Navigating polypharmacy and addressing debilitating symptoms in multiple sclerosis patients

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By Carolina Brooks, BA, IFMCP

I see a lot of patients with multiple sclerosis (MS) in my clinic, all with different health histories, different overriding symptoms such as uncontrolled spasms interfering with sleep, gut dysmotility, fatigue, insomnia, and inability to manage stress. Some of my patients are at the relapsing remitting stage (RRMS), while others have been diagnosed with secondary progressive MS (SPMS) by the time they come to me.

According to a 2016 review in Journal of Neurology, early and effective intervention provides a window of opportunity to maintain neurological function and prevent subsequent disability. An integrative approach is crucial, ideally as early as possible, and I have seen MS stabilize quickly when patients adopt an integrative approach early on in the process.

A 2016 review in Cellular and Molecular Life Sciences explored the environmental factors which play a role in the pathogenesis of MS, highlighting the dominant drivers, including the typical Western diet, high in saturated inflammatory fats, high in sugar and salt. Toxin exposure also plays a role and negatively impact mitochondrial function, including environmental chemicals, pesticides, heavy metals, and mold. How we process and clear toxins is partly down to biological variability and optimising detoxification pathways to reduce total body burden.  

Other drivers in Western populations include cigarette smoking, Epstein-Barr virus (EBV) infection, lower exposure to sunlight and imbalances of the gut microbiome. A 2020 research article in Proceedings of the National Academy of Sciences of the United States of America found microbial and functional differences within the gut microbiome, but even at different stages of disease, including lower abundance, and reduced numbers of short-chain fatty acids in RRMS patients, and higher levels of fecal oxidation in SPMS patients. We might also see reduced levels of Faecalibacterium, Prevotella and Anaerostipes species, and higher levels of Methanobrevibacter and Akkermanisa species.

Most of my MS patients have more than one autoimmune disease present, so much as I would love to put patients on a ketogenic, low lectin, or Paleo diet, sometimes this isn’t possible, particularly if the patient is persistently constipated due to opiate medications, so we focus on ensuring strict removal of inflammatory and potential cross-reactive foods such as gluten and dairy, which contains the protein butyrophilin, which a 2004 article in The Journal of Immunology discussed as a modulator of molecular mimicry in the pathogenesis of MS disease progression. We also focus on increasing phytonutrients in the diet and shifting cooking methods to optimise lectin and oxalate breakdown and minimise formation of damaging compounds, such as heterocyclic amines and advanced glycation end products (AGEs), by encouraging use of a pressure cooker and keeping heat low during cooking.  

Sulphur is key for repair of damaged tissue membranes, detoxification processes of the kidneys and liver, and to produce glutathione and taurine, which mitigate oxidative stress and support proper functioning of muscles and nervous system. High sulphur foods such as cruciferous and allium family vegetables can initially be problematic for patients who have sulphur sensitivity, high oxalates or who have high levels of sulfidogenic bacteria in their guts, so it’s worth addressing these factors first, avoiding sulphur-containing supplements and supplementing with molybdenum to break down sulphites and ensure that sulphur is tolerated before bringing in sulphur compounds in supplements and increasing volume of these foods in the diet.

Case Study

A severely underweight female MS patient with concomitant Grave’s disease, active EBV, acute and painful spasms, restless legs, insomnia, interstitial cystitis, and multiple food intolerances became a patient eight months ago. This patient’s biggest stressor was the lack of support from her family. She felt neglected and unsupported and was extremely unhappy. She was on thyroid medication, benzodiazepines and opioid medications for spasms and insomnia, regular steroids, and hormone replacement therapy, despite a family history of hormone-driven cancer.

She was self-supplementing with unregulated cannabis bought online which interacted with her medications. Other challenges, which are common in my practice, including finances, so this patient was not willing to spend money on testing and was not open to engaging in or travelling for recommended additional therapies, including frequency specific microcurrent to reduce symptoms and improve tissue integrity or family therapy to improve communication with family members to be able to express her needs more openly. The patient had already addressed obvious toxic load triggers bar amalgam fillings due to cost, but I insisted that removal should not occur until gut function had stabilized in any case.

This patient had been to see multiple practitioners before me, and nothing had ever been done to support nutrient assimilation. Instead, her previous clinician had focused on aggressive die-off strategies for dysbiotic bacteria and the EBV and put her on a restricted elimination diet. If a patient has lost oral tolerance, they will react to most foods that they try and reintroduce. I do not advocate restrictive elimination diets in patients who are severely underweight and are not absorbing nutrients.

We focused on optimising the microbiome and restoring oral tolerance with digestive enzymes, short-chain fatty acid supplementation, prebiotics, probiotics, and high dose vitamin A supplementation to support mucosal immune function. We prioritised what best use of finances would be, and to ensure she was eating enough food, she engaged someone to come to the house to batch cook a couple of times a week. This allowed her to increase volume and diversity in her diet, introducing pressure-cooked legumes, as well as tolerable grains and small fatty fish at least four times a week in addition to ramping up phytonutrients.

Within three months, her food intolerances had been addressed and she started to eat a much more varied diet, she had put on weight and was able to tolerate cold food. We introduced magnesium and daily electrolytes which improved restless leg symptoms. We used cold infusions of urinary tract supportive herbs such as Barosma betulina (buchu), Arctostaphylos uva-ursi (bearberry), Althaea officinalis (marshmallow root), and specific probiotics to support urinary tract microbiome restoration, and she saw a reduction of symptoms there also.

We started using some herbs in drop dose such as Datura stramonium (jimson weed, which is restricted), Eschscholzia californica (California poppy), Valeriana officinalis (valerian), and Passiflora incarnata (passionflower), and Thymus vulgaris (thyme), which is one of the most effective herbs for spasms. Timing and dosage were critical due to polypharmacy, which meant we could only use herbs to prevent spasms in the afternoon, while at the same time trying to address dysmotility of the gut, which we did with aloe vera, Plantago major (plantain) and Matricaria recutita (chamomile) tea, and ileo-cecal valve self-massage with castor oil. The patient experienced significant improvement and was able to slowly discontinue the opioid medications and benzodiazepines.

A serious setback occurred when a medical procedure went wrong at month four and left her in worse and more extreme chronic pain, which caused her primary care practitioner to put her on anti-epileptic medication, stronger benzodiazepines, and back on high doses of opiates, which caused some regression as dysmotility returned, and the patient started to self-administer strong laxatives. During this period, we focused on repleting nutrient depletions, and supplementation with carnitine, glutathione to address oxidative stress, and high levels of omega-3 fatty acids. I asked her partner to be more involved with her care, although this area is a work in progress. At this juncture, we also introduced regular frequency specific microcurrent sessions, which has allowed us to gently taper the patient off these medications as function gradually returns, and symptoms start to abate.

References

Guggenmos, J., Schubart, A.S., Ogg, S., Andersson, M., Olsson, T., Mather, I., and Linington, C. (2004) Antibody Cross-Reactivity between Myelin Oligodendrocyte Glycoprotein and the Milk Protein Butyrophilin in Multiple Sclerosis. Journal of immunology. Retrieved from: https://doi.org/10.4049/jimmunol.172.1.661

Jörg, S., Grohme, D. A., Erzler, M., Binsfeld, M., Haghikia, A., Müller, D. N., Linker, R. A., and Kleinewietfeld, M. (2016) Environmental factors in autoimmune diseases and their role in multiple sclerosis. Cellular and Molecular Life Sciences. Retrieved from: https://doi.org/10.1007/s00018-016-2311-1

Takewaki, D., Suda, W., Sato, W., Takayasu, L., Kumar, N., Kimura, K., Kaga, N., Mizuno, T., Miyake, S., Hattori, M., and Yamamura, T. (2020) Alterations of the gut ecological and functional microenvironment in different stages of multiple sclerosis. Proceedings of the National Academy of Sciences of the United States of America. Retrieved from: https://doi.org/10.1073/pnas.2011703117

Ziemssen, T., Derfuss, T., de Stefano, N., Giovannoni, G., Palavra, F., Tomic, D., Vollmer, T., and Schippling, S. (2016) Optimizing treatment success in multiple sclerosis. Journal of Neurology. Retrieved from: https://doi.org/10.1007/s00415-015-7986-y