Select Studies on Multiple Sclerosis (MS) and Supplementation
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Supplement Studies and
Multiple Sclerosis (MS)
Introduction to MS
Multiple sclerosis (MS) is an autoimmune disease that affects the central nervous system. The immune system malfunctions and begins to attack the myelin sheath that protects nerve fibers. This leads to communication problems between the brain and the body resulting in a number of symptoms including fever, visual impairment, and coordination issues. The disease is progressive and characterized by relapses followed by periods of recovery. [Ref #1]
Correlative Studies of Multiple Sclerosis (MS) and Epstein-Barr Virus (EBV)
Epstein-Barr Virus (EBV) is a member of the herpes family of viruses and is also known as human herpesvirus 4. The virus can lead to a number of health issues, most notably mononucleosis, more commonly known as “mono” or “glandular fever”. Following infection, the virus typically becomes inactive, existing in a latent state, and the infected person does not exhibit any symptoms. If a person does experience symptoms, as a result of reactivation, they are typically fatigue, fever, and sore throat making it difficult to distinguish EBV reactivation from other illnesses. [Ref #2] For more information on Epstein-Barr Virus see the Epstein-Barr Virus Overview.
The scientific community has observed a connection between Epstein-Barr Virus and multiple sclerosis. People who experience a reactivation of EBV in the form of mononucleosis may have an increased risk of developing MS [Ref #1]
“Infectious mononucleosis, which is caused by delayed primary EBV infection, increases the risk of developing MS. EBV may also contribute to MS pathogenesis indirectly by activating silent human endogenous retrovirus-W. The emerging B-cell depleting therapies, particularly anti-CD20 agents such as rituximab, ocrelizumab, as well as the fully human ofatumumab, have shown promising clinical and magnetic resonance imaging benefit. One potential effect of these therapies is the depletion of memory B-cells, the primary reservoir site where EBV latency occurs. In addition, EBV potentially interacts with both genetic and other environmental factors to increase susceptibility and disease severity of MS.” [Ref #1]
Monolaurin and EBV
Given the prevalence of EBV, some studies have explored the immune supporting potential of select supplements in conjunction with EBV. One such supplement is called monolaurin.
Monolaurin is a supplement formed from the medium-chain fatty acid “lauric acid”. Lauric acid occurs naturally in coconut oil and mother’s breast milk but can also be taken in the form of monolaurin as a dietary supplement. Studies suggest monolaurin may possess various immune supporting benefits. [Ref #3]
For more in-depth information on monolaurin visit the Monolaurin Essential Guide.
EBV belongs to the herpes family of viruses. Laboratory studies suggest monolaurin may inactivate select virus types, including herpes family viruses, in controlled settings.
“The body converts lauric acid into monolaurin (a Fat otherwise found in breast milk) which has anti-viral, anti-bacterial and anti-protozoa properties. Monolaurin is a monoglyceride that can actually destroy lipid coated viruses such as [redacted], herpes, measles, influenza virus, various pathogenic bacteria, protozoa such as giardalamblia.” [Ref #3]
This study demonstrated the potential of monolaurin to inactivate lipid coated viruses in the lab including herpes viruses. Another study explored the potential of medium chain fatty acids like monolaurin with respect to the reactivation of EBV once it has been contracted.
“In fact, our data suggest that MCFAs (Medium Chain Fatty Acids), such as VPA (Valproic acid) and phenylbutyrate, may be used to block EBV lytic reactivation….Given the effects we observed on EBV and KSHV (Kaposi's sarcoma-associated herpesvirus) lytic reactivation, dietary sources of fatty acids may also be considered for treating virus-associated cancers.” [Ref #4]
Using Monolaurin Safely
As with all dietary supplements, monolaurin should be taken under the direction and supervision of a healthcare professional. It is especially important to note that those already diagnosed with multiple sclerosis may experience adverse effects from the use of medium chain fatty acts (including monolaurin) as evidenced by the following studies.
“Medium-chain fatty acids (MCFA), including caproic acid (CA), promote TH1 and TH17 differentiation, thus supporting inflammation…The gut microbiota dysbiosis found in MS is possibly associated with alterations of the SCFA (short-chain fatty acid) /MCFA ratio and of the intestinal barrier; this could explain the chronic inflammation that characterizes this disease.” [Ref #5]
and
“In summary, these findings indicate that SCFAs (short-chain fatty acids), either dietary or formed by the microbiota, may have therapeutic value for MS by inducing Treg cells. In contrast, diets rich in particular medium‐chain fatty acids (MCFAs), long‐chain fatty acids (LCFAs), and very‐long‐chain fatty acids (VLCFAs) species may exert a detrimental effect on MS disease progression.” [Ref #6]
While monolaurin may be a potential supplement for some healthy individuals, caution must be observed if you think you may be suffering from MS.
MS and
Other Supplements
Other supplement studies and MS
Vitamin D is essential and responsible for many crucial biological functions including calcium absorption. Nearly half the world population has Vitamin D insufficiency. Studies have found that Vitamin D plays an essential role in several chronic diseases. There is a large body of research that suggests Vitamin D insufficiency may be a factor with relation to MS, especially those already diagnosed with the autoimmune disease. [Ref #7]
Vitamin D and Multiple Sclerosis (MS)
A study conducted over six months on multiple sclerosis patients found that Vitamin D supplementation had a beneficial effect on immune regulation in diagnosed patients.
“Six month supplementation with vitamin D3 increased levels of 25-hydroxyvitamin D and TGF-β1 in the sera of MS patients. These two positive beneficial results suggest that vitamin D supplementation could be beneficial in patients with MS. The immune system seems to be one of the systems that require vitamin D at some unknown concentration for optimal performance. The evidence continues to accumulate supporting a link between vitamin D, immune regulation, and MS.” [Ref #8]
A second study conducted on 132 multiple sclerosis patients observed the effects of Vitamin D supplementation on T cells. T cells and their balance is critical to the body’s immune response. The study found that Vitamin D supplementation can aid in achieving T cell homeostasis.
“Proliferation of both freshly isolated CD4+ T cells and MBP-specific T cells was significantly inhibited by 1,25(OH)2D3. Moreover, activated Vitamin D enhanced the development of IL-10 producing cells, and reduced the number of IL-6 and IL-17 secreting cells. Notably, Vitamin D receptor expression was induced by 1,25(OH)2D3 in both activated and resting cells. Interestingly, T cells were able to metabolize 25(OH)D3 into biologically active 1,25(OH)2D3, since T cells express α1-hydroxylase constitutively. Finally, 1,25(OH)2D3 also increased the expression and biological activity of indoleamine 2,3-dioxygenase, mediating significant increase in the number of CD4+CD25+ T regulatory cells. Collectively, these data suggest that 1,25(OH)2D3 plays an important role in T cell homeostasis during the course of multiple sclerosis, thus making correction of its deficiency may be useful during treatment of the disease.” [Ref #9]
A clinical study conducted on 468 multiple sclerosis patients over the course of five years had incredible results. It found that not only did Vitamin D supplementation lead to less MS activity, but it also slowed brain atrophy, clinical progression and lessened the MRI lesion load of the patients over the five years.
“By the end of the follow-up at 60 months, those patients with serum 25(OH)D concentrations greater than or equal to 50 nmol/L had a 4-times lower change in T2 lesion volume, a 2-fold lower rate of brain atrophy, and lower disability than those below 50 nmol/L. Although associations were generally stronger for MRI than for clinical outcomes, the latter were still remarkable considering the overall low rate of relapses (0.2 per year) and small EDSS score change (median change, 0.0) in BENEFIT…..It is also noteworthy that the inverse relation of 25(OH)D levels with development of MS, relapses, and MRI measures was observed in a population being treated with IFNB-1b, which had a considerable impact on these outcomes in the present study…In summary, in this large longitudinal study among patients with CIS randomized to early vs late treatment with IFNB-1b, we found that higher serum 25(OH)D levels robustly predicted a lower degree of MS activity, MRI lesion load, brain atrophy, and clinical progression during the 5 years of follow-up.” [Ref #10]
More research has been conducted on the effects of Vitamin D supplementation with regard to relapse of multiple sclerosis. One such study found that Vitamin D significantly decreased the exacerbation rates for the disease and offered the potential of a beneficial effect on the diseases course.
“Exacerbation risk decreased significantly with higher serum vitamin D levels: respective relative exacerbation rates for the medium and high-level category as compared to the low-level category were 0.7 and 0.5 (p value for trend: p = 0.007). The association between 25-OH-D concentrations and exacerbation rate was log linear without a threshold. With each doubling of the serum 25-OH-D concentration the exacerbation rate decreased by 27% (95% confidence interval 8%–42%, p = 0.008)….Our finding that higher vitamin D levels are associated with decreased exacerbation risk in relapsing-remitting MS suggests a beneficial effect of vitamin D on disease course in MS.” [Ref #11]
A second study observed the effects of Vitamin D supplementation on the incidence of relapse in people diagnosed with MS. The results were significant, finding that Vitamin D considerably reduced the chance of relapse in patients.
“Pooling data collected before and during supplementation, we found a significant strong inverse relationship between the relapse incidence rate and the 25-OH-D level (p < 0.0001), suggesting that vitamin D did indeed influence the relapse rate. Results of univariate, bivariate and multivariate analyses were analogous: in the multivariate model adjusted for age, disease duration and previous use of immunomodulatory therapy, every 10 nmol increase in 25-OH-D level was associated with a reduction in the relapse incidence rate of 13.7%.” [Ref #12]
Conclusion
Multiple sclerosis can be a debilitating disease and these studies suggest an important relationship between Vitamin D and its potential role as a therapeutic agent against MS. Further study is needed but the existing body of research offers hope that Vitamin D has the potential to slow the progression of multiple sclerosis, reduce the incidence of relapse, and alleviate some of the symptoms.
Dietary supplements should be taken under the direction and supervision of a healthcare professional.
References
Guan, Yi et al. “The role of Epstein-Barr virus in multiple sclerosis: from molecular pathophysiology to in vivo imaging.” Neural Regeneration Research. 2019.
“About Epstein-Barr Virus (EBV).” Center for Disease Control and Prevention, US Department of Health and Human Services, May 8, 2018.
Ezigbo, Veronica O., Mbaegbu Emmanuella A. “Extraction of Lauric Acid from Coconut Oil, Its Applications and Health Implications On Some Microorganisms. African Journal of Education, Science and Technology.” April, 2016.
Gorres, K L, et al. “Activation and Repression of Epstein-Barr Virus and Kaposi's Sarcoma-Associated Herpesvirus Lytic Cycles by Short- and Medium-Chain Fatty Acids.” Journal of Virology, July 2014.
Saresella, Marina, et al. “Alterations in Circulating Fatty Acid Are Associated With Gut Microbiota Dysbiosis and Inflammation in Multiple Sclerosis.” Frontiers in Immunology, 7 July 2020.
Matveeva, Olga, et al. “Western lifestyle and immunopathology of multiple sclerosis.” Annals of the New York Academy of Sciences, 2018.
Nair, Rathish, and Arun Maseeh. “Vitamin D: The "sunshine" vitamin.” Journal of Pharmacology & Pharmacotherapeutics, 2012.
Mahon, B. D., et al. “Cytokine Profile in Patients with Multiple Sclerosis Following Vitamin D Supplementation.” Journal of Neuroimmunology, Jan. 2003.
Correale, Jorge, et al. “Immunomodulatory effects of Vitamin D in Multiple Sclerosis”. Brain, May 2009.
Ascherio A, et al. “Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression”. JAMA Neurology, 2014.
Runia, Tessel F, et al. “Lower Serum Vitamin D Levels Are Associated with a Higher Relapse Risk in Multiple Sclerosis.” Neurology, July 2012.
Pierrot-Deseilligny, Charles, et al. “Relationship between 25-OH-D Serum Level and Relapse Rate in Multiple Sclerosis Patients before and after Vitamin D Supplementation.” Therapeutic Advances in Neurological Disorders, 17 May 2012.