By Ellen Kamhi PhD, RN, AHG, AHN-BC and  Eugene Zampieron, ND, AHG www.drznaturally.com

Osteoporosis is a disease of the skeletal system, which is characterized by deterioration of bone tissue, along with a decrease in bone mass. It can strike anyone at any age, although it is most prevalent in Caucasian and Asian, small boned woman over 50 years old. Osteoporosis is recognized as a major public health issue. Over 10 million Americans are afflicted, with 34 million more who may already be exhibiting signs of low bone mass, which increases the risk of developing osteoporosis. Bone mass can be determined by a bone mineral density test (BMD), such as a dual-energy x-ray absorptiometry (DXA). Low bone mass increases the risk of developing osteoporosis and fractures.  Osteoporosis can effect any bone in the body, although the most common sites are the wrist, spine and hips. It is credited with more than 1.5 million fractures in both the United States and Canada per year, causing a huge amount of personal suffering and loss of quality of life. (3) (4) This disease also has a high cost to society. The cumulative economic burden of care for fractures due to osteoporosis from 2008-2028 is estimated at $474 billion dollars in the United States alone. (5) 

The term, ‘osteoporosis’, describes the condition of the inside of the bones in people who have this disease, where large porous areas develop, weakening the bone structure. Throughout life, bone is a living tissue that maintains a balance through the bone building activity of osteoblasts, with the reabsorptive activity of osteoclasts. When factors such as advancing age cause a change in this balance towards reabsorption, bone mass decreases. After reaching a ‘fracture threshold’, bone that was normally able to withstand a minor stress, such as a fall or blow, becomes subject to break or fracture more easily. Osteoporosis is most often diagnosed in the senior years. However, the most important time to focus on building healthy bone is during the first 3 decades of life. Providing sufficient bone building nutrients, along with weight bearing exercise, may be the best protection against this disease. (6)   

There are several risk factors that increase the chance for an individual to develop osteoporosis: family history, female (six to eight times more likely than male) especially post-menopausal, due to decreased estrogen levels, advancing age, Caucasian , low calcium intake, smoking, alcohol consumption, a sedentary lifestyle , (7)  and soft drink consumption. (8)  (9)

Since many of these contributing factors are self regulated, health care providers can have a direct impact on this health issue by diligently educating clients. Risk of osteoporosis is also directly linked to the use of many prescription and OTC drugs: corticosteroids/steroids, thyroid hormones, anticonvulsants, aluminum containing antacids(ironically often recommended as a calcium source by mainstream physicians), loop diuretics,  gonadotropin-releasing hormones, and many others. (10)   Wherever possible, health care providers can instruct clients about natural therapies that may be equally effective for specific health conditions, but present a substantially lower risk for interfering with bone density.

Drug therapies for osteoporosis include bisphosphonates, such as alendronate and risedronate. A growing list of concerns is linked to the use of these drugs, including research that suggests a link between the use of these agents and esophageal cancer. (11)   A once per month tablet, ibandronate sodium, claims the advantage of greater convenience, but still has a host of possible adverse effects such as esophageal irritation, heartburn, and ulcers. In addition, it is not recommended that women with hypocalcemia take these drugs. Hormone replacement therapy was previously touted as a treatment, and may, in fact be quite useful for decreasing bone loss. However, this benefit decreases if hormone therapy is discontinued. In addition, many women refuse hormone therapy due to other known or perceived adverse effects. (12)  (13) Although pharmaceutical agents can be effective, there is an increased interest in non pharmacological prevention and treatment of osteoporosis. (14) 

Health care providers can be proactive on this front by supporting the improvement of nutritional status through diet and nutritional supplementation, along with suggestion for an increase in exercise training.

There are several natural interventions that promote increased bone health. These include sufficient consumption of bone supportive nutrients through healthy eating, regular exercise, and nutritional supplements including calcium, magnesium, vitamin D, boron, strontium, soy isoflavones and Vitamin K. Novel supplements such as  bone morphogenic proteins are also under investigation.   (15)  

Exercise

Exercise has an important impact on bone health. Several studies have increased awareness on how exercise can most constructively be used to prevent the development of osteoporosis. (16)  

Starting to exercise at a young age is best to achieve long term positive effects, since maximum bone mass is usually achieved during the first third of the life cycle. However, exercise at any age can improve bone health. Weight bearing exercises, including weight training, hiking, climbing stairs and walking, and other exercises that force the bones to work against gravity, are effective at increasing bone mass. (17)   Researchers from the Bone & Joint Injury Prevention & Rehabilitation Center at the University of Michigan investigated a host of exercise studies from 1961 to 2009 to determine the kind of exercise that had the greatest impact on bone health and density. They concluded that three factors were most important in predicting the best exercise outcome: Strain magnitude (how much impact the exercise has on the bones and muscles), strain rate (how often maximum vs minimum strain is applied ) and strain frequency ( how often strain occurs in a given amount of time).  (18) 

A combination of these three factors determines how helpful a given exercise regime is in helping increase bone density. However, there is no consensus about the exact combination of these three factors that is most likely to maximize osteogenic activity. (19)  For most individuals, practicing weight bearing exercise three times per week for 12 to 20 minutes is sufficient to increase bone density.  Since each joint will respond to the strain load individually, its best to rotate exercise sites, and focus on each one for a limited time period. Continuing to exercise throughout life helps to reduce bone loss and the risk of falls. (20)  

Dietary Interventions

The best approach to getting sufficient nutrients to build and maintain strong bones is by consistently making healthy food choices. As we discuss each nutrient below, food sources will be included, along with suggestions for possible supplementation, which is secondary to whole food ingestion.

Calcium

Calcium is the most abundant mineral in the human body. It is well-recognized for its importance in the development of bones and teeth, and has many other functions as well. The ability of calcium supplements to “maintain good bone health and reduce the high risk of osteoporosis later in life.” is one of the few health label claims allowed by the United States FDA.   The best food sources of calcium, other than dairy, include whole grains, beans, almonds and other nuts, and dark green leafy vegetables, such as kale. (21) Milk and dairy products contain a substantial amount of calcium; however, it is interesting to note that individuals who avoid dairy due to lactose intolerance do not experience a corresponding increase in osteoporosis. (22) Calcium supplements have been shown in several studies to be effective at slowing bone loss in both peri-menopausal and post menopausal women. (23)   A Cochrane Database Review Article (2004), states that “calcium supplements ….. at 500 to 2000 mg per day, are the simplest and least expensive way to prevent bone loss.”  (24) A comprehensive literature review published in the British Medical Journal (2010) questioned the commonly held belief in the  benefits of using calcium supplements. In this meta-analysis the reviewers concluded that subjects who took a 500 mg/day calcium supplement (without Vitamin D), experienced an increased risk of myocardial infarction, when compared to those who did not take calcium supplements. These results will likely lead to further investigation of current recommendations. (25) 

To maintain bone health, 1000- 1500mg/day of calcium (including food sources and supplements) is recommended (varies with age, weight, sex, etc.) by the National Academy of Sciences. (26)  Sufficient  calcium intake  is important in preventing osteoporosis, because if thebody’s stores of calcium is low, calcium will be leached from bones, which can lead to decreased bone mass and the initiation or worsening of osteoporosis.   While diet is the ideal source for all nutrients, calcium supplementation is often recommended to ensure that adequate amounts of this important mineral are ingested daily. This can be confusing, due to the many forms of calcium on the market, the differences in dosage levels, absorption rates, delivery forms (ie tablets, vs. liquids), cost, etc.  Several studies have shown that calcium citrate is absorbed better than tricalcium phosphate, calcium lactate and calcium carbonate, (the kind of calcium in antacid tablets). (27)   Calcium citrate does not tend to cause gastric distress, and has a pleasant taste. One study surmised that calcium formate is better absorbed than either calcium citrate or calcium carbonate. (28) Microcrystalline hydroxyapetite (MH) is a form of calcium that was demonstrated to be more effective at slowing bone loss than calcium carbonate. (29)   MH was also shown to support bone density in a randomized double blind 2007 control study.   (30)   Since calcium is so intimately involved in an array of metabolic reactions, it is not surprising that there is a long list of possible interactions with pharmaceutical drugs. Examples follow: Calcium decreases the absorption of bisphosphonates, (31) levothyroxine (32)  , tetracycline and quinolone antibiotics (33) Thiazide can reduce calcium excretion, leading to hypercalcemia, metabolic alkalosis and renal failure. (34) Health care practitioners can assist customers to choose a calcium supplement that best meets their needs.

Magnesium

Magnesium is the second most common mineral in the body (after calcium). Magnesium is important for many metabolic processes, including building bone, formation of ATP, and promoting calcium absorption. Dietary sources of magnesium include nuts, whole grains, dark green vegetables, fish, meat and legumes. Magnesium is often deficient in the Standard American Diet, due to eating a diet low in this nutrient, and soil depletion due to commercial farming practices such as overcroping. (35)  Low levels of blood magnesium correlates with low bone density, (36) and several studies have supported the use of oral magnesium supplementation  to increase bone density. (37) (38) (39) (40)  Even a moderate magnesium deficiency has been documented to cause bone loss in rats. (41) Magnesium deficiency may impair the production of parathyroid hormone and 1,25-dihydroxyvitamin D, which negatively effects bone mineralization. (42)  Supplementing with 250-400 mg a day of magnesium is usually recommended. Magnesium glycinate or gluconate are preferable to magnesium oxide, and are less likely to cause loose stools. Adverse effects of magnesium usually occur at higher dosages, and are most often associated with intravenous magnesium. These may include: diarrhea, drowsiness, loss of tendon reflexes, thirst, hypotension,  muscle weakness and respiratory and cardiac irregularities. (43)   Drug interactions include neuromuscular weakness and possible paralysis when combined  with aminoglycoside antibiotics, decreased absorption of biphosphates, tetracycline antibiotics and calcium channel blockers(take at different times). Conversely, many drugs cause hypomagnesemia, including aldesleukin, aminoglycosides and amphotericin-B(common). (44)   Magnesium supplementation helps to balance a number of health issues in addition to osteoporosis, such as insomnia, headaches, chronic constipation, restless leg syndrome, anxiety and irritability, and is often the first supplement we recommend in our clinical practice, after implementing a whole food based diet.

Vitamin D

Vitamin D is essential for the formation and maintenance of bone tissue, due to several complex mechanisms, including the regulation of calcium and phosphorous absorption. If Vitamin D levels are low Parathyroid hormone (PTH) increases, and triggers osteoclasts to release calcium into the blood via bone adsorption. If this process continues over time it weakens bone and leads to osteoporosis. In addition, vitamin D stimulates intestinal epithelial cells to synthesize calcium-binding proteins that support the absorption of calcium in the blood. (45) 
Vitamin D is called ‘the sunshine vitamin’ because the best source of vitamin D is from sensible sun exposure. Vitamin D is synthesized when sunlight hits the skin and transforms 7-dehydrocholesterol into vitamin D3 (cholecalciferol). D3 is shuttled to the liver where it is converted to 25-hydroxycholecalciferol, which is then transformed into 1,25 dihydrocholecalciferol (calcitriol); 10 times more potent than Vitamin D3.  Magnesium and boron act as co-factors in this reaction. Food sources of vitamin D include fish and fish oils.  Vitamin D deficiency is now recognized as an epidemic in the United States (46), and is especially common in dark skinned persons, the elderly, people living in northern areas, and anyone who has limited sun exposure. Deficiency can create secondary hyperparathyroidism, leading to a loss of collagen matrix and minerals, which increases the risk of osteoporosis and fractures. Poor bone remodeling due to higher osteoclast vs. osteoblast activity can be due to low levels of vitamin D, reduced synthesis of calcitriol in the kidneys or a lack of calcitrol receptors in target organs (47) Vitamin D is available as a supplement in several forms. Vitamin D 3 ( cholelcalciferol) Vitamin D 2( ergocalciferol) and Alfacalcidol are three common forms. Studies indicate that alfacaldidol  has been shown to prevent osteoporosis in women on high dose corticosteroids, (48)  as well as increasing muscle power and walking distance in the elderly. (49) A study which compared results using alfacalcidol with ergocalciferol (Vitamin D 2) in elderly women with vertebral fractures, discovered that alfacalcidol has a greater effect than D2 at stimulating calcium absorption by bones.  (50)  Vitamin D 3 is more effective than Vitamin D 2, and is a better supplement choice for most individuals. (51) An exception would be vegans, who prefer not to use any product that may have been animal sourced, since the starting material for D 3 is fish or lanolin. Mechanisms of action of Vitamin D’s role in building healthy bones includes increasing the number and activity of osteoblasts, (52) reducing the activity of osteoclasts, (53)  and normalizing the turnover of bone in osteoporosis. (54)  

Vitamin D appears to be most effective as a therapy for osteoporosis when combined with calcium. (55)     While 400 IU’s of oral vitamin D (cholecalciferol) is the current RDA, this level of supplementation appears to be insufficient to prevent fractures, while 700 to 800 IU/d appears to reduce the risk of hip and any nonvertebral fractures in both institutionalized and ambulatory elderly persons. (56)  Vitamin D is well tolerated at doses of 400 -800 IU. Current studies are moving towards increasing the RDA of Vitamin D, and many health practitioners are already recommending much higher doses. Scandinavian countries are considering ways to increase levels of Vitamin D through both supplementation and the use of UV lights. (57)Vitamin D has a low incidence of adverse effects, although intoxication can result if higher doses are used long term. Symptoms include weakness, nausea, vomiting and poor appetite. Toxicity may be seen when serum 25(OH)D concentration is consistently >200 ng/mL (>500 nmol/L) (58) More problematic are drugs which deplete Vitamin D. These include carbamazepine, (59)  cholestyramine and colestipol. (60)

Boron

Boron is ubiquitous throughout the human body with the highest concentrations found in the bones and dental enamel. Although there is currently no RDA, boron appears to be indispensable for healthy bone function, possibly via effects on reducing the excretion and absorption of calcium, magnesium and phosphorus,

( 61)  and by affecting signal transmissions across cell membranes by acting indirectly as a proton donor, which influences ion gradients that are involved with cell/cell communication. (62)   (63)   Boron may be involved in the synthesis of steroidal vitamins and hormones, such as Vitamin D, 17 beta-estradiol and testosterone  and  inhibits a range of microsomal enzymes which catabolize  these steroids, thus delivering a net up-regulatory effect, which could explain its bone building properties. (64) Boron clusters or carboranes have a high binding affinity for steroidal receptors (65)  and are being formulated into medications such as specific protease enzyme inhibitors. (66) Boron may be beneficial in the treatment of osteoporosis, especially in the case of vitamin D, magnesium, and potassium deficiency. (67)  One study found that boron supplementation as an isolated nutrient was not useful in terms of preventing bone loss.  (68)   Fruits, vegetables, soybeans and nuts can be rich sources of boron, but the level depends on the soil in which it is grown. A safe daily intake is estimated to be between 1 and 10 mg. Breast cancer patients are often cautioned not to use more than 3 mg a day due to references of boron’s ability to increase endogenous estrogen. (69) Sodium borate and boron chelated with glycinate, aspartate or citrate are the most common forms used in dietary  supplements. Toxic effects appear at intakes of about 100 mg. A fatal dose in adults is 15 to 20 g and in children 3 to 6 g. Repeated intakes of small amounts can cause accumulative toxicity, so pulse dosing is recommended, rather than continuous use.

Strontium

The mineral strontium is a powerful agent in the treatment and prevention of osteoporosis. Strontium is a naturally occurring mineral present in water and food. Trace amounts of strontium are found in the human skeleton, where it is adsorbed at the matrix crystal surface of bones. The Spinal Osteoporosis Therapeutic Intervention study is a double-blind, randomized, placebo-controlled trial, which compared two groups of postmenopausal women who already had a diagnosis of osteoporosis. One group was given two grams daily of non-radioactive strontium ranelate , while another group received a  placebo. The strontium group illustrated a significant reduction (41%) in the relative risk of experiencing a new vertebral fracture. (70) Other promising studies showed reduced risks for non-vertebral fractures, including hip fractures following the use of strontium. (71)  In addition to reducing the risk of fracture, strontium ranelate increased bone mineral density throughout the study, peaking at 3 years, with augmented scores of 8.2% in the femoral neck and 9.8% in the hip. Japanese pharmaceutical researchers have trade named the strontium salt PROTELOS and are in phase two drug trials. The mechanism of strontium’s bone strengthening effect is believed to be decreased bone resorption and increased bone formation which increases bone mass, microarchitecture and strength. (72) 

In the US, strontium is available as a dietary supplement in the form of strontium citrate. Theoretically, this form may have similar action to strontium ranelate, which has been used in most studies. UC Davis is investigating the use of Sodium Citrate for the prevention of osteoporosis, but the results are not yet available. (73) Most practitioners recommend that strontium should be taken at bedtime, and not at the same time as calcium supplements, since they compete for adsorption into bone matrix.It is important to ensure calcium and vitamin D intakes are adequate when supplementing with strontium.  This is underscored by earlier research on animals suggesting that increasing the intake of strontium via diet may de-mineralize bone when calcium is deficient. (74)   In rats with chronic kidney failure, strontium has been shown to cause osteomalacia, a condition in which bone is softened due to lack of mineral content. (75)  For this reason, it is suggested that people on kidney dialysis should not use strontium supplements.

Isoflavones

Research supports the positive effects of soy isoflavones for reducing the risk of developing osteoporosis. (76)  Diets high in soy may decrease bone re-absorption in postmenopausal women. (77)  Although ipriflavone, a semi synthetic flavone comparable to genistein and diadzein found in soy foods, was ineffective in restoring bone density in rats, it modulated IGF-I(insulin growth factor I), (78) which is linked to bone mineral density and increased bone remodeling through several mechanisms. (79) IGF-I (Somatomedin C) is currently being measured by holistic health practitioners as one of the parameters to assess overall aging. Ipriflavone yielded positive results on bone mass in elderly women with osteoporosis in human trials at doses of 200 mg per day, (80)  and seems particularly beneficial when combined with calcium.  (81)   Moderate soy consumption (2-4 ounces per day) is likely a reasonable and prudent measure due to scientific validation of its positive effects, combined with a low incidence of adverse reactions.  Soy can cause allergic reactions in some individuals, and may inhibit thyroid hormone synthesis. (82)  Fermented soy is less likely to cause these adverse effects.

 Vitamin K

Vitamin K is a fat soluble vitamin known for its effect in blood clotting, which it accomplishes by regulating the coagulation cascade via its ability to bind calcium ions (Ca2+), among other mechanisms. (83) There are three known vitamin K dependent proteins that have been isolated in bone: MGP (matrix Gla protein), protein S and osteocalcin. One of Vitamin K’s roles in helping to maintain healthy bone mass is linked to its importance in the formation of osteocalcin by osteoblasts. The synthesis of osteocalcin requires both Vitamin D and Vitamin K. There are two naturally occurring forms of vitamin K: Vitamin K 1 (phylloquinone), synthesized by plants, and Vitamin K 2 (Menaquinone-n) synthesized by bacteria. The ‘n’ signifies the number of 5 carbon chains that a specific kind of K 2 contains. Vitamin K 2 is available as both M-4 and M-7 as a dietary supplement. Research supports the use of both Vitamin K 1 and Vitamin K 2 in terms of benefits associated with osteoporosis. Vitamin K 1 supplementation has been shown to support a favorable bone biomarker profile. One study included vitamin K 1, along with Hop rho iso-alpha acids, berberine, vitamin D. The treatment group showed a significant decrease in  biomarkers that indicate bone turnover. (84) However, in a double blind study which followed patients who were given 500 mcg of Vitamin K 1 for three years their bone density scores were no better than the placebo group. (85)   Patients who undergo transplants have an increased risk for osteoporosis. A randomized, double blind, prospective longitudinal study investigated the effect of a dietary supplement which included vitamin K2 (180 mcg menakinon-7) on bone mass of 94 subjects who were followed for the first year after lung and heart transplantation. The outcome showed a favorable effect on bone mass density of the lumbar spine. (86)  Although Vitamin K 2 is currently gaining popularity as the preferred form to use in supplementation, Vitamin K 1 is more cost effective, and therefore may be the better choice for some patients.

Vitamin K is a fat soluble substance; however the body does not store a significant amount at any given time. The need to constantly replenish vitamin K through dietary intake is decreased due to the vitamin K cycle, which allows a small amount that is present to be used by the body several times. Vitamin K deficiency is rare, due to the reuse via the vitamin K cycle, and wide availability in the diet. Vitamin K is found in dark green vegetables such as kale, swiss chard, parsley and spinach, and to some extent in Olive and Soybean oils. Deficiency may occur in those taking anti-coagulant pharmaceutical drugs, or who have difficulty with fat metabolism. People who develop osteoporosis have been documented to have a low dietary intake of vitamin K containing foods, (87) as well as low  blood levels of Vitamin K. (88)   Health practitioners can emphasize the importance of eating high quality (preferably organic) green vegetables as part of the diet. If supplementation with vitamin K is recommended, common doses include the RDA amount of 65-80 mcg/day.

Bone Morphogenic Proteins

In the early 1960’s, orthopedic surgeon Dr. Marshall Urist discovered a family of proteins that stimulates osteoblasts and cartilage chondrocytes, and named these proteins Bone Morphogenetic Proteins – or BMPs. The impact of Dr. Urist’s contribution to medicine and healthcare was first realized in the 1990’s when commercial bone-protein preparations containing BMP’s and key growth factors were used by orthopedic surgeons for bone healing and spinal fusions. In 2002, the FDA approved select individual BMPs for use in surgical procedures as a more effective way to grow and heal bone. BMP’s account for the major proportion of the osteoinductive potential of bone extracts. (89)  BMP’s bind to one of the two types of serine and threonine kinase membrane receptors, and upon binding, initiate an intracellular signaling cascade which modulate the activity of transforming growth factor beta ligands. (90) This in turn leads to the expression of the transcription factorCbfa1 (Runx2), which results in the expression of several proteinscritical for bone formation, ultimately leading to regulation of target genes involved in bone remodeling. (91)  BMPs are thought to be key regulators of embryonic skeletogenesis (92), endochondral ossification (93), bone remodeling (94) (95), fracture repair (96), and bone regeneration. (97)  Over 20 BMPs family members have been identified.  (98) It was once thought that BMP’s  could only be applied locally by orthopedic surgeons  for a procedure known as “screw and glue” as they attempt to mend a fracture, but recent research in animals suggest that that systemically administered  BMP-6 restores the bone inductive capacity, micro-architecture, and quality of the skeleton in osteoporotic rats. Human trials are needed. (99) Somehealth practitioners are now recommending the use of oral BMP’s for osteroporosis and osteopenia at a dosage of 200-1000 mg/day with minimum adverse effects, except for occasional GI upset in some patients.

Health care practitioners can be instrumental in educating their patients to the fact that, with intelligent dietary and lifestyle choices, osteoporosis is largely preventable for most people.

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Image Credit:

By BruceBlaus – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=46602308

Rising Above MS

Coping with an unpredictable, chronic illness can take its toll, but natural treatments can help.

By Ellen Kamhi PhD, RN, AHN-BC, AHG, and Lynn Allison

Imagine for a moment knowing that you have problems keeping your balance but not knowing when you will lose it.

Most of the time you are fine, but sometimes you just can’t keep your feet under you. Will it be at the grocery store? While you’re walking to the bathroom? While holding your daughter? Imagine again that you also suffer from intolerable spasms and pain that cripple you at times, but you don’t know how long they’ll last or when they will happen.

Welcome to the world of Multiple Sclerosis (MS).

With more than 400,000 Americans suffering from MS, more cases are being diagnosed every day. This degenerative illness interferes with your central nervous system—the part of your body that controls behavior and movement—and manifests in unpredictable ways, creating different symptoms for each sufferer. Furthermore, the symptoms often “come and go” and are rarely consistent. They may include numbness and tingling of limbs, loss of coordination, tremors, loss or distortion of eyesight, dizziness, and pain.

What is MS?

MS is a chronic, unpredictable, autoimmune disease of the central nervous system that affects the brain, spinal cord, and optic nerves. It’s considered autoimmune because it’s believed that the body’s own immune system attacks the person’s healthy tissue—in this case the healthy tissue of the central nervous system. More specifically, the immune system compromises the integrity of the myelin sheath that surrounds the nerves in the spinal cord and brain.

Think of the myelin sheath like a coaxial cable, the one that brings cable or satellite TV to your home. If you peel back the black plastic coating of the cable, you will find delicate wires underneath. If one of them is cut or damaged, the picture to your TV may not be as crisp or may fail completely. This is the same with your nerves.

Myelin is the protective insulation of your nerve fibers and is made of proteins and fats, and supports the correct transmission of signals along the nerve fibers. So when your brain tells you to pick up a cup of coffee, your hand will actually reach for the cup and pick it up. When the myelin is worn down, inflammation occurs and interferes with the transmission of nerve signals and can damage the nerve fibers themselves. So instead of picking up that cup, your hand may suffer a tremor instead, or not react at all.

Once the myelin is destroyed, it’s often replaced with scar tissue (also called sclerotic tissue). This is where the term “Multiple Sclerosis” originated, meaning “multiple scars.” Patches of these scars are found in random locations along the central nervous system because the body’s immune system seems to attack the central nervous system at random. Therefore, the symptoms and onsets of MS vary and are essentially unpredictable.

Diagnosis occurs in women at least twice as often as men, and MS is more prevalent in colder climates than in their tropical counterparts. Most people are diagnosed between the ages of 20 and 50, but even children as young as 2 years old and others as old as 75 have developed the condition. It’s not considered a fatal disease, and the vast majority of people with MS end up living a normal life span, accented with unpredictable symptoms and attacks.

There are different types of MS, including relapsing remitting, secondary progressive, primary progressive, and progressive relapsing. About 85 percent of individuals are initially diagnosed with relapsing remitting MS, which means that the attacks of neurological dysfunction can become acute, followed by complete or partial recovery periods. After being diagnosed, an MS sufferer may fall into the other three categories depending on the severity, duration, and onset of symptoms.

The symptoms vary greatly from one individual to another and can come and go in an unpredictable manner. These symptoms are all neurological in nature and can include numbness and tingling in the extremities such as the hands and feet, and often occur on one side of the body. Loss of coordination of any limb and visual disturbances such as dim or double vision in one eye is common. Walking difficulties, tremors, lack of bladder control, bouts of dizziness, and mood changes also can appear, sometimes for years before the condition is diagnosed.

This makes diagnosis difficult because there is no actual definitive test for MS. The patient will usually go through several physicians and batteries of diagnostic tests to rule out other possibilities before the final diagnosis is made.

Obtaining a diagnosis can also be a struggle because conventional medicine says the exact cause of MS is unknown. Genetics is thought to play a role, since studies have uncovered an increased risk to relatives of people stricken with MS. Viral infections, such as Epstein Barr, have been established as a possible risk factor, and over the years, experts theorized that MS was caused by overexertion, toxins in the system, poor circulation, and allergies.

Modern science now supports the role of these “causes” as possible triggers that can lead to the development of a deregulated autoimmune response. Experts believe this could, theoretically, contribute to the development of MS, although no direct link has been established. “Research suggests that multiple causative factors convene in the development of auto-immune diseases,” says Dr. Nita Bishop ND. “Components include genetic predisposition (HLA Dr2 haplotype) and a trigger, such as a virus or environmental insult.”

For instance, several studies have shown that exposure to insecticides, solvents, X-rays, and other pollutants may be involved as a triggering agent in this illness. Mercury in amalgam fillings have been linked by some reports (although disputed in others) to MS. Furthermore, MS patients who had their mercury fillings removed reported a 34 percent fewer relapse rate than a group of MS sufferers that kept their fillings.

Exposure to environmental toxins may also help to explain the “cluster effect” where MS is more prevalent than normal in a given geographic area. Current research is also exploring the effect of various environmental toxins which may trigger genetic predispositions to the development or progression of MS.

What can I do about it?

Today, a diagnosis of Multiple Sclerosis no longer means that your vibrant past is over. It’s an exciting time for treatment of the disease because both conventional and natural medicine are coming together to offer sufferers renewed hope. Science is making great strides in tackling the progression and symptoms of the disease, and both pharmaceutically based drug therapies and natural support can work together to focus on curbing the destructive immune responses.

MS is a complex disease, and the most prudent approach is to investigate many treatment options. Natural treatments can often compliment pharmaceutical and conventional therapies, and support the development of a healthy body, which may help to overcome or slow the development of many of the symptoms associated with MS and assist in overall disease management.

Medications are complemented by a growing number of natural therapies that can assist in overall disease management. In 2010 and 2011, there have been several breakthrough oral drugs that help treat symptoms without the pain and inconvenience of traditional injections. Treatments today, according to Dr. Timothy Coetzee, chief research officer of the National Multiple Sclerosis Society (see below), can both help to modify the disease course by slowing down its progression and by reducing the number and severity of attacks.

“Basically, there are currently two ways to treat MS,” says Coetzee. “We try to modify the disease by redirecting the immune system so that the brain is not the enemy, and we deal with the symptoms including fatigue or difficulty walking. The current research underway is providing great hope that we will someday soon be able to stop the progression of the disease, restore function that has been lost, and end the disease forever.”

One of the newer medications available to specifically treat MS symptoms is Ampyra (dalfampridine), a potassium-channel blocker that is licensed for use to improve walking in people with MS. It has been shown to assist in promoting the conduction of nerve signals along nerve fibers whose insulating myelin coating has been damaged by MS. This has helped improve the walking abilities in patients experiencing mobility issues. However, as with all drug therapy, side effects exist. Common ones may include urinary tract infections, insomnia, dizziness, headache, and an MS relapse (2 to 5 percent of people tested).

Another breakthrough in the field of MS includes a study of more than 5,000 people with MS, where researchers identified characteristics that can help pinpoint or predict the rate of progression of the illness. There has also been recent FDA approval clearing the way for the first human clinical trials of stem cell-based therapy. Researchers are hoping to generate progenitor cells, which make cells called oligodendrocytes that, in turn, make the insulating myelin that wraps around nerve fibers. This could potentially help to regenerate the myelin that has been destroyed by the immune system.

MS is a complex disease, and the most prudent approach is to investigate many treatment options. Natural treatments can often compliment pharmaceutical and conventional therapies, and support the development of a healthy body, which may help to overcome or slow the development of many of the symptoms associated with MS, and assist in overall disease management.  One survey found that most MS patients tried natural therapies because they wanted treatments that recognized the body-mind connection, and they were dissatisfied with conventional medicine. The study found that the most frequently used natural therapies among MS patients included herbs, chiropractic massage, and acupuncture. Coetzee points out that alternative or complimentary treatments for MS “are a very serious area of research for the National Multiple Sclerosis Society.”

Diet

Currently, there is no scientific evidence that proves diet affects the long term course of MS, beyond the fact that it’s important for everyone to have a well balanced, low fat diet. However, Dr. Roy Swank, Professor Emeritus of Neurology at Oregon Health Science University, began a study in the 1950s on the effect of reducing MS disabilities by eating a diet high in linoleic acid, and low in hydrogenated oils and animal fats, in addition to supplementing with cod liver oil (5 grams) daily.

After following 144 patients for 34 years on this diet, Swank found that there was a positive effect in terms of morbidity and function for those who stayed on the diet. Although the reason is still unknown, there is no negative effect to eating a diet high in vegetables and healthy oils, and low in animal products and hydrogenated fats. This type of diet also coincides with the Mediterranean style of eating.

Many MS patients, as well as all people in general, report better energy levels and less symptoms when they follow a gluten-free diet, and increase their consumption of healthy organic foods, and eliminating junk foods.

Exercise

 “As recently as the early 90s, people with MS were told to take it easy and rest to help manage their disease,” says Coetzee. “Research studies by our Society and others now support the benefits of many types of exercise in maintaining wellness and function, reducing fatigue, and improving the quality of life.”

Virtually all of the nation-wide network of chapters of the National Multiple Sclerosis Society now offer free or minimal cost exercise programs, particularly in the area of yoga because it helps improve coordination, flexibility, and concentration. Not to mention, it supports healthy functioning of the mind-body connection. Other exercises that have also been shown to aid MS patients include aquatics and resistance training.

Mind/Body

Relaxation therapies, such as meditation are worth learning and practicing for everyone, including MS patients. Researchers in Basel, Switzerland, held the largest study on the effect of meditation for people who suffered from MS. The controlled study showed that mindfulness-based meditation significantly improved the quality of life, including lifting depression and fatigue, in people with progressive MS.

Tens Therapy 

Ellen Kamhi, PhD RN, (co-author of this article) says, “I have had tremendous success with MS patients who decided to try TENS (Transcutaneous Electrical Nerve Stimulation) therapy. In our clinic, we utilized a specific TENS machine called the Neural Conduction Accelerator as part of our protocol, which also included light therapy, relaxation, and weekly massage along with a super healthy diet including juicing, lots of organic vegetables, and good fats such as organic unrefined coconut oil and avocados. TENS has been useful for MS patients to decrease pain and muscle tension.

“I remember when one patient proudly strutted into the office (no longer in his wheel chair) after 16 weeks of following the program. He said to me ‘See what kind of shirt I am wearing?’ At first I was not sure what he meant, but he pointed out that it was a button down shirt, which he had not been able to put on without help for over 13 years!”

Since MS is a disease where symptoms can be intermittent and remissions are common, this protocol cannot be proven to be the catalyst that caused the positive changes. However, improvements did occur in the many MS patients who received TENS treatment over the course of 10 years.

Will supplements work?

Adding dietary supplements has shown to reduce symptoms of MS and aid in the overall health of the MS sufferer. It’s important for MS patients to recognize that they may be at risk for vitamin and mineral deficiencies. Natural healthcare practitioners such as licensed Naturopathic Physicians will test all patients for levels of vitamins and minerals including B vitamins, folic acid, vitamin D, and iron, as well as exploring levels of possible contaminants such as heavy metals.

Low level deficiencies in these nutrients, along with high levels of heavy metals and other pollutants can interfere with healthy nerve function and normal tissue repair. This is especially important since most of the conventional drug therapies that are used for managing MS specifically deplete the very nutrients that are already low in most MS patients.

For example, prednisone and related drugs deplete folic acid, vitamin D, zinc, magnesium, vitamin C, and calcium, and MS patients often have low levels of these important nutrients. It would be prudent for everyone— regardless if you suffer from an autommune disease—to be regularly tested for nutrient levels, but this is especially appropriate for anyone suffering from a degenerative illness such as MS. For information on nutrient blood levels testing visit metametrix.com.

There are specific supplements that have been found to be useful for MS patients, including vitamin D, vitamin B1, vitamin B2, fish oil, L-carnitine, calcium, and magnesium.

VITAMIN D Recently, an Australian study proposed that people who live closer to the equator and are exposed to more sun and vitamin D, are less likely to develop MS. Similarly, a study in the Journal of the American Medical Association determined that people who have a higher blood level of vitamin D have a lower incidence of MS than those with low vitamin D levels. When asking your physician for a Vitamin D level test, request a Serum 25-hydroxyvitamin D level, since this more accurately reflects the amount of vitamin D available to body tissues. For more in-depth information about vitamin D, see our February 2011 issue, or visit naturalsolutionsmag.com and search for “Vitamin D” in the article database.

Fish Oil This supplement has been enjoying wide regard as a healthy addition to the diet, even among mainstream physicians for a number of health conditions. One study that lasted two years investigated a supplement and dietary regimen on the progression of MS. Patients used 5,000 mg of fish oil per day, along with vitamin A, vitamin D, vitamin E, and reduced consumption of alcohol, sugar, coffee, tea, meat, and dairy, while increasing their intake of vegetables, fruit, and whole grains. Although the study size was small, outcomes were positive for a majority of the participants. It’s important to note that the risk-benefit ratio of attempting such a regimen makes for outstanding odds for the patient!

Herbs A specific Tibetan Herbal formula called Padma was tested on MS patients and showed that those patients had increased their muscle strength. A 2010 rat study further investigated the reason for this effect and showed that Padma actually enhances muscle contractility. Plants used in this herbal formula include Iceland moss, costus root, neem fruit, cardamon fruit, red saunders, chebulic myrobalan, allspice fruit, beal tree fruit, columbine, English plantain, licorice root, knotweed, golden cinquefoil, clove flower bud, spiked ginger lily rhizome, heartleaf sida, valerian root, wild lettuce leaf, and calendula flower.

Chinese Skullcap Chinese Skullcap (Scutellaria baicalensis Georgi) is an Asian herb that enjoys wide use as an aid for inflammatory conditions. A mouse study tested the use of this herb on MS and found that it may be a useful adjunct therapy to reduce the autoimmune response that is prevalent in MS. PhytoDyne RX is an herbal formula that combines Scutelleria baicalensis with white willow bark, ginger, bromelain, boswellia, corydalis, and other natural anti-inflammatories that can help reduce inflammatory symptoms.