MS: Intestinal Bacteria On Stone Age Diet

28. November 2017
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Research shows that intestinal bacteria are linked to multiple sclerosis. An American doctor, suffering from MS herself, is investing efforts on a special diet which resembles the paleo diet. Her self-experiment will now be tested in a clinical trial.

Multiple sclerosis (MS) is an autoimmune disease. Here, misdirected cells of the immune system attack the body’s own cells in the brain and spinal cord. The attack carried out by auto-aggressive T-cells damages the affected neurons and leads to the degradation of their outer layer. Cells die and nerve stimuli are no longer transmitted correctly. Whether a person ends up suffering from MS or not depends on both genetic factors and environmental factors.

Factors triggering MS

“We have come to know more than 200 genes which make people susceptible to MS”, Hartmut Wekerle from the Max Planck Institute of Neurobiology in Martinsried (Germany),explains. “For an outbreak to occur, however, a trigger is required, something which has previously been looked for in their infective environment”. The already recognised disease-causing environmental factors include smoking, low levels of sunlight, and infection with the Epstein-Barr virus. With the advent of modern DNA sequencing methods, scientists are also for the first time discussing the involvement of intestinal flora in outbreaks of MS. “The whole thing is growing so fast at the moment that I am absolutely sure that we can no longer ignore the intestine when it comes to the treatment of diseases”, according to Prof. Aiden Haghikia, neurologist at St. Joseph Hospital of Ruhr University in Bochum (Germany).

No concrete conclusions on gut microbiota analysis possible

As early as 2011 Wekerle working together with his colleagues was able to demonstrate a connection between intestinal flora and MS. To do this, they studied mice which were genetically engineered during the course of their lives through T-cell activation to spontaneously fall ill with an MS-like condition. However, when the mice were kept in germ-free conditions, none of the genetically modified animals fell ill. In contrast, mice which had grown to maturity with normal intestinal flora fell ill within three to eight months. Only the intestinal flora therefore came into question as a potential trigger. Subsequently, numerous research groups analysed the differences in the bacterial composition of healthy and MS sufferers – with moderate success:

“The genetic diversity of these people and their intestinal flora made it very difficult to draw concrete conclusions from the results”, according to Wekerle. “In addition, the presence of a particular microorganism in MS patients does not really say anything about whether this actually carries out a function in disease development. This question can only be clarified with the help of animal experiments”.

Twin study reveals causality

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Studies of twins show that natural intestinal flora has an influence on whether a person suffers from multiple sclerosis (left). A central role is played here by T-cells (blue). © MPI f. Biochemistry/ Menzfeld

The researchers led by Wekerle succeeded recently in a further study in proving the involvement of the intestinal flora in the development of MS. To do so, they used stool samples from more than 50 identical twins, one of whom in each pair had MS, the other did not. In genetically identical twins, the influence of human genes on intestinal flora in pair comparisons can be disregarded.

When comparing the gut microbiota of the twins, the researchers found some interesting, albeit subtle, differences. For example, numbers of bacteria of the species Akkermansia were often lower in the twins with MS. “Things got really exciting, however, when we inoculated the germ-free, genetically modified mice with the respective human microbiome”, Guru Krishnamoorthy, also from the Max Planck Institute for Neurobiology in Martinsried, reports. Nearly 100 percent of the animals that received gut flora samples from MS-sick twins fell ill with MS-like brain inflammation. The studies confirmed for the first time that constituents of the intestinal flora of MS patients play a functional role in T-cell activation and can thus be a trigger for multiple sclerosis in humans.

Without intestinal bacteria, the immune system changes dramatically

“For a well-functioning brain you need an intact intestinal system, because the intestine nourishes the brain”, Prof. Marco Prinz, neuropathologist at the University Hospital Freiburg (Germany), states assuredly. His studies on mice have shown that without intestinal bacteria, the immune system of animals changes dramatically. The researchers at University Hospital Freiburg have closely examined the immune defence of the brain. The conclusion: The immune cells in the brain only work if the intestinal bacteria feed them with certain substances. “Without short chain fatty acids, the immune cells, the microglia, of the brain retract considerably”, according to Prinz.

Propionic acid regenerates brain in mice

Intestinal bacteria produce from healthy food sources, among other things, short-chain fatty acids such as propionic acid. When mice suffering from MS-like illnesses were fed propionic acid via their drinking water, the immune system recovered in the brain of the mice. The way this trial so clearly turned out surprised Prof. Prinz and his colleagues.

Reduced biodiversity in the intestines of MS patients

Doctors at Bochum’s St.Joseph Hospital then studied whether these amazing test results could also be transferred to humans. This is because the analysis of patients with MS has shown: In addition to the changes in the brain, changes also occur in the intestine. “The intestinal microbiome is composed differently in MS patients”, Haghikia says. Particularly striking is the reduced biodiversity in the intestines of MS patients. A healthy person harbours about 160 types of bacteria, a MS patient significantly fewer. That in turn obviously affects fatty acid production.

This can be proven directly: MS patients have less propionic acid in their blood than do healthy people. In an interview with NDR (a north German TV station) Haghikia reported on how his MS patients benefit from the propionic acid supplementation: “Many feel after a short time more powerful, fatigue and exhaustion subsides. What’s more, susceptibility to infection decreases. “Blood analyses of the patients confirmed: the intake of propionic acid improved the number of immune cells by 30 percent. The number of inflammatory cells on the other hand decreased, in some patients even by half.

No side effects expected from propionic acid

Risks from taking propionic acid are not foreseen by Prof. Ralf Gold, also a neurologist at St. Joseph Hospital in Bochum. “The approved level given by the European Food Authority EFSA is 200 times higher than the concentration we have found to be useful”. At the moment, there is still no clinical data on the efficacy of propionic acid against MS. Haghikia advises his patients for this reason to take propionic acid in parallel to the usual MS medication and to simply try it out, and see if it works.

Investing in vegetable based food

The production of propionic acid in the intestine allows, provided the appropriate bacteria are present there, production of the right nutritional components. In order to stimulate propionic acid production in the intestine, one should take in as much plant-based food as possible, according to Matthias Riedel, Nutritionist in Hamburg (Germany). Intestinal bacteria produce propionic acid from insoluble fibre. “Insoluble fibre is found, for example, in the skin of apples, in grain pods and in lentils. Nuts and pistachios also contain much of this fibre.

How useful is the paleo-diet according to Dr. Terry Wahls?

Interest was also advanced by a TED Talk given by a US-American doctor who herself suffers from MS, and who was able through a radical diet to escape life in a wheelchair. Following an extensive literature search, Dr. Terry Wahls put a nutrition plan together, which is supposed to provide her ailing brain cells with everything they need. In doing so, the doctor relied on a simple “cup method”, which is based on the paleo diet: She ate 3 cups daily of green leafy vegetables, 3 cups of good full coloured fruit or vegetables and 3 cups of sulphurous vegetables. In addition, meat and offal from grazing animals, sea fish, algae and seagrass – all from organic farming and not processed. Grain and starchy foods were removed from her diet. In the remaining mixture there are enough vitamins, minerals and co-enzymes to stimulate the body to self-heal. For those with other autoimmune diseases such a diet would also be sensible, according to Wahls.

Pilot study delivers disillusionment

The doctor is now working again at the University of Iowa and now wants to carry through her self-experiment in clinical trials. However, a recent pilot study by the doctor is a source of disillusionment in relation to Wahl’s approach: out of 20 MS patients with different degrees of motor impairment, after a year there were only benefits from the paleo like diet for those whose immobility had been classified as mild to moderate at the beginning of the intervention.

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Image copyright: Samantha Forsberg, flickr / Licence: CC BY
Medicine, Neurology, Research

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2 comments:

Dr. med. Christoph Semler
Dr. med. Christoph Semler

Thank you for this article, it is very interesting.

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Marsha Carter
Marsha Carter

I would encourage the researcher to test the paleo diet against a whole food, plant based diet. I think they would find a completely different outcome.

#1 |
  0


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