Multiple sclerosis or MS is an inflammatory disease that affects the central nervous system. The disease usually worsens slowly and depends, among other things, on the severity of the signs and symptoms and the frequency of relapses.
Multiple sclerosis affects the central nervous system, especially the brain, optic nerves, and spinal cord. It alters the transmission of nerve impulses and can manifest itself through a variety of symptoms: Numbness in a limb, visual disturbances, sensations of electrical discharge in a limb or back, movement disorders, etc.
Learn more about the symptoms of multiple sclerosis
Most often, multiple sclerosis progresses in the form of relapses in which the symptoms reappear or new symptoms appear. After a few years, the relapses leave behind consequences (permanent symptoms) that can be very disabling. The disease can impair many functions: movement control, sensory perception, memory, speech, etc. The disease can also affect a person’s ability to walk, talk, etc.
Multiple sclerosis is a chronic autoimmune disease that varies greatly in severity and course. It was first described in 1868 by the French neurologist Jean-Martin Charcot.
The disease is characterized by inflammatory reactions which in some places lead to the destruction of myelin (demyelination). Myelin is a sheath that surrounds the nerve fibers. Its function is to protect these fibers and to accelerate the transmission of messages or nerve impulses. The immune system of people with demyelination is said to destroy myelin because it sees it as something external to the body (autoimmune reaction). As a result, at certain points in the nervous system, the flow is slowed or completely blocked, causing the various symptoms. Between the outbreaks, the inflammation disappears and the myelin partially rebuilds around the fibers, resulting in complete or partial regression of the symptoms. However, repeated and prolonged demyelination can permanently destroy the neurons. This leads to permanent disability.
What causes multiple sclerosis?
Multiple sclerosis is a complex disease that appears inexplicably. Researchers believe that it occurs in people who are predisposed to the disease by heredity in the presence of a combination of environmental factors. It may be caused by a viral infection contracted during childhood, such as measles or Epstein-Barr virus or mononucleosis. There are also many genetic predisposing factors. In recent years, several genes have been identified that may be involved and may increase the risk of multiple sclerosis.
Diagnosis: How is multiple sclerosis detected?
There is no test that can diagnose multiple sclerosis with certainty. In fact, misdiagnosis is still widespread, as many diseases can have symptoms similar to those of multiple sclerosis.
In general, diagnosis is based on:
A medical history, including a medical questionnaire that establishes the history of problems associated with the disease and, if necessary, identifies previous neurological manifestations.
A physical examination consisting of an assessment of vision, muscle strength, muscle tone, reflexes, coordination, sensory functions, balance, and mobility.
a lumbar puncture, in which cerebrospinal fluid is taken from the lower back This procedure checks whether the cerebrospinal fluid – which circulates in the brain and spinal cord – has high levels of certain proteins and contains molecules that cause it to produce abnormal antibodies.
A record of electrical activity that measures the time it takes for visual information to reach the brain.
Magnetic resonance imaging (MRI), which shows lesions in the white matter (which contains myelin) of the brain, cerebellum and spinal cord
Multiple sclerosis is difficult to diagnose and usually requires 2 or more flare-ups with at least partial remission to confirm the diagnosis.
In order to make a definitive diagnosis of multiple sclerosis, the neurologist must be convinced that there is myelin damage at two different sites which cannot be the result of other diseases. Furthermore, the neurologist must also prove that the damage occurred at two different points in time. The medical questionnaire is therefore crucial for a good understanding of the symptoms and for checking whether there have been neurological manifestations in the past.
How does multiple sclerosis progress?
The course of multiple sclerosis cannot be predicted. Each case is unique. Neither the number of relapses, nor the type of disease, nor age at diagnosis can predict the future of the person with MS. There are mild forms of the disease that do not cause physical difficulties even after 10 or 20 years of the disease. Other forms may progress rapidly and may be more disabling. Finally, there are people who only have one relapse in their lives. It is important to know that the life expectancy of people with this disease is reduced by 7 to 14 years according to a large study. Half of all deaths are related to the complication of MS. The death rate associated with infectious and respiratory disease, suicide, and cardiovascular disease is higher in people with MS than in the general population.
What are the different forms of multiple sclerosis?
There are generally 3 main forms of multiple sclerosis, depending on how the disease progresses over time
Relapsing-remitting MS (RRMS): In 85 to 90 percent of cases, the disease begins with the relapsing-remitting form which is characterized by relapses with intermediate remissions. A relapse is defined as a period of at least 24 hours with new neurological symptoms or the recurrence of old symptoms separated from the previous relapse by at least one month. Recurrences usually last from a few days to a month and then gradually disappear. In most cases, this form of the disease can change into a secondary form after a few years.
Primary progressive MS (PPMS): This form is characterized by a slow and steady progression of the disease from the time of diagnosis. It affects 10% of cases. Unlike the relapsing-remitting form, there are no real relapses, although the disease can sometimes get worse. This form usually occurs later in life, around the age of 40.
Secondary progressive MS (SPMS): After an initial period of relapsing-remitting form, the disease can get steadily worse. This is called the secondary form. There may be relapses, but these are not followed by clear remissions, and the disability gradually worsens. Most people with the relapsing-remitting form will develop the progressive form within 15 years of diagnosis.
Clinically Isolated Syndrome (CIS): It is an initial episode characteristic of the disease (e.g. optic nerve inflammation, brainstem symptoms, myelitis), which has the characteristics of inflammatory demyelination, but does not meet all the diagnostic criteria for multiple sclerosis. The symptoms of the clinically isolated syndrome vary from person to person depending on the location of the lesions in the central nervous system. It is estimated that one in five people will develop multiple sclerosis after 10 years if the clinically isolated syndrome is not accompanied by lesions typical of multiple sclerosis. This percentage increases to 80% if the clinically isolated syndrome is characterized by lesions similar to those in multiple sclerosis.
How many people are affected by multiple sclerosis?
It is estimated that on average 1 in 1,000 people suffer from multiple sclerosis, but the prevalence varies from country to country.
Northern countries are more affected than countries near the equator. In Canada, the rate is said to be among the highest in the world (1/500), making it the most common chronic neurological disease among young adults. It is not yet clear why twice as many women as men have multiple sclerosis. The disease is most often diagnosed in people between 20 and 40 years of age, but in rare cases, it can also affect children (less than 5% of cases).
Can multiple sclerosis be prevented?
There is currently no way to prevent multiple sclerosis, as the cause is unknown. People who are at risk for developing multiple sclerosis may want to improve their chances by avoiding the hypothetical risk factors listed above as much as possible.
Symptoms of Multiple Sclerosis
The symptoms depend on the location of the plaques, that is, the part of the nervous system affected by the inflammation. They vary greatly from person to person and from relapse to relapse. In most cases, the disease begins with a single symptom. Here are the most important ones:
- Vision problems (double vision, total or partial loss of vision, usually in one eye at a time, pain when moving the eyes, involuntary eye movements, blurry vision). These disorders are caused by inflammation of the optic nerve (damage to the optic nerve). They are the first symptom in about 20% of cases
- Abnormal sensations (sensory disturbances)-short-term pain, tingling, or the impression of electric shocks that are mainly felt when moving the head
- Numbness or weakness in one or more extremities
- Abnormal fatigue
- Tremors and difficulty controlling movement (for example, difficulty walking)
- Loss of balance
- Muscle cramps or contractures (spasticity), sometimes painful
The following symptoms, which are rarely mentioned, may also occur (especially as the disease progresses):
- Difficulty speaking
- Urinary incontinence or urinary problems (urges, difficulty emptying the bladder, urinary tract infections, etc.)
- Sexual dysfunction
- Partial or total paralysis (of any body part)
- Memory, mood, or concentration problems
- In some cases, an increase in body temperature (fever, hot bath, physical exertion) may cause the reactivation of old neurological symptoms, usually visual disturbances. This transient phenomenon is known as the Uhthoff phenomenon. It is not a true outbreak because the symptoms disappear when the body temperature drops.
People at risk of multiple sclerosis
People who have a close relative with multiple sclerosis have an increased risk of developing MS: the risk increases from 0.1% (in the general population) to 1% to 3%. However, multiple sclerosis is not an inherited disease. There are several genes (including the HLA DRB1 gene) that can lead to susceptibility to the disease. Scientists are also investigating the relationship between the genes and the timing or severity of the disease.
Northern European descendants have a predisposition to multiple sclerosis. People in Asia, Africa, and indigenous peoples in the Americas are least affected by the disease.
People who live in the high latitudes of the northern or southern hemisphere or who have lived there for the first 15 years of their lives are at higher risk. The disease occurs five times more often in northern or temperate regions (such as North America and Europe) than in tropical and southern climates. The “unaffected” zone is on the periphery of the equator, between 40°N and 40°S latitude. The reasons for this are not yet known, but vitamin D (which is produced by solar radiation) may play a role.
People with autoimmune thyroid problems, type 1 diabetes, or inflammatory bowel disease are at slightly higher risk.
Risk factors for multiple sclerosis
Studies on identical twins (with the same hereditary history) show that environmental factors play a predominant role in the occurrence of the disease. Take the fictional example of Jennifer and Linda, identical twins aged 30. Jennifer has suffered from multiple sclerosis since she was 25 years old. The risk of Linda having multiple sclerosis-like her twin is estimated at 30%, whereas it should be 100% if the multiple sclerosis were only of genetic origin. So it is mainly environmental factors that trigger the disease. This is probably a combination of many factors and not a single event.
The following risk factors are presented as hypotheses:
- Having a vitamin D deficiency. The distribution of multiple sclerosis cases worldwide (more cases in less sunny countries) has led researchers to hypothesize a link between vitamin D and the risk of multiple sclerosis. Vitamin D is produced by the skin through exposure to sunlight. Low levels of sunlight leading to vitamin D deficiency could, therefore, be linked to the onset of the disease. Several studies have evaluated the relationship between vitamin D levels in the blood and the risk of multiple sclerosis. In 2004, a study of 2 cohorts with a total of 187,563 nurses found that women who supplemented daily with vitamin D (400 IU or more) reduced their risk of developing multiple sclerosis by 40%. In 2006, a study of U.S. soldiers showed that those with higher vitamin D levels had a lower risk of developing multiple sclerosis. In a 2013 article, the risk of developing multiple sclerosis is estimated to be reduced by 30% for women with the highest vitamin D levels compared to those with the lowest levels. In addition, vitamin D levels are low in most people with MS, especially in the early stages of the disease. Finally, studies in rats show that vitamin D can reduce the number of relapses and slow disease progression. Unfortunately, current data do not indicate whether vitamin D supplementation can influence disease progression in humans.
- Having contracted the Epstein-Barr virus. This virus, implicated in infectious mononucleosis, has been implicated in several studies on the development of the disease. On the other hand, no formal evidence of its involvement could be presented. In June 2010, a study of 900 people showed that the risk of multiple sclerosis increases after infection with the Epstein-Barr virus (EBV). In 2006, the same researchers had shown that people with EBV have a higher level of antibodies to EBV than normal. Finally, a recent meta-analysis of 18 studies involving over 19,000 people concluded that infectious mononucleosis increases the risk of developing multiple sclerosis.
- Smoking cigarettes. People who smoke 20 to 40 cigarettes per day are about twice as likely to develop multiple sclerosis as non-smokers. Smoking also appears to aggravate the symptoms in people with MS and accelerate the progression from relapse to progressive MS.
- They consume a lot of animal fat. Multiple sclerosis is thought to be more common in populations whose diets are high in animal fat and lower in those consuming mostly polyunsaturated fatty acids. Since populations in the North generally have higher animal fat diets, it is difficult to isolate the impact of the diet from the impact of geographical location. As mentioned above, multiple sclerosis is 5 times more common in northern or temperate regions than in tropical and southern climates.
- Being in contact with chemical solvents in the workplace.
- There is evidence in the scientific literature that the use of dental mercury amalgam increases the risk of multiple sclerosis and also worsens the symptoms. However, most of this data comes from studies that are considered to be of low scientific quality. Several mercury amalgam fillings over the years may increase the risk of developing the disease, but this has not been clearly demonstrated. Therefore, doctors generally consider dental amalgams to be safe.
- In France, following a mass vaccination campaign against hepatitis B in 1994, a study suggested a possible causal link, which was never confirmed in retrospect. Epidemiological studies have not found a link between vaccination against hepatitis B and the development of multiple sclerosis.
Medical treatments for multiple sclerosis
Although multiple sclerosis is considered an incurable disease, medical research has led to the discovery of relatively effective drugs to relieve symptoms and slow the progression of the disease. The sooner treatment is started, the greater the chances of reducing the number of attacks.
Treatment of relapses
Relapses do not necessarily require treatment, as they usually subside within a few days. Corticosteroids such as oral prednisone and intravenous methylprednisolone are prescribed to reduce inflammation and shorten the duration of relapses. Side effects (insomnia, high blood pressure, mood swings, water retention, and osteoporosis) can be significant. Plasmapheresis (plasma exchange) is one approach that can also be used. The liquid part of the blood (plasma) is removed and separated from the blood cells. The blood cells are mixed with a solution of proteins (albumin) and injected into the body. Plasmapheresis may be used if symptoms are recent, severe, and have not responded to steroids.
Substantial treatments can reduce the frequency of relapses and delay the progression of the disease. They are usually proposed as soon as relapsing-remitting multiple sclerosis is diagnosed and should be taken continuously even when there are no symptoms.
There is extensive scientific evidence that early treatment can reduce the frequency of relapses. In addition, the fact that the disease progresses in episodes that are unpredictable is a major difficulty in assessing the effectiveness of these treatments in a given individual.
There are three types of disease-modifying therapies: immunomodulators, immunosuppressors, and selective adhesion molecule inhibitors. These treatments reduce the activity of the immune system, thus slowing down the destruction of myelin.
Immunomodulators: These include molecules in the beta-interferon family: ß-1a interferon (Avonex®, injected intramuscularly once a week and Rebif®, injected subcutaneously three times a week) and ß-1b interferon (Betaseron®, Extavia®, injected subcutaneously every other day).
Interferons are endogenous substances that inhibit the multiplication of viruses and stimulate the activity of certain immune cells. They are among the most commonly prescribed medications for the treatment of multiple sclerosis. They reduce the frequency of relapses by 30%. However, they often cause flu-like syndrome (fever, chills, headache, and muscle pain) and skin reactions a few hours after the injection during the first 3 months of treatment. These side effects disappear later. Liver damage (reversible) is common but usually mild. Patients must have blood tests to check their liver enzymes. People taking interferons may also develop neutralizing antibodies, which can reduce the effectiveness of the drug.
Fingolimod (Gilenya®) is a neuromodulator that was approved by the U.S. Food and Drug Administration (FDA) in September 2010. This drug has the advantage that it can be taken orally. It is believed to reduce the frequency of relapses in relapsing-remitting multiple sclerosis and slow the progression of the disease. Heart rate should be monitored for six hours after the first dose as taking the drug is usually associated with a decrease in heart rate. Side effects include headaches and blurred vision. The doctor may also prescribe glatiramer acetate (Copaxone®), another immunomodulator, which rarely causes side effects and has no toxic effects, but requires daily subcutaneous injections. Like interferons, the injections can cause local inflammatory reactions (redness, pain, etc.). Ocrelizumab (Ocrevus®) is a disease-modifying treatment approved by the FDA. This immunomodulator treats both recurrent and progressive forms of the disease. Clinical studies have shown that it has halved the rate of relapse in recurrent disease and reduced disability in both forms of the disease. Ocrevus administered intravenously causes side effects such as irritation at the injection site, low blood pressure, fever, and nausea. Ocrevus can also increase the risk of certain types of cancer, especially breast cancer. Dimethyl fumarate (Tecfidera®) is a twice-daily oral medication for the treatment of patients with relapsing-remitting multiple sclerosis. It appears to reduce relapses, with side effects such as diarrhea, nausea, and reduced white blood cell count. Teriflunomide (Aubagio®) is a once-daily medication that can reduce the rate of relapse. However, it can cause liver damage and hair loss. It is harmful to the developing fetus and should not be used by women who wish to become pregnant.
Immunosuppressants: These are rarely used and are reserved for very severe forms of the disease (rapidly progressing and accompanied by severe outbreaks) or forms that are resistant to other treatments. It is usually a second or third choice drug. Mitoxantrone is not officially approved for the treatment of multiple sclerosis, but some doctors prescribe it. It is usually used to treat cancer. It is not very effective in multiple sclerosis and its potentially toxic effects are significant. This immunosuppressant can be harmful to the heart and is associated with the development of blood cancer. As a result, its use in the treatment of multiple sclerosis is extremely limited. Mitoxantrone is usually only used for the treatment of severe and advanced multiple sclerosis. Another oral drug, cladribine, just recently became available on the market. According to the results on the efficacy and safety of cladribine published in 2017 (Annual Meeting of the American Academy of Neurology, Boston, USA), a subgroup of patients with an increased risk of disease progression using cladribine has a more than 80% reduced risk of disability progression compared to the placebo group. Alemtuzumab (Lemtrada®) is a drug that helps reduce relapses in people with relapsing-remitting sclerosis (relapsing-remitting MS) by attacking white blood cells. In view of the product’s serious adverse effects, the French health authorities consider that it has no proven clinical benefit in the treatment of multiple sclerosis.
Selective Insulin Monitoring (ISMA): These are a newer class of drugs that prevent certain cells of the immune system (T cells) from entering the brain and triggering an inflammatory process. Natalizumab (Tysabri®), a type of protein known as a monoclonal antibody is used to treat the relapsing-remitting form of the disease to reduce the frequency of relapses. It is reserved for patients who do not experience any improvement with other treatments or who cannot tolerate them. It can be considered a first-line treatment for some people with severe MS. Natalizumab increases the risk of progressive multifocal leukoencephalopathy (PML), a rare and potentially fatal virus-induced brain disease.
Treatments for progressive forms of MS
While disease-modifying therapies are relatively effective in relapsing-remitting MS, they have little effect in progressive (primary or secondary) forms. Some immunosuppressive drugs, such as cyclophosphamide or mitoxantrone and fingolimod are sometimes used.
Various medications and treatments can be used to relieve the many symptoms such as fatigue, muscle cramps, pain, sexual dysfunction, and urinary problems. Here are some of them.
Physical therapy and rehabilitation. These are important parts of management. The goal of rehabilitation is to maintain certain functions (for example, walking), reduce complications (urinary problems, spasms), and learn to live with a disability as well as possible. If necessary, the physiotherapist or occupational therapist can also suggest and adapt technical aids (cane, wheelchair, etc.) to make daily life easier.
To treat pain: Neurontin® (an anticonvulsant) and Elavil® (a tricyclic antidepressant) are usually effective. Sativex®, a cannabis-based drug, can also be used (as a spray under the tongue or on the cheek). Over-the-counter acetaminophen and ibuprofen may be helpful from time to time.
For muscle cramps: Muscle relaxants (Lioresal®, Zanaflex®) in combination with stretching exercises in physical or occupational therapy help reduce leg spasms, which can be painful.
Against fatigue: Fatigue is extremely common in people with multiple sclerosis and can significantly affect the quality of life. In addition to adapting your daily life to your state of exhaustion, it is also possible to take certain medications such as amantadine or methylphenidate.
For urinary problems: Several medications may be prescribed to increase bladder or sphincter muscle strength and limit leakage.
Cannabis: Americans with multiple sclerosis in states where cannabis is legal may use marijuana to relieve severe pain and persistent cramping.
Oxygen treatment in a hyperbaric chamber: This treatment involves inhaling pure oxygen in a chamber at a higher than normal pressure. It was intensively tested in England from 1983 to 1987. Many patients reported benefits, although the treatment appears to improve bladder and bowel function. However, none of the double-blind controlled studies conducted in this area showed a positive effect on objective disease criteria.
Dr. Zamboni’s experimental treatment: In 2009, an Italian doctor, Paolo Zamboni, hypothesized that multiple sclerosis might be related to poor blood flow in the neck veins. Poor drainage of venous blood from the brain may damage neurons and cause symptoms of multiple sclerosis. Dr. Zamboni has described this disease as chronic cerebrospinal venous (or vascular) insufficiency (CCSVI).
According to a preliminary study conducted by Dr. Zamboni on 65 people with multiple sclerosis, a surgical procedure called angioplasty can alleviate this vein problem and in some cases reduce the symptoms of multiple sclerosis. Angioplasty involves “opening” the veins by inserting a small balloon or vascular stents (which keeps the veins open). Doctors already use this technique for other types of health problems, such as dilating the arteries of the heart to prevent a heart attack.
This promising study has raised a lot of hope for people with MS, but Dr. Zamboni’s hypothesis has not yet been confirmed by other studies. However, some private clinics (Poland, Bulgaria, Germany, etc.) offer this treatment based on Dr. Zamboni’s experience.
Many neurologists advise against this costly treatment, the efficacy of which is uncertain, especially as the procedure may involve risks (headache, displacement of the stent, formation of clots). Dr. Zamboni himself confirmed that this procedure is not recommended outside clinical studies.
Clinical trials are underway to investigate the efficacy and safety of angioplasty and to determine what proportion of patients with or without multiple sclerosis actually suffer from venous insufficiency. The results of one of these studies, published in April 2011, suggest that chronic cerebrospinal venous insufficiency (CVI) is unlikely to be a cause of multiple sclerosis. Instead, it may occur as a consequence of the disease.
Unfortunately, results published in 2016 suggested that this treatment of the dilated neck veins (venoplasty) does not significantly reduce the symptoms of multiple sclerosis compared to the placebo group. Of the 104 patients with multiple sclerosis, 49 had undergone venoplasty. The quality of life improved in as many patients in the treatment group as in the placebo group.
Here are some ways to reduce fatigue and improve the quality of life.
Get some rest: Fatigue, one of the most common symptoms, often occurs early in the disease. It is important to save energy by resting or relaxing, especially before an activity.
Exercise regularly: Contrary to what has long been claimed, physical exertion does not trigger a flare-up. On the contrary, people who remain active through activities adapted to their physical abilities tend to have milder symptoms and slower disease progression. Moreover, the positive effect on morale should not be overlooked. A physiotherapist can be consulted for this purpose.
Better stress management: It is recommended to reduce stress factors and make life easier. Getting help is certainly desirable. Behavioral therapy or psychotherapy can help to better understand the source of stress and ways to overcome it. Regular practice of relaxation techniques can also improve well-being.
Take part in a support group: Participation in meetings, conferences, and various activities will help you to better understand your illness and to exchange practical advice with other people in the same situation.
Avoid coffee, alcohol, and tobacco: These stimulants of the nervous system usually tend to aggravate the symptoms.
Protect yourself from infections: Washing your hands frequently is the most effective measure. Minor respiratory tract infections or sinusitis have often been reported as the cause of relapses.
Avoid sudden changes in temperature: For people in whom these variations cause or worsen symptoms
Multiple sclerosis: complementary approaches
As with medical treatments, the therapeutic effect of complementary approaches is difficult to determine due to the unpredictable course of multiple sclerosis. Vigilance is required when promises of “efficacy” are made.
Watch out. Some natural health products are contraindicated in cases of multiple sclerosis, such as Echinacea and cat’s claw. Consult a trained professional before using any product.
Possible efficacy of hypnotherapy: Several case studies show the beneficial effects of hypnosis in controlling chronic, difficult-to-treat pain caused by spinal cord injuries, amputations, multiple sclerosis, neuromuscular diseases, and many others. In 2009, a small clinical study (22 patients) showed that self-hypnosis was effective in relieving pain associated with multiple sclerosis.
Possible efficacy of magnet therapy: Magnet therapy is the use of magnets for therapeutic purposes. Magnets are placed on the skin and connected to a small electrical device. According to 4 randomized clinical trials, pulsed electromagnetic fields may help reduce spasms and fatigue and decrease many other symptoms of multiple sclerosis. The results of these studies, which are rather preliminary or pilot studies, are encouraging. However, their scope is limited due to methodological deficiencies.
The efficacy of the Swank diet is uncertain: It is possible that the fat content of the diet influences the course of the disease. In 1948, Dr. Swank, a professor, and researcher in neurology developed a special diet to relieve the symptoms of his multiple sclerosis patients. Swank’s diet is low in saturated fat and rich in unsaturated fat, which means that there is little room for animal fats.
Only one clinical study has examined the value of the Swank diet, led by Dr. Swank himself. It lasted 34 years and included 144 people with multiple sclerosis who followed the diet. The overall condition of people who adhered strictly to the diet deteriorated significantly less than that of people who consumed more fat. In addition, their death rate was much lower. The benefits were greatest for those who started the diet in the early stages of the disease. However, this research is of limited value because it did not include a control group. Alternative practitioner J.E. Pizzorno recommends the Swank diet because it would counteract the autoimmune response while normalizing essential fatty acid intake.
Composition of the Swank Diet
– The amount of saturated fatty acids should not exceed 15 g per day (3 teaspoons).
– Consume 20 to 50 g of unsaturated fatty acids per day (4 to 10 teaspoons).
– Red meat is prohibited during the first year. After that, 60 g (3 oz) of red meat per week is recommended.
– Dairy products with 1% fat or less can be consumed.
– Ban commercial products containing hydrogenated vegetable oils: cookies, crackers, cakes, cake batter, etc.
– Consume one teaspoon of cod liver oil per day.
– Take a multivitamin and mineral supplement daily.
Note: Protein should come from legumes, fish, oilseeds, and whole grains.
Uncertain effectiveness reflexology massage: Reflexology consists of applying continuous pressure with the fingertips on the reflex points of the feet, hands, and ears corresponding to the organs or organic functions. Several clinical studies have examined the effectiveness of this practice in patients with multiple sclerosis, with encouraging results. A study conducted in 2003 showed that reflexology reduces motor, sensory, and urinary symptoms after 11 weeks of treatment. In 2009, another study showed that reflexology was effective, regardless of whether it was “real” reflexology or randomized point stimulation. Both methods reduced pain by 50% within 3 months.
Effectiveness uncertain Omega-3 fatty acids. In 2007, a review of several clinical studies concluded that a diet rich in polyunsaturated fatty acids, including omega-3 fatty acids, does not appear to have any effect on the progression of multiple sclerosis or the number of relapses. However, the authors conclude that there is very little data that can confirm or refute these observations. In addition, in 2009 a study involving 10 patients showed that administration of omega-3 (9.6 g/day fish oil) over 3 months reduced the concentration of MMP-9 protein by 58%. MMP-9 may contribute to an increased inflammatory response in the nervous system. The authors, therefore, believe that omega-3 may have a beneficial immunomodulatory effect, but further studies are needed to confirm this.
Feldenkrais method of uncertain effectiveness: The results of a randomized clinical study of 20 patients with multiple sclerosis in 1999 showed a decrease in the rate of depression and anxiety in patients who practiced the Feldenkrais Method for 8 weeks. However, the use of the method would have no benefit for the patients’ symptoms and functional capacity. However, no other study has confirmed these results.
Physical activity: Yoga and Physical activity can improve the quality of life and reduce pain. A small study involving 20 patients in 2010 showed that yoga improved attention and that climbing significantly reduced fatigue.
Approaches to dietary modification: Dr. Andrew Weil argues that it is particularly important to eat enough fruit and vegetables when suffering from multiple sclerosis. He suggests that these should preferably be grown organically. Three more tips: stop consuming milk and dairy products (find other sources of calcium), increase your intake of omega-3 fatty acids (fatty fish, nuts, flaxseed, etc.) and eat foods seasoned with ginger and turmeric regularly.
In addition, some people with MS may benefit from an allergen-free diet (dairy products, eggs, nuts, foods containing gluten or preservatives, etc.). Allergies and food intolerances can contribute to the disease. This approach requires follow-up by a dietician and is not validated by clinical studies.
Meditation and visualization: These two forms of mental training are recommended by Dr. Andrew Weil. They can be used to relax, relieve pain, and reduce the stress that is often associated with worsening symptoms. Above all, they can help you to better deal with the disease.