Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

Half a million Americans are estimated to have MS or a related disease. About one-third of these will suffer emotional or intellectual disturbances. Some victims will have partial blindness, loss of speech or equilibrium, tremor, paralysis, weakness, spasm, sensations of "pins and needles," numbness of fingers, visual loss, vertigo, impotence, constipation, urinary urgency or frequency, urinary incontinence, hearing loss, seizures, and loss of bladder and bowel control.

MS is a disorder of the nerves in which the sleeves of myelin surrounding the nerve fiber is destroyed by a process which has as yet eluded researchers. The sites most commonly involved are certain areas near the ventricular system in the brain, the optic nerves, and the white matter controlling muscular coordination in the cerebellum. The course of MS is highly unpredictable, some patients having repeated attacks and rapid progression to become severely crippled or die within a short time, while others show progression of the disease over decades. It is recognized that there is no medical treatment for MS that alters the length or severity of the disease. Steroid therapy does not alter the outcome of the disease and should not be used because of its serious complications.

On the home remedies front, however, individuals have claimed benefit or even cure of carefully diagnosed cases from very simple remedies. Some of these remedies do not cause any injurious influences on the body, and some can be considered a part of general hygiene. Unfortunately many of these home remedies are regarded by members of the medical profession as quackery and are enthusiastically denounced. While I am as opposed to exploitation of a patient under any guise, as the most vocal crusader, I have lost the enthusiasm that I had in my youth for fighting harmless "quackery," as I have found through my 55 years of practicing medicine that many things generally relegated to backwoods practitioners when I began medicine have become main line modes of therapy.

Further, when the patient is responsible and participating in selecting and applying the remedy, it seems that he feels he must be more careful in all aspects of life, a carefulness which of itself can often give some benefit. While I think I would not go so far as Dr. Michael Halberstam (1), who states that among the most precious of patients' rights is the right to make fools of themselves, I certainly believe that when dealing with an incurable disease, the patient should be encouraged to try any kind of bath, diet, simple exercise, or other non-injurious treatment that he feels gives promise of success. No claim of cure or false hope should be held out to the patient, merely a manifestation of interest and assistance. In the support of a patient with MS, certainly that should be considered the kind and helpful thing to do.‍

The Diet in the Treatment of MS

‍A number of things have been promoted as curative for MS from the dietary realm. The first thing to be achieved in a good diet for MS is that of the permanent and total exclusion of anything that could be considered junk food. Along those lines should be coffee, tea, colas, and chocolate—the methylxanthine-containing group. The methylxanthines have a toxic effect on the nervous system. It is not known if they play any part in the development of the disease, but certain serious diseases are associated with their use: cancers of the bladder and pancreas, mental depression, injury to unborn babies, etc.

White sugar has been implicated by several researchers as being important in producing MS. Additionally, anything that can be purchased from a vending machine is almost certainly junk food. TV dinners and similar types of convenience foods should usually be classed as junk foods. There are, however, some foods considered nourishing and good that may not be the best for the person with MS. These will be considered individually.

The first of these is food high in fats and food containing "free fats," that is, fats not intimately bound together with other nutrients. We prescribe a diet entirely devoid of free fats and teach patients how to make it palatable.

Beef products, both the flesh as well as dairy milk, should be eliminated from the MS diet. There is somewhat more than circumstantial evidence for doing so, as in heavy beef-producing areas MS is higher then in other sections. Persons with MS tend to have more antibodies in their blood to beef protein than do persons who do not have MS. Eskimos have very little MS. Perhaps their lack of exposure to beef and diary products may be helpful in protecting them from a high risk of MS, even though they live above the 40th parallel. Of course, since pork is not a good food for healthy persons, all pork and pork products should be eliminated from the MS diet.

The low-fat diet, used by Dr. Roy Swank of the University of Oregon Medical School, has shown a remarkable benefit for patients, reducing the average number of annual attacks from 1.1 to 0.15, and slowing down the rate at which the disease gets progressively worse. Using a modification of the diet of Dr. Swank, we have made the same observations. We believe that the diet, being simple and easy, is well worthwhile. Patients usually lose weight when adopting the diet, but stabilize about 5 to 10 percent below average weight. The diet consists of no free fats (mayonnaise, margarine, fried foods, and cooking fats), and no heavy natural fats in large quantities—nuts, seeds, coconut, wheat germ, etc. The person may take a few olives, avocado, and nuts, but should carefully control the quantity of these items, using only 3 or 4 olives or almonds at a meal. (2, 3) Other investigators using a low fat diet have reported also a reduced frequency of relapses, as well as a shortening of the length of the relapses, when this diet is carefully followed. (4)

Vegetables and fruit intake should be increased. Patients must be warned against gaining weight and are encouraged to remain lean. Dr. Swank found no severe relapses were ever experienced by a patient who had been on the low fat diet for as long as one year. The longer the diet is followed, the lower the relapse rate. The death rate in untreated MS is 3 to 4 times higher than in patients on the low-fat diet. The earlier the diagnosis and treatment are begun, the greater the success in treatment. (5)

Some have recommended a gluten-free diet—the person avoiding eating wheat, oats, rye, and barley (and anything containing them). (6) The diet is not difficult to prepare with a little instruction.

Magnesium deficiency gives symptoms very much like some of those experienced in MS. Since calcium is known to be antagonistic both to the absorption of magnesium from food, as well as the reclaiming from the tubular filtrate in the kidneys, it is well not to take extra quantities of calcium. (6)

Linoleic acid, an unsaturated fatty acid present in fruits, vegetables, whole grains, and nuts, appears to improve MS as compared to those receiving oleic acid. (7) Since sunflower kernels are high in linoleic acid, we have at times used sunflower seed for patients with MS. Inositol is a factor especially useful in the early childhood development of myelin.

Geographic distribution of MS and the variations in the components of the diet certainly strengthen the idea that dietary factors are high on the list of suspects for the cause of MS. Prolonged inactivity in persons with MS plays a large part in the progressive deterioration in muscle strength. Patients should keep active, but should not exceed their strength. To go beyond the bounds of reason in taking exercise is never wise.

Hydrotherapy

Fever treatments have been given for MS for many decades. Use a bathtub of hot water at 102 to 110 degrees, depending on the vigor of the patient and how well heat is enjoyed. A thermometer is placed in the mouth while the temperature is going up. Someone should be constantly with the person, since weakness may develop quickly as the mouth temperature goes up. The mouth temperature may be allowed to rise to 101 or 102 degrees. This can usually be accomplished in 10-20 minutes with a nice soak in the hot tub.

When patients have been treated with hot baths, upon return to their baseline temperature their performance of muscular tasks at the same temperature is significantly better when the temperature is coming down than when it was going up, indicating some improvement in tolerance to heat.‍

The Immunological Aspects of MS‍

Some believe that MS is a carrier state of the Sendai virus and that interferon and prostaglandin A-1, along with other prostaglandins, may block the virus replication. There appears to be an immune deficiency in MS. A young adult who had his tonsils removed as a child is 1.7 times more likely to get MS than is a person who did not. Certainly it would be well to enhance the immune mechanism by whatever means can be safely applied. A hot bath one to five times weekly, a proper diet, proper exercise, and other important aspects of healthful living are certainly worthwhile. Patients should adjust such matters as clothing, housing, and habits of life to stabilize heat loss to prevent sudden changes in temperature.

Changeable weather has been shown to be more important than either hot or cold weather in inducing symptoms. Days with the highest difference between high and low temperatures affect the symptoms greater. A warm climate and freedom from upper respiratory tract infections, coupled with much rest, appear to be helpful in the treatment of MS. (4, 6) Very few persons understand that chilling the extremities reduces the defense mechanisms against infection and weakens the body, increasing inflammation and slowing the body's rate of repair. No patch of chilled skin should be tolerated in a person with MS.

There are certain cells in the brain or spinal cord known as astrocytes, which form fibers that make a sort of scar tissue in the central nervous system. These scar cells grow on a nerve, which has had myelin damage. Heat is believed by some to loosen already formed scar tissue and to reduce the amount of inflammation so that scar tissue formation will be less.

There are some cases of MS, which have been thought to have started during periods of exercising. Yet the benefits of exercise in the treatment of MS have been outlined. We suggest that the patient should not emphasize exercise when the disease is in an acute stage. With chronic disease, however, exercise should be promoted.

‍The Diagnosis of MS

‍MS is characterized by attacks, which last a few days or a week or so and recur about once a year, tending to be more frequent as the disease progresses. Some individuals will be totally incapacitated within six months of the onset. At the beginning a patient may experience only one "attack" in two or three years. MS does not appreciably shorten the life span in most patients, unless a serious complication arises. The average age of onset is 29.9 years. There is no laboratory test that confirms the presence of MS, and the diagnosis is made by the meticulous exclusion of all other disorders that could cause the neurologic defects seen.

MS may be due to a slow virus that acts somewhat after the fashion of polio. In 50 MS patients, exposure to household pets was higher than in 50 control subjects not having MS. Antibodies to canine distemper virus show higher titers in patients with MS than in controls who do not have MS. Canine distemper virus is related to the human measles virus. Measles virus particles have been found in some individuals with MS, but most authorities believe there is insufficient evidence for accepting this hypothesis. That a virus is involved in the disease, however, seems to be a strong possibility. The use of vaccinations and other sera as a cause of MS has been suggested by the fact that there is often the onset of MS or an exacerbation of MS following the use of a vaccine or some kind of serum.‍

The Cause of MS

‍The rate of MS is higher than has been previously estimated. In Canada the previous estimation was 40 per 108,000, but now appears to be between 110-133 cases per 168,000 population in Vancouver. There are twice as many women as men. Over 50% of the patients first resided on a farm, as compared with 31% in a town and 18% in a city. These percentages correlate fairly well with the expected exposure to milk between rural and urban population groups.

The disease is more common in the higher latitudes. Those parts of Europe and America north of the 40th parallel have more MS. The location of a person's childhood determines the risk one has to develop the disease. (9) Persons habituated to tobacco or those who are exposed to smoke secondhand tend to get some of the central nervous system symptoms of MS.‍

Bibliography on Multiple Sclerosis‍

Modern Medicine, December 15, 1577, p. 11-13.

Journal of the American Dietetic Association, Vol. 36, pp. 322-325, April 1960.

Nutrition Today, November-December 1977, p.34.

British Medical Bulletin, Vol. 33(1), pp. 47-83, January 1977.

Archives of Neurology, Vol. 23, pp. 460-474, November 1970.

The Lancet, October 5, 1974, p. 831.

British Medical Journal, Vol. 2, pp. 1390-1391, 1978.

Archives of Neurology, Vol. 31 pp. 267-272, 1974.

Postgraduate Medicine, Vol. 59, pp. 219-221, May 1976.

Annals of Neurology, Vol. 6(5) p. 456, November 1979.

The Physical Therapy Review, Vol. 39(5), pp. 297-299, May 1955.

Mount Sinai Journal of Medicine, (New York), Vol. 41, pp. 127-130, Jan/Feb. 1974.

Brain Research, Vol. 36, pp. 133-151, January 14, 1977.

Physical Therapy Review, Vol. 8, pp. 333-334, May, 1958

The Medical Journal of Australia, October 12, 1963, p. 612-614.