The Gut - Multiple Sclerosis Interaction

Whether you like it our not, we co-exist with more than 100 trillion microorganisms in our intestines (colon and rectum) that are essential to our health and survival.  These microrganisms (collectively all organisms connected to you are termed your microbiota) in your gut perform essential roles in:

• synthesizing vitamins
• metabolizing foods and other chemicals (including drugs)
• developing and maintaining normal immune function
• maintaining an effective barrier between the gut and the rest of your body
• fighting off harmful microorganisms attempting to infect your body
  

What does this have to do with MS? Well, it turns out that the gut is a major immune system control center that responds to stress, disease, diets and drugs in complex ways that are only beginning to be studied.  Preliminary studies suggest that certain diseases may be the result of exposure to microorganizations and/or changes in the normal microbiota due to improved sanitation and altered diets in western, industrialized societies.

Some observations, such as the increased incidence of MS in populations that adopt western diets, support this hypothesis.  However, a more compelling argument was provided by Dr Jorge Correale, an MS specialist in Argentina. He observed several years ago that MS patients asymptomatically infected with common Helminths (intestinal parasites commonly referred to as worms) experienced a dramatic reduction in MS activity including reduced relapses, new MRI lesions and disease progression.

This benefit persisted as long as the Helminth infection was allowed to persist. If the patient developed symptoms from the Helminth infection (eg. diarrhea, weight loss, anemia) and required treatment to eradicate their worms, their MS activity tended to return promptly.  He was also able to link the beneficial response to Helminth infection to improved regulation of immune responses and reduced inflammatory responses designed to fight off infections. 

They and others have proposed that Helminths were once a common symbiotic parasite in the human gut that helped control human immune responses. This control of immune response helps both the worm and the human; the worm gets to survive destruction by the human immune system and the human experiences less of an inflammatory response to environmental stimuli (foods or harmful organisms) that can cause disease states like allergies, eczema and possibly autoimmunity. Of course, the harmful effects of a symptomatic Helminth infection potentially offsets this control of other disease states.

So what can you expect to read and hear about in the near future regarding alterations in gut microbiota and your multiple sclerosis?

1.     Studies are underway to determine if controlled, asymptomatic infection with Helminths is beneficial to MS. The studies have cute, easily recognized acronyms such as TRIOMS and WIRMS and should report results in the next 2 years. However, it will be very important to extend the observation periods of these studies to ensure that there are no long term health risks associated with chronic helminth infections.

2.     Studies are underway to characterize the diversity and molecular properties of gut microbiota in different disease states and better understand the signaling pathways that result in certain beneficial and harmful downstream effects on human health. These studies will dominate the headlines and draw excessive conclusions that will not be justified until controlled interventional studies are undertaken.

3.     It is likely that you will start to hear about studies of fecal transplantation for diseases like MS.  This is gaining in popularity for certain diseases of the GI tract linked to pathological alterations in gut microbiota, such as Clostridium difficile infection, and will almost certainly spread (excuse the pun) to other disease states.

Is there anything you should be doing about your microbiota now to benefit your MS? Certainly, there are no demonstrated benefits to any particular intervention; but since this has never stopped any of us from trying out new things, here are some suggestions.

1.     The health craze that involves colon cleansing and a return to more natural diets, particularly the Paleo diet, has its roots, knowingly or not, in the concept of altering your gut microbiota. As there is no known harm and many patients report feeling better, it is a program I support, although I personally avoid the colon cleansing part of the routine. I suspect that other dietary alterations such as gluten restriction have a similar effect. In general my recommendation on diets is that an individual should shop around the edges of the grocery store and at farmer’s markets.  Edge shopping at grocery stores specifically means avoiding the processed foods and grains in the aisles and confine your shopping to the produce, meat, poultry, dairy and nuts section. There are many variations on this theme but one should try to at least accomplish this basic approach.

2.     Probiotic supplements are very popular but expensive and little is known about which products are beneficial or potentially risky in MS. Most of the marketed supplements contain different strains of lactobacillus or bifidobacterium that may have very different effects on your body. These products are more well known for their beneficial effects on irritable bowel syndrome or travelers diarrhea and those containing bifidobacterium strains seem useful for dental gum disease. Generally, for MS patients I recommend fermented foods high in probiotics.  Yogurt with the label, “Live active cultures”, is a good source of probiotic organisms. Other fermented products known to be good sources of probiotics include kefir, sauerkraut, pickles and kimchi.

Bon Appetit