Multiple Sclerosis is a debilitating disease affecting around 2.9 million people worldwide and around 1 million people in the United States. MS results from demyelination of the nerves in the central nervous system. Think of the myelin sheath as the insulation around the nerves. We have all seen electrical wires with a plastic coating. If the plastic coating becomes damaged, the electrical wires short out and can’t conduct electricity. Your nerves are much like electrical wiring, and when the coating (the myelin) becomes damaged, your nerves “short out” and cannot conduct signals.
What causes multiple sclerosis?
Although the cause of MS is unknown, many believe that it is an autoimmune disorder caused by aberrant signaling of the nervous system defense cells, known as glial cells. When these cells are signaled, they release chemicals called cytokines that tell the body’s immune system to attack. Sometimes, the attacking cells cannot tell the difference between “good” cells and “bad” cells. When “good” cells are attacked, the body suffers.
Causes of MS include female gender, obesity, smoking, Epstein-Barr virus infection, and vitamin D deficiency. There are no known cures for MS. However, treatments can help to manage symptoms, slow progression, and improve quality of life.
Immunomodulation vs. Immunosuppression
The idea of “immunomodulation” or controlling an overactive immune system has been the mainstay of MS treatment for the last few decades or so. Everyone’s seen commercials on television regarding pharmaceutical products for slowing down the progression of MS. These so-called biologics target white blood cells and beta cells. White blood cells and beta cells are critical components of your body’s immune system. When they are targeted and prevented from working, your body’s immune system will be compromised, leaving you vulnerable to infections and cancer. This is known as immunosuppression. In addition, these drugs are extremely expensive, often costing $30,000 per year or more.
There is an option for “immunomodulation” rather than “immunosuppression”. Immunomodulation calms down the immune system and does not destroy it.
LDN and MS
One immunomodulatory drug is a drug called naltrexone. Naltrexone blocks your body’s own opioid receptors. It has been shown that your body’s endogenous opioids cause an inflammation of the nervous system and a breakdown of myelin, thereby leading to MS in animal models1.
Naltrexone was originally developed as a treatment for alcoholism and drug addiction because it blocks your body’s own morphine signals. In the 1980s, it was discovered that, when given in small doses (also known as low-dose naltrexone or LDN), LDN inhibits part of the glial cells called the toll-like 4 receptors. These receptors, when activated, send out the damaging chemicals that cause the body to attack itself. By blocking these receptors, LDN modulates the immune system. LDN does not result in immunosuppression but a more gentle modulation response. It makes sense, given the work cited above, that by blocking your body’s opioids, you can block the signaling that leads to nerve tissue damage.
Cree, et al evaluated the efficacy of 4.5mg LDN given nightly on the quality of life for 80 MS patients over an 8-week period. They found improvements in mental health, pain, and perceived deficits associated with MS, including the ability to walk and perform daily tasks2. In another study, researchers examined 215 patients using LDN for a median period of 804 days. They found that 77% of patients had no side effects, while the main side effect was sleep disturbances occurring in 11% of patients. They found that 60% of patients reported less fatigue and 75% had an improved quality of life3. Although there have been no large, multi-centered placebo placebo-controlled clinical trials with LDN, it appears to have promise, and further research is warranted.
Vitamin D and MS
Vitamin D deficiency is another risk factor for MS. We live in Michigan, where we live indoors for many months of the year and then slather on sunscreen to protect our skin during the other months. Unless we are supplementing our bodies with exogenous vitamin D, we are likely to be deficient.
Vitamin D's ability to support the immune system is well known. It has been shown to get into the brain and reduce the aforementioned glial cell activation. It has been demonstrated that patients with vitamin D levels less than 75 nmol/L had an increased incidence of inflammation of the optic nerve4, one of the leading causes of vision loss in MS patients.
A recent article in the Journal of the American Medical Association (JAMA) demonstrated that supplementing with Vitamin D at a rate of 100,000 IU every 2 weeks significantly reduced disease activity in MS, including reduced MRI activity of new lesions and observation of contrast-enhancing lesions. It was observed that patients benefiting the most were patients with severe vitamin D deficiency, defined as less than 30 nmol/L. Although the study was small, the authors concluded, “these results make high-dose vitamin D an interesting candidate for further studies evaluating add-on therapy in the therapeutic strategy for managing MS”.
Functional Medicine and MS
If you suffer from MS or if you know someone suffering from MS, there may be treatment options available that are well tolerated. If you have further questions, please give Keystone Compounding Pharmacy a call and arrange a consultation with our Anti-Aging and functional medicine specialist, Dr. Logan Morse.
Resources:
- Zagon IS and McLaughlin PJ. Endogenous opioids in the etiology and treatment of multiple sclerosis. Multiple Sclerosis: Perspectives in treatment and pathogenesis. (2017:8) November 2018. pubmed.ncbi.nlm.nih.gov/29261263/
- Cree BD, Kornyeyeva E and Goodin DS. Pilot trial of low-dose naltrexone on quality of life in multiple sclerosis. Ann Neurol (2010) Aug;68(2):145-150.
- Ludwig, MD, Zagon IS, McLaughlin PG. Long-term treatment with low dose naltrexone maintains stable health in patients with multiple sclerosis. Mult Scler J Exp Transl Clin (2016), 2.
- Derakhshandi H, Etemadifar M and Feizi A. Preventative effect of vitamin D3 supplementation on conversion of optic neuritis to clinically definite multiple sclerosis: a couple blind, randomized, placebo-controlled pilot clinical trial. Acta Neurol Belg (2013): 113(3):257-263
