Part 3 is from Gabriella Kadar, DDS, a practicing dentist from Toronto. Over her many years seeing patients, she put together a working hypothesis about a connection between lactose intolerance and multiple sclerosis (MS). The connection between lactose and MS has never been explored before. Gab promises she will continue writing about this, here, as she finds the time.
|Adapted from gotmilk.com|
Zamboni's MS Theory
This story goes back to 2009 when an Italian vascular surgeon by the name of Paolo Zamboni made a huge news splash. He claimed that multiple sclerosis was caused by compromised blood drainage from the brain due to narrowing and blockage of veins in the neck. His hypothesis was based on observations made as far back as 1863 by German doctors who noticed iron deposits next to veins inside the brains of patients who had died of MS. Zamboni claimed that he'd done 10 year follow up Doppler ultrasound examinations on patients in Sardinia who he had earlier detected to have narrowed veins. He found, lo and behold, on this new visit, many of these people had in the interim developed MS.
The heartstring puller of the story was that poor Senora Zamboni suffered from MS. Paolo adapted a surgical procedure usually used on coronary arteries for patients with heart disease. He performed balloon angioplasty and stent placement to widen her veins and now she was cured! At least that's what he claimed. I haven't been able to ask Mrs. Zamboni how she's feeling these days.
You can imagine how this all played out when the news flashed around the world. Multiple sclerosis is a chronic neurodegenerative disease for which there is no cure. It strikes people when they are in their 20s and 30s, a time when most people are establishing themselves in their careers, getting married, starting families. The social costs are enormous. The personal costs can be devastating. Understandably, there was a huge buzz among MS patients who flocked to their neurologists asking about this Liberation Therapy. Almost instantly clinics opened in places like Mexico, Poland and India offering the procedure and the promise of at least improvement if not an all out cure.
Zamboni's theory did not pan out
I had enough exposure to the devastating effects of MS to be sufficiently intrigued by Zamboni's ideas to sit down one day and give it a big think. That was back in 2009. Now there is evidence that MS patients do not have a higher incidence of narrowed veins than the general population. There is some ongoing study going on in regards to this procedure but the enthusiasm with which it was at first embraced is over.
From the research paper: CCSVI and MS: no meaning, no fact.
A condition called "chronic cerebrospinal venous insufficiency" (CCSVI) has been postulated to play a role in the pathogenesis of multiple sclerosis (MS). This hypothesis implies that a complex pattern of extracranial venous stenosis determines a venous reflux into the brain of MS patients, followed by increased intravenous pressure, blood-brain barrier breakdown and iron deposition into the brain parenchyma, thus triggering a local inflammatory response. In this review, we critically analyze the scientific basis of CCSVI, the current literature on the relationship between CCSVI and MS, as well as the ultrasound methodology that has been claimed to provide evidence of impaired cerebral venous drainage. We show that no piece of the CCSVI theory has a solid supportive scientific evidence. The CCSVI appears to be a rather alien condition and its existence should be definitely questioned. Finally, no proven (i.e., based on strict scientific methodology and on the rules of evidence-based medicine) therapeutic effect of the "liberation" procedure (unblocking the extracranial venous obstruction using angioplasty) has been shown up to date.
A geographic connection...
I went back to what are considered to be the factors associated with MS: lots of neurologists and research papers mention low vitamin D levels as being a possible predisposing factor for developing MS. There has been a lot of speculation that peoples living at high latitudes are more susceptible. I took a closer look at high MS areas in the world like Scandinavia, Scotland, Ireland, Canada, Australia, New Zealand. For some reason, south and western Finland had a much higher recorded MS rate than eastern Finland. I was intrigued. Same latitude. What's the difference? History reveals that the people in eastern Finland migrated there from the eastern European arctic. They are the Sami people. The western and southern Finns are actually migrants from Sweden and Denmark because at one time this area was ruled by a Swedish king. "So, what's the diff?" I asked myself.
Let's look at other areas of the world where vitamin D levels should not be a problem. The island of Sardinia, Zamboni's stomping ground, is located in the Mediterranean west of Italy. The rate of MS among the people who live on the northern part of the island is orders of magnitude higher than along the eastern and southern parts of the island. It turns out that the people living in the north migrated there from western Europe after the fall of the Western Roman Empire. They were Vandals and Ostragoths. The people living on the eastern and southern portions of the island trace back their founding ancestors to Carthage, Phoenicia and southern Italy. So okay, they all get lots of sun, right? They all can eat as much fish as fits in their bellies so oily fish sources of vitamin D are readily available. But the distribution of auto-immune diseases like MS are entirely skewed to the people who live on the northern part of the island.
...or a Vitamin D connection?
Ironically, a European study done to measure the vitamin D levels from north to south found that Scandinavians had higher Vitamin D blood levels than people living in southern Italy. Surprise! Why? During the warmest part of the day, people living in sunny climates retreat from the sun. It's called taking a siesta. They re-emerge later in the afternoon when the sun's heat has abated. But those sun-loving Scandinavians? June 21 is midsummer festival party time when the sun does not set. Germans and Scandinavians take as much advantage as they can to spend time outdoors during summer days. Studies note that a combination of darker skin tones and avoidance of the sun during the hottest times of the day results in lower vitamin D blood levels in southern Mediterranean people. So, really? MS diagnoses should be higher in the south than the north. They are not.
Meantime, reports of low vitamin D levels in MS patients are done post-diagnosis. Anyone who knows anything about MS will tell you that because of mobility issues, these people are not out and about the same way as able bodied individuals. Furthermore, due to de-myelination of nerves, they can't just be out in the full sun during hot summer days. The nerve impulses slow down and their muscles become very weak. Even taking a nice hot soaking bath can result in an inability to get out of the tub! And the effect lasts for hours. So yes, of course, MS patients have lower vitamin D levels than their compatriots! It is good that neurologists are now including vitamin D supplementation for their patients, but adding vitamin D does not cure MS or reduce disability.
What did the GI's bring to the Orkneys?
Then I looked at the darling of the MS researchers: the Orkney Islands. The rate of MS became 'epidemic' here after the mid 20th century. One in every 170 women has been diagnosed with MS. What was going on? There was speculation that an infective agent had entered the population somehow. But no matter how much researchers look in all MS populations, an infective agent like a virus or bacterium cannot be found. What happened in the Orkneys? During World War 1 there was a British naval base established temporarily on the Islands. Subsequently, there was an upward blip in MS rates. But after WW2, there was a huge jump in rates that alarmed doctors and researchers.
Let's take a closer look at what happened here. During WW2, approximately 12,000 servicemen and women were stationed on the islands. Some even brought their children. The location was strategic to prevent German U-boats from getting through to Scotland, England and Ireland. In their usual lives, Orcadians were mostly subsistence farmers. Then suddenly there came a huge demand for farm products. The military introduced electricity. The farmers were given financial support to install running water and flush toilets. Excellent roads were also built. They were selling their produce and making money. They were able to afford to keep more cows. Historically, these farmers were cheesemakers. After all, they didn't have electricity or refrigeration. But now milk was being supplied to the 'troops' and electricity also made it possible and/or desirable to drink fluid milk as well. After all, British and American troops were milk drinkers.
But there is also a DNA aspect to the story. 25% of the DNA of Orcadians is of Norwegian origin. MS rates in Norway are also very high. So it is not a surprise that MS rates went sky high after a change in the way in which people consumed dairy. Eventually the dairy business on Orkney reduced considerably. The farmers make more money selling beef cattle. The rate of new MS diagnoses may be going down.
A worldview of MS and Lactase Persistence genes
A close look at the geographical distribution of MS in Eurasia (and let's face it, MS is largely a disease of 'white' people) overlaps wonderfully well with a geographic distribution of people who are also LP. Now I thought, but this can't possibly be the reason. It's too simple. Why would being able to digest fluid milk be a problem? Why is it that in regions where people consume fermented dairy there are no high rates of MS? Is it because they are LNP? No.
Map of "Lactase Persistence" gene prevalence:
|Picture Credit: Archaeology: The milk revolution|
|Picture Credit: Worldwide survey seeks MS answers|
What's happening in Iran?
Data from Isfahan, Iran indicates that there is an alarming increase among women in the rate of MS (and PCOS) diagnosis. Iranians mostly use yoghurt don't they? Not the unfortunate women in Isfahan. They've been encouraged to drink low fat fluid milk to prevent unwanted weight gain.
Isfahan province of Iran is now globally well known for its high prevalence of Multiple Sclerosis (MS). Fifteen years ago, this fact was in spite of primary north–south based expectations (MS gradient hypothesis) in which Isfahan, as a part of Iran, could only be a low-risk area with prevalence of less than 5/100,000.
And what about Crete?
Over the past three decades the incidence of MS on the island of Crete has skyrocketed. There have been very detailed studies done on why this may have happened. It's higher among urban dwellers, higher among smokers, higher among women using contraceptives BUT cow milk consumption has gone up tremendously. If it would be smoking, then the MS rate in China would have also skyrocketed. In fact, as smoking has become less and less popular in the developed world, the rate of people smoking in the developing world has tremendously increased. The tobacco manufacturers are desperately seeking new markets for their products. But in those areas, MS has not made a jump in incidence rates. It's not the birth control pill, because men don't take it. Remember: it's where you lived for the first 15 years of life that counts. There aren't many children taking birth control pills.
On the island of Crete and generally in Greece, fluid milk consumption had gone up signficantly due to the importation of pasteurized, oftentimes UHT or just refrigerated milk. The EU is helping out in this regards making the movement of not only people but goods much easier. A glance at the map indicates that MS rates in Greece are high. Not as high as Scandinavia. Not yet, anyway. Goat milk was the primary source of dairy in Greece. Goats don't produce that much milk and besides, farmers make more money from selling cheese.
And in the US?
On purpose I have not gone into the rates of MS in North America. The indigenous population of the Americas were LNP and did not have access to any form of dairy. The movement of peoples from Europe to both Canada and the USA meant that LP genes were brought over. Cattle were imported to the Americas from Europe. MS rates in areas of both countries settled largely by LP immigrants is high. In Canada, the provinces of Nova Scotia and Alberta are recorded as having very high rates. The northern states of Minnesota, Wisconsin, North Dakota are also very high MS. The former have high rates of individuals of Scottish, English, Irish ethnic background. The latter are home to the descendents of German and Scandinavian immigrants. Wisconsin, especially, is famous for its dairy farms.
MS epidemiologists have ascertained that a person, who we can presume is LP, lives for the first 15 years of life in a high MS region, makes them more susceptible to developing MS even if they move to an area that is low MS. They retain the same risk as their location of origin. If someone spends the first 15 years of life in a low MS area, then if they move to a high MS location, their risk of developing MS remains the same as their location of origin. What's going on here? High MS areas are also high LP and high childhood fluid milk consumption areas. Low MS regions are also high LNP and/or low fluid milk consumption areas. An LP individual would probably not have as much ready access to fluid milk in these regions. It's not part of the 'food culture'.
What would I recommend? Stop the lactose consumption at the age of weaning. If the child enjoys fluid milk, use lactose free milk. Even better: explore other options like cultured buttermilk and yoghurt. They are probiotic. I am not anti-milk at all. I think it is a good source of protein and fat. In developed countries, milk is a convenient source of nutrition especially for growing children. But if someone may have close relatives with auto-immune disease, cut the lactose. There is more, much more to the auto-immune disease picture than just MS. Stay tuned.
In Part 4, we'll see what Gemma has to say about Gabriella's hypothesis!