Welcome! This blog contains research & information on lifestyle, nutrition and health for those with MS, as well as continuing information on the understanding of the endothelium and heart-brain connection. 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 auto-immune paradigm of MS, and continues the 20 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
Saturday, August 28, 2010
Treating Neurodegenerative Diseases--a new approach
August 28, 2010 at 5:27pm
Here's a wonderful piece on a new way of treating brain diseases---a preventative/diagnostic approach rather than a search for a specific pharmaceutical cure--although this piece focuses on Alzheimer’s, I believe the logic behind preventative measures for brain health apply to all neurological diseases.
"While the search for a pharmaceutical cure plays front and center, quietly in the background countless neuroscientists worldwide have concluded that Alzheimer's, as well as memory decline and other age-related dementias are actually slow-developing chronic diseases, like heart disease and cancer, partly dependent on lifestyle and other treatable diseases.
De la Torre, for example, is convinced that Alzheimer's and dementia are particularly tied to cardiovascular factors, notably, constricted blood flow to brain cells, and that midlife screening to detect and correct such heart-related deficits would help prevent much brain degeneration during aging.
The special journal issue produced by de la Torre, called "Basics of Alzheimer's Disease Prevention," also included new research on the relationship between Alzheimer's and diabetes, high blood pressure, triglycerides, cholesterol and cholesterol- lowering drugs, (statins), a Mediterranean diet, exercise, fish oil, B vitamins and antioxidants.
Friday, August 27, 2010
August 27, 2010 at 10:58pm
The idea that MS is related to hypoperfusion, or slowed blood flow, is not new.
Here's is Dr. Juurlink's proposal from 12 years ago--
Hypoperfusion in the MS brain explained:
"Hypo"; meaning under or sub-par and "perfusion"- meaning the delivery of blood to the capillary bed.
In MS brains, there is a below normal delivery of blood into brain tissue. Neurologists have never given a good explanation as to why this happens. Here's a great paper that looks at this phenomena.
(terms to know -NAWM is normal appearing white matter, or healthy myelin.
Ischemia means a lack of oxygen or hypoxia.)
"Accumulating evidence indicates that there is a decreased perfusion throughout the NAWM (normal appearing white matter) in patients with MS. It occurs in both relapsing–remitting and primary progressive MS, strongly suggesting that it represents an integral part of the disease process. Ischemic changes might be involved in the development of a subtype of focal demyelinating lesions (type III lesions). There appears to be a relationship between reduced white matter perfusion and cognitive dysfunction in patients with MS.
Ge et al (2005) interpreted the hypoperfusion in NAWM as a vasculopathy in the context of the perivascular inflammations that occur in focal MS lesions. However, although inflammatory infiltrates in MS are typically located around small- or medium-sized veins (Adams, 1989) and in the perivascular spaces surrounding arterioles (Gay, 2006; Gay et al, 1997), microvessel thrombosis is only exceptionally being observed within these lesions (Aboul-Enein and Lassmann, 2005; Wakefield et al, 1994)."
So, this paper comes pretty close to saying that this slowed perfusion and white matter lesions could be created by slowed blood flow and a lack of oxygen in the brain. This is exactly what Dr. Juurlink was proposing.
Here's a study that shows that white matter lesions in rats were formed when cerebral hypoperfusion was created in their brains.
"Cerebrovascular white matter lesions represent an age-related neurodegenerative condition that appears as a hyperintense signal on magnetic resonance images. These lesions are frequently observed in aging, hypertension and cerebrovascular disease, and are responsible for cognitive decline and gait disorders in the elderly population. In humans, cerebrovascular white matter lesions are accompanied by apoptosis of oligodendroglia, and have been thought to be caused by chronic cerebral ischemia. In the present study, we tested whether chronic cerebral hypoperfusion induces white matter lesions and apoptosis of oligodendroglia in the rat. Doppler flow meter analysis revealed an immediate reduction of cerebral blood flow ranging from 30% to 40% of that before operation; this remained at 52–64% between 7 and 30 days after operation. Transferrin-immunoreactive oligodendroglia decreased in number and the myelin became degenerated in the medial corpus callosum at 7 days and thereafter."
There is NO NEED for any auto- immune system activation to create white matter lesions or myelin destruction. NONE. Dr. Juurlink knew this. Many doctors who study stroke know this. All that is needed is slowed blood flow.
Did you know that most elderly people have white matter lesions in their brains? We don't see them, because they are not routinely given MRIs. But it's a known fact that the aging brain has slower perfusion, slower circulation and decreased blood flow, resulting in less oxygenation. Why has the correlation of circulation in MS and other neurodegenerative diseases been ignored? This chaps my hide.
Here's a paper where they created white matter lesions in rats' brains by clamping their carotid arteries closed. Remember, the arteries bring the blood in, the veins take it out. Slowed perfusion can be created by slowed delivery of blood, or slowed removal. It works both ways.
Notice in this study, the first areas of white matter lesions were on the optic nerve after only THREE DAYS of ligation. This mimics the order of problems we see in pwMS. RRMS patients typically present with vision problems first and show white matter lesions.
"Cerebral white matter (WM) lesions are observed frequently in human ischemic cerebrovascular disease and have been thought to contribute to cognitive impairment. This type of lesion can be experimentally induced in rat brains under chronic cerebral hypoperfusion by the permanent occlusion of both common carotid arteries. However, it remains uncertain whether chronic ischemia can damage both the gray and white matter, and whether it can induce demyelination with or without axonal damage. Therefore, we examined axonal damage using immunohistochemistry for the amyloid β/A4 precursor protein (APP), chromogranin A (CgA) and demyelination using immunohistochemistry for the encephalitogenic peptide (EP) in this model. Severe WM lesions such as vacuolation and the loss of nerve fibers appeared in the optic nerve and optic tract after 3 days of ligation, and less intense changes were observed in the corpus callosum, internal capsule, and fiber bundles of the caudoputamen after 7 days with Klüver–Barrera and Bielschowsky staining. These WM lesions persisted even after 30 days. The APP, CgA, and EP-immunopositive fibers increased in number from 1 to 30 days after the ligation in the following WM regions: the optic nerve, optic tract, corpus callosum, internal capsule, and fiber bundles of the caudoputamen. "
When neurologists say that Dr. Zamboni's research is not based on fact....give them a lecture on hypoperfusion and white matter lesions. This is science, this is fact, this is real.
Monday, August 16, 2010
August 16, 2010 at 11:32am
Lots of people have commented on how the stresses of life have caused MS exacerbations and flare ups for them. My husband Jeff has noted this; he'd be in a stressful situation at work, and his left foot would tingle and then go numb. Many of you have written about how stress brought about your MS diagnosis. So, what's up with this? How does it fit in with what we know about CCSVI? I've got a theory I wanted to share it with you, in case it might help someone. It's helped Jeff a lot.
There's new research out about internal jugular vein valve incompetence and people who have transient global amnesia. This is different than CCSVI, but related. These people have been shown to have reflux of blood in their jugular veins, which creates an ischemic (low oxygen) event in the brain.
"A high prevalence of internal jugular vein (IJV) valve insufficiency appears to be present in patients with a clinical diagnosis of transient global amnesia (TGA), suggesting that venous congestion in areas of the brain associated with memory may partially explain episodes of benign TGA. Claudia Cejas, MD, and colleagues at the Institute for Neurological Research, FLENI, in Buenos Aires, Argentina, found that IJV valve insufficiency was present on at least 1 side in almost 80% of patients with TGA, compared with only 25% of control subjects. There was also a trend toward a predominance of right-sided IJV valve insufficiency."
There are many papers about the connection of venous return and TGA.
The researchers tested the reflux in the jugular veins using doppler ultrasound and having the patients do a "valsalva maneuver". A valsalva manuever is when you force air up from your lungs, but keep your mouth and nose closed. Some people do this to relieve pressure in the ears when flying, some people do this when breath holding, or straining with lifting heavy objects, having sex or going to the bathroom. This is not something you want to do with any regularity. Many people do this when they are under stress, and do not even realize it! Valsalva manuevers create reflux of blood.
(It's important to note that Dr. Zamboni found a reflux of blood from blocked jugulars in people with CCSVI---he did NOT use valsalva manuever to see refluxing blood. That means pwMS are at a disadvantage, because your blood could be refluxing without performing these breath holding manuevers.)
Another link to transient global amnesia is severe emotional stress. Read the next case history.
A healthy 61-year-old man was brought to the emergency department by his wife after she noticed that he was forgetful of the previous evening's activities and was unable to form new memories during the subsequent day. The patient repeated the same questions and could not remember events minutes after their occurrence. There was no history of intoxication, drug use, head trauma, or obvious physical or emotional stress. He had no medical history other than seasonal allergies and took no regular medications. The physical and neurologic examinations were otherwise normal.
On hospital day 2, the patient had a normal mental status and was able to form anterograde memories. He remembered that just before his amnestic episode, he had fallen asleep and dreamed about his son joining the Marines and being killed in combat in Iraq. He vividly saw his son in a casket draped with an American flag. At this point, he screamed and woke up with amnesia. The patient was especially distraught because his son was contemplating joining the military at the time the dream occurred. The episode of transient global amnesia was considered to be due to the stress of the dream, and the patient was discharged."
Stress can create this retrograde blood flow. It can be so severe, it can starve the brain of oxygen.
So, what can pwMS do to prevent this exacerbation of reflux? How can we avoid this kind of emotional turmoil, and keep blood flowing back to the heart?
I believe the answer begins with our breathing.
When we are stressed, we tend to hold our breath, use valsalva manuever, or breathe too shallowly.
Try this experiment.
Breathe on your fingers like you just burned your hand. Make your breath cool, and do it quickly.
This is called "clavicular breathing", it is from the top of your lungs, and is shallow.
Your throat is tight. This is what I call "stressed out breathing."
Now, breathe on your hands like you are outdoors at winter time and want to warm your fingers.
Make your breath warm, do this slowly.
This is called "diaphragmatic breathing." It comes from deep in your belly, below your lungs. Your throat is open.
This low, warm breath is what we want to find when we start to get stressed. This type of breathing is practiced in yoga and the ancient traditions of meditation and breath counting. It is this low and slow, conscious breath that can slow our heart rate, open our blood vessels, relieve valsalva pressure, calm our spirits.
Take a deep, low breath. Open your mouth, open your throat. Lower your shoulders, fill your lungs. Let your belly release.
Now, let this breath slowly escape thru your nose. Think "warm air" at the back of your throat.
This is conscious breathing.
Feel the sense of calm. Try to do this when the world gets too noisy or insane.
I do this is the car during traffic jams, when LA traffic is driving me crazy.
Jeff does it when work becomes overwhelming, and his feet don't tingle any more.
I hope this connection of jugular vein reflux, valsalva manuever and stress makes some sense to you, and that learning how to counteract life's stresses and strains with your own breath will help you--
don't forget to breathe,