BDNF, exercise and the vascular endothelium

Another new paper showing the vascular connection to MS.

New research shows that a 24 week resistance and endurance exercise program increases brain derived neurotrophic factor (BDNF) in people with MS.
link

At baseline, the BDNF concentration of persons with RRMS was 21% lower than healthy controls. Following 24 weeks of intervention, changes in BDNF concentrations differed significantly between exercise group and sedentary group.  In particular, within exercise group, BDNF concentrations increased 13.9% ± 8.8%, whereas it decreased 10.5% ± 4.1% within sendentary group. 

BDNF is called the "Miracle-Gro" for the brain.  It is a very important cerebrovascular protein which protects neurons and allows for neurogenesis, or the growth of new neurons.  BDNF is vital to learning, memory and executive function.

Lower levels of BDNF are linked to Alzheimer's, dementia, depression, diabetes---and now, Multiple Sclerosis.

Cardiovascular researchers have known that exercise increases BDNF levels for quite some time.  Why?  Because BDNF is created by healthy vascular endothelial cells.  Cardiovascular health allows for BDNF creation.  How?  Shear stress--which is caused by blood flow over the lining of our blood vessels--activates the endothelium, and allows for BDNF secretion.
An active, moving body with an active, pumping heart is essential to the brain.
link

When will the tipping point occur?  When will MS specialists refer to the vascular connection to Multiple Sclerosis and begin to look at the endothelium?  When will they prescribe cardiovascular fitness to their patients?   When will they change the dialogue, to include heart health?

Still waiting for them---but you don't have to.
Move as much as you are able.  Incorporate an exercise program, and increase your own BDNF levels today.

Joan

 

A Single Step

There is a paradigm shift which is happening in our understanding of human health and disease.  More and more, researchers are looking at how our everyday movement is impacting our health.

There is a difference between supervised exercise training, physical therapy, and "lifestyle activity".  For years, people with MS have been encouraged to seek physical therapy.  But they have not been encouraged to simply move more.  For those with MS who are still able to take steps and walk, I'd like to offer some information, encouragement and cheerleading.

The MS activity paradigm is changing.  Here is a recent abstract on this topic:

Lifestyle physical activity in persons with multiple sclerosis: the new kid on the MS block.

Supervised exercise training has substantial benefits for persons with multiple sclerosis (MS), yet 80% of those with MS do not meet recommended levels of moderate-to-vigorous physical activity (MVPA). This same problem persisted for decades in the general population of adults and prompted a paradigm shift away from "exercise training for fitness" toward "physical activity for health." The paradigm shift reflects a public health approach of promoting lifestyle physical activity through behavioral interventions that teach people the skills, techniques, and strategies based on established theories for modifying and self-regulating health behaviors. This paper describes: (a) the definitions of and difference between structured exercise training and lifestyle physical activity; (b) the importance and potential impact of the paradigm shift; (c) consequences of lifestyle physical activity in MS; and (d) behavioral interventions for changing lifestyle physical activity in MS. The paper introduces the "new kid on the MS block" with the hope that lifestyle physical activity might become an accepted partner alongside exercise training for inclusion in comprehensive MS care.

http://www.ncbi.nlm.nih.gov/pubmed/24603882

What is the difference between exercise training and "physical activity for health"? 

Many of us may exercise and train at the gym or at home.  We lift weights, swim, do yoga, stretching----but then, for the rest of the day, we are seated.  Doctors and researchers are noting that people simply do not walk anymore.  And this is a problem.

There is a new movement many of you may have been reading about.  For those who are still able to walk, it may be in your best interest to see if this program is something you can incorporate in your life.

It's called the 10,000 Steps A Day Program.  Walking 10,000 steps is the goal doctors and the surgeon general would like us to have. 

 If you're just getting started, 10,000 steps a day probably seems enormous. Don't worry––it won't take long to reach it! According to research into activity levels, anything under 5,000 steps a day is considered to be a sedentary lifestyle, and it isn't until you reach 10,000 steps a day that you're considered to be "active".^[1][6] It is recommended that you begin walking as much as feels comfortable to you, then aim to walk in increments of 1,000 to 2,000 steps more each week until you're comfortably at 10,000 steps a day.^[7] There is nothing stopping you walking more than this each day, but the aim is to always make 10,000 steps.

http://www.wikihow.com/Walk-10,000-Steps-a-Day

For me, 10,000 step equals about four miles of walking.  How do I know this?  I've been using a pedometer for a couple of months now. Mine is a free app called Pedometer++ on my iphone.  But you can use any type of pedometer that works for you.  I was surprised at how few steps I had been taking!  Getting to 10,000 a day has taken a real, concerted effort for both me and Jeff.  Jeff is active, but he spends most of his day at his desk, writing music.  And I spend most of my time writing or singing.  We really have to go on longer walks every day to reach the 10,000 step goal.  We're parking the car further from the store, taking stairs, simply moving more during the day.  And we're finally reaching the goal.  Our son is home for spring break, and he has the same pedometer.  He walks about 12,000 steps a day, getting around his campus....but since he's been home with his folks, he's been sitting around more.  We all went on a long walk last night, and made our goals.

The truth is, most people, even healthy people, are simply not taking enough steps.  We've become a sitting society.

Sitting has been getting a lot of attention lately, to the point that there’s a new adage: “Sitting is the new smoking.” In addition to encouraging everyone to sit less, people are specifically encouraging exercises during TV watching and during work hours, with walking meetings and standing desks, as ways to decrease sedentary time.

“The real problem is that we are raising sedentary children,” said one of the researchers, Pamela Semanik, assistant professor of adult and gerontological nursing at Rush College of Nursing. “It’s so insidious in our culture.”

At her workplace, where people see the results of not moving, people have changed their ways, she said, adding that she has sold her car and reads medical journal articles on a treadmill.

The researchers in the current study said as many as 5.3 million annual deaths worldwide are related to insufficient activity.

http://www.latimes.com/science/sciencenow/la-sci-sn-sedentary-disability-20140219,0,7209026.story#ixzz2vshgBlk7

So, what to do?

I'd like to paraphrase a familiar quote.  The Journey of 10,000 steps begins with a single step.

Be encouraged!  Move more, to whatever extent you are able.  Get a pedometer, and follow your results.  And let me and our MS community know how you're doing!

We're all in this together,

Joan

A Body in Motion

More research coming in on the importance of execise for people with MS.  This newest study looked at how aerobic exercise can INCREASE the size of the brain, and improve memory.

The hippocampus (literally "sea monster") got its name because of its shape--it resembles a sea horse.  It is the part of the forebrain responsible for memory forming,  mood, organizing and storing.

The hippocampus is much smaller in people who have MS, Alzheimer's, depression and in those who have had some sort of hypoxic, or low oxygen injury to the brain.  And yes, this ties in with Dr. Zamboni's discovery of restricted cerebral outflow and CCSVI.  The hippocampus needs adequate oxygen and blood flow to remain healthy.
http://ccsviinms.blogspot.com/2010/07/study-on-brain-changes-in-ms-and.html

Hippocampal atrophy seen in MS is linked to the memory deficits that affect approximately 50% of individuals with MS. Despite the prevalence of this disabling symptom, there are no effective pharmacological or behavioral treatments. 

"Aerobic exercise may be the first effective treatment for MS patients with memory problems," noted Dr. Leavitt, research scientist in Neuropsychology & Neuroscience Research at Kessler Foundation. "Moreover, aerobic exercise has the advantages of being readily available, low cost, self-administered, and lacking in side effects." 

The study's participants were two MS patients with memory deficits who were randomized to non-aerobic (stretching) and aerobic (stationary cycling) conditions. Baseline and follow-up measurements were recorded before and after the treatment protocol of 30-minute exercise sessions 3 times per week for 3 months. Data were collected by high-resolution MRI (neuroanatomical volumes), fMRI (functional connectivity), and memory assessment. Aerobic exercise resulted in a 16.5% increase in hippocampal volume, a 53.7% increase in memory, and increased hippocampal resting-state functional connectivity. Non-aerobic exercise resulted in minimal change in hippocampal volume and no changes in memory or functional connectivity.

http://www.sciencedaily.com/releases/2013/11/131101125506.htm

Please note that the researchers make some great points.  There are NO MS drugs that can increase your brain size or help with memory.  Exercise, with the consult of your physician, has no side effects, doesn't cost much and you can do it on your own schedule.

Now, here comes the cheerleading part.

Aerobic exercise simply means "with oxygen."  When we engage in aerobic exercise, we get our heart pumping!  Our blood vessels widen, our heart pumps faster and stronger, to deliver oxygen rich blood throughout our body.  This strong flow of blood creates a wonderful effect on the endothelium, called "shear stress."  The forceful flow of blood throughout vessels releases healing and vasodilating nitric oxide.  

I have spoken with Dr. Cooke and Dr. Dake from Stanford about those who have remained stenosis free in the four years since treatment for CCSVI, they have commented that the patients that remained the most aerobically active have done the best.  

If there is any way for you to take 30 minutes, 3x a week, to get your heart pumping, find it!  Suggestions on how to do this include stationary biking, elliptical machines, swimming, jogging, biking, hiking, treadmills, dancing, zumba, jazzercise, boxing, an aerobics or cardio class.   Please consult with a physician or physical therapist to learn which activity might be best suited to your activity abilities.  It may be simply impossible for you to move enough to get your heart pumping, and that's the terrible tragedy of MS progression.  But if there is any way---please try it.  

Jeff started slowly, using an elliptical machine. It wasn't pretty.  He had numbness and balance issues after his MS diagnosis, and this was about all he could handle.  But he kept at it, even with pain and fatigue.  A year later, he was back on his bike, and able to walk the dog and hike a bit.  After venoplasty, his heat intolerance disappeared, and he could work up a real sweat, so he went to mountain biking, hiking and even returned to skiing.  Last week he was showing off, and jogging up the hills on our hike.  And now his brain volume looks normal on MRI.

You can do this!!

Please, share this info in your MS community, and encourage others to join you.

A body in motion, stays in motion--

As the winter approaches and hours of sunshine diminish, fight the impulse to stay in bed or on the couch.  Get up, get moving, and feel the blood moving through your vessels.  The shear stress created heals the endothelium. You are, quite literally, healing your brain.

be well, be active,

Joan

Just keep swimming

May 15, 2012 at 9:51am

In Finding Nemo, Dory the fish has a little song she sings, to keep Nemo from becoming too despondent...

When life gets you down, you know what you gotta do?

Just keep swimming, just keep swimming.

I had an interesting conversation with Dr. John Cooke at the Hubbard Foundation conference.  It was good to catch up with him.  We hadn't seen him in two years, since Jeff was up to Stanford for his one year testing.  He asked how Jeff was doing, and to what did I credit his health after venoplasty.   I told him that Jeff was much more fit now, then he was at his MS diagnosis.  He was down 15 pounds, and his aerobic capabilities were great.  He out paces me up the hills when we hike and bike, and is much more active in his daily life.

"That's great!"  said Dr. Cooke.  "He's keeping the blood flowing."  

Later that day, in his presentation, Dr. Cooke discussed how the endothelium likes fast blood flow.  Shear stress, or the stress caused by fast moving blood through our body, is good for our blood vessels.  It keeps them open, and flowing.

You see, the body and brain respond to aerobic exercise in many ways that are being studied in the MS population.  I know I don't have to tell you this---the terrible tragedy in MS is that as the disease progresses, your ability to move is shut down.  It becomes a vicious cycle.  Your disabilities increase, your ability to move decreases, your blood flow slows down, your pain and fatigue increase, your MS progresses.

I want to encourage you, like Dory, to find ways to just keep swimming.  Find ways to move, everyday.  It may not be pretty, but your heart and circulatory system need this.  When Jeff was first diagnosed with MS, he had trouble walking.  He started with an elliptical machine.  He couldn't do very much, and his legs hurt...but he did it, as best he could.  After venoplasty, he was able to get back on his bike.  He started slowly, with street rides, and then progressed to mountain biking, as his balance and endurance increased.  Every single day, he gets his heart pumping.  And his veins are staying open, and his gray matter looks normal on MRI.

Here's some research to encourage you:

The "Alternative" Connection

January 2, 2010 at 3:37pm

Many, many MS patients have found symptom relief and stabilization by utilizing "alternative" treatments. I thought it might be interesting to go thru these and connect the dots to Dr. Zamboni's findings of impaired endothelial health and venous outflow in MS.

1. Diet- Back in 1948, Dr. Roy Swank came forward with a way to help MS patients using his specialized low fat diet. From Dr. Swank's site:

"60 years ago Dr. Roy Swank discovered that a low-fat diet, very low in saturated fats and polyunsaturated oils, helps MS patients live healthy and productive lives. Also low in red and other fatty meats, high in grains, fruits and vegetables, it is simple to follow and in many cases alleviates chronic symptoms. Some of his very first patients are still ambulatory and leading independent lives thanks to following Dr. Swank's regimen for the last half-century."

http://www.swankmsdiet.org/Home%20Page

Other researchers, such as Dr. Ashton Embry, Dr. George Jelinek and Dr. Terry Wahls encourage MS patients to eat a variety of whole food diets high in antioxidants and vitamins. I won't go through each program, but I believe they all have great merit, and advise MS patients and caregivers to look at each program. Why? Because they promote cardiovascular and endothelial (lining of blood vessels) health.

2. Exercise- many MS patients are able to keep moving-through varieties of vigorous exercise, or swimming, yoga or seated exercise. Most patients find that any motion seems to help symptoms and keep progression at bay. Why? Because exercise promotes cardiovascular and endothelial health.

3. Lifestyle changes- Here are a few that seem to help many MS patients:

a. reducing stress, limiting cortisol release

b. quitting smoking

c. getting more sunshine and Vitamin D

d. finding time for meditation, prayer, quiet reflection

Why? Because each of these changes promotes cardiovascular and endothelial health.

4. Other treatments:

Here are a list of some common alternative treatments and supplements that help MS patients- and links to Dr. Zamboni's findings.

a. prokarin- combines histamine and caffeine. Both are known vasodilators (open the blood vessels)

b. LDN- low dose naltrexone. One of the effects of LDN is angiognesis, the creation of new blood vessels

c. Bee stings- increase histamine in the system, which creates vasodilation (opening of blood vessels)

d. EGCG- green tea extract- chelates iron from brain tissue and is an anti-oxidant

e. HBO- hyperbaric oxygen treatments- increases oxygen delivery to the brain

Some of these alternative treatments make no sense when looked at from the autoimmune paradigm. 

One glaring example is smoking cessation. Smoking is linked to MS progression, yet cigarette smoking hinders immune system functioning. In the autoimmune paradigm, smoking might actually be good for MS patients!

None of these alternative treatments can "cure" MS; but each of them has offered individuals a means to better health and symptom relief. Isn't it funny how quickly most doctors will discount these alternatives, without even questioning WHY they help so many MS patients? 

I believe Dr. Zamboni's discovery of CCSVI provides us with a link to understanding the affect of alternative treatments in MS.

For more info on the Endothelial Health program I put together for my husband:

http://www.ccsvi.org/index.php/helping-myself/endothelial-health

Joan