sibling under age 2 in the first 6 years of life was associated with reduced MS risk: <1 infant-year, 1.00 ; 1 to <3 infant-years, 0.57; 3 to <5 infant-years; > or =5 infant-years, 0.12; P = .002). A history of exposure to infant siblings was associated with a reduced IgG response to EBV among controls. Controls with at least 1 infant-year contact had a reduced risk of infectious mononucleosis and a reduced risk of very high composite EBV IgG titers (AOR, 0.33) compared with other controls. The inverse association between higher infant contact and MS was independent of EBV IgG titer. Exposure to infant siblings during early life and risk of multiple sclerosis. Ponsonby AL, van der Mei I, et al. The Australian National University, Canberra, Australia. JAMA. 2005 Jan 26;293(4):463-9.

Immunoglobulins IV No Benefit for MS: Although several double-blind placebo-controlled trials of relapsing-remitting multiple sclerosis have shown beneficial effects of intravenous immunoglobulin (IVIG) on relapse rate and disability, this large DB PC study of 318 patients with secondary progressive multiple sclerosis found IVIG 1 g/kg per month for 27 months had no benefit whatsoever on progression or frequency of relapse. Intravenous immunoglobulin in secondary progressive multiple sclerosis: randomised placebo-controlled trial. Hommes OR, Sorensen PS, et al. Nijmegen, Netherlands. Lancet. 2004 Sep 25;364(9440):1149-56

Interferon Good for MS: Use of interferon for first demyelinating episodes may prevent progression to clinically definite multiple sclerosis. BMJ 3/16/02

Interferon Beta-1a Weekly No Benefit for Relapses in 3 Year Study: At a variety of doses an using the standard weekly frequency of injections for relapsing-remitting multiple sclerosis, once weekly IFN beta-1a, particularly at the 44 mcg highest dose, induced a significant MRI, but not relapse, effect, compared with placebo. In contrast to the significant effect with three-times-weekly dosing of subcutaneous IFN beta-1a, once-weekly dosing was not of benefit. Randomized study of once-weekly interferon beta-1la therapy in relapsing multiple sclerosis: three-year data from the OWIMS study. Freedman MS, Francis GS, et al. University of British Columbia. Mult Scler. 2005 Feb;11(1):41-5.

Interferon Beta-1a (Avonex) Not Cost-Effective in MS; Very Slight Benefit: Interferon beta-Ia (Avonex) 30 microg, intramuscular (i.m.), once weekly is somewhat effective in delaying clinically definite multiple sclerosis (CDMS) following a single demyelinating event (SDE). The incremental cost of Avonex per quality-adjusted monosymptomatic life years gained was $227,586 and $189,286 from Ministry of Health and societal perspectives, respectively. Economic evaluation of Avonex (interferon beta-Ia) in patients following a single demyelinating event. Iskedjian M, et al. PharmIdeas Research and Consulting Inc., Oakville, Ontario, Canada. . Mult Scler. 2005 Oct;11(5):542-51.

Interferon Beta-1a Weekly Somewhat Reduces Risk of MS in High Risk: In a DB PC study of patients with MRI findings compatible with developing MS and symptoms of demylination but not severe enough to be MS, IM interferon-beta-1a 30 microg once weekly had a 44% reduction in the cumulative probability of developing MS (RR 0.56; p = 0.002). MRI showed smaller increases in the volume of brain lesions and the number of new/enlarging and gadolinium-enhancing lesions in interferon-beta-1a recipients. A nonblind extension of this trial demonstrated that early treatment with interferon-beta-1a significantly reduced the probability of developing MS by 35% (p = 0.03), compared with delayed treatment, over a 5-year period. Intramuscular interferon-beta-1a: in patients at high risk of developing clinically definite multiple sclerosis. Siddiqui MA, Wellington K. Adis International Limited, Auckland, New Zealand. CNS Drugs. 2005;19(1):55-61. Ed: While figures were not available to me to estimate cost-effectiveness, the cost of this intervention is very, very high for the benefit achieved. One wonders what a vitamin D and seafood vegan diet would have done and what if any benefit the interferon would be in such a case.

Interferon Beta-1a Every Other Day Did Not Stop Progression in Huge 3-Year Study: In a 3-year DB PC study of 939 adults with secondary progressive multiple sclerosis (SPMS), those given IFNbeta-1b (250 microg or 160 microg/m2 body surface area) every other day showed no significant difference in time to progression of EDSS scores. IFNbeta-1b treatment resulted in improvement on secondary outcome measures involving clinical relapses, newly active MRI lesions, and accumulated burden of disease on T2-weighted MRI. Interferon beta-1b in secondary progressive MS: results from a 3-year controlled study. Panitch H, Miller A, et al. University of Vermont. Neurology. 2004 Nov 23;63(10):1788-95.

Interferon and Glatiramer Not at All Cost-Effective According to Harvard Researchers: Treatments for newly diagnosed nonprimary progressive MS with interferon beta-1a, interferon beta-1b, and glatiramer acetate, assuming a 10-year treatment duration found that interferon beta-1a yielded the largest gain in quality-adjusted life expectancy with an incremental cost-effectiveness ratio of $2,200,000/QALY for women and $1,800,000/QALY for men, compared with no treatment. For a 5-year treatment duration, a "no treatment" strategy yielded more quality-adjusted life years than any of the treatment strategies. Cost-effectiveness ratios were similar for all three immunomodulatory treatments evaluated. Cost-effectiveness of interferon beta-1a, interferon beta-1b, and glatiramer acetate in newly diagnosed non-primary progressive multiple sclerosis. Prosser LA, Kuntz KM, et al. Department of Ambulatory Care and Prevention, Harvard. Value Health. 2004 Sep-Oct;7(5):554-68.

Interferon Beta-1a for MS Not Worth The Extremely High Cost: Interferon beta-Ia (Avonex) 30 microg, intramuscular (i.m.), once weekly is somewhat effective in delaying clinically definite multiple sclerosis (CDMS) following a single demyelinating event (SDE). The incremental cost of Avonex per quality-adjusted monosymptomatic life years gained was $227,586 and $189,286 from Ministry of Health and societal perspectives, respectively. Economic evaluation of Avonex (interferon beta-Ia) in patients following a single demyelinating event. Iskedjian M, et al. PharmIdeas Research and Consulting Inc., Oakville, Ontario , Canada. . Mult Scler. 2005 Oct;11(5):542-51.

Marijuana Helped a Little in Defective Study: In a DB PC study of 66 patients with MS and central pain states (59 dysesthetic, seven painful spasms) of a whole-plant cannabis-based medicine (CBM), containing delta-9-tetrahydrocannabinol:cannabidiol (THC: CBD) delivered via an oromucosal spray, as adjunctive analgesic treatment, patients could gradually self-titrate to a maximum of 48 sprays in 24 hours. Pain and sleep disturbance were recorded daily on an 11-point numerical rating scale. CBM was superior in reducing pain (CBM -2.7 points vs. placebo -1.4, p = 0.005) and sleep disturbance (CBM -2.5 vs. placebo -0.8, p = 0.003). More patients on CBM than placebo reported dizziness, dry mouth, and somnolence. Cognitive side effects were limited to long-term memory impairment. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Rog DJ, et al. University of Liverpool, United Kingdom. . Neurology. 2005 Sep 27;65(6):812-9. Ed: These authors made no report on whether patients could accuratedly guess if they had received the marijuana or the placebo. This could have a major impact on outcome these subjective measures. While the differences were quite significant, they were still small in size.

Meat and Dairy Associated with MS in Germany: J Clin Epidemiol 1994 Jan;47(1):43-8. German study found diet and latitude factors.

Meat, Whole Milk, and New Potatoes Associated with MS in Croatia: Daily consumption of different quantities of full fat unskimmed milk (OR 21.7), potatoes with lard and fresh or smoked meat (OR 20.7), and new potatoes (OR 20.7) were found associated with MS in a Croatian study of 46 patients and 92 controls. Nutritional factors and multiple sclerosis in Gorski Kotar, Croatia. Sepcic J, Mesaros E, et al. University of Rijeka, Croatia. Neuroepidemiology 1993;12(4):234-40

Meat: Pork, Fats Implicated: prevalence rates of multiple sclerosis (MS) in several countries and the corresponding per capita consumption of fat, beef and pork was investigated. A significant correlation was obtained between prevalence of multiple sclerosis and fat intake (r = 0.63, p less than 0.01), total meat intake (r = 0.61, p less than 0.01) and pork consumption (r = 0.87, p less than 0.001). There was no significant correlation with beef consumption. Med Hypotheses 1986 Jul;20(3):279-82

Meat: Meat Most Important Risk Factor in Russian Study: In a study of 155 MS and 155 controls, MS patients reported a higher frequency of: 1) tonsillitis; 2) allergic reactions age 15; 3) head trauma below age 16; 4) a predominant meat vs. vegetable diet during childhood. Stratified analysis and logistic regression pointed to "meat predominance" as the most significant risk factor. Environmental risk factors in MS: a case-control study in Moscow. Gusev E, Boiko A, et al. Russian State Medical University, Moscow, Russia. Acta Neurol Scand. 1996 Dec;94(6):386-94

Meat, Especially Smoked Meat Bad in Russian Study: In a study of 250 "patient-control" pairs, "tonsillitis at the age under 15 years" and "predominance of meat in the diet at the age under 15 years" were significant as well as the consumption of smoked meat. Risk factors of multiple sclerosis in Moscow population. I. Exogenous risk factors. Gusev EI, Boiko AN, Smirnova NF, Demina TL. Zh Nevrol Psikhiatr Im S S Korsakova. 1999;99(5):32-40.

Meat, Dairy Bad; Fish Good in U.S. Study; Latitude Most Important: In a case-control study of U.S. veterans from World War II, latitude was, by far, the variable most closely associated with MS Multivariate analysis found a higher meat consumption in particular, and a higher sanitary level were the prominent features in the first factor. The second MS-related bundle comprised characteristics of a colder climate along with further dietary variables (i.e. a diet low in fish and high in dairy products). The risk of multiple sclerosis in the U.S.A. in relation to sociogeographic features: a factor-analytic study. Lauer K. Darmstadt, Germany. J Clin Epidemiol. 1994 Jan;47(1):43-8.

Meat Smoked Linked to MS: In an epidemiologic study, the distribution of multiple sclerosis was associated with the wood smoking of meat in both countries. Multiple sclerosis in relation to meat preservation in France and Switzerland. Lauer K. Darmstadt, FRG. Neuroepidemiology. 1989;8(6):308-15.

Meat, Animal Fat Avoidance Helps as does Fish: From 1909 to 1945 the average daily consumption of saturated animal fat in the United States increased from 125 to 141 grams. In Canada to 132 grams, In Denmark to 145 grams and to 97 grams in England. In contrast much of the less developed countries all consumed much less animal fat, and more oil in its natural state. Three fourths of the world population consume very low amounts of saturated fats and have the lowest numbers of Multiple Sclerosis(MS) patients. This relationship was first observed by Dr.Roy Swank after 1945. Multiple Sclerosis occurs in countries whose populations consumed over 100 grams of animal fat per day. And only very rarely where fat intake was below 50 grams per day. In Norway in 1949 Swank and Backe found that the internal variations correlated with MS. On the fish-eating coast there was very little MS. Inland flat areas prevalence was low. In the Mountainous areas, MS was 8 times as frequent as the coastal area and in the central farming areas it was 4 times that of the coast.This correlated directly with the level of dietary fat intake. In 1951, Swank demonstrated that MS patients on a low fat diet had a marked decrease in severity and frequency of symptoms. Fitzgerald, et al found a similar relationship in a 3 year study. When the Montreal Neurological Institute studied 156 patients for 6 years, they found that early MS patients did best on the diet and moderately and severely disabled patients did far better than those who failed to follow the diet. Only those who consumed less than 20 grams of saturated fat /day had no or very little deterioration and fewer died. The group that increased their saturated fat intake by 5 grams/day suffered no exacerbation of symptoms but deteriorated more rapidly with an increased death rate. Swank advocated a total avoidance of beef, pork, mutton, dairy, and butter as well as the skin of poultry. Fish is good.

Melatonin Lower in Suicidal MS Patients: In a study of 28 relapsing MS patients admitted to an inpatient Neurology service, the 6 of whom had a history of suicide attempts and who were having suicidal ideation at the time of admission had a lower melatonin level than the others (19.0 vs. 45.5 pg/ml; p<.05). Nocturnal melatonin secretion in suicidal patients with multiple sclerosis. Sandyk R, Awerbuch GI. Danbury, CT. Int J Neurosci. 1993 Jul-Aug;71(1-4):173-82.

Melatonin:Pineal Calcifications High in MS:

Mitoxantrone Helps MS Some: In a DB PC study of 194 patient with relapsing MS, mitoxantrone reduced disability and exacerbations. Lancet 36:2018-5;’02

Modafinil No Benefit for MS Fatigue: In a 5-week DB PC study of 115 MS patients, modafinal up to 400 mg/day made no significant difference in fatigue scores. Modafinil for fatigue in MS: a randomized placebo-controlled double-blind study. Stankoff B, Waubant E, et al. Hopital de la Salpetriere, Paris, France. Neurology. 2005 Apr 12;64(7):1139-43.

MSP Protein Overproduced: dramatic increase in a newly discovered degradative enzyme, myelencephalon-specific protease (MSP), in demyelinated tissue, indicating that inhibiting this enzyme could potentially block the process of tissue damage. This is a first-ever finding of the link between MSP and the debilitation that patients experience in MS. June 2002 Brain

Natalizumab Lowered Progression: Natalizumab is the first alpha4 integrin antagonist in a class of selective adhesion-molecule inhibitors. In the 2-year AFFIRM trial of 942 MS patients, 627 received natalizumab 300 mg by intravenous infusion every four weeks. The cumulative probability of progression 17% for natalizumab vs. 29% for placebo. Natalizumab reduced relapse at one year by 68% (P<0.001) and led to an 83% reduction of new or enlarging hyperintense lesions. The adverse events that were significantly more frequent in the natalizumab group than in the placebo group were fatigue (27% vs. 21%, P=0.048) and allergic reaction (9% vs. 4%, P=0.012). Adhesion-molecule inhibitors hold promise as an effective treatment for relapsing multiple sclerosis. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. Polman CH, et al. AFFIRM. Vrije Universiteit, Amsterdam, The Netherlands. . New Eng J Med 2006 Mar 2;354(9):899-910.

Oligodendrocyte Cell Death May Trigger MS: A study of a 14-year-old who died on the first day of a relapse found myelin intect without any immune response but oligodendrocytes, which produce the myelin, dying. Myelin is an extension of these cells that wraps itself around nearby nerve fibers. Annals Neurol 2/23/04

Picornavirus Colds Associated with MS Attacks: MS relapses are sometimes associated with upper respiratory infections (URIs). In a study of 16 RRMS patients, the viral causes of 21 separate URIs were investigated. Seven of the nine (78%) URIs due to picornaviruses were associated with an MS attack during the at-risk period (2 weeks before to 5 weeks after cold symptoms). By contrast, only two of 12 (17%) picornavirus-negative URIs were associated with an MS attack (P = 0.01). Multiple sclerosis attacks are associated with picornavirus infections. Kriesel JD, White A, et al. University of Utah. Mult Scler. 2004 Apr;10(2):145-8.

Relatives of MS Patients At Risk: Using a nationwide registers, the risks of MS in a population-based cohort of 19,615 first-degree relatives of 8,205 Danish MS patients followed for 30 years, first-degree relatives had a 610% increased risk of MS (n = 90) compared with the background population. The familial excess lifetime risk was found to be 2.5%. This percentage should be added to a sporadic absolute risk in the general population of 0.5% in women and 0.3% for men. Spouses of MS patients did not experience an increased risk of MS, suggesting no major role for environmental factors acting in adulthood. Familial risk of multiple sclerosis: a nationwide cohort study. Nielsen NM, et al. Copenhagen, Denmark. Am J Epidemiol. 2005 Oct 15;162(8):774-8.

Sildenafil (Viagra) Helps Multiple Sclerosis Men: In a 12-week DB PC study of 217 men with multiple sclerosis with an open extension after 12 weeks, those on sildenafil (25-100 mg) had much improved erections 89% vs. 24% (p<0.0001). At the end of the extension phase, 95% of men reported improved erections. Men receiving sildenafil also showed improvements in five of the eight general quality of life questions compared with men receiving placebo (p<0.05) with 43% improving vs. 13% (p<0.0001). A double blind, randomised study of sildenafil citrate for erectile dysfunction in men with multiple sclerosis. Fowler CJ, Miller JR, et al. London, England. J Neurol Neurosurg Psychiatry. 2005 May;76(5):700-5.

Smoking a Major Risk Factor: A Norwegian study of over 22,000 ages 40-47 found that smokers were 181% more likely to develop MS which typically occurred after 15 years of smoking. Neurology 10/28/03

Smoking Dramatically Increases Switch From Relapsing to Progressive MS: In a nested case-control study of 201 cases 1913 controls, there was a 30% increased risk of MS in smokers. Of 179 cases with 5.3 years of follow-up, there was a 260% increased risk of secondary progression for ever smokers compared with never smokers (HR = 3.6). Cigarette smoking and the progression of multiple sclerosis. Hernan MA, Jick SS, et al. Harvard. Brain. 2005 Mar 9

Statins Might Help Multiple Sclerosis: 30 patients with relapsing-remitting MS received simvastatin, 80 mg daily. On MRI scans, the mean number of lesions after six months of treatment decreased by 44% (P < .0001), and total lesion volume decreased by 41% (P = .0018). Inderjit Singh, Medical University of South Carolina. Lancet. 2004;363:1570, 1607-1608. Ed: It would also be good to know if the much less expensive and safer policosanol, which lowers cholesterol as well as the statins, benefits MS. See Cholesterol Lowering Medications.

Stress Doubles Risk of Relapse: Relapse-remission pattern in 85-90% of all MS patients. 73 Dutch 18-55yo MS pt with >1 relapse in previous 24 months had 457 stressful life events and 134 relapses in next 1.4 years. 2.2 times as many relapses in next 4 weeks after the stressful event. Infections caused independent triple relapse risk. Self reported stressful life events and exacerbations in multiple sclerosis: prospective study D Buljevac, W C J Hop, W Reedeker, A C J W Janssens, F G A van der Mech, P A van Doorn, R Q Hintzen BMJ 2003;327:646 (20 September)

Suicide Increased 112% in MS: In a linkage study using the Danish Multiple Sclerosis Registry and the Cause of Death Registry of all 10,174 persons with multiple sclerosis from 1953 to 1996 with follow up to January 1999, 115 adults had taken their own lives, whereas the expected number of suicides was only 54.2. The increased risk was particularly high during the first year after diagnosis (SMR = 3.15). The excess suicide risk has not declined since 1953. Suicide among Danes with multiple sclerosis. Bronnum-Hansen H, et al. Copenhagen K, Denmark . . J Neurol Neurosurg Psychiatry. 2005 Oct;76(10):1457-9.

Sun, Vitamin D Reduce Risk: Higher sun exposure when aged 6-15 years (average 2-3 hours or more a day in summer during weekends and holidays) was associated with a decreased risk of multiple sclerosis (adjusted odds ratio 0.31) in a case control study of 136 cases and 272 controls in Tasmania. Higher exposure in winter seemed more important than higher exposure in summer. Greater actinic damage was also independently associated with a decreased risk of multiple sclerosis (0.32 for grades 4-6 disease). A dose-response relation was observed between multiple sclerosis and decreasing sun exposure when aged 6-15 years and with actinic damage. ultraviolet radiation can attenuate T helper cell type 1 mediated immune responses through several mechanisms. Administration of ultraviolet radiation or 1,25-dihydroxycholecalciferol, the active form of vitamin D₃, which is produced under the influence of ultraviolet radiation, has shown protective effects against the induction or progression of experimental allergic encephalomyelitis. Ultraviolet radiation or vitamin D may also protect against multiple sclerosis. A strong ecological association between regional levels of ultraviolet radiation and prevalence of multiple sclerosis is evident in Australia (r = -0.91). In a death certificate based case-control study, high residential or occupational exposure to sunlight was negatively associated with mortality from multiple sclerosis. A strong latitudinal gradient of prevalence of multiple sclerosis in Australia even among immigrants from the United Kingdom and Ireland (70% who migrated after age 15) suggests exposure later in life might also be important. Tasmania latitudes 41-3°S and has a high prevalence of multiple sclerosis at 75.6 per 100 000 population. BMJ 2003;327:316

Tetracyclines: Add to Benefit in Mouse Model of MS: The addition of minocycline resulted in a significant reduction of disease severity and disease burden with attenuation of the inflammation, axonal loss and demyelination. Giuliani F, Metz LM, et al. University of Calgary. J Neuroimmunol. 2005 Jan;158(1-2):213-21. Ed: Doxycycline and minocycline also helped rheumatoid arthritis, another autoimmune disease. Minocycline has attenuates the severity of disease in stroke, multiple sclerosis, spinal-cord injury, Parkinson's disease, Huntington's disease, and amyotrophic lateral sclerosis in animal models. Lancet Neurol. 2004 Dec;3(12):744-51.

Vitamin A-C-E, Vegetables, Fruit No Help: In a 6 year follow-up study of 95,000 women comparing highest quintile (fifth) with lowest quintile (fifth), the odd ratios for developing MS were 1.1 for alpha-carotene, 1.1 beta-carotene, 1.4 beta-cryptoxanthin, 1.0 lycopene, 1.0 lutein/zeaxanthin, 1.4 total vitamin C, 1.3 dietary vitamin C, 0.8 vitamin E, and 0.9 dietary vitamin E. No associations between intakes of fruits and vegetables and risk of MS were significant. Nurses Health Study and Nurses Health Study II of Harvard found 214 cases MS. Intakes of carotenoids, vitamin C, and vitamin E and MS risk among two large cohorts of women. Zhang SM, Hernan MA, Olek MJ, Spiegelman D, Willett WC, Ascherio A. Neurology 2001 Jul 10;57(1):75-80

Vitamin D Might Help MS: 15 patients with relapsing-remitting MS and at least one clinical relapse within the previous 12 months received oral calcitriol (target dose: 2.5 microg/d) for 48 weeks. Dietary calcium was restricted to 800 mg/d. The on-study exacerbation rate (27%) was less than baseline. Four patients experienced five clinical relapses but only one patient worsened by >1 EDSS point. Brain MRI revealed enhancing lesions in five patients at baseline (33%) and in four (29%) at both 24 and 48 weeks. A pilot study of oral calcitriol (1,25-dihydroxyvitamin D3) for relapsing-remitting multiple sclerosis. Wingerchuk DM, et al. Mayo Clinic, Scottsdale, Arizona. . J Neurol Neurosurg Psychiatry. 2005 Sep;76(9):1294-6.

Vitamin D: Multiple Sclerosis Protected By: In a Harvard study of 187,563 women in the Nurses' Health Study I and II, women were followed for an average of 11 years with the diet assessed at baseline and updated every 4 years thereafter, during follow-up, 173 cases of MS were confirmed. The highest quintile (1/5) of total vitamin D intake at baseline compared to those in the lowest had a 33% lower risk of MS: RR 0.67 (p = 0.03). The intake of vitamin D from supplements was also inversely associated with risk of MS; the RR for women with intake of >or=400 IU/day vs. women with no supplemental vitamin D was 0.59 (p = 0.006) or 41% lower. No association was found between vitamin D from food and MS incidence. Vitamin D intake and incidence of multiple sclerosis. Munger KL, Zhang SM, O'Reilly E, Hernan MA, Olek MJ, Willett WC, Ascherio A. Neurology. 2004 Jan 13;62(1):60-5. Ed: I recommend all adults take 800 IU per day. An MS victim would probably be wise to start at 2000 IU per day for the first 2 months and then take 1200 IU per day long-term. Osteoporosis is high in MS victims.

Vitamin D: Fetuses Developing During Sunny Months Have Less MS: In a study of 17,874 Canadian, 11,502 British, and 12,700 Danish and Swedish patients with multiple sclerosis, fewer (8.5%) people with MS were born in November and significantly more (9.1%) were born in May. Timing of birth and risk of multiple sclerosis: population based study. Willer CJ, Dyment DA, et al. University of Michigan. BMJ. 2005 Jan 15;330(7483):120. Ed: Infants born in November would have developed during the months of greatest sunlight and therefore highest vitamin D levels in the mothers, especially in the 4th to 6th months which are critical for nervous system development. May is the opposite.

Vitamin D to Prevent Osteoporosis Important: Patients with MS carry an enormous risk of osteoporosis. Diet and multiple sclerosis. Schwarz S, Leweling H. Universitat Heidelberg. Nervenarzt. 2005 Feb;76(2):131-42.

Vitamin D: Increased Vitamin D Gene Variants in MS: To investigate VDR gene variation using three intragenic restriction fragment length polymorphisms (Apa I, Taq I and Fok I) in an Australian MS case-control population, 104 Australian MS patients and 104 controls were studied. There was a significant difference of genotype distribution frequency between the case and control groups for the functional exon 9 VDR marker Taq I (p(Gen) = 0.016) and a stronger difference for the allelic frequency (p(All) = 0.0072). The Apa I alleles were also found to be associated with MS (p(All) = 0.04) but genotype frequencies were not significantly different from controls (p(Gen) = 0.1). The Taq and Apa variants are in very strong and significant linkage disequilibrium (D' = 0.96, P < 0.0001). The genotypic associations are strongest for the progressive forms of MS (SP-MS and PP-MS). Variation in the vitamin D receptor gene is associated with multiple sclerosis in an Australian population. Tajouri L, et al. Griffith University Gold Coast, Southport, Queensland, Australia. J Neurogenet. 2005 Jan-Mar;19(1):25-38.

Vitamin D: Sun, Vitamin D Reduce Risk: Higher sun exposure when aged 6-15 years (average 2-3 hours or more a day in summer during weekends and holidays) was associated with a 69% decreased risk of multiple sclerosis (adjusted odds ratio 0.31) in a case control study of 136 cases and 272 controls in Tasmania. Higher exposure in winter seemed more important than higher exposure in summer. Greater actinic damage was also independently associated with a 68% decreased risk of multiple sclerosis (0.32). Administration of ultraviolet radiation or 1,25-dihydroxycholecalciferol, the active form of vitamin D-3, which is produced under the influence of ultraviolet radiation, has shown protective effects against the induction or progression of experimental allergic encephalomyelitis. A strong ecological association between regional levels of ultraviolet radiation and prevalence of multiple sclerosis is evident in Australia (r = -0.91). In a death certificate based case-control study, high residential or occupational exposure to sunlight was negatively associated with mortality from multiple sclerosis. A strong latitudinal gradient of prevalence of multiple sclerosis in Australia even among immigrants from the United Kingdom and Ireland (70% who migrated after age 15) suggests exposure later in life might also be important. Tasmania's latitude is 41-3°S and it has a high prevalence of multiple sclerosis at 75.6 per 100,000 population. BMJ 2003;327:316 8/9/03. Ed: Taking vitamin D is a lot easier than moving to the Equator.

Vitamin D Low: In a study of 31 MS patients and 30 controls, BMD of the lumbar spine was nearly 1 SD lower in MS patients compared with the healthy reference population (Z scores). MS patients had significantly lower vitamin D levels (17.3 ng/ml vs 43.1 ng/ml; P < 0.001) compared to controls, and 19 patients (61%) had a serum level of vitamin D that was less than 20 ng/ml. Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity. Ozgocmen S, et al. Firat Universitesi, Elazig, Turkey. J Bone Miner Metab. 2005;23(4):309-13

Vitamin D Receptor Gene Variants Increase MS Risk: In a study of VDR gene variation using three intragenic restriction fragment length polymorphisms (Apa I, Taq I and Fok I) in 104 Australian Relapsing Remitting MS patients vs. matched controls, the results support a role for the VDR gene increasing the risk of developing multiple sclerosis, particularly the progressive clinical subtypes of MS. Variation in the vitamin D receptor gene is associated with multiple sclerosis in an Australian population. Tajouri L, et al. Griffith University Gold Coast, Australia. J Neurogenet. 2005 Jan-Mar;19(1):25-38. Ed: This can probably be at least partially overcome by taking supplemental vitamin D.

Vitamin K Helped Prevent Animal Model of MS: Vitamin K(2) is widely used for hypoprothrombinemia and osteoporosis in Japan. In experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS), VK2 helped although it was not effective when given after the onset. Inflammatory cellular infiltration and the expression of both MHC class II and inducible nitric oxide synthase (iNOS) were reduced in the spinal cords of VK2-treated rats with EAE. The inhibitory effect of VK2 on the iNOS expression in glial cells was also observed in vitro. Considering the long use of VK2 is without noticeable untoward effects, it may be applicable to the patients with MS. Vitamin K(2) ameliorates experimental autoimmune encephalomyelitis in Lewis rats. Moriya M, et al. Osaka University, Japan. J Neuroimmunol. 2005 Sep 5

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