This presentation was part of the Chicago Wellness for MS Forum held Saturday April 22, 2023

Dr. Block, MS Fellow at the University of Chicago, presents How the Inside and Outside Environment Affects MS. Her discussion includes information about the Gut Microbiome, Epstein-Barr Virus, Obesity, Tobacco Use, Vitamin D, Organic Solvents, and Shift Work.

Watch the full presentation: How Inside and Outside Environment affects MS

The Gut Microbiome is a key factor in MS

The gut microbiome is made up of the microorganism that live in our intestinal track. It manifests throughout the body and can elevate inflammation, which impacts MS. People with MS have a different microbiome than people without MS. There is a bacteria Clostridium perfringens that produces the epsilon toxin in people with MS. They have double the amount in their gut on average. Epsilon toxin is thousands folds more prevalent in the guts of people with MS than those without MS.

One way to induce the mouse version of MS is to use a toxin to cross the blood-brain barrier. Researchers used the epsilon toxin and found it created a new model of MS in the mice that mimics MS in humans better than any other model.

To strengthen the gut microbiome, a group at the University of Chicago advises people with MS to eat a diet high protein, low in sugar, and to take a probiotic with more than one type of bacteria in it.

Exposure to the Epstein-Barr Virus is required to develop MS

Epstein-Barr virus (EBV) is a herpes virus usually acquired asymptomatically as a child or as mononucleosis as an adolescent. It’s impossible to get rid of and everyone with MS has EBV in their blood. Over 95% of adults have EBV and most don’t have MS. We don’t know how EBV relates to MS but it’s multifactorial. There is likely an interaction between genes and the EBV. There’s more research underway to see if drugs that target EBV in the body affect MS and if MS can be prevented through an EBV vaccine.

Obesity is a risk factor for developing multiple sclerosis

MS is an inflammatory disease where the immune system is overactive. Obesity is pro-inflammatory. Obesity impacts our ability to use vitamin D. We know that adolescent years are key so obesity in adolescence increases risks of developing MS two fold. If a person has a predisposition like a family member with MS and they are obese they have a 14 fold increase in risk for developing MS. Abdominal obesity increases severe disability by 50% compared to people with MS who don’t have excess belly fat. It’s important to exercise and follow a healthy diet to stay at a healthy weight.

Smoking and tobacco use exacerbates MS

Tobacco smoking is pro inflammatory. Smoking increases the risk of developing MS both from active and passive or secondary smoke. The more exposure the higher the risk. Rate of disability and symptom progression are increased greatly 1.5 to 2 times faster than in non smokers. Some DMTs are less effective in people who smoke tobacco. Some smokers develop antibodies to Tysabri (natalizumab) and some interferons that make these drugs less effective. We don’t see the same risk in people who use oral tobacco like snuff, although there are other health risks with those product.

If you use cannabis, it’s best to use more CBD than THC and better to go to a dispensary than the black market. It’s better to use topical creams or ingest oral cannabis like gummies rather than smoking it which is inflammatory.

Vitamin D is key in preventing and regulating MS

Vitamin D promotes calcium absorption and is needed for healthy bones. People who contracted Covid-19 and had high vitamin D levels did better than those with low levels. Vitamin D reduces inflammation. Those with low vitamin D living at a more southern or norther latitude away from the equator are at a higher risk of MS due to less UVB and summer sun exposure. The risk is most pronounced in vitamin D levels in adolescence. Children who immigrate from a country of low risk to a country of high risk during their childhood years actually will carry the risk of the the high-risk country despite living in a low-risk country for part of their early life if they immigrate before adolescent years. The opposite also holds true. A child who lives in a low risk country and moves to a high-risk country in adulthood is less likely to develop MS. The genes related to MS are related to vitamin D regulation.

The research suggested that early in MS low vitamin D leads to more disability, more relapses and more disability down the line. It’s recommended that all people with MS take supplements to get their levels to between 40ng/ml and 100ng/ml. Check your levels regularly with blood tests.

Vitamin D toxicity is very rare, is only shown in levels above 250ng/ml and can cause kidney stones. The best source of vitamin D is the sun. Expose your arms and legs for 15 minutes per day without sunscreen to get UVB exposure. Only apply sunscreen after 15 minutes in the sun as your body cannot make vitamin D if you’re wearing a UVA/UVB blocking sunscreen.

Food sources of vitamin D include oily fish, egg yolks and fortified foods. Most people needs a supplement of D3 of 3,000IU to 10,000IU per day. It’s also important for the children of people with MS to take a supplement and get out in the sun to reduce their risk of developing multiple sclerosis.

Organic solvents may exacerbate multiple sclerosis

Organic solvents are liquids with carbon dissolved in them such as dry cleaning chemicals, paint thinner, nail polish remover, glue solvents, spot removers and perfumes. These cause lung inflammation like tobacco use. If you have a family history of MS, you should try to reduce your exposure to organic solvents wherever possible.

Shift work contributes to the onset of MS and affects disease progression

Shift work is defined as any nontraditional working hours like the night shift (working after 9pm or before 7am) or working inconsistent shifts at different times throughout the week. If you are a shift worker before age 20 your risk of developing MS is increased by 70%. If you do shift work after age 20, your risk increased by 20%. It’s very important to maintain good sleep hygiene and keep to your circadian rhythm. If you have MS or have relatives with MS and are at a higher risk of developing MS, it’s best not to engage in shift work.

Allison N. Block, DO is a Multiple Sclerosis Fellow at the University of Chicago. She went to Medical School at Des Moines University. She recently completed her neurology residency at the Medical College of Wisconsin in Milwaukee. She is currently doing a clinical fellowship in multiple sclerosis at the University of Chicago. Dr. Block has a special interest in a mimicker of MS called anti MOG associated disease. Next year, she will be practicing with Edward Elmhurst in Naperville, where she lives with her spouse and toddler.