Multiple Sclerosis Newsletter
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Research UpdatesVITAMIN D MAY LOWER RISK OF MULTIPLE SCLEROSIS IN WHITESHealthDay News 12/20/06 Those with highest levels of sunshine vitamin have lower rates of MS, finds study. Could getting some extra sunshine help prevent the development of multiple sclerosis? Maybe, according to new research that found white people with high circulating levels of vitamin D – a vitamin mainly produced by the body after sun exposure – had a lower risk of developing multiple sclerosis (MS). No such association was found for blacks or Hispanics in this study, which is published in the Dec. 20 issue of the Journal of the American Medical Association. “The group [of whites] with the highest vitamin D levels had a 62% decreased risk compared to the group with the lowest levels,” said the study’s lead author, Dr. Alberto Ascherio, an associate professor of nutrition and epidemiology at the Harvard School of Public Health in Boston. However, Ascherio cautioned that it was too soon to recommend that anyone - even those at high risk of developing MS - start taking vitamin D supplements or increasing their sun exposure with the hope of preventing MS. Multiple Sclerosis is a disease of the central nervous system. It’s believed to be an autoimmune disease that causes the body’s immune system to attack the substance – myelin – that covers nerve cells. About 400,000 Americans have MS, according to the National Multiple Sclerosis Society. Symptoms of the disorder include poor coordination, loss of balance, blurred vision, fatigue, cognitive problems, numbness and possible paralysis. Using blood samples stored among a repository of more than 7 million samples maintained by the U.S. Department of Defense, the researchers compared blood samples of 257 people with multiple sclerosis to 514 age, sex and race-matched control samples. One hundred forty-eight of the samples were from whites; 77 were from blacks, and 32 were from Hispanic adults. The researchers analyzed the blood samples for levels of circulating vitamin D and separated the samples into five groups based on the vitamin D levels. They found that the group with the highest levels had a 62% decreased risk of MS compared to the group with the lowest. However, these differences only held true for white people. There was no association for blacks and Hispanics. The researchers theorized that may be either because the sample sizes were much smaller than they were for whites or because blacks and Hispanics have lower levels of circulating vitamin D. Ascherio said the researchers don’t know for sure whether vitamin D may play a role in causing MS, but they suspect hat it probably does. “There is a pretty good convergence of evidence that vitamin D affects the immune system to lower the risk of MS,” he said, adding that if that is the case, “the potential for prevention is enormous.” “This is another piece of the puzzle, and it may help to explain why we see geographic differences in MS,” said Dr. Nicholas LaRocca, associate vice president of health care delivery and policy research at the National Multiple Sclerosis Society. But what this association means – “is it an actual risk factor; how does it work; what can we do about it? - is open to question, he added. “In the future, if one could establish a causal relationship, it could present an opportunity for a partially preventive strategy. Right now, the scientific, community is not convinced that there’s enough evidence to recommend taking vitamin D supplements, though,” LaRocca said. FOOD FOR THOUGHT: MS AND NUTRITION By Denise M. Nowack, RD, with Jane Sarmoff Helping yourself to a healthier life: MS is an unpredictable disease that affects each person differently. But a person’s quality of life can often be improved by focusing on those aspects of health that can be changed. Good health has a lot to do with what you put on your plate at every meal, so diet is an area where you can be in control. Nutrition basics: Eating for good health is as simple as A-B-C. * Aim for fitness. Make a healthy weight your target. There are many reasons why a person with MS may gain or lose weight—but controlling weight is the same story for everyone: watch the calories and do regular physical activity. Calories are a measure of the energy locked inside the carbohydrates, fats, and proteins found in foods. This energy fuels our body but what we don’t use gets stored as fat, and over time results in extra weight. Physical activity and good nutrition are perfect partners in managing weight. Not only does physical activity burn calories, it can help you: - Make the most of your potential muscle strength, or even build strength, depending on your program. - Increase your endurance. - Maximize range of motion and joint flexibility. - Strengthen your heart. - Decrease feelings of fatigue (really, even with MS). - Decrease symptoms of depression. - Maintain regular bowel and bladder functions. - Minimize the risk of skin breakdown and irritation. - Protect your weight-bearing bone mass. High fat foods and uncontrolled portion sizes are leading contributors to weight gain. High-fat foods contain more calories per portion than their carbohydrate or protein counterparts. To cut back on calories look at ways to trim the fat. Also, keep tabs on portion sizes. Do a little measuring with raw rice or water to see what ˝ cup really looks like. If your portion sizes have crept way up, you may want to switch to smaller plates and bowls. * Build a healthy base: Translating good nutrition to your table takes planning, attention, and some innovation. Let the U.S. Department of Agriculture’s Food Guide pyramid provide a starting point. Each part of the pyramid provides a building block of nutrient-rich foods. The choices are many and they’re all yours! Make a variety of grains, fruits, and vegetables the foundation to your diet plan. Choices from these groups are rich in vitamins, minerals, carbohydrates, and other substances important for good health – most help create a feeling of fullness and satisfaction to keep the snack urge quiet. Whole grains – such as whole wheat, brown rice, oats and whole grain corn – provide a fiber boost to the carbohydrates in your diet. A single serving from this group provides about 70 calories. You can find that in a half-cup of cereal, rice or pasta, or one slice of bread. When it comes to fruits and vegetables, enjoy five a day – at least three servings of vegetables and two servings of fruit. It doesn’t take much to make a serving – just one cup of raw leafy vegetables, a half-cup of other vegetables or fruit, or six ounces of fruit juice. Choose dark-green leafy vegetables and brightly colored fruits and vegetables often. Next add low-fat choices from the protein and dairy level of the pyramid to the nutritional groundwork you have laid. This includes lean meats, fish and poultry, low-fat or non-fat dairy products, dried beans, tofu, and other plant sources of protein. * Choose sensibly. There are many ways to build a personal pyramid - and lots of room for choice. When in doubt, go easy on fat, the sugar, and the sodium. Trimming the fat from your diet – especially saturated fat – not only cuts calories, but may cut your risk for chronic diseases, such as heart disease and stroke. Use vegetable oils as a substitute for solid fats like butter and hard margarine. Choose fat-free or low-fat dairy products and lean meats. Trim the skin from poultry. The Nutritional Fact Label on food products can be a useful tool for finding foods lower in total fat – as well as sodium and cholesterol. It’s OK to enjoy sweets occasionally. But don’t let soft drinks or sweets crowd out important foods you need. To lower salt or sodium intake experiment with low-sodium condiments, herbs, spices, and seasonings. And if you drink alcoholic beverages, do so sensibly. Make water and decaffeinated beverages your first choice. Meeting the challenges of changing your diet. The A-B-C of good nutrition is the goal. But food is not just about nutrition – it’s about emotions, culture, socializing. Because what and how we eat is so personal, changing eating habits can be difficult. Special diets and radical fitness programs sometimes promise the quick fix – or even the cure. But the best advice for people with MS continues to be what is recommended for everyone. Eat a low-fat diet with a variety of grains, vegetables, and fruits, along with some high-protein foods like meat or dairy products. – and balance calorie intake with physical activity. Deciding to change is the first step. But the changes don’t have to happen overnight. Start with the easy changes. Then, one by one, add more kinds of vegetables, reduce portion sizes, introduce more low-fat foods. Here’s a checklist: -Be realistic. Make small changes over time. Small steps can work better than giant leaps. -Be adventurous. Expand your tastes by trying new foods. Thee are many low-fat recipe books and magazines on the market, as well as televised cooking shows which can inspire new ideas. -Be flexible. Balance what you eat with your physical activity over the span of several days. Don’t focus on just one meal or one day. -Be sensible. Enjoy what you eat. Practicing moderation doesn’t mean crossing all your favorite foods off your list forever. Think smaller amounts, less frequently. -Be active. Choose activities that you enjoy and that fit into the rest of your life. Make a move! Physical activity comes in different shapes and sizes. Aerobic activities raise your heart rate and breathing, and help promote cardiovascular fitness. Other activities develop strength and flexibility. For example, lifting weights helps develop strength and can help maintain good bone health. Activities like yoga and gentle stretching can improve flexibility. Have a conversation with your doctor about exercise, your target weight, and special needs. If possible, get a referral to a physical therapist to help you begin a program. Commit to doing what you can do on a consistent basis. Choosing activities you enjoy will help you keep to your fitness plan. Start slowly. If you haven’t been active, introduce your body to a low level of intensity for short periods of time. As your body adapts, gradually build the intensity and duration of your program. Keep your cool. Overexertion and overheating can temporarily increase MS fatigue and other MS symptoms. Drink plenty of fluids before, during and after your activity. Try exercising in cool water or in air-conditioned space. For some, using a cooling vest or neck wrap helps keep the core body temperature at an appropriate level. Join a group! Exercising with others may give you the motivation and support to keep going. Contact your chapter of the National MS Society for referrals to physical activity programs in your community. * Feeding your special needs: Good nutrition is essential for everyone, but people with MS may have special considerations and needs. Your MS symptoms or your medications may impact your nutritional well-being. Talk to your nurse or doctor about dry mouth, fatigue, and other symptoms that interfere with eating. MS symptoms can also reduce mobility or physical activity. If your eating habits remain the same while activity drops off, the usual result is weight gain. Added weight can increase fatigue, further limit mobility, put a strain on the respiratory and circulatory symptoms and increase your risk for other chronic illnesses. Ask a registered dietitian or doctor to recommend an optimal weight, and reasonable daily calorie intake. To get extra weight under control, put the physical activity and diet partnership into action! Being underweight can also compromise your health, especially if it is caused by lack of appetite or fatigue that limits food intake. It’s important that you meet your daily nutritional needs to ensure that your body is able to fight off infection. SYMPTOMS OF MS MSFOCUS Common symptoms of MS include fatigue, weakness, spasticity, balance problems, bladder and bowel problems, numbness, vision loss, tremors and depression. Not all symptoms affect all MS patients. No two persons have the same complaints; no one develops all of the symptoms. Symptoms may be persistent or may cease from time to time. Most patients have episodic patterns of attacks and remissions throughout the disease course. Symptoms may remit completely, leaving no residual damage, or partially leaving degrees of permanent impairment. Because the symptoms that define the clinical picture of MS are the result of nerve lesions causing disturbances in electrical conduction in one or more areas of the CNS, the nature of the symptoms that occur is determined by the location of the lesion. For example: an optic nerve lesion may cause blurred vision; a brain stem lesion may cause dizziness or double vision; a spinal cord lesion may cause coordination/balance problems. Depending on the location of the lesion, the MS patient may experience the following signs & symptoms:
The following list of symptoms followed by typical courses of treatment are not the only symptoms to affect those with MS. These symptoms may be intermittent or persistent. Not all of these symptoms affect all patients. Fatigue: The most common complaint of MS patients is fatigue. Occurs in as many as 78% of patients, usually in the late afternoon and often subsides in the early evening. -Modifying activities, occupational therapy, and mediations. Numbness, Tingling, Burning Sensations: Sensory complaints occur in up to 55% of patients and are often the earliest symptoms of MS. Disturbances of feeling in the extremities of the trunk such as tingling, crawling sensations, feelings of swelling or numbness. Numbness also depends upon its cause. If severe neurological damage to the myelin sheath takes place, then numbness may remain. -Medication, exercise, healthy diet, body cooling, acupuncture, or pointed pressure therapy. Tremors: Shaking or trembling of a limb or occasionally the head. Up to 50% report extremity ataxia (shaky movements or unsteady gait) or tremors. Tremors may come and go. This symptom of MS impairs mobility and often is associated with difficulty in balance and coordination. -Exercises, physical therapy, occupational therapy, adaptive equipment, and medications. Balance/Coordination: Gait and balance disturbances are common with MS. Balance problems without vertigo may be more constant, causing the person to sway or stagger. - Exercise, physical therapy, occupational therapy. Depression: As in most cases with the onset of an illness, depression is a frequent reaction. MS-related lethargy and fatigue may also be mistaken for depression or heighten its effects. - Medications, counseling, and alternative treatment options. Spasticity: Occurs with the initial attack of MS in up to 41% of patients and is present in about 62% of patients with progressive disease. Occurs when opposing groups of muscles contract and relax at the same time. When spasticity is present, the increased stiffness in the muscles means that a great deal of energy is required to perform daily activities. - Exercise, stretching, physical therapy, mechanical aids, and medications. Bladder: Increased frequency of urination, urgency, dribbling, hesitancy, and incontinence. - Modifying activities, catheterization, medications. Bowel: Constipation, diarrhea and incontinence. Dysfunction occurs in almost two thirds of patients during the disease course. - Diet management, adequate fluid intake, and medications. Vision Loss: Rarely involves both eyes simultaneously, usually starts with blurred vision followed by vision loss from 20/20 to 20/30 to 20/40. - Medications, eye patch. Cognitive and Emotional Dysfunction: Affects approximately 50% of MS patients. Involves memory, reasoning, verbal fluency and speed of information processing. Emotional changes include euphoria, depression. Memory problems are fairly common among people with MS. Memory and reasoning problems may affect between two thirds and three fourths of those diagnosed with MS in varying degrees. - Consider other issues that may lead to memory problems such as depression, other illnesses, and normal absent-mindedness. If memory loss is a constant problem, there are certain “mnemonic” exercises that may help, or consult a physician. Some treatments may be available to enhance cognitive functioning. Sexual Difficulties: More than 90% of men and 70% of women with MS report some change in their sexual life after the onset of the disease. Some problems include decreased sexual drive, impaired sensation, diminished orgasmic response, and loss of sexual interest. - Good communication between partners, counseling, medications. For further information on symptoms and symptom management, call our Program Services Department at 1-888-MSFOCUS (673-6387) or you can contact us by email: support@msfocus.org. |
*This
material is provided as general medical information and is not intended as advice
for individual patients;
please contact your physician for specific recommendations.
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Last updated 11 March 2007
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