Karin Nortje: MS diagnosis in 2006; part of MS program since 2006; ran the Two Oceans Halfmarathon in 2013, 2014 and 2015; Cape Town Marathon in 2018; and completed Two Oceans Ultramarathon in 2019.

Multiple sclerosis (MS) is generally considered to be an autoimmune disease which invariably results in disability. Recently the autoimmune theory has been criticised, in view of the fact that a specific diagnostic antigen has never been found that would be able to activate the immune cells (in other words there is no blood test for MS as is the case with other autoimmune diseases). If the autoimmune theory is unproven, which alternative theory may be suggested, and could there be a way to arrest disability in MS, or even turn it around? Researchers have found that a nutritional element is involved in disability related to MS. When brain cells are maintained through nutrients and lifestyle-related factors, such as a Mediterrean diet, which includes moderate consumption of red wine, combined with exercise, disability may be overcome.

The autoimmune theory contends that activated immune cells attack the sheath (myelin) of the nerve fibres (axons), which results in interruptions in signal transduction from the brain to the body. The inability to arrest disability from this theoretical framework has inspired researchers to suggest an alternative theory.

The clinical picture of MS looks a lot like loadshedding. The symptoms start for example with double vision or blindness, which clears up after cortisone treatment, whereafter a temporary paralysis in an arm or a leg may occur. Then it may manifest in bladder problems or balance. At the same time white lesions appear in the brain or spinal cord which are visible through magnetic resonance (MRI). These lesions are an indication of cells that have died, and cause an inflammatory reaction. General death of cells further causes the brain to shrink at 0.7% per annum, compared to a 0.1% shrinkage due to old age. This is a serious matter, since it may result in disability and consequently it is important to determine the cause and to find ways of arresting cell loss and disability in MS, or even turn it around. The medications that are currently available are not licensed to arrest disability. They are nevertheless licensed to reduce relapses and give a better outcome as far as the increase in the number of lesions is concerned.

To take the loadshedding analogy further, one should pay careful attention to the damage in myelin. Myelin (or white matter) is produced by specialised cells (oligodendrocytes) that occur all along the axons, and surround the axons with myelin. However, myelin is far more than an isolation material such as the plastic covering of electrical wires. It is involved in electrical conduction and increases the signal transduction of the axons. Myelin forms the basis of the “bandwidth” of the brain’s “computer capacity”. The difference between the human brain and that of a chimpanzee is the fact that humans have 20% more white matter relative to grey matter. The myelin is therefore involved in cognitive capacity, as well as physical abilities. If the signals have to increase, such as for example when one learns to play the piano, then the structure of the myelin improves to comply with the demand for increased conductivity. The oligodendrocytes can therefore be considered to be “power stations” that provide the electrical capacity required by the body. The electricity is generated by mitochondria that occur within the oligodendrocytes.

Just like the power stations in Eskom’s electricity network have to be maintained, the oligodendrocytes require ongoing maintenance. The generation of power requires oxygen, iron, vitamin B12 and folic acid, as well as antioxidants, which have to constantly counter oxidation (“rust”). Vitamin D is required for many reactions, such as controlling inflammation. Furthermore copper, zinc and magnesium also form part of the power generation mechanism of the mitochondria. Essential fatty acids and lecithin form part of the structure of the oligodendrocytes. The uptake of nutrients from food is genetically controlled and the provision of nutrients to brain cells occurs through the blood vessels.

 

The ethically approved MS project of Stellenbosch University, which is supported by Winetech, has the following objectives:

  • To conduct research to determine whether genetic aberrations or environmental factors may impact on the availability of nutrients, and
  • To empower patients with knowledge about taking responsibility for their health by maintaining the oligodendrocytes and protecting them against toxic substances, such as inhalation of cigarette smoke (active or passive smoking).

 

The results obtained so far are very encouraging. The project has been running for about 20 years. We have found that people with an MS diagnosis who make sure that they ingest sufficient amounts of iron (but not too much) to keep their iron levels within normal parameters, who regularly supplement their vitamin B12, vitamin D and essential fatty acids, and who include sufficient amounts of folic acid and antioxidants (fruit and vegetables) in their diet on a daily basis, are protected against disability and have a normal neurological outcome. For such people it is therefore not true that their MS diagnosis condemns them to experience disability.

Neurological outcome in MS is measured by means of the EDSS. Dr Clint Johannes, an MMed student on the project, conducts the EDSS tests. It comprises an objective measurement that has to be done by a doctor. On a scale of 0 to 10, a lower figure indicates reduced disability. Our research shows that the same factors which cause heart disease are also involved in disability in MS.

Increased physical exercise is also very beneficial. A few patients participating in our project regularly run athletic races, for example Karen Nortje, who was diagnosed with MS in 2006. She completed the most recent Two Oceans Ultramarathon of 56 km (see photo).

Such unexpected outcomes for patients diagnosed with MS years ago cause confusion in medical circles. Recently studies were published showing that approximately one in five MS patients were incorrectly diagnosed with MS.

Our research project, “The role of moderate alcohol consumption in promoting improved disease outcome in multiple sclerosis (MS); an investigation involving transformation training to persons from previously disadvantaged groups in South Africa”, aims to carefully analyse the diagnosis of 22 MS patients to examine their initial diagnoses. Clear guidelines exist in the literature according to which people are diagnosed with MS. Dr Coenie Hattingh, a post-doctoral fellow, and Mariaan Jaftha, an MSc student, will do the MRI analyses. Merlisa Kemp is currently doing her PhD on the health of the vascular system in these patients using ultrasound examination of the neck vessels. In her MSc study Merlisa showed that the thickness of the intima media of the carotid artery walls correlate significantly with the EDSS, in other words that the health of the arteries impacts disability outcomes. We hope to confirm this finding in the PhD study.

Our hypothesis is that a nutritional element is involved in MS disability, rather than an autoimmune-driven process. Our study shows that at the time of diagnosis patients often follow a deficient lifestyle and diet and that their outcome improves when these factors are remedied. The original diagnoses may therefore possibly have been correct, with the outcome having been remedied through adjustments in lifestyle. It is an exciting study and we look forward to interesting results.

 

– For more information, contact Prof. Susan Janse van Rensburg at sjvr@sun.ac.za.

 

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