Multiple sclerosis: complementary methods of managing the disease

by Dr. Jacki Hart

Multiple sclerosis (MS) is a mysterious disease of the nervous system that afflicts 1.1 million people worldwide. It affects different people in different ways, with extreme variation in degree and progression of physical disability. Some of the symptoms include fatigue, muscle weakness, numbness, loss of balance, muscle spasm, tremors, bladder urgency, incontinence, constipation, visual disturbances, and sexual dysfunction.

The cause of MS is not completely understood, and because there is no clearly identified cause, doctors and researchers are without a definitive treatment for the disease. There are some medications to help stave off the progression of MS, including beta-interferon and copolymer 1.

Given the mysterious nature of MS, alternative or complementary methods of care do not offer any more of a \"cure\" than do standard Western approaches. But when used in conjunction with standard care, they may help to improve level of function, lessen fatigue and other symptoms of MS, provide better coping mechanisms for the emotional ups and downs associated with MS, and aid in alleviating side effects from medications, such as fatigue, muscle pains, depression and feelings of the flu.

In searching for a cause for MS, which seems to be attributable partially to genetics and partially to environment, some researchers have turned to diet as a potential contributor. A Russian survey published in 1999 reported that people with MS tended to eat more meat, particularly smoked meat, prior to being diagnosed than did people without MS. Results of a Canadian survey published in 1998 also reported a possible association with increased consumption of red meat. My recommendation would be to avoid meat, particularly smoked meat, if you have MS, symptoms suggestive of MS (with a work-up by a physician in progress), or a family history of MS.

As with other chronic inflammatory and autoimmune disorders, British researchers have suggested a theoretical connection between MS and decreased consumption of dietary omega-3 fatty acids. This theory is based on the observation that inflammation is decreased when people eat more omega-3 fatty acids, found in certain fish and fish oil. Flaxseed, green leafy vegetables, and walnuts are also good sources of omega-3s. I generally recommend eating small quantities of herring or sardines packed in tomato or canola oil every day or consuming two to four tablespoons of flaxseed daily (flax must be kept refrigerated and ground within 24 hours of use).

Also, eat plenty of fiber (in vegetables, grains, fruit, and beans) and drink lots of fluid if you are prone to constipation. If you tend to get urinary tract infections, as some people with MS do, drink cranberry juice, but avoid citrus, tomatoes, antacids, and potatoes, which can make the urine more alkaline.

Some researchers suspect that people with MS may be more susceptible to oxidative stress (a process that damages cells, making a person more vulnerable to injury and illness) than those who do not get the disease. In support of this theory, Italian researchers found lower levels of vitamin E and ubiquinol, two antioxidants protective against oxidative stress, in the blood of patients with MS compared with healthy controls. If you have MS, therefore, you could consider taking 400-800 international units (IU) vitamin E/day and 30 milligrams coenzyme Q10 (which is converted to ubiquinol in the body) two to three times per day. Selenium (200 micrograms/day) is another antioxidant to consider. Make sure that your doctor knows that you are thinking about using these antioxidants, particularly if you are taking beta-interferon or copolymer 1.

People with MS tend to have low levels of vitamin D, which raises several questions and concerns. People with MS have a much higher rate of bone fractures than people without MS, because they lose bone at a faster rate. This bone loss is attributable to three processes: (1) decreased ability to be physically active; (2) prolonged use of steroidal medications for acute exacerbations of MS; and (3) vitamin D deficiency.

Supplementing with vitamin D is tricky because it may become toxic to the liver at high doses. Although this toxicity generally occurs only at levels greater than 40,000 IU or 1,000 micrograms per day, my conservative recommendation is to take no more than 25-50 micrograms or 1,000-2,000 IU each day. The recommended dietary allowance for vitamin D is 400 IU for healthy adults, but there is some research suggesting that the higher dose may help prevent bone loss in situations such as MS. You should take 500 milligrams calcium two to three times per day along with the vitamin D to help build stronger bones. As always, make sure that your doctor knows you are considering taking these supplements.

Exercise and physical activity to whatever level you are capable are extremely important. Movement against the force of gravity, such as light, repetitive weight lifting, walking, or using cardiovascular machines, can help lessen bone loss. Physical activity contributes to an overall feeling of well-being and improves flexibility. Exercise helps reduce depression, anxiety, feelings of self-doubt, and emotional swings common with MS.

A study conducted in Utah found that MS patients who exercise experience less fatigue, better bladder and bowel function, greater ability to focus, less depression, and increased participation in social activities. Work closely with a physical therapist to determine an appropriate regimen for your level of fitness and mobility. You may even need to see a physician who specializes in physical medicine and rehabilitation. Be careful to avoid exercising in the heat and get plenty of rest. Most of all, do what you can and be proud of what you accomplish.

Many experts say that finding methods for coping with the emotional difficulty of MS and the uncertainty of the disease progression is of utmost importance. Depression, anger, fear, and anxiety are among the most common feelings associated with MS. I would also add grief for the loss of the abilities, sense of freedom, and lack of worry that may have existed before the onset of MS symptoms. I think that MS is one of the most humbling and difficult diseases with which to live.

Methods of coping can include individual or group therapy, support groups, as well as the practices of meditation, yoga and tai chi. A study in California was conducted in which people with MS participated in an eight-week tai chi program. At the end of the eight weeks, extensive questionnaires revealed improvement in psychosocial well-being; in addition, the participants experienced a 28% increase in hamstring flexibility and a 21% increase in walking speed.

Finally, having a supportive, openly communicative relationship with all of your health care providers is extremely important, so choose them carefully. And, strive to have open, clear communication with your friends and family.

Many people with MS who use acupuncture report improvement in symptoms as well as reduction of the initial side effects of beta-interferon and copolymer 1. However, people with MS tend to have more skin sensitivity to the needles than those without MS; plus, the needles may occasionally provoke muscle spasm. If you are inclined to try acupuncture, I think that is fine with these words of caution in mind. You may or may not experience skin sensitivity or muscle spasm. If you do experience muscle spasm, I would not continue; at the very least speak to an experienced acupuncturist to see if there is an adjustment that can be made to avoid this reaction. In terms of sensitivity to the needles, only you can determine your level of tolerance. If this does happen, though, keep careful track of your symptoms and how you are responding to acupuncture treatments in order to decide whether it is worth continuing or not.

A study was done in Seattle, Washington, in which 30 people were randomized to receive either magnetic treatment with a device called an Enermed or to wear a placebo device that delivered no treatment. The participants wore the real or fake device for two months and did not know whether they were receiving the magnetic impulses or not. Those wearing the real device reported improved bladder control, cognitive function, mobility, and vision as well as reduced fatigue and muscle spasm. The study is small but intriguing.

Using beta-interferon, copolymer 1 or any other medication recommended by your doctor is important and the side effects experienced early in treatment usually resolve. Incorporating some of the complementary methods discussed here, including dietary alterations, nutrient supplements, physical activity (when possible), and methods of coping may be helpful.

In addition, acupuncture helps symptoms and side effects of medication for some people, but other people may be quite sensitive to the needles and therefore cannot tolerate the process. Magnetic therapy may show some early promise as an adjunctive treatment to medications; watch for more information, since often with MS things look promising early on, only to prove to be of no more use than the approaches weve discussed.

Finally, I think MS is an example of how health care can be truly holistic and integrated. Integration means not only bringing together Eastern and Western medical practices, but also integrating the care of the whole person as an active participant in his or her own healing. True care for a person with MS cannot occur without such a comprehensive perspective. Compassion for the particularly unique physical and emotional situation of each person with MS is part of the treatment, as is sensitivity to the particular burden of this disease and the need for hope under all circumstances.