Eat Fish to Reduce the risk of Multiple Sclerosis

  Researchers at USC in LA reviewed the diets of 1,153 people, and found that eating fish at least once weekly in addition to taking daily fish oil supplements may be associated with a reduced risk of MS.
  Those with high fish intake as described above was found to be associated with a 45% reduced risk of MS.
AAN Annual Meeting 2018

Obesity Is BAD for your Health....Duh...AND MS

  Obesity (BMI over 30) and those overweight (BMI 25-30) affects 46% of Americans over the age of 15 compared to 17% globally.
  Obesity is associated with chronic low-grade inflammation, greater brain atrophy and white matter changes, disturbances in the blood-brain barrier, and an increased risk of Alzheimer's disease. In multiple sclerosis, obesity/overweight in childhood and adolescence is a risk factor for pediatric and adult-onset MS. This is true for both sexes but is more pronounced in females. (Lancet Neurol 2014;13(9);913-923)

Treatment Therapies For Fatigue In MS

  Primary fatigue (unique to multiple sclerosis) involves no precipitating activity, is worsened by heat or humidity, and is worse in the early afternoon. 40 % of MS patients report it as their most disabling symptom. This fatigue may be constant in 30 % of affected individuals.
  The cause of primary fatigue is unknown.
  Treatment options include : cooling, aerobic and strength training, energy conservation, mindfulness, relaxation therapy, magnetic therapy, transcranial stimulation, and drugs.
  Drug therapy to treat fatigue include : amantadine, modafinil, armodafinil, gingko biloba, methylphenidate and amphetamines.
  Comorbid conditions must be addressed : depression, anemia, thyroid disease, disrupted sleep, medication side effects, motor disability with increased energy use. (Continuum 2016;22(3):815-836) 

Fatigue In MS

   Fatigue is an overwhelming sense of tiredness and is often considered the leading symptom in multiple sclerosis.     Significant fatigue in isolation may precede a diagnosis by several years (Mult Scler 2013;19(11):1526-1532)
  Fatigue at the time of a first attack of MS (CIS) independently predicts a diagnosis of MS (J Neurol Neurosurg Psychiaty 2015;86(5):543-546) 

Immunologic Profile in MS Patients Altered with High Dose Vitamin D

   Those with low Vitamin D levels have been shown to have have an increased risk of developing multiple sclerosis in previous studies as well as an increased number of brain lesions on MRI. NEJM JW Neurol Dec 2015, JAMA Neurol 2015;72:1458
  A newer study revealed reduced percentages of IL17+CD4+T cells and effects memory cells CD4+ in patients that received 10,400 IU of vitamin D3 daily.
Neurology 2015 Dec 30

Increased Risk of MS in Children In Pregnant Women with Low Vitamin D3

  The children born to women with low vitamin D3 levels were found to be at double the risk of developing multiple sclerosis.
JAMA Neurol. March 7,2016

Drink LOTS of Coffee and Reduce Your Risk of MS (AD and PD too) !

In two large population-based studies, one in Sweden the other in the US out of Johns Hopkins University SOMed indicates that caffeine intake is associated with a decreased risk of PD and AD and now a suggested neuro-protective effect against MS. 
BUT the amount of coffee drunk to provide protection may make lavatories even more  popular in Starbucks....which ALWAYS seem to be occupied. In the Swedish study 5-10 cups per day. In the US study more than 4 cups per day.

Increase In MS Exacerbations With Increased Dietary Sodium

  High intake of dietary sodium increases exacerbations of multiple sclerosis almost four-fold.
  These studies suggests that clinicians advise their patients with MS to follow a low-salt diet.
Nature 2013;496(7446):513-517
J Neurol Neurosurg Psychiatry 2014;Epub2014 Aug 28

Correct Vitamin D Deficiency and Improve MS Outcomes

  From Harvard researchers and he BENEFIT study, normalizing vitamin D levels early in the treatment course of MS patients with interferon beta 1-b likely improves the outcome for patients with Multiple Sclerosis.

New Oral MS drug Reduces Brain Lesions

From the 2012 AAN annual meeting, ONO-4641, a potent selective sphingosine-1-phosphate (S1P) receptor agonist (two other similar drugs are Fingolimod...already FDA approved... and BAF), was found to reduce the number of lesions on MRI in patients with the relapsing remitting form of MS.The drug was well tolerated with no unexpected adverse events. Those adverse events were dose related cardiovascular ones. The phase 2b study of ONO-4641 shows that lower doses will be safer.

Oral Therapies for MS

The Findings:

TRANSFORMS STUDY

Oral fingolimid vs. interferon beta 1A : at one year ,no difference in disability at one year. Fingolimid 0.5 mg/d 52% reduction in relapse rate ; 1.25 mg/d 38% reduction

FREEDOMS STUDY

Fingolimid superior to placebo re: new lesions

CLARITY TRIAL

Cladribine vs placebo, significant reduction in brain lesions on MRI