“Cheer up, Multiple Sclerosis; you can always serve as a very, very bad example. By the way this would be a truly excellent blog for all MS patients to read. Patients hold tremendous potential for self-cure as knowledge and behavior change.” Rajjpuut
18 Vital Questions about Multiple Sclerosis;
One Possible/Probable Answer
The Ol’ Health Educator, will put down his political pen here and return to his roots. Rajjpuut has noted repeatedly that agencies such as the American Medical Association (AMA) seem to show high propensity for and deep, deep satisfaction with “nihilistic answers” to questions about disease. In a phrase, nihilism is surrender to nothingness or meaninglessness . . . they just “give up” on good research medicine and latch on to the easy and highly profitable answer: “auto-immunity.”
For quite awhile there was only one suspected auto-immune disease, now there are over sixty of them. Not surprisingly, none of the auto-immune diseases is considered ultimately curable. Not surprisingly the auto-immune patient requires a lifetime of treatment by the doctor and/or the drug. Not surprisingly expensive and risky (involving many side effects or a few serious or deadly side effects, or both) solutions produced by the pharmaceutical companies amount to lifetime drug regimens for the purpose of controlling symptoms and or pain but NOT for the purpose of curing anyone of anything . . . . This is the obvious example of what is meant by the term “nihilistic medicine.”
Not surprisingly, all of this nihilistic medicine is wreaking havoc on the health care costs the nation faces. The results of nihilistic medicine are beneficial for doctors, hospitals and pharmaceutical companies (more profits, more patients, lifetime subscribers); but not necessarily a help to the patient or the governments state or federal or the taxpayers. In short, it appears that nihilistic medicine is a specious way to claim to have an answer . . . while actually abandoning the questioning process . . . that is, giving up on real science . . . and nihilistic medicine is personally and fiscally a disaster for the patient and for the government.
In accord with the most recognized portion of the Hippocratic Oath, Rajjpuut would suggest “First do NO Harm” is the essence of real medicine and nihilistic medicine does harm and should be replaced by real medicine at each and every juncture. Let us take one apparently insoluble “auto-immune disease” Multiple Sclerosis (MS), for example. What is MS? A protective “sheath” of myelin surrounds our nerve cells. This myelin sheath becomes damaged in MS victims and doesn’t repair itself. It’s about time something good was associated with Multiple Sclerosis. “Cheer up, Multiple Sclerosis; you can always serve as a very, very bad example. By the way this would be a very good blog for all MS patients to read. Patients hold tremendous potential for self-cure as knowledge and behavior change. Let us now examine MS from the point of view of asking seemingly obvious questions . . . would you be surprised if our search led us in a positive direction and away from auto-immunity’s convenient medical conventionality and from nihilism altogether?
NOTE: at first it was thought that myelin for the nerve sheath never could be “regenerated” but some of the most recent research since late 2009 seems to point in the contrary and positive direction. Brain stem cells can apparently be “tricked” into recreating or repairing the myelin sheath. This would amount to a refutation of the auto-immune hypothesis about Multiple Sclerosis. The process has been triggered semi-naturally (with physician intervention); now the drug companies want to avoid all of nature (which works NOW) and find an artificial way of recreating the effect (presumably with all the inherent side-effects and risk) . . . in other words, even with a possible CURE at hand, medicine is here and now more concerned with profits???? Label that as the second “bad example” connection to MS (medical nihilism via the “convenient” auto-immune description was the first connection) we’ve encountered.
Rajjpuut first became aware of the world of MS when his ex-wife was diagnosed with the disorder in late 2001. Awhile later one of his girlfriends was also diagnosed. His natural curiosity took over and generated the following questions . . . by the way, some of these questions are quite elementary while other require actual SCIENCE, dear reader. Do not be afraid, if a question seems ‘beyond your ken’ just skim over it . . . the big picture is what’s vitally important, and all of us can understand clearly and deeply what that big picture is and how it can impact us personally as both taxpayers and patients. That big picture is abundantly clear to anyone who respects the ideas behind the scientific process regardless of how much in-depth science he or she understands. Back to those questions . . . .
1. Why is Colorado, where Rajjpuut lives, the highest incident U.S. state for MS?
2. Why is Colorado Springs the highest incident large city in the highest incident state for MS?
3. Why do women suffer from MS at a rate roughly 2-4 times as great as men?
4. Why is MS less prevalent on the coasts?
5. Why is MS far more prevalent in urban settings than in rural areas?
6. Why is there an increased risk of developing MS among smokers?
7. Why is there an increased risk of developing the progressive form of MS from Relapsing/Remitting MS among smokers?
8. Why is there an apparent acceleration of MS progression and of movement from R/R MS among smokers?
9. Central Nervous System Dilators pioneered as an MS treatment during the 1950’s by Bayard Horton of the Mayo Clinic were apparently quite successful with few or no side effects in relieving acute attacks promptly and often prevented progression? Why?
10. MRI examinations today frequently depict a lack of correlation between symptoms and lesions in MS (often called the “clinico-radiological paradox). What’s going on? If demyelization is the fundamental essential lesion in multiple sclerosis, why is there often no correlation?
11. Trials of sex hormones show they improve lesions as well as MS symptoms; and L-arginine, zinc and magnesium supplements also seem to lesson symptoms. Why?
12. What role do deficiencies of endothelial and neuronal nitric oxide and elevated levels of inducible nitric oxide play in MS? Is this symptomatic or causal?
13. Is better detection the reason MS incidence has risen so dramatically in the last 40 years, or are some environmental factors (external or internal toxins?) exacerbating the situation?
14. What about the “brain leak” theory of MS? That theory says free hemoglobin scavenges nitric oxide avidly, which may create deficiencies especially in the central nervous system, with its greater vasodilator tone. Could depletion of endothelial nitric oxide shift blood from the arterial circulation to the venous circulation in MS sufferers as in diabetics? Could multiple sclerosis result from too little blood in arteries and arterioles leading to vasospastic symptoms? Meanwhile could too much blood in veins and venules lead to blood-brain barrier leakage and lesions?
15. Is there a logical reason or reason why acne and Multiple Sclerosis incidence may be linked?
16. Is there any logical reason for continued loyalty by many to the idea that MS is an anti-immune condition?
17. Is there one over-arching theory that might explain all these factors?
18. Several hundred MS “reversals” have been documented. About a dozen verified instances of reversal after lightning strikes have occurred. What the hell is going on?
The more Rajjpuut read about the disease, the more certain he become that these factors/these questions need to be explained and understood.
An obvious main or, at least, exacerbating factor seems to jump out from the first eight questions and indeed (upon further, deeper study to all of these questions): OXYGEN! The clearest correlation for Question #1 is that higher altitudes = lower oxygen levels. Question #1’s obvious correlation? Colorado is the state with the highest average altitude among the 50 states. As far as Question #2, Colorado Springs, the 49th largest city in the country, is easily the highest large metropolitan area in the country roughly 750 ft. (14%) higher than “Mile-High” Denver.
As far as correlation between oxygen and Question #3, Women’s bodies and their unique chemistry may make them far more vulnerable than men to MS for any number of reasons. Exploring the OXYGEN HYPOTHESIS among women more deeply . . . women tend to be smaller and society until recently encouraged female physical fitness far less than it did male activity so generally speaking females are less efficient VO max processors than men. Additionally, hemoglobin and iron are more problematical in females during their menses which makes females more likely prey for anemia again potentially lessening oxygen-use efficiency.
A factor also noticed and which may not have any bearing on the issue is that females are about eight or nine times more likely than man at any given moment to be engaged in dieting, skipping breakfast and sometimes fad dieting that is just plain nonsensical healthwise . . . which could spark nutrient deficiencies. I've seen nothing about dieting, eating 3-5 regular meals daily, good nutrition, or having a good breakfast in the MS literature, but common sense says, good habits are important and could play a role.
Moving on to Question #4, the coasts, are by definition, found at sea level hence, lower than 99.999% of the inland areas of the country with more oxygen available. Additionally, coastal diet is far more likely to include fish with its attendant fish oil (deficiencies implicated in Alzheimer’s, high blood pressure and heart attacks) which aids in oxygen processing.
Question #5, people in rural areas are less likely to face high levels of air pollution (smog) than city dwellers. In particular: diesel fumes, ground level ozone contamination and INHALED nitric oxide contamination are brutal every-day facts of life in our largest cities. (By the way: INHALED nitric oxide is confusing in many respects to the layman. A. it is NOT nitrous oxide (laughing gas) once used as anesthetic. B. Our bodies naturally create nitric oxide and it is one of the most important gases found in our blood stream (as reflected in the Nobel Prize for Medicine awarded to Dr. Louis Ignarro) which we will discuss later as it relates to MS. C. Many people realize that nitric oxide is also an important negative component of tobacco smoke. In any case, the obvious effect of air pollution is less oxygen allowed to reach the lungs, heart, brain and every cell of the human body than one would expect from clear, pure country air.
Talking about pure, clean outdoor air . . . well the contrary situation is created by smoking. Questions #6, #7 and #8 indicate that the “personal internal pollution” of smoking may exacerbate MS (earlier onset; quicker progression; worse symptoms) and again ties in to Oxygen.
Question #9 is way beyond the scope of this stumbling/bumbling comment. Peter Good’s thought-provoking website on nitric oxide and MS seems to indicate that there was great success with the CNS
vasodilator histamine diphosphate during the late 40's, the 50's and 60's. Today’s “fashion” calls for different meds with greater potential for dangerous side effects. CNS vasodilation with histamine not only consistently relieved a disease now thought to be incurable, it thereby demonstrated that its fundamental lesion may be something entirely different from demyelization . . . beyond even Rajjpuut’s oxygen hypothesis, this is real science . . . exploring the question about what is MS, really?
Having said that let's skip ahead and examine Question #16, is there any logical reason for continued loyalty by many to the idea that MS is an anti-immune condition? As a result we regard MS today as incurable because its primary lesion is thought to be relatively irreversible disintegration of myelin sheaths in the brain and spinal cord. That thought pattern has been in place for roughly 55 years. Neurologists who successfully treated MS with vasodilators thought the lesion was REVERSIBLE because the underlying cause – a diminished blood supply in the brain and cord (leading to OXYGEN lack there) was treatable. Because of the autoimmune assumption, workable theories and workable treatments (and cures?) have been relegated to the trash heap. Certainly some MS cases have reversed 100% (see the question on lightning strikes).
Question #10, since MRI results seem NOT to show continued and progressive demyelization as the fundamental and unvarying effect of MS and they don’t rule out oxygen as a key factor, we can continue to keep an open mind toward blood and oxygen as the fundamental truth of the disease. Lest anyone decide that I’m seeking oversimplification of a complex problem . . . Siblerud and Kienholz (1994) compared red blood cell concentrations and hemoglobin levels of MS patients who had their mercury amalgam dental fillings removed against blood values of MS patients who retained their amalgam fillings:
MS subjects with amalgams were found to have significantly lower levels of red blood cells, hemoglobin and hematocrit compared to MS subjects with amalgam removal.... The MS amalgam group had significantly higher blood urea nitrogen and lower serum IgG.... A health questionnaire found that MS subjects with amalgams had significantly more (33.7%) exacerbations during the past 12 months compared to the MS volunteers with amalgam removal. Obviously, while we’re still talking about the blood’s ability to deliver oxygen . . . every indication is that a wide variety of toxins and negative effects might stimulate that same over-arching undesirable effect. The specific trigger may vary from case to case, but the indications are that oxygen and blood might well hold the key to understanding MS.
Just as in AIDS, the possibility that the immune system is responding to an agent like a virus is countered by the reality that no such agent has ever been identified. We know that once identified, if transmitted to any animal or human in clinical experiments that theory could be proved. Retrovirus, where art thou????? In truth, endogenous retroviruses have not yet been proven to play any causal role in this disease. According to PO Behan and A Chaudhuri of Glasgow University, together with BO Roep of Leiden University (2002) contend there is little support for contemporary views that multiple sclerosis is an immunological disease. And not surprisingly, according to them, there is little benefit from treatments based on this misconception. In any case, since no "smoking gun" for MS has ever been found, isn't it a little short-sighted to UNCRITICALLY say that it MUST BE an autoimmunity problem?
Questions #11 and 15 again brings up questions of gender. Women, who typically undergo puberty earlier than men, get MS more often and earlier and its path is less likely to be predictable and progressive compared to male victims. Some success has been had treating with either or both male and female hormones. Additionally, L-arginine creates nitric oxide in the blood which dilates blood vessels. Zinc and magnesium are under-appreciated nutrients which play vital roles in human health. And then there’s the question of acne. Looking at #15 For both men and women the doctor-approved use of strong prescription antibiotics for extended periods of time in treating acne brings us back to the fundamental question raised earlier about the Hippocratic Oath’s main principle (First do NO harm) . . . upsetting all the positive bacteria in one’s gastro-intestinal system seems like a harmful answer to the clear skin problem. For women specifically, anti-acne medicines and make ups seem to exacerbate the probability that the individual will contract MS later in life. Again, the specific (toxic?) trigger for MS may vary from case to case, but there are no indications here that oxygen and blood do not hold the major key to understanding MS and certainly there is no outright refutation for that idea to be found in this question. Let’s look more deeply . . . .
Questions #12 and #14 are best answered and best understood together through the insights of Peter Good: “Two signs that endothelial nitric oxide may be chronically depleted in multiple sclerosis are that patients tend to be very heat-sensitive, and their platelets are sticky. Sensitivity to stress may reveal depletion of the parasympathetic transmitter neuronal nitric oxide. Other reasons to suspect endothelial nitric oxide depletion in multiple sclerosis are apparent deficiencies of sex hormones; magnesium, and zinc. Estrogen, testosterone via estrogen, and magnesium all utilize endothelial nitric oxide, the primary endogenous vasodilator, to relax vascular smooth muscle. The (most simple and straightforward explanation) of multiple sclerosis might be that too little blood in arteries and arterioles leads to vasospastic symptoms, while too much blood in veins and venules leads to blood-brain barrier leakage and lesions.” A recent Nobel Prize based upon L-arginine and nitric oxide gas in the blood being a "trigger" for the body seems to offer a promising area for further study. In any case, Oxygen's potentially primary role would be in harmony with this data.
Question #13, is easily dealt with, in principle the last 40 years have seen a precipitous rise in all manner of environmental toxins. Polluted foods (steroids in meats, for example), side effects of certain pharmaceuticals, residential toxins (such as arising from carpet liners, asbestos, etc., etc., ad nauseum), the preponderance of intimate electronic devices such as cell phones, and just plain stress all could easily be regarded as potential triggers somehow setting in motion the conditions leading to diminished blood and oxygen to the brain and spinal cord. Obviously, we live in toxic times, but is this toxicity really where MS comes from, or perhaps what exacerbates MS? There is NO necessary connection here to Rajjpuut’s oxygen hypothesis.
Question #17 (Is there one over-arching theory that might explain all these factors?) In answering the previous 16 questions we have laid the groundwork for open mindedly considering that “Yes, there could be, perhaps not . . . but maybe . . . and for now the overarching theory that holds the key to understanding MS seems to be: a theory of diminished blood or oxygen supply.
Question #18 is both the most esoteric and the most fundamental. MS reversals are not uncommon; did they all get re-myelinized? More startling, there are many documented cases of complete MS reversal following lightning strikes. How lightning could ever "re-myelinize" the nervous system is a mystery far, far beyond the question of how lightning could possibly reverse the symptoms. Like many earlier questions this suggests that demyelization is NOT the fundamental result of Multiple Sclerosis. Could this question too tie into Rajjpuut’s theory of an oxygen or blood connection to MS?
Rajjpuut wishes to thank the reader for his immense patience. This was not an easy read (nor write). The main point here is that claims that the American medical system is the “best in the world” may need to be approached on a case by case or disease by disease basis. Certainly the AMA seems to be a counterproductive agency. Clearly the notion of auto-immunity seems to be a convenient end point for doctors and medical researchers and pharmaceutical companies and highly inconvenient for patients** and taxpayers. Thanks again.
Ya’all live long, strong and ornery,