Multiple Sclerosis 9- Yoga & Exercise

The health community has had an evolving view of exercise over the past few decades. For example, in individuals with low back pain, the conventional wisdom of the 1980's was to have plenty of bed rest. The consensus in 2011 is that people with low back pain should move regularly and in a safe, controlled manner.  

Even the management of Parkinson disease has changed in the past few years.  

"For many years, exercise was not a recommended rehabilitation strategy for persons with a diagnosis of idiopathic Parkinson's disease (PD). Since it was believed that exercise had no measurable effect on PD, or might worsen the underlying pathology, it was to be avoided... A rich vein of bench and translational research now suggest non-pharmacological approaches, such as exercise or physiotherapy, have a far greater effect on the cardinal features of PD than previously believed."  Eur J Phys Rehab Med 2009. Jun 45(2):215-29

Exercise seems to be of benefit in any health condition; MS is no exception.  A 2004 study published in Neurology found that people with multiple sclerosis who regularly exercised or practiced yoga had significantly less fatigue than those who did not.  Another study in 2010 found that yoga improved symptoms of MS and the researchers suggested, that yoga "should be considered in the future as possible complementary treatments."  

Admittedly, there are many gray areas in prescribing exercise to people with MS. We are still unclear on how often, which method and what intensity is ideal.  The best suggestion seems to be, "Find a way to move your body regularly.  Nothing extreme, just move."  When that happens, there seems to be general improvement in MS symptoms.

 
Over the past 9 posts, I've been writing about options to complement the conventional care of MS.  There is no magic cure, no simple pill to take and no easy way out of this.  But there are options to feel better and reduce symptoms.  To close out this series on MS, I will refer to a 2009 paper published in Quality and Primary Care.  The title of the article is "Managing multiple sclerosis in primary care: are we forgetting something?" I've quoted extensively here but it is well worth the read.

"...studies suggest that nutrition, sunlight, exercise, stress and social factors can all modulate the rate of progression of MS and the level of disability....If lifestyle approaches do offer potential avenues for therapy, this raises important questions regarding the management of MS in primary care. More widely prescribed conventional medicines have been studied in more detail but are only modestly effective and may have significant side-effects. Are we presently neglecting the most effective approach of combining the non-drug or holistic approach with the best of conventional pharmaceutical therapies, and if so what are the implications of this omission?"  

Multiple Sclerosis 8- Dairy

In 1976, there was a quiet suggestion that consumption of dairy products may be related to MS.  In 1992, an epidemiological study was published that also showed some association between MS and milk.  Intrigued by the possibility, researchers at Oxford set out to determine whether childhood milk allergy had any relationship to MS.  Published in 2010, the study found no relationship between childhood milk allergy and development of MS.

I've written about the risks of milk consumption previously. It is worth noting that in addition to the risks I described earlier, some of the proteins found in cow's milk (butyrophilin) exhibit cross reactivity with proteins found in myelin.  In other words, some proteins in milk look like proteins in your brain.  A 2000 study in the Journal of Immunology found that these proteins in milk may influence the immune response that triggers demyelinating events. These findings were replicated in 2004 as researchers found that butyrophilin can influence the immune response to myelin.

Another problem with dairy is the prevalence is lactose intolerance.  While some may view lactose intolerance as a mere inconvenience, researchers expand on this:

The symptoms of lactose intolerance are caused by gases and toxins produced by anaerobic bacteria in the large intestine. Bacterial toxins may play a key role in several other diseases, such as diabetes, rheumatoid arthritis, multiple sclerosis and some cancers.  Sci Prog 2005;88 (Pt3):157-202

There are certainly good things that go along with milk.  It is the world's richest source of calcium.  But consider the other potential costs.  Along with the hormones, windup of the insulin IGF-1 axis, casein related problems, generation of beta casomorphin, potential cross reactivity with myelin protein & consequences of lactose intolerance, there is much potential for immunological aggravation.  Given this evidence, I do not believe it is in your best interest to regularly consume milk.

Multiple Sclerosis 7- Oxidative Stress 2

In the last post, we established that oxidative stress occurs when there is inappropriate activation of the immune system as in multiple sclerosis.  This oxidative stress can be just as damaging as the disease process itself.  In this post, I'd like to focus on a broad counter-measure to the hazards of oxidative stress.  A flippant, generic response may simply be, "increase ingestion of antioxidants and take a good broad-spectrum antioxidant supplement."

But in order to approach our therapy with "eyes wide open," we need to consider oxidative stress in a broader sense, not just in multiple sclerosis patients.

1.  Hyperglycemia induces oxidative stress.  Life Sci 2010 Aug 14;87(7-8):197-214

2.  Pollution causes oxidative stress.  Biomarkers 2010 Sep;15(6):538-45.

3.  Smoking causes oxidative stress.  Biomarkers 2009 Jul;14 Suppl 1:90-6

4.  Trans fats (cookies, cakes and pies )cause oxidative stress.  Lipids 2007 Sep; 429):787-99. 

5.  Chronic alcohol use causes oxidative stress. World J Gastroenterol 2010 Dec 28;16(48):6035-43

The list goes on and on and on.  The point is; if you are a human being, you are subject to many triggers that promote oxidative stress.  This is true whether you are a man or woman, adult or child, with MS or without MS.  While we have built in antioxidant systems, they require the intake of healthy foods.

If you have MS, not only do you have an immune disorder that promotes oxidative stress, you also live in a world that promotes oxidative stress.  You are subject to a "double whammy."   What this means, if we are being honest, is that while other people may choose to eat junk food or enjoy other vices "in moderation", you are not "other people."  Those "other people" eating junk food "in moderation" are very likely to suffer other ill health consequences.  The health statistics in the United States seem to bear that fact out.

I strongly encourage you to be absolutely disciplined in your diet.  The amount of fresh vegetables you consume should make other people think you are weird.  Your avoidance of junk foods and other vices should make others think you are weird.  Multiple sclerosis is a dramatic disease and its successful management requires dramatic actions.  A salad a day is not enough; you must be extreme.  

Imagine a raging forest fire destroying acres of beautiful land.  Then imagine a group of campers 2 miles away gathering wood to start a campfire.  What if they argued, "Don't worry.  The fire is going the other way.  Things are OK on this side of the forest."  It's absurd isn't it?  Your immune system is that raging fire.  Don't tempt it by adding fuel to the flames.