Multiple Sclerosis

Slowing a Nerve-Racking Disease

Leonard Flynn of Morganville, New Jersey, considers himself lucky. Diagnosed with multiple sclerosis (MS) in 1988, the organic chemist believes he is healthier now than he has been in years. To prove it, he climbed Mount Scenery, a peak on the island of Saba in the West Indies that has more than 1,000 stony steps cut into its steep side. “If there’s one thing that people with MS have problems with, it’s steps,” he says. “I wouldn’t have been able to do that earlier.”

He attributes his improved health to a low-saturated-fat diet that some studies suggest slows the course of this disease. He also takes the same antioxidant nutrients thought to protect against cancer and heart disease: vitamins C and E, selenium and beta-carotene, the yellow pigment found in carrots, cantaloupe and other orange and yellow fruits and vegetables. Plus he eats lots of fatty fish, mostly sardines, salmon and water-packed tuna, and relies on sunflower oil and safflower oil for additional fat.

This is not to say that MS isn’t a serious condition or that it can be cured by a particular diet. But there are ways to make life with MS easier. Doctors are especially excited about three new drugs, all of which have been shown in large studies to significantly reduce the relapse rate. The studies also show that two of these drugs slow the disease’s progression and delay the onset of physical disability.

Fending Off the Immune System

In MS, certain cells in the immune system attack the nerves, causing a breakdown in the fatty sheath that surrounds and insulates a nerve cell. The breakdown occurs mostly in the brain and spinal cord. Once the fatty sheath starts to go, messages traveling to and from the brain are blocked. A message from the brain to “shake a leg,” for instance, may simply dead-end while it’s still in the brain, never reaching the muscles in the leg that could perform the task.

“No one knows for sure what sets off the immune system to attack nerves,” says Timothy Vollmer, M.D., medical and research director of the Rocky Mountain Multiple Sclerosis Center in Englewood, Colorado. “There are good data to suggest that genetics plays a role in determining risk and that other risk factors include some sort of outside trigger, possibly exposure to a virus, that apparently sets off immune system changes.”

Depending on which nerves lose their fatty sheaths, symptoms may include blurred or double vision, numbness, loss of bladder control and fatigue or tremors in the arms or legs. Fatigue so extreme that it has been called paralyzing also strikes some. Most symptoms wax and wane, with problematic conditions and remissions occurring over the years.

Dr. Vollmer believes most doctors think that nutrition has little, if anything, to do with the development or progression of MS and that no dietary measure can repair damaged nerve cells.

“Many of us do, however, think that a healthy diet is important to maximize function and to decrease the disability that occurs in MS,” Dr. Vollmer says. “We want to avoid nutritional deficiencies and keep our patients as healthy as possible so that they don’t develop some additional chronic ailment such as heart disease or diabetes, which can magnify the symptoms of MS.” Even an infection that raises body temperature as little as 1°F can worsen symptoms of MS, Dr. Vollmer says.

Here’s what nutritional research suggests may play a role in controlling the symptoms of MS. Keep in mind that even the doctors who recommend nutritional therapy use it along with other medical care, including physical therapy. Dr. Vollmer suggests that you enlist your doctor to work with you in devising a treatment plan that is best for your particular case.

Antioxidant Nutrients May Help

There’s some evidence that the damage to a nerve’s fatty sheath that is associated with MS is caused by what is known as oxidative injury. That damage, also called lipid (fat) peroxidation, occurs because unstable molecules called free radicals steal electrons from the healthy molecules in this fatty covering, causing breakdown and scarring that eventually destroys the nerve. Free radicals can be generated by attacking immune cells. They also occur when the body is exposed to certain toxic chemicals.

Researchers at Cook County Hospital in Chicago found that people experiencing MS attacks had significantly higher levels of pentane, a by-product of lipid peroxidation, in their breath than they did when their symptoms were in remission.

“Our findings very much support the theory that the mechanism for destruction in MS is associated with free radicals,” says Edwin Zarling, M.D., associate professor of medicine at Loyola University of Chicago Stritch School of Medicine in Maywood, Illinois, and a researcher for the Cook County Hospital study. “Our work shows that antioxidants should be tried for MS.” Studies have yet to be done that show antioxidants help people with MS, he adds.

Because of these findings, some doctors recommend that their patients with MS take the array of so-called antioxidant nutrients, which neutralize free radicals by offering up their own electrons, protecting your body’s healthy molecules from harm. These nutrients include vitamins C and E, beta-carotene and the mineral selenium. Amounts recommended can vary widely.

“I recommend taking at least 500 milligrams of vitamin C two to four times a day and 100 micrograms of selenium and 800 international units of vitamin E once a day,” says Mary Dan Eades, M.D., medical director of the Arkansas Center for Health and Weight Control in Little Rock and author of The Doctor’s Guide to Vitamins and Minerals. It’s a good idea to check with your doctor before taking more than 600 international units of vitamin E a day. Vitamin C in doses exceeding 1,200 milligrams a day can cause diarrhea in some people.

Check Out Vitamin B₁₂

Most doctors in the United States say there is no proof that a vitamin B₁₂ deficiency contributes to the development of MS or that taking B₁₂ helps reduce symptoms. Nevertheless, there appear to be some potential links between the nutrient, which is so essential for proper nerve function, and this debilitating disease.

For instance, vitamin B₁₂ deficiency can mimic some of the symptoms of MS, such as numbness and tingling in the arms and legs, loss of balance and fatigue, says Donald W. Jacobsen, Ph.D., director of the Department of Cell Biology at the Cleveland Clinic.

“A severe vitamin B₁₂ deficiency can cause breakdown of the myelin sheath, similar to what occurs in MS,” Dr. Jacobsen says. That’s why many doctors test for B₁₂ deficiency if you have symptoms of MS. Although most people get enough B₁₂ in their diets, absorption problems can cause a B₁₂ shortage, especially in people ages 60 and older. If you have absorption problems, you’ll probably have to get B₁₂ shots or possibly include daily supplements in your diet for the rest of your life, depending on your particular case.

Studies are mixed as to how many people diagnosed with MS or with MS-like symptoms have low blood levels of vitamin B₁₂, Dr. Jacobsen says. For example, a study by British researchers found that a fairly high number of people with MS have low blood levels of B₁₂. On the other hand, researchers at the Cleveland Clinic, using tests that measure blood levels of B₁₂ and two B₁₂-related compounds, homocysteine and methylmalonic acid, found fewer B₁₂-deficient people than did the British.

“At this point, we just don’t know what to make of all of this,” Dr. Jacobsen says. “We still feel like we are missing major pieces of the puzzle. It’s still an open question whether true, functional vitamin B₁₂ deficiency exists in MS.”

To complicate matters further, people with MS often have what’s called mild macrocytosis. They have some larger than normal but immature red blood cells in their blood that resemble a budding case of pernicious anemia, a disease that is associated with severe vitamin B₁₂ deficiency. Most, however, never go on to develop a full-blown case of pernicious anemia.

Your doctor can determine with a few tests whether you’re having absorption problems. If it turns out that you do have an absorption problem, you’ll need to get injections of vitamin B₁₂ from your doctor. If you don’t have absorption problems, you can safely take oral doses of up to 500 micrograms of B₁₂ a day, Dr. Jacobsen says. (This amount is many times the Daily Value of B₁₂, which is only 6 micrograms.)

It’s also important to have your doctor check your blood levels of the B vitamin folate (the naturally occurring form of folic acid), Dr. Jacobsen says. That’s because folate deficiency can cause symptoms similar to vitamin B₁₂ deficiency, although its neurological consequences are much less severe. If you’re found deficient, you’ll have to take oral folic acid supplements to get your blood level back to normal. You shouldn’t take folic acid unless your doctor recommends it, says Dr. Jacobsen.

Prescriptions for Healing Drugs are the mainstay of treatment for multiple sclerosis. There are, however, a few nutrients that may prove helpful. Here's what some doctors recommend. Nutrient Daily Amount Selenium 100 micrograms Vitamin B12 500 micrograms Vitamin C 1,000­2,000 milligrams, taken as 2­4 divided doses Vitamin E 800 international units Plus a multivitamin/mineral supplement containing the Daily Values of all essential vitamins and minerals MEDICAL ALERT: If you have been diagnosed with multiple sclerosis, you should be under a doctor's care. Injections of vitamin B12 are required for people who have problems absorbing this nutrient. Vitamin C in doses exceeding 1,200 milligrams a day can cause diarrhea in some people. It's a good idea to check with your doctor before taking more than 600 international units of vitamin E a day. If you are taking anticoagulant drugs, you should not take vitamin E supplements.