Multiple Sclerosis is Likely Caused by a Virus, Says Study

US military study suggests that the Epstein-Barr virus may be a leading cause of Multiple Sclerosis (MS). Image courtesy of HealthCentral.

Multiple Sclerosis (MS), a debilitating autoimmune disease, may in fact be caused by a virus, suggests a new study published in Science by Harvard Medical School Researchers.

The researchers tested a cohort of more than 10 million young adults on active duty in the US military between 1993 and 2013. During this 20-year timeframe, 955 individuals were diagnosed with MS over the course of their period of service. The researchers found that the risk of MS increased 32-fold after infection with the Epstein-Barr virus, known as EBV for short.

MS is a chronic inflammatory demyelinating disease of the central nervous system. The chronic inflammation occurs when the immune system mistakenly attacks the protective sheath (myelin) that covers nerve fibers, causing communication problems between your brain and the rest of your body. According to the Mayo Clinic, the disease can eventually cause permanent damage or deterioration of the nerves. Other symptoms include vision problems, slurred speech, fatigue, dizziness, tingling or pain in parts of the body, and bowel, bladder, and sexual dysfunction.

Multiple Sclerosis and the Epstein-Barr Virus

Although the exact cause of multiple sclerosis is unknown, it has long been hypothesized that the demyelination in the brain and spinal course is triggered by a viral infection. This particular study found that serum levels of neurofilament light chain, a biomarker of neuroaxonal degeneration, increased only after EBV seroconversion, suggesting that EBV is a leading cause of MS. However, the risk of MS was not increased after infection with other viruses, such as the cytomegalovirus (CMV); the researchers had also compared samples to CMV positivity as a negative control group, and found that CMV positivity was actually associated with a lower risk of MS.

“The key finding is that MS is a complication of infection with EBV,” said Alberto Ascherio, a professor of epidemiology and nutrition at Harvard’s T.H. Chan School of Public Health. Commenting on the size and longevity of the study, Ascherio said: “There is no comparable population in the world.”

Stanford University researchers believe that molecular mimicry may be the culprit behind why those infected with Epstein-Barr have a higher risk of developing MS. Molecular mimicry occurs when immune cells targeting EBV accidentally attack myelin, due to the molecular similarities between the virus and this tissue. A 2018 study identified EBV-infected B cells in the brains of MS patients, lending support to the molecular mimicry theory.

Deficiency of vitamin D from the sun may also play a role in the development of MS. Image courtesy of Minnesota Oncology.

Multiple Sclerosis: Vitamin D Deficiency and Genetic Factors

It’s unlikely that EBV is the sole reason behind the development of MS, however. The study suggests that EBV seropositivity is necessary to develop MS, but it isn’t sufficient – otherwise, 95% of the world’s population would have MS, since the virus is prevalent worldwide. According to the UK-based Multiple Sclerosis Trust, an estimated 2.5 million people worldwide have multiple sclerosis. So why do only some people develop MS and not others?

Another theory about the development of MS is vitamin D deficiency. Vitamin D, also known as the sunshine vitamin, may be a protective compound against the development of MS; it has been found, for instance, that the distribution of MS around the world is uneven; generally, the prevalence of the disease increases as you travel further north or south from the equator. The parts of Asia, Africa and America that lie on the equator have extremely low levels of MS, while Canada and Scotland have particularly high rates. This suggests that vitamin D, particularly from the sun, is important in preventing MS, possibly due to its anti-inflammatory properties.

Other studies have shown that certain ethnic groups have a markedly lower prevalence of MS, despite living in places where the disease is more common. For example, the Sami or Lapps of northern Scandinavia, the Inuits of Canada and Greenland (Denmark), and the Maoris of New Zealand exhibit very low rates of MS, despite living in some of the northernmost and southernmost climates in the world.

The Inuit people of Canada and Greenland have very low rates of MS among their population, despite living in some of the northernmost regions of the world. Photo courtesy of The Paleo Diet.

Multiple Sclerosis and Diet

Another theory that has evolved is the relationship between Multiple Sclerosis and one’s diet. As noted above, many northernmost communities do not get sufficient vitamin D from the sun, due to their local climate. However, they make up for this by consuming a vitamin D-rich diet; for example, fish and marine mammals like seal and whale. These foods are also rich in healthy omega-3 fatty acids, which are also known to have anti-inflammatory properties and may help other autoimmune conditions beyond MS, like rheumatoid arthritis, Crohn’s disease, ulcerative colitis, and systemic lupus erythematosus.

Although considered controversial to some, Dr. Terry Wahls, who has multiple sclerosis herself, developed a dietary approach to treating autoimmune conditions with paleo principals, which she calls the Wahls Protocol.

New Ways to Treat MS

Ascherio, for his part, believes that his team’s groundbreaking research on the connection between viruses like Epstein-Barr and MS could pioneer the development of new multiple sclerosis treatments. For example, immunosuppressive therapies that deplete B cells infected by EBV.

There is also renewed interest in developing vaccines and antivirals against EBV with the objective of eradicating MS. While antivirals targeting EBV don’t yet exist, Ascherio says their development is realistic: “Once you establish the causal connection, I think it’s a question of providing sufficient rational for research on antivirals, specifically for EBV, that could help people with MS [around] the world,” he concluded.

Woman with Rare Autoimmune Disease Affecting Eyes Describes Diagnosis Journey

Emma Zaks was a 33-year-old fitness instructor when she began experiencing debilitating symptoms of a rare, undiagnosed autoimmune disease.

Emma Zaks was 33 years old and living in New York City. As a fitness instructor at SoulCycle, she taught up to 18 spin classes per week, and was in terrific shape. That’s why Zaks was taken by surprise when, in the middle of teaching a spin class, she had to leave to throw up. Unable to continue the class with the debilitating stomach pains and nausea she was experiencing, she took an ambulance from her work to the ER.

After a few tests, including a colonoscopy, an endoscopy, and CT scans, Zaks was told that she likely had an infection affecting her stomach or intestines, and was given antibiotics and discharged after a six-day stay in hospital. The antibiotics didn’t work, however, and she woke up to a terrifying sight in the mirror: her right eye was pointing sideways. She was also seeing double.

Zaks woke up to impaired vision as a result of a stroke. She didn’t know it yet, but she suffered from a rare autoimmune disease.

Zaks later learned that she had had a stroke. Doctors prescribed her steroids, and covered her right eye with an eye patch to help her see straight. She was discharged from hospital, but Zaks’ troubling symptoms continued. “I found myself back at home, sicker than I’d ever been, and without a single real explanation. For two weeks, I lived and worked with continuing pain,” she explained.

She returned to the ER a third time, and an X-ray revealed that she had a stricture – her small intestines were abnormally narrow and had twisted around themselves, preventing anything from passing through. She received laparoscopic surgery to correct the stricture, and a biopsy to explore her condition further.

While awaiting her biopsy results, Zaks had an MRI done, which revealed a small lesion in her brain that controls eye movement and direction. Both her MRI and biopsy results lead doctors to diagnose Zaks with an autoimmune disease known as Wegener’s Vasculitis, or Granulomatosis with polyangiitis. The autoimmune condition had caused her stroke and her initial gastrointestinal issues.

Zaks went from being an active fitness instructor to a ‘shell’ of her former self.

“In a matter of months I’d become a shell of myself both externally and internally,” Zaks said. Her new treatment regimen included intense steroids and Rituxan infusions. She dropped to 95 pounds, was extremely weak, and always off balance due to her compromised vision.

Doctors offered few treatment options for her wayward right eye – which at this point, had been pointed sideways for a year. One medical provider even suggested Botox as a way to paralyze her eye muscles. Thankfully, she eventually found a physician that performed strabismus surgery, sewing the eye muscle to the wall of her eye, thereby fixing her vision.

Zaks was able to return to her job as a SoulCycle fitness instructor, and is grateful for her newfound health. “Since the surgery, I have to remind myself not to take for granted the everyday activities that used to drive me to tears in frustration,” she reflected.

Something else that has caused Zaks to reflect is the medical gaslighting she went through as part of her journey to diagnosis. “Knowing what I know now, I wish I had pushed harder for more answers, but who was I to question these doctors?” she lamented. “I hate confrontation and wanted to be a ‘good patient’ who was liked. So I took the prescriptions and advice to rest and went home, hoping for the best. Needless to say, things didn’t get better.”

Zaks believes it’s important to advocate for yourself as a patient, and trust your gut instinct. “If I had just listened to the initial diagnosis and prognosis, I would still be wearing an eye patch,” she declared.

To learn more about Zaks and her battle with Granulomatosis with polyangiitis, listen to her interview on the podcast Pregnantish.

10 Facts About Type 1 Diabetes

10 facts about type 1 diabetes. Image courtesy of the Nursing Times.

According to the Centers for Disease Control & Prevention (CDC), type 1 diabetes is an autoimmune disease in which the body’s own immune system destroys pancreatic beta cells that produce insulin. Without sufficient insulin, glucose levels build up in the blood and become too high, resulting in potentially life-threating symptoms. Read on to learn 10 interesting facts about type 1 diabetes.

1. T1D is less common than other forms of diabetes

Type 1 diabetes is less common than type 2 diabetes; approximately 5-10% of people living with diabetes have type 1. However, type 1 diabetes is far from a rare disease. According to Beyond Type 1, In the United States alone, 1.6 million Americans live with T1D, and an estimated 64,000 people are diagnosed with the condition each year. In fact, it is estimated that 5 million people will be diagnosed with T1D by 2050.

2. T1D is often diagnosed at a young age

Type 1 diabetes is usually diagnosed in children, teens, and young adults, but it can develop at any age. Because type 1 diabetes is caused by an autoimmune reaction, the destruction of beta cells can go on for months or even years before any symptoms appear in the patient. Type 1 diabetes can be diagnosed through a simple blood test, such as an A1C test, which measures your average blood sugar levels over the past 2-3 months. An A1C level of 6.5% or higher indicates you have diabetes.

3. There are several risk factors for T1D

Although the exact cause of type 1 diabetes is unknown, certain genes can make you more susceptible to developing T1D. Studies have shown, for example, that children with a genetic predisposition for and a family history of type 1 diabetes have more than a 1 in 5 risk for developing this autoimmune disease.

However, many people with these genes won’t go on to develop the condition even if they have a genetic predisposition. For that reason, environmental triggers, such as exposure to viruses, are also thought to play a part in the development of type 1 diabetes. Contrary to popular belief, diet and lifestyle habits do not cause type 1 diabetes.

4. Insulin is key to managing diabetes

T1D patients need to take insulin shots, or wear an insulin pump, every day to manage their blood sugar levels and get the energy their body needs. Patients with type 1 diabetes should work with their doctor to determine the most effective type of insulin and dosage that are right for them. Types of insulin range from ultra rapid-acting insulin, to rapid-acting, short-acting, intermediate-acting, long-acting, and ultra long-acting.

In addition, T1D patients also need to check their blood sugar levels regularly. By keeping their blood sugar levels close to a target determined by their physician, patients can prevent or delay further complications. Blood sugar levels can be monitored through the use of a blood glucose monitor and finger sticks, or a continuous glucose monitoring (CGM) system.

5. T1D causes a variety of symptoms

Type 1 diabetes symptoms can vary from patient to patient. According to the Mayo Clinic, some signs and symptoms of type 1 diabetes include: increased thirst, frequent urination, bed-wetting in children, extreme hunger, unintended weight loss, bacterial and fungal infections of the mouth, gum disease, irritability and mood changes, fatigue and weakness, and blurred vision.

Another common complication of type 1 diabetes is hypoglycemia, otherwise known as low blood sugar. This occurs when the patient has too much insulin, or has waited too long for a meal or snack, or simply hasn’t eaten enough food. It can also be caused by getting extra physical activity.

6. T1D can be disabling

Type 1 diabetes can result in complications affecting various bodily systems. For example, T1D can cause nerve damage, also known as neuropathy. Symptoms include tingling, numbness, burning or pain in one’s extremities. This can also cause gastrointestinal issues, like nausea, vomiting, diarrhea, or constipation. In men, erectile dysfunction can be an issue.

Foot damage may also occur, as a result of poor blood flow to or nerve damage in the feet. If not treated, cuts and blisters in the feet can turn into serious infections that may require limb amputation.

T1D may also cause kidney damage, resulting in kidney failure or irreversible end-state kidney disease, which requires dialysis or a kidney transplant.

It’s less commonly known that type 1 diabetes can also cause eye damage. The blood vessels of the retina become damaged (called diabetic retinopathy), potentially causing blindness. Diabetes also increases the risk of developing other vision conditions, like cataracts and glaucoma.

7. T1D can be life-threatening

Type 1 diabetes can in fact be life-threatening. For instance, T1D can cause cardiovascular problems like high blood pressure, coronary artery disease, chest pain (angina), atherosclerosis (narrowing of the arteries), heart attack, and stroke.

Another life-threatening complication of type 1 diabetes is diabetic ketoacidosis (DKA), a state in which your body cannot use the sugar in its bloodstream to produce energy, so it starts to break down fat as fuel. This causes ketones to be released into the body. If the level of ketones in your body becomes excessively high, this can result in a coma or even death. Some warning signs of DKA include dehydration, extreme thirst, flushed skin, nausea, stomach pain, vomiting, shortness of breath, fruity-smelling breath, and disorientation.

8. Lifestyle changes can make a difference

Although type 1 diabetes isn’t caused by poor diet or lifestyle habits, maintaining healthy lifestyle habits can go a long way to improving your overall health and wellbeing. Such habits include stress reduction, getting sufficient sleep, making healthy food choices, being physically active, and controlling your blood pressure and cholesterol levels.

Maintaining a close working relationship with your medical care team, and regularly attending your appointments, are also important in managing your type 1 diabetes. Your care team may include your primary care physician, endocrinologist, podiatrist (foot doctor), ophthalmologist and optometrist (eye doctors), dentist, pharmacist, registered dietician, and more.

9. Type 1 diabetes can develop during pregnancy

Type 1 diabetes may develop in women who are pregnant, a condition referred to as gestational diabetes. This occurs when blood sugar levels become high during pregnancy. Gestational diabetes affects up to 10% of women who are pregnant in the US each year. While gestational diabetes does go away after giving birth, it can impact your baby’s health, and raises your risk of developing type 2 diabetes later in life.

10. There is hope

If you are a type 1 diabetes patient, it’s important to get the support and resources you need to manage daily life with the condition. Here are a few resources that may help:

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