Welcome! This blog contains research, information on lifestyle, nutrition, dietary supplements and health for those with MS, as well as continuing information on the understanding of CCSVI and cerebral hypoperfusion. This blog is informative only--all medical decisions should be discussed with your own physicians.

The posts are searchable---simply type in your topic of interest in the search box at the top left.

Almost all of MS research is initiated and funded by pharmaceutical companies. This maintains the EAE mouse model and the immune paradigm of MS, and continues the 15 billion dollar a year MS treatment industry. But as we learn more about slowed blood flow, gray matter atrophy, and environmental links to MS progression and disability--all things the current drugs do not address--we're discovering more about how to help those with MS.

To learn how this journey began, read my first post from August, 2009. Be well! Joan

Wednesday, December 10, 2014

You and Your Microbiome

During the past year, there has been a lot in the medical press on the "microbiome."   Researchers continue to explore the connection between the microbiome and neurodegenerative disease.  Articles on the microbiome and MS, Alzheimer's, and dementia as well as cardiovascular disease and stroke, are being published in medical journals and discussed in online communities.

You might say 2014 has been the Year of the Microbiome!

But what is it??  Microbiome literally means the "small living community" inside each of us.  It's the word doctors and researchers use to describe your own, unique ecosystem.  You see, we are not just "ourselves", we are also host to a universe of living organisms.  And most of these guests take up residence in our gut.

We have about two pounds of bacteria living inside us.  These bacteria are broken down into four families: the Actinobactera, Bacteroidetes, Firmicutes and Proteobacteria.  http://www.nature.com/nri/journal/v13/n11/fig_tab/nri3535_F2.html

When these families live in balance, the human body functions better.  When these families get knocked out of balance, diseases can be linked.  "Dysbiosis" is when inflammatory bacteria outnumber beneficial bacteria.  Whether the link to specific diseases is causal, or resultant, is yet to be established.  But there's more and more evidence connecting an imbalanced microbiome to inflammation and diseases of "autoimmunity."

Here are some more specifics on what researchers found, when looking at the fecal bacteria in people with MS, and comparing them to healthy controls.  This is Dr. Sushrit Jangi of Brigham and Women's Hospital discussing results of a recent study:

The preliminary data show that there are at least a couple of different genera of bacteria that are different in the gut of MS patients compared with healthy controls. We found that a bug called Methanobrevibacteriaceae *** is enriched in the gut of MS patients and seems to have immunoproliferative properties that drive inflammation. We also found that the population of Butyricimonas ### bacteria is low in MS patients compared with healthy controls. This is an interesting result because these bacteria produce butyrate, which is thought to be immunosuppressive, but we do need to repeat this study in a larger cohort.
So it seems that our work initially supports the idea that the gut in MS patients contains bugs that drive inflammation and are low in the types of bacteria that control inflammation. This is consistent with work in rheumatoid arthritis and inflammatory bowel disease.
This also mirrors the idea that MS is a disease of the western world. If you go to countries like India and parts of Asia, where diets are far more vegetarian, you don't really see MS. However, when these people come to the United States and adopt a more westernized diet, the incidence of the disease goes up. I think this is an exciting premise but it's still too early to say anything about the causality.
***Methanobrevi bacteria are found to be enriched in those who are constipated.  
### Batyricimonas is also low in RA and inflammatory bowel disease.

I included probiotics and eating more plants in the Endothelial Health Program, because I read a lot of research on the link between bacteria, inflammation and the endothelium.  And I wanted to help Jeff.  He was severely constipated when we started the program (sorry, hon!  Is that TMI?)  His serum numbers were off the charts for inflammation.  His meat and animal protein to plant food ratio was far too high in meats, too low in vegetables and fruits.  His just wasn't eating enough living, plant-based foods with phytonutrients and fiber.  I thought there might be a connection, and found it in the endothelium.  Here is a post from 2011, where I explain:
Probiotics, also know as helpful bacteria, are included in the Endothelial Health program, because they affect the lining of our blood vessels in a positive way, by reducing inflammation and regulating NO. A strong endothelium is less permeable, and will keep plasmic particles out of tissue--in the brain and the gut.  This can modify the reaction of immune cells, and reduce what is called the "autoimmune" reaction.  (Although I believe calling this reaction "autoimmune" is a misnomer.  The immune cells are simply doing their job, by responding to foreign particles which should not be in brain or intestinal wall tissue.)

What to do?  How can we create a more balanced, happier microbiome, and encourage growth of healthy bacteria?   There are a few things scientifically proven that we can do today, while the researchers continue to look for specific answers.

1. Work with your own healthcare provider, and find a probiotic solution that fits your lifestyle and needs.  Some people eat yogurt, others prefer fermented foods like sauerkraut, kimchi or kombucha, or some take a probiotic supplement.  Some folks (like me!) enjoy all three.  Jeff finds his supplement is enough.   Each individual needs to discover what works best for them.

2. Eat more plants, eat less meat and animal products.   And stay away from processed foods. The research shows that the more saturated and trans fats, the less balanced the microbiome.  The more fresh vegetable and fruits, the better the microbiome.

3. Watch your bowel movements!  Are you going at least once a day?  If not, you're not moving waste products through your body efficiently, and that build up of noxious or "bad" bacteria may be enhancing inflammation in your body.  If you are having a couple smooth, not runny, bowel movements a day, chances are, your microbiome is pretty happy.  (sorry, was that TMI again??)

4. Stay at a healthy weight.  Obesity is linked to an unbalanced microbiome.

Let's be good hosts to the universe within us all!

Monday, November 24, 2014

NASA, the Drain Brain and Astro Samantha

Right now, on the International Space Station, the first female Italian astronaut, Samantha Cristoforetti, is settling into her new home.  Over the weekend, Cristoforetti left the earth's orbit from a rocket launch in Kazakhstan.  As she joins other international astronauts as part of Expedition 42/43, Cristoforetti will be conducting a major research experiment, using the technology developed by Dr. Paolo Zamboni.   This study, called Drain Brain, is a collaboration between NASA and the Italian Space Agency.  It will be using strain-gauge plethysmography (a neck collar which measures blood flow) to analyze cerebral drainage in space.  Here's why, as explained on the NASA site.

On Earth, blood flows down from a person’s brain back toward the heart thanks in part to gravity, but very little is known about how this flow happens without gravity’s effects.  Many crew members report headaches and other neurological symptoms in space, which may be related to the absence of gravity acting on blood flowing through the veins. Drain Brain uses a special neck collar to measure blood flow from the brain, to help researchers understand which physical processes in the body can compensate for the lack of gravity to ensure blood flows properly.

Space Applications
Drain Brain studies how blood returns to the heart from the brain through veins in an astronaut’s neck. This can help scientists better understand the mechanisms that ensure proper blood flow in microgravity. ISS Crewmembers report a variety of neurological symptoms that may be related to changes in this blood flow. The project also studies how blood flow changes in response to crewmember schedules in space, which do not follow the typical day-night schedule of most humans on Earth.
Earth Applications
The instrument developed for Drain Brain, called a strain-gauge plethysmograph, does not require any surgery or special knowledge, which could make it an ideal tool for monitoring patients with a wide range of heart or brain disorders. In previous research, the scientists who developed the instrument identified a possible link between some neurodegenerative disorders, such as multiple sclerosis, and blockage of veins that connect to the brain. Researchers are also interested in studying the connection between these brain-related veins and cognitive disorders, such as Alzheimer’s disease. Drain Brain’s novel system could be a new way to screen for this vein abnormality.
As NASA explains, Dr. Zamboni has been using this neck collar to study people with multiple sclerosis.  And he has found that in people with MS, when compared to healthy controls, there is marked delay in drainage of the brain when patients go from lying down to upright.  Dr. Zamboni, who also discovered Chronic Cerebrospinal Venous Insufficiency (CCSVI) in MS, believes that extracranial obstructions are causing this delay in blood leaving the brain to travel back to the heart.  

What I find particularly ironic in all of this, is the fact that NASA and the smartest rocket scientists on the planet are eager to use Dr. Zamboni's technology, to understand how zero gravity and delayed venous return is affecting the brains and eyes of their astronauts, yet neurologists won't even consider the correlation of slowed venous flow and MS.  
From the abstract of Dr. Zamboni's study:
The rate at which venous blood discharged in the vertical position (EG) was significantly faster in the controls (2.73 mL/second ± 1.63) compared with the patients with CCSVI (1.73 mL/second ± 0.94; P = .001). In addition, respectively, in controls and in patients with CCSVI, the following parameters were highly significantly different: FT 5.81 ± 1.99 seconds vs 4.45 ± 2.16 seconds (P = .003); FG 0.92 ± 0.45 mL/second vs 1.50 ± 0.85 mL/second (P < .001); RV 0.54 ± 1.31 mL vs 1.37 ± 1.34 mL (P = .005); ET 1.84 ± 0.54 seconds vs 2.66 ± 0.95 seconds (P < .001). Mathematical analysis demonstrated a higher variability of the dynamic process of cerebral venous return in CCSVI. Finally, ROC analysis demonstrated a good sensitivity of the proposed test with a percent concordant 83.8, discordant 16.0, tied 0.2 (C = 0.839).


Cerebral venous return characteristics of the patients with CCSVI were markedly different from those of the controls. In addition, our results suggest that cervical plethysmography has great potential as an inexpensive screening device and as a postoperative monitoring tool.

Some of the neurological issues being reported by astronauts living in microgravity include loss of vision, fatigue and headaches,  possibly due to increased intracranial pressure.  One in five astronauts report changes in vision after returning to earth, and many problems involve the optic nerve, also an area of change in multiple sclerosis, which could be related to disturbed venous flow.  After five to six months in zero gravity, 20% of the astronauts are noting vision problems.
21 U.S. astronauts that have flown on the International Space Station for long flights (which tend to be five to six months) face visual problems. These include “hyperopic shift, scotoma, and choroidal folds to cotton wool spots, optic nerve sheath distension, globe flattening and edema of the optic nerve,” states the University of Houston, which is collaborating with NASA on a long-term study of astronauts while they’re in orbit. http://www.universetoday.com/114161/eye-problems-from-space-affect-at-least-21-nasa-astronauts-study/
"What we are seeing is flattening of the globe, swelling of the optic nerve, a far-sighted shift, and choroidal folds," said Dr. C. Robert Gibson, one of authors of the study published in the October 2011 issue of Ophthalmology, the journal of the American Academy of Ophthalmology. "We think it is intracranial pressure related, but we're not sure; it could also be due to an increase in pressure along the optic nerve itself or some kind of localized change to the back of the eyeball."

These black spots, swelling of the optic nerve, and changes to vision are seen in increased intracranial pressure, as well as multiple sclerosis.  My husband had all of these issues, and a loss of peripheral vision, as a child.  It would decades before he would be diagnosed with MS, and after that have a repair of his malformed venous system.

It will be interesting to learn what the Drain Brain study teaches us about venous return and the long terms affects of zero gravity. It is absurd to claim that slowed venous drainage does not matter to brain and eye health.

Here's to rocket scientists!  Here's to Samantha Cristoforetti!  You can follow her on twitter @AstroSamantha   Here's to Dr. Zamboni!  
Here's to answers.


Wednesday, November 19, 2014

How to remyelinate your own brain. New research

New research from the Karolinska Institute shows us, once again, that human and mouse brains are not the same.  Past assumptions about remyelination have been incorrect.  Attempting to model remyelination in the human brain using a mouse model simply does not work.

But there are things humans can do to remyelinate their own brains---and it's all about using the brain, and plasticity.

Here's the new research, which is calling into question all MS specialists thought they knew about myelin.

The brain's plasticity and its adaptability to new situations do not function the way researchers previously thought, according to a new study published in the journal Cell. Earlier theories are based on laboratory animals, but now researchers at Karolinska Institutet in Sweden have studied the human brain. The results show that a type of support cell, the oligodendrocyte, which plays an important role in the cell-cell communication in the nervous system, is more sophisticated in humans than in rats and mice - a fact that may contribute to the superior plasticity of the human brain. 

The learning process takes place partly by nerve cells creating new connections in the brain. Our nerve cells are therefore crucial for how we store new knowledge. But it is also important that nerve impulses travel at high speed and a special material called myelin plays a vital role. Myelin acts as an insulating layer around nerve fibres, the axons, and large quantities of myelin speed up the nerve impulses and improve function. When we learn something new, myelin production increases in the part of the brain where learning occurs. This interplay, where the brain's development is shaped by the demands that are imposed on it, is what we know today as the brain's plasticity. 

Myelin is made by cells known as oligodendrocytes. In the last few years, there has been significant interest in oligodendrocytes and numerous studies have been conducted on mice and rats. These studies have shown that when the nerve cells of laboratory animals need more myelin, the oligodendrocytes are replaced. This is why researchers have assumed that the same also applies in humans. Researchers at Karolinska Institutet and their international collaborators have shown that this is not the case. In humans, oligodendrocyte generation is very low but despite this, myelin production can be modulated and increased if necessary. In other words, the human brain appears to have a preparedness for it, while in mice and rats, increased myelin production relies on the generation of new oligodendrocytes.

In the study in question, researchers have studied the brains of 55 deceased people in the age range from under 1 to 92 years. They were able to establish that at birth most oligodendrocytes are immature. They subsequently mature at a rapid rate until the age of five, when most reach maturity. After this, the turnover rate is very low. Only one in 300 oligodendrocytes are replaced per year, which means that we keep most of these cells our whole lives. This was apparent when the researchers carbon-dated the deceased people's cells. The levels of carbon-14 isotopes rose sharply in the atmosphere after the nuclear weapons tests during the Cold War, and they provided a date mark in the cells. By studying carbon-14 levels in the oligodendrocytes, researchers have been able to determine their age. 

"We were surprised by this discovery. In humans, the existing oligodendrocytes modulate their myelin production, instead of replacing the cells as in mice. It is probably what enables us to adapt and learn faster. Production of myelin is vital in several neurological diseases such as MS. We now have new basic knowledge to build upon," says Jonas Frisén, PhD, Professor of Stem Cell Research at the Department of Cell and Molecular Biology at Karolinska Institutet.

Human and mice brains do not remyelinate in the same way.

That's right.  By keeping the mind active, learning new skills and firing your neurons, you can potentially remyelinate your own brain.  The problem is, there is no way for pharma to monetize this--so, you probably won't be hearing about this research in the mainstream press.  Because there is nothing to sell you.  No prescription.

After a comment below on how plasticity can't possibly remyelinate the MS brain, because it's "too easy" a solution--I've decided to add recent research that shows how plasticity has been noted in MS recovery.

Cortical plasticity predicts recovery from relapse in multiple sclerosis. http://www.ncbi.nlm.nih.gov/pubmed/24263385
Neuroplasticity and functional recovery in multiple sclerosis

Increasingly sophisticated brain imaging techniques indicate that brain plasticity - the brain's ability to reorganize neural pathways based on new experiences - is the compensatory mechanism largely responsible for the clinical remissions that are typical of early stages of relapsing remitting MS. The adult brain is capable of both functional and structural plasticity - processes that are operational in normal brain development such as learning and memory5.
Interestingly, functional and structural changes can also take place in the brain after injury or damage, and brain plasticity is seen to act as an adaptive mechanism to compensate for a loss of function6. Following tissue damage, the structure and function of undamaged parts of the brain can be remodeled and shaped by the sensorimotor experiences of the individual in the weeks to months following injury7, 8.

Here's more on neuroplasticity from Dr. Norman Doidge on his research and book, "The Brain that Changes Itself."  Learning changes the connection between the neurons in our brain cells.  Activity changes and heals the brain.

Want to remyelinate your brain?  Learn a new language.  Take up a new, challenging hobby.  Paint a picture.  Do a crossword puzzle.  Read books about new topics.  Learn a musical instrument (which is especially helpful for the corpus callosum)   Move as much as you are able, and if you can,  combine a cardiovascular pursuit with learning--like taking a ballroom dancing class, learning a new sport, practicing yoga.  It's all possible.

Don't wait for your neurologist to tell you.
Do this for yourself, your brain.
And please let me know what new skill you're mastering---

be well!