A Holistic Functional Medicine Protocol For Multiple Sclerosis

Multiple sclerosis is an autoimmune neurological disease that affects approximately 400,000 Americans and 2.5 million individuals worldwide. It is responsible for long-term disability due to neurological dysfunction that results from the autoimmune process. (15)

While there is no known cure for multiple sclerosis, many treatments are available to slow disease progression, palliate symptoms, and improve the quality of life in those diagnosed with the disease. A functional medicine and integrative protocol aims to identify and address causative factors known to contribute to disease onset and progression.

[signup]

What Is Multiple Sclerosis?

Multiple sclerosis (MS) is a chronic neurological disease affecting the brain and spinal cord, collectively comprising the central nervous system. MS is an autoimmune disorder, caused by the immune system mistakenly attacking myelin, the protective covering of nerve fibers. Myelin acts as an insulating sheath around nerve fibers and helps to facilitate the transmission of electrical signals between the brain and the rest of the body. When the myelin is damaged or destroyed, the normal flow of nerve signals is disrupted, leading to the symptoms and complications associated with MS. (12) 

MS can progress in different ways, classifying the four types of the disease, including clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS), primary progressive MS (PPMS), and secondary progressive MS (SPMS). The course of the disease and the severity of symptoms can vary greatly among individuals.

Multiple Sclerosis Signs and Symptoms

The symptoms of MS can vary widely from person to person and can also change over time. RRMS, the most common form of MS, is characterized by relapses (periods of symptomatic flare-ups) followed by remission (symptom-free periods). PPMS and SPMS lead to progressively worsening neurological deterioration and symptoms without periods of remission. (6) 

The most common symptoms of MS include (19):  

• Fatigue
• A squeezing sensation around the torso, referred to as an MS hug
• Difficulty walking due to muscle weakness, spasticity, and loss of balance
• Numbness and tingling of the face, body, and extremities
• Vision problems
• Vertigo and dizziness
• Sexual dysfunction
• Bladder and bowel dysfunction
• Pain and itching
• Memory loss and difficulty concentrating
• Anxiety, depression, irritability, and mood swings

Less common symptoms that may occur in patients with MS include (19): 

• Speech problems, including slurring, stuttering, and loss of volume
• Loss of taste and hearing
• Difficulty swallowing
• Tremor
• Breathing problems
• Seizures

What Are the Possible Causes of Multiple Sclerosis?

The exact cause of MS is unknown, and it is unclear why it develops in some people and not others. However, as with other autoimmune diseases, it is speculated that a combination of environmental triggers can set off a cascade of immunological dysfunction and autoimmunity in genetically susceptible individuals.

Certain non-modifiable factors have been identified as increasing the risk of developing the disease. We know that MS affects women 2-3 times more than men. The onset of MS symptoms also tends to occur most commonly between ages 20-40. (20) 

While MS is not directly inherited, the disease has a genetic component. Individuals of Northern European descent and those with first-degree relatives with the disease are at a higher risk for developing it (20). Specific variations in the HLA region of the human genome have been strongly linked to an increased risk of developing MS. The HLA genes encode proteins that are crucial in regulating the immune system. The HLA-DRB1*15:01 allele is the most strongly associated with MS risk. In addition to the HLA genes, several other genetic variants have been identified as risk factors for MS. These include genes, such as IL2RA and IL7R, that are involved in immune system regulation and the maintenance of myelin. (14, 31)  

Several environmental factors are associated with the onset of MS. Exposure to viral and bacterial agents, including Epstein Barr virus (EBV), human herpesvirus 6 (HHV-6), and mycoplasma pneumonia, can trigger an autoimmune attack through a mechanism called molecular mimicry. Smoking, vitamin B12 and D deficiencies, and diets high in saturated fat have been identified as potential causes of this disease. (14) 

Imbalances in the gut microbiome, called dysbiosis, have been associated with various autoimmune conditions. While still an active area of research, recent evidence suggests that MS is no exception, and gut health plays a role in MS development. The gut microbiota modulates the immune system and influences various physiological processes. The gut and the brain are connected through the gut-brain axis, which involves bidirectional communication between the gut and the central nervous system. Changes in the gut microbiota can contribute to immune system dysregulation and inflammation, increasing the risk of MS. Some studies have reported differences in the gut microbiota composition of individuals with MS compared to those without the disease. While further investigation is required to more adequately establish a causal relationship, studies have also noted an increased prevalence of small intestinal bacterial overgrowth (SIBO) in patients with MS.

Functional Medicine Labs to Test for Root Cause of Multiple Sclerosis

Functional medicine tests play a critical role in managing MS by helping to uncover the root causes of immune dysregulation and inflammation responsible for MS. By ordering and interpreting the following tests, functional medicine providers are better able to customize treatment plans to reduce the severity of MS symptoms, slow progression of the disease, and improve quality of life.

Autoimmune Cross-Reactivity

The Array 7X test by Cyrex Laboratories is a blood test that detects various antibodies and immune system markers associated with MS, including those associated with demyelination, herpes viruses, and EBV.

Vitamins & Nutrition

Identifying and correcting nutritional deficiencies and imbalances is important in reducing MS risk, slowing disease progression, and preserving neurological function. SpectraCell's Micronutrient Test measures essential vitamins, minerals, antioxidants, and other nutritional biomarkers to comprehensively evaluate an individual's nutritional needs and status at the cellular level. Because a micronutrient panel may be cost-prohibitive for some, a serum vitamin D test can be a more affordable screening option for vitamin D deficiency.

Comprehensive Gut Assessment

A comprehensive stool analysis, like the GI-MAP + Zonulin test by Diagnostic Solutions or the GI Effects® Comprehensive Profile from Genova Diagnostics, assess the composition of the gut microbiome and measures various markers of overall gut health and integrity. Results can indicate imbalances stemming from the gut that perpetuate the inflammatory cycle of autoimmunity correlated with disease progression and severity.

Additionally, SIBO can be diagnosed with an at-home breath test, which measures various gaseous byproducts of bacterial fermentation within the digestive tract.

Additional Lab Tests 

While functional medicine testing can help achieve long-term goals for patients with suspected or confirmed MS, all patients with suspected MS should be referred to a neurologist for a comprehensive diagnostic evaluation to rule out MS mimics and confirm the presence of MS. MS diagnosis is based on hallmark findings of MRI imaging, lumbar puncture, and evoked potential tests. (13)

[signup]

Conventional Treatment for Multiple Sclerosis

While there is no cure for multiple sclerosis, many pharmacologic options are available to slow MS activity and progression, reduce the severity and duration of relapses, and treat the symptoms of MS. Treatment aims to reduce inflammation, manage symptoms, and prevent relapses. (16) 

Integrative Medicine Protocol for Multiple Sclerosis

Integrative medicine is an approach to healthcare that combines conventional medical treatments with complementary therapies to address the physical, emotional, and psychological aspects of health. For individuals with MS, integrative medicine can be a valuable addition to their overall care plan. It can help manage symptoms, improve quality of life, and support long-term health goals. Some studies have indicated that up to 67% of MS patients use complementary and integrative medicine to relieve symptoms and reduce relapses. In 2014, the American Academy of Neurology issued evidence-based guidelines for using cannabinoids, ginkgo biloba, low-fat diet with omega-3 supplementation, magnet therapy, reflexology, and bee venom therapy in treating MS.

Therapeutic Diet For Multiple Sclerosis

Studies have found that consuming a diet rich in fish is associated with a reduced risk of MS; conversely, a diet high in animal fat-based calories is linked to an increased risk of MS (14). The Swank diet is a dietary approach developed by neurologist and researcher Dr. Roy L. Swank for managing MS. Dr. Swank believed that reducing saturated fat intake could help slow the progression of MS and reduce the frequency and severity of MS relapses. Studies show that patients with MS who adhere to the Swank diet exhibit a lower risk for relapse, disease progression, and reduced mortality (24). 

Here are the fundamental principles of the Swank Diet:

• The diet aims to limit saturated fat intake to less than 15 grams (about 1.5 tablespoons of fat) per day. Saturated fats are primarily found in animal products such as red meat, dairy, and certain oils (e.g., coconut and palm oil). 
• While saturated fats are restricted, the diet encourages the consumption of unsaturated fats, including those found in fish, nuts, seeds, and plant-based oils like olive oil. These fats are considered healthier for cardiovascular and overall health.
• The diet includes lean protein sources, such as poultry, fish, and legumes, while limiting red meat and high-fat dairy products.
• A significant portion of the Swank Diet consists of anti-inflammatory fruits and vegetables, which are rich in vitamins, minerals, antioxidants, and fiber.
• Whole grains like brown rice, whole wheat, and oats are recommended as sources of complex carbohydrates and dietary fiber.
• The diet advises moderate alcohol consumption, if at all, and suggests avoiding excessive drinking.

Alternatively, the Wahls Protocol is a modified Paleo dietary and lifestyle approach developed by Dr. Terry Wahls to manage and improve the symptoms of MS and other autoimmune conditions. Dr. Wahls was diagnosed with MS and developed this protocol based on her personal experiences and scientific research. The protocol has three progressive diet stages, each with increasing levels of dietary restrictions. The stages help individuals gradually transition to the full Wahls Protocol. The WAVES trial demonstrated clinically significant improvements in fatigue and overall quality of life in patients following the Walhs Protocol for 12-24 weeks.

The core principles of the Wahls Protocol include:

• The Wahls Protocol strongly emphasizes consuming a nutrient-dense diet rich in whole foods, focusing on vegetables, fruits, lean proteins, organ meat, healthy fats, and fermented foods.
• The Wahls Protocol advises eliminating certain foods that are believed to trigger inflammation and immune reactions in individuals with autoimmune conditions. This includes gluten-containing grains, dairy products, and processed foods.

Best Supplements For Managing Multiple Sclerosis

Prescribing supplements for patients with MS should be highly individualized based on their lab results, history, and risk factors. For example, those with identified intestinal dysbiosis may benefit from natural antimicrobial and probiotic therapy to reestablish a healthy gut microbiome. Or, a trial of vitamin C and antiviral herbs can be recommended for those with chronic or reactivated EBV infection. Several supplements have been researched to be universally effective in treating and preventing the progression of MS and, therefore, should be considered as part of a foundational protocol for all patients with MS.

Vitamin D

Results of a 5-year randomized trial including 468 participants with MS suggest that low blood levels of vitamin D may be a risk factor for long-term disease activity and progression. Additionally, evidence suggests that people with vitamin D levels above 50 nmol/L were less likely to have relapses or new MRI lesions after five years. In addition to natural sunlight exposure, supplemental vitamin D can optimize serum vitamin D levels and exert immunomodulating effects to downregulate neurological autoimmune activity. 

Dose & Duration: Taking at least 400 IU of vitamin D daily has been shown to lower the risk of MS in women. If you are diagnosed with vitamin D deficiency, doses up to 50,000 IU weekly for up to three months may be prescribed. Once you've reached an optimal vitamin D level, switch to a maintenance dose of 2,000-5,000 IU daily. (8) 

Omega-3 Fatty Acids

Omega-3 fatty acids are polyunsaturated fatty acids that possess anti-inflammatory properties. Two of the most important omega-3 fatty acids are EPA and DHA, which provide a broad array of neurological benefits. Studies show that diets rich in omega-3 fatty acids are linked to lower MS rates and improved markers of inflammation and neurological health. However, most Americans do not meet the recommended daily dietary requirements for omega-3s. A 2019 systematic review concluded that using omega-3 and fish oil supplements to achieve the desired balance of omega-6 to omega-3 ratio and reducing inflammation led to reduced relapse rates and improved quality of life in MS patients. (22) 

Dose: at least 2,000 mg combined EPA & DHA daily 

Duration: Ongoing

Antioxidants

​​Antioxidants help protect cells from oxidative damage caused by free radicals, which are unstable molecules that can damage cells and contribute to inflammation. Antioxidant supplements may have potential benefits for people with MS, as reduced activity of antioxidant systems has been measured in the brain of patients with MS, and oxidative stress is believed to play a role in the progression of the disease. Various antioxidant compounds, including curcumin, flavonoids, melatonin, and resveratrol, have been shown to modulate immune responses to downregulate the production of inflammatory chemicals, prevent neuronal damage, and reduce neurological dysfunction. (18)

Dose: Varies, depending on the antioxidant formulation used

Duration: Ongoing

When to Retest Labs

The patient's clinical presentation and initial laboratory results will help guide appropriate recommendations for follow-up and retesting. Repeat testing is indicated in a month for patients with diagnosed vitamin deficiencies at baseline to assess if therapeutic interventions have been sufficient in normalizing serum levels. Otherwise, because autoimmune biomarkers take time to normalize with appropriate intervention, it is generally recommended to repeat labs within three to six months to monitor treatment progress. Lab findings should always be interpreted in the context of patient signs and symptoms to determine the appropriate course of treatment and modify treatment recommendations.

[signup]

Summary

Multiple sclerosis is a chronic autoimmune condition that can lead to debilitating neurological symptoms, disability, and reduced quality of life when left untreated. Functional medicine doctors are trained to work adjunctively with neurologists to identify modifiable risk factors contributing to MS's development and progression. The treatment plan outlined in this article exemplifies how functional doctors combine natural and complementary therapies to modulate the immune system, slow disease progression, prevent MS-associated complications, and improve health outcomes.