A new study was recently released that showed that a significant number of people without multiple sclerosis have narrowing of their neck veins. There is a new theory that chronic cerebrospinal venous insufficiency due to narrowing of veins outside the skull may be responsible in causing MS in a significant percentage of patients. Using venograms in MS patients and in controls without MS a recent study from the University of British Columbia, Vancouver, BC showed that normal controls also had narrowing of neck veins and the authors felt that this invalidated the vascular theory of MS. This story is based on this Lancet publication. What was not mentioned in this publication was that venous blood flow on the surface of the brain can get obstructed inside the skull. It’s all about brain tissue oxygenation; if the brain gets enough oxygen, all is well. If there were a lack of perfusion due to venous congestion inside or outside the skull, the patient would be in trouble. I will discuss this further below.
In this blog I will discuss first how MS is diagnosed, then mention some newer studies where circulation has been investigated using SPECT scanning. I will then review various causes of MS that have been established and armed with this knowledge return to a discussion of the Vancouver study mentioned above.
How MS is diagnosed
MS is diagnosed by a combination of tests. This will include the patient’s symptoms such as balancing problems, double vision, memory problems, fatigue etc. Neurological examination, imaging studies like MRI scanning, lumbar puncture to examine the cerebrospinal fluid and evoked potential studies would be what a neurologist would order. All of these findings are considered when deciding whether the criteria for making a diagnosis of MS have been fulfilled. In 2001 an international neurological panel developed the McDonald criteria for diagnosing MS, which were revised in 2010.
Newer ways diagnosing perfusion problems in MS patients (SPECT scan)
One of the newer functional scans is a SPECT scan. It shows areas where there is a lack of blood supply to the brain, but can also identify areas where too much blood circulates. Here is a site where the technique of the SPECT scan is reviewed in more detail.
SPECT scan results in MS patients
SPECT scans in MS patients showed a significant reduction in blood flow to the frontal lobes and to the left temporal lobe. Reduced activity of the left temporal lobe on SPECT scans correlated with MS patients having a deficit in verbal fluency and having a problem with verbal memory. This would indicate that reduced blood flow to these areas of the brain is associated with developing MS.
Perhaps a SPECT scan of the brain (which is where the action of MS is) may be a better indicator for MS than looking for veins in the neck by ultrasound or venograms, as SPECT scans look directly at brain perfusion. The question is whether these blood circulation problems in MS patients may cause deficiencies in the brain of oxygen, nutrients and possibly of other internal mediators.
Known causes of MS
There are a number of known causes of MS, which I will review below.
As this link shows, MS is a disease due to inflammation of the brain. The area where there is inflammation leads to demyelination from loss of the myelin sheaths, which causes the white lesions visible on MRI scans of the brain. One such cause is an allergy to wheat and wheat products. Gliadin antibodies and anti-tissue transglutaminase antibodies were positive in a significant number of MS patients, but not in controls. This suggests at least in part that immunological causes are at play. I agree with this blog that describes that there is significant evidence that gluten intolerance can lead to MS and the positive tests that were found by researchers are likely just the tip of the iceberg. Dr. William Davis describes in Ref. 1 and 2 that you can have celiac disease with no gut symptoms, in other words a person can develop autoimmune symptoms from gliadin and gluten sensitivity without diarrhea or bowel cramps. Dietary lectins, particularly the ones found in wheat lead to leaky gut syndrome and subsequently to autoimmune diseases. One of these autoantibodies can be directed against the myelin sheath, which can cause MS. In a mouse model Mayo Clinic researchers have shown that an antibody injection can be used to block autoantibodies against the myelin sheath. Investigations are ongoing with regard to whether this type of treatment would work in humans as well.
It is known that a human leukocyte antigen (HLA -DRB1) is associated with the risk for developing MS. It is found more commonly in Caucasians who have a higher risk of developing MS. Another genetic factor is a variation of the IL7R gene, which is also discussed under this link. On average the risk of getting MS in the general population is about 10 to 20%.
Nutrition and dietary factors
It has been described that vitamin D3 levels when obtained from in MS patients are low. Vitamin D3 can prevent against MS to a certain degree, so does sun exposure. In countries where malnutrition is common, MS occurs more often.
According to Dr. Terry Wahls who is a clinical professor of medicine at the University of Iowa Carver College of Medicine, a diet of vegetables, fruit, meat, no grain, no dairy, no sugar, no corn and no potatoes can cure MS. Dr. Wahls herself had severe MS in the past and cured it with the help of this diet!
Certain infections can cause MS. Probably the best correlation was found between the mononucleosis virus (Epstein Barr virus) and the later development of MS.
Chronic cerebrospinal venous insufficiency
According to Dr. Zamboni from Italy clogged veins in the neck can cause MS. Dr. Zamboni found that about 50% of MS patients get better when stents are placed into narrowed neck veins, which allows the blood from veins around the brain to drain normally. This could improve brain circulation in the areas described above where SPECT scans detected a lack of blood supply to certain parts of the brain.
Discussion of the Vancouver publication
It is important to note that certain areas of the brain were not circulating blood as well as others when SPECT scans were used to depict blood circulation of the brain. The fact that 50% of patients with chronic cerebrospinal venous insufficiency get cured from MS with simple venous stent procedures is remarkable. Sure, the Vancouver researchers (who are heavily sponsored by Big Pharma) found that normal controls also have a significant amount of venous abnormalities in their necks, but this does not explain the successes in those MS patients who got better with a simple venous stunt procedure. Without doing SPECT scans on both the control groups and the experimental MS groups before and after stent procedures we do not know whether the brain circulation following stent procedures improved or not. However, this is what I would have expected to see. In other words more research needs to be done by other investigators to show whether or not the surgical stents in those who are helped by the surgical procedure have been helped because of a normalization of their brain circulation.
Our knowledge regarding MS is getting more multifaceted as new research is emerging. Diet appears to be a major contributing factor, as vitamin D3 is essential for normal brain function and for a normal immune system. At the same time grains and wheat have been identified as causing MS in a subgroup of patients (through developing leaky gut syndrome and subsequently autoimmune antibodies). Avoid the foods Dr. Wahls described as being causative in developing MS and you can improve MS remarkably or get cured. The same is true for avoidance of wheat and wheat products as Dr. Davis described. In my opinion not every MS patient will benefit from a stent, but not every MS case is caused by vitamin D3 deficiency or by having had mononucleosis in the past. We simply do not have all of the answers yet. But we do have enough information to thoroughly investigate MS patients; the treating physician will then use clinical judgment to decide which treatment would be the most suitable one for an individual MS patient.
More information on multiple sclerosis: http://nethealthbook.com/neurology-neurological-disease/multiple-sclerosis/
1. Stern: Massachusetts General Hospital Comprehensive Clinical Psychiatry, 1st ed. “DSM-IV SUBTYPES OF MDD”. Copyright © 2008 Mosby
2. William Davis, MD: “Wheat Belly. Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2011.
3. William Davis, MD: “Wheat Belly Cookbook. 150 Recipes to Help You Lose the Wheat, Lose the Weight, and Find Your Path Back to Health”. HarperCollins Publishers LTD., Toronto, Canada, 2012.
Last edited Nov. 7, 2014