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Wednesday, December 21, 2011

Huge news: multiple sclerosis is a metabolic disorder

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In the latest issue of the Quarterly Review of Biology (Vol 86 Number 4, December 2011), in a paper titled "Multiple Sclerosis is Not a Disease of the Immune System," Dr Angelique Corthals argues that multiple sclerosis (MS) isn't a disease of the immune system: it is caused by faulty lipid metabolism.

The very basic précis of the paper: looking at MS as a metabolic disorder helps to explains many puzzling aspects of the disease. MS cases are on the rise as a direct consequence of a high-sugar, high-animal-fat diet. MS is similar in many ways to atherosclerosis.

This is huge. It is not an incremental improvement of what's known about MS, it's a paradigm shift. It will change the way MS is understood, researched, and treated.

Full disclosure: Angelique is a good friend of mine. I've seen every draft of this paper. It is not original research. It's an overview of what is known to be known. It takes what has been researched, reviewed and replicated and reassembles it into something utterly new: a jigsaw puzzle in which, for the first time, all the pieces fit. There are no pieces left out, none hammered in with brute force. It's brilliant. It's elegant, clean, and makes complete and utter sense.

At some point soon I'll write about how this makes me feel. But today I want to give you the gist of the paper without editorialising. (All mistakes are mine; nifty illustration and direct quotes are from Angelique.)

WHAT THE PAPER SAYS
The medical profession has believed for a long time that MS is a disease in which the body’s own immune defenses attack nerve tissue in the central nervous system. [For an overview of changing medical wisdom, see The Incredible Journey, courtesy Rocky Mountain MS Center.] The disease's main characteristic is inflammation, then scarring, of tissue called myelin which insulates the brain and spinal cord. Over time this scarring can lead to profound neuron damage.
Researchers have thought that the fault lies with a runaway immune system, but no one's been been able to explain what triggers the onset of the disease. They've linked genes, diet, pathogens, and vitamin D deficiency to MS, but evidence for these risk factors is oddly inconsistent and often contradictory. This frustrates researchers in their search for effective treatment.

"Each time a genetic risk factor shows a significant increase in MS in one population, it's been found to be unimportant in another. Pathogens like Epstein-Barr virus have been implicated, but that doesn’t explain why genetically similar populations with similar pathogen loads have drastically different rates of disease. The search for MS triggers in the context of autoimmunity simply hasn’t led to any unifying conclusions about the etiology of the disease."

Understanding MS as metabolic in origin rather than autoimmune begins to bring the disease and its causes into focus. "The new approach explains both the recent rise in incidence and all pathological, genetic, and environmental aspects of the disease."

In other words, this new understanding of MS will finally make it possible to find effective treatment including preventative treatment.

THE LIPID HYPOTHESIS

The etiology of MS (click to enlarge)



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