This is the first article in a three-part series on the current state of multiple sclerosis diagnosis and treatments with focus on effective nutritional treatments. A summary of detailed treatments worthy of consideration based on clinical data is included at the end of this first article. The second article will provide more background on high-dose therapy with thiamine and niacin. The final article is written for those scientifically inclined and will describe where more research focus is needed.

The party line for researchers is "We need more research." The party line for clinicians is "There is no clinical proof; RCTs are needed." But as far as the patient is concerned, it might be this: "Based on current available data and studies so far, what can be most useful in preventing my disease progression?" With that in mind, this series of articles presents the patient's perspective first. The patient's needs are the most urgent of all.

Approximately 200 people per week are diagnosed with multiple sclerosis (MS) in the United States and if current trends continue, 30% will become wheelchair bound for the rest of their lives. [1, 2]. Multiple sclerosis is the most commonly diagnosed CNS disorder and we do not know what causes this autoimmune disease. Many different etiologies (bacterial, viral, heavy metal poisoning) can present with clinical symptoms identical with an initial MS diagnosis. There are no effective consensus treatments. Accordingly, differential diagnosis of MS is exceptionally challenging since biopsies are not an option for much of the CNS. The average age of MS onset is approximately 34 years. Imagine that you are in the prime of your life having just graduated from college after previously completed 12 years of school. Then out of the blue, you are diagnosed with a neurodegenerative disease for which there is no cure and the cause of the disease is unknown. As if student loan debts and the prospect of four decades of stagnant wages weren't enough to worry about, the average monthly cost for many MS therapeutics including one of the most popular multiple sclerosis treatments (dimethyl fumarate; Tecfidera) is roughly $5,000 a month.

A recent study from Oregon State University and the Oregon Health and Science University found that the average cost for MS drugs is $60,000 a year, as compared to $10,000 a year twenty years ago [3, 4]. What's more, the price for some MS therapeutics climbed by an average of 30 percent per year for two decades, according to the report [4-7]. Even the earliest useful drugs have increased significantly in price with time. The rules of supply and demand appear not to apply here. This is the unfortunate state of multiple sclerosis treatments today.

However, there is excellent evidence that adequate doses of essential nutrients can effectively treat MS -- and they're inexpensive. Sound to good to be true? Niacin (also called nicotinic acid) can activate the same receptor as dimethyl fumarate (DMF; TecfideraTM) and this can be done for $15 a month instead of $5,000! [8] Niacin has a long history of use in the treatment of a variety of neurological and autoimmune diseases, but it is commonly ignored in treatments offered at the clinic [9,10]. Niacin costs just cents per gram and 3 grams per day is a typical high dose niacin regimen that has been and continues to be used for over 60 years [11]. After treating thousands of patients throughout his life with high-dose niacin therapy Dr. Abram Hoffer, MD, PhD, (1917-2009) settled on this dosage: 3-18g/d in divided (3x daily) doses for neurological disease [9]. Further comparative analysis of dimethyl fumarate vs. niacin as related to safety and effectiveness is presented in sections below. Let's consider the safety profile of dimethyl fumarate (DMF) compared to high dose niacin therapy. DMF was banned 2009 in Europe for certain applications due to skin reactions and has been only used for MS since 2013 [12]. Meanwhile, high dose niacin therapy has been safely used for over 60 years [11, 13].

In fact, niacin was deemed so important that mandatory thiamine and niacin-fortification of flour was made law by the US government in the 1940s to prevent neurodegeneration leading to death by pellagra, which is the niacin-deficiency disease. [14] Later, after treating thousands of schizophrenic patients for over 50 years, Dr. Abram Hoffer proved in 2008 that some individuals require higher amounts of niacin than others to prevent neurological schizophrenia. [9, 15] For a case example, see the full text for "A neurological form of schizophrenia," which describes recovery from progressive degenerative cerebellar syndrome by using just 3x1 gram a day of niacin. [16]

Finally, and most significantly, recent studies have revealed that MS patients are deficient in niacin, a precursor for NAD (nicotinamide adenine dinucleotide) the molecule that is a cofactor in more than 400 biochemical reactions. [17, 18] The holy grail of most longevity research today is focused on ways to boosting NAD+, where particular focus is on neuronal health. [19-23] One study after another is focused on ways to NAD+ levels, but nobody had more clinical experience treating patients with NAD+ precursors than Dr. Abram Hoffer, MD, PhD and in the end he settled on 3g-18g preferably as niacin a day in divided doses for mental health issues. [9] Again, NAD+ is depleted by multiple sclerosis and prevention of loss of NAD+ is critical to neuronal survival in multiple sclerosis! [19,24] DMF is not a precursor to NAD+ biosynthesis.

Successful nutritional treatments for MS

The first steps should be to remove as many risk factors for MS as possible.[25] This can decrease the risk of further progression of the inflammation that causes MS and in some cases reverse MS. Recent research has revealed that for some individuals, the single most important requirement for reversal of multiple sclerosis is the elimination of gluten and restoration of a healthy microbiome (e.g. probiotics or fecal microbial transplant). [26, 27] The elimination of dairy, the second most common food allergy, can be critical too [28, 29], but grass-fed butter is OK and will hardly affect cholesterol levels. If an individual has egg allergies, then eliminate eggs, but for most people, eggs are an ideal source of protein. If you do smoke, you should immediately stop, as smoking is a known risk factor for the initiation of MS and for the inflammation that drives MS relapses. You may find it difficult at first but considering the alternative, worsening of the inflammation that causes degeneration of neurons in the brain, the challenge of stopping smoking can be overcome. Next, obesity in early life is known to be a risk factor for MS, and in adult life it also likely increases the progression of the disease because it drives inflammation throughout the body. By focusing on an excellent diet that includes lots of raw vegetables including microgreens, nuts, generous servings of greens and colorful vegetables, with eggs (if no allergies), and minimal/no meat, and little to no processed foods, you can eliminate unwanted calories and reverse the inflammation that causes MS. Gluten-sensitive MS patients may require elimination of gluten and/or dairy (except grass-fed butter is OK) to enable recovery of their symptoms.

Terry Wahls, MD, was diagnosed with MS and her condition progressed through the standard stages to an inability to walk. [28, 30] After considering conventional treatments she intensively studied how nutrition may impact on the health of mitochondria in neurons that control brain and spinal cord function. Ultimately, she was able to reverse her condition of progressive MS, getting out of the wheel chair and walking normally. She was so successful that she now directs her own funded clinical research on diet-based treatments for neurodegenerative disease. Her treatment uses no drugs, but rather an elimination diet followed by a highly nutritious diet full of vegetables that provides adequate doses of essential nutrients.

When considering all these treatments for MS, one theme has consistently emerged, which is the importance of nutrients in an excellent diet. I (WTP) am a career researcher with a doctorate in biochemistry, and a background in developmental biology. After being involved in research to study the effects of pharmaceuticals, I chose a different path: to focus in particular on niacin, and on diseases that can be prevented or reversed with this essential nutrient. The problem of MS and how it is treated today is that treatments that in some cases have historically worked are not universally effective, and the outcomes for the latest drug strategies are not much better. Therefore the emphasis in this series of articles is on effective orthomolecular nutritional treatments. Knowledge from research studies supports the use of inexpensive orthomolecular approaches: treating disease with appropriate doses of natural molecules required by the healthy human body.

Orthomolecular medicine is based on an understanding of the cause of disease. For the neurodegeneration that leads to MS, treatment should start with supplements of magnesium, niacin, thiamine, and vitamin C and D. Magnesium is involved in more reactions (>800) than any other nutrient, and niacin is involved in more reactions (>400) than any other vitamin. Magnesium deficiency is the single most common deficiency and multiple sclerosis patients are deficient in niacin-derived NAD and tryptophan. [17, 18] Thiamine has been clinically proven to provide benefit for treating multiple sclerosis.[31-33] Vitamin C is essential for preventing inflammation throughout the body. Vitamin D also has a long established medical history influencing multiple sclerosis and has even been shown to reduce relapse rates by 50-70% compared to individuals with insufficient vitamin D. [36-41]

High-dose thiamine and niacin

Supplements of the vitamins thiamine (vitamin B1) and niacin (vitamin B3) have both been found to be helpful in preventing and reversing MS. The reason is that the biochemical pathways they serve are important for the survival of neurons that typically get damaged in MS. These B vitamins are very safe when safe taken in high doses, and when taken along with a multivitamin supplement and an excellent diet, can help the body activate all the metabolic pathways that require them. Niacinamide is also considered vitamin B3, as it gives most of the benefits of niacin, for example, it is also a precursor for NAD; however it does not provide the benefit of increasing blood levels of HDL.

Vitamin B3 refers collectively to any precursor for the biomolecule NAD+, which is essential to cellular bioenergetics and metabolism. Boosting NAD+ levels is an important goal of most longevity and disease prevention research [10, 19, 20]. There are three molecular forms of vitamin B3: niacin/nicotinic acid, niacinamide/nicotinamide, and nicotinamide riboside. Niacin is distinguished in its ability to correct dyslipidemia, properly adjusting triglycerides, HDL, VLDL, cholesterol, and LDL levels. It causes a flush that is beneficial to health but is unpleasant for some; however, others enjoy it. Ideally, an individual adjusts the dose to give at least a minimal flush response. This dose varies depending on the individual's need. Further, with greater need for niacin, there is less flush response. Nicotinamide riboside is the most expensive, as it was discovered in 2004 and patented. Niacinamide does not correct dyslipidemia, does not cause a skin flush, and does not boost NAD+ as much as the others. Niacin's ability to boost NAD+ can be increased by including glutamine (10-20g 3x a day).[42-44] Additional therapeutic approaches of ongoing consideration include nicotinamide mononucleotide and NAD+. Based on current data, supplementing with niacin (as nicotinic acid) is still perhaps the best approach, especially when used in combination with glutamine (10-20g 3x a day). Niacin is superior to niacinamide for most clinical indications and it is far less expensive than the other NAD+ boosting approaches.

It is critical that an individual get to know the niacin skin flush because for some it can be quite shocking at first. So an uninitiated individual should start with low doses, e.g. 25 mg, then 50 mg, then 100mg, then 2x 100mg, taken several times per day. To make small initial doses, break apart 100 mg tablets. Ultimately, for treatment of MS, optimal suggested doses range higher, starting with 1,500 mg per day but ranging from 1,500 mg to 18,000 mg per day taken in at least 3 divided doses (divided doses of 3x 500 mg per day ranging to 3x 6,000 mg per day) as needed. Putting bulk powder niacin into smoothies is the most convenient and inexpensive way to administer. When taking niacin, at each dose level, tolerance will gradually build up so that the flush is not apparent. Then continue to increase the dose and slowly ramp up to 3x500 mg /day, then higher to find the most effective larger dose. Suggested doses of thiamine range from 1,000 mg to 3,000 mg per day (taken in divided doses of 3x 300mg to 3x 1000mg per day). 100-500mg injection 3x a day initially followed by 2x 500mg daily oral maintenance to just 2-3x a day with 500mg thiamine. [31-33,45,46] The treatment using these vitamins is described in more detail in Part II.

Current state of health care

One problem with the current health system in the US is that the profit motive does not always work well in supporting the best health care or publicly funded research. This is your tax dollars at work. A big part of the problem is that drug companies and health care providers generate the most profit by maintaining patients in a state of partial cure, which encourages patients to continue health care spending. It has already been proven that the most expensive healthcare does not lead to be best healthcare. The US has the most expensive healthcare in the world, but ranks dead last amongst developed nations in terms of outcomes and quality of care. We are not even in the top 25 of the world (How bad is U.S. health care? Among high-income nations, it's the worst, study says, 2017; U.S. Health Care Ranked Worst in the Developed World, 2014 World Health Organization's Ranking of the World's Health Systems, 2000). [47-49]

We already have the data. We just do not yet have the knowledge to make the best decisions in treating MS. On a positive note, consider yourself fortunate to know that the orthomolecular treatments described here are free (elimination diets) or nearly the cost of food in treating most chronic diseases, especially when supplements are purchased as bulk powders.

The current approach to medicine seems to lead to more medications. In recent years, there have been over 4 billion prescriptions per year in the USA (over 10 per person on average in the USA. [50,51] One reason is that the primary symptoms are being treated with one set of drugs, and then the side effects of those drugs are treated with another set of drugs. Too often, this does not address the cause of the condition and so the path is not towards recovery, but instead is towards more medications. Orthomolecular medicine empowers the body to recover from disease caused by deficiencies of essential nutrients by providing the nutrients in adequate doses to prevent and recover from the deficiencies. Orthomolecular medicine does this with natural methods such as emphasizing an excellent diet, supplements of vitamins and minerals, fasting, and elimination diets. Some drugs, for example, antibiotics, inhibitors and secretagogues (e.g. to stimulate insulin release) do have a valid place in medicine, to deal with an acute potentially deadly situation. As such they can be lifesaving, but on the whole they are not useful for stimulating recovery and should not become crutches.

The profit motive: niacin derivatives

The profit motive in vitamin research is typical but unfortunate. Contrast the discovery of niacin vitamins in the 1920s (nicotinic acid, NA, later renamed "niacin," and nicotinamide, NAM, renamed "niacinamide") versus the discovery in 2004 of nicotinamide riboside (NAMR). Niacin and thiamine were made publicly available and were deemed so important to preventing populations from suffering and dying of diseases, that governments mandated that refined flour and rice be fortified with these molecules. More recently (2004), the laboratory of Dr. Charles Brenner at Dartmouth discovered nicotinamide riboside.[52] The molecule has since been patented as useful for many conditions. It is now connected with a company (Chromadex) and the discoverer has been reported to make the outrageous claims that nicotinamide riboside can effectively treat disease conditions of the brain or muscle whereas other NAD precursors (niacin and niacinamide) cannot. However, this claim is unsupported since nicotinic acid was used to save thousands from the pellagra epidemics of the first 2 decades of the 20th century. This was a period during which over 100,000 individuals died in the southern USA alone due in large part to the niacin deficiency disease, pellagra. Mental asylums were full of individuals suffering from this terrible condition. Dementia was one of the main symptoms and it was rescuable, especially if treated early, after the discovery the discovery and administration of niacin. Then there is the lifetime of treatment of schizophrenics by Dr. Abram Hoffer MD, PhD, using niacin or niacinamide. The reported claim that only nicotinamide riboside can provide benefits to brain and muscle is unsubstantiated and belies the unfortunate state of affairs that a vitamin analog discovered in 2004 gets patented for marketing. It is an unsupported claim, as all forms of niacin are converted in the body to NAD+, which mediates most of the benefits.

Niacin prevented dementia in hundreds thousands of pellagra patients recovering from the epidemic in insane asylums which is surely a benefit for the brain. Similarly notable, Dr. Abram Hoffer's work used high-dose niacin therapy to successfully treat thousands of schizophrenic patients. Clearly niacin can provide enormous benefits for the brain and muscles. The high affinity niacin GPCR (G-protein-coupled receptor) is present in neurons and glia. It is also likely to be a chemosensor controlling the expression of NAD salvage pathway genes (NAMPT and/or NMNAT1-3) required for the conversion of niacin to NAD, which are known to provide enormous neuroprotection - extending life for axotomized neurons to over 20 hours in a petri dish when they typically live just a few hours.[24]

It is unfortunate that today when a vitamin-derived drug is patented, industry moves in, the discoverer becomes chairman of a department at a major university, and outrageously incorrect claims are made about the related and inexpensive niacin molecule. The profit motive has largely confounded the humanitarian purpose of both publicly funded research and drug development.

Although the three forms of vitamin B3 (niacin, niacinamide, and nicotinamide riboside) are compared only rarely, I (WTP) have done this experimentally in my laboratory. There are some subtle differences. Niacin (nicotinic acid) was the most effective of these three in promoting survival under otherwise lethal anoxic conditions in zebrafish animal models. Niacin treatment caused the greatest increase in total NAD in the whole animal, while niacinamide was second. However, resveratrol was even better at increasing NAD levels, presumably via alterations of the gene expression of NAD salvage enzymes. These were determined after first doing 10-fold dose curve analysis to find the range of concentration likely to exert benefits.

Confusion in diagnosis of multiple sclerosis

It is important to understand that since the cause of MS is not known, a diagnosis of MS is a default diagnosis largely based on exclusions. A diagnosis of multiple sclerosis is often confused with a variety of conditions that are treatable! Heavy metal poisoning, viral diseases, bacterial (Lyme in particular) diseases, celiac disease, ergotism, and more can all be diagnosed as MS. [53] Fortunately these are all safely treatable when diagnosed correctly and treated appropriately and most of these treatments are inexpensive. The neurologist's job can be especially challenging as these conditions can be difficult or impossible to diagnose when the damaged tissues cannot be biopsied. In many cases, the different possible underlying conditions can be addressed by careful attention to their etiologies with the proper treatment. A summary of the details of treatments that address conditions often confused with MS are provided in Part III.

Eliminate gluten to help reverse autoimmunity

Multiple sclerosis is generally considered an autoimmune disease. To cure an auto-immune disease, the auto-reactive T cells and/or antibodies must be eliminated. To determine the cause of an autoimmune disease, you must eliminate the antigen (e.g. in this case no more gluten) that is stimulating production of auto-reactive T cells. That can be difficult, as which antigen causes an autoimmune diseases is usually unknown. For example, for the autoimmune diseases multiple sclerosis, thyroiditis, type 1 diabetes, rheumatoid arthritis, and lupus, we do not know what antigen is causing the production of auto reactive T cells. However, there is one autoimmune disease for which we do know the cause and that is celiac disease, which is caused by gluten. After going gluten-free for only a few weeks, some individuals see benefits and a reduction in their celiac symptoms.

Most significantly, gluten has clearly been shown to cause symptoms that can result in a diagnosis of MS. In some cases, a diagnosis of MS has been reversed by simply eliminating gluten from the diet. Although for some people this requires some learning, it is essentially free because gluten-free food is widely available. Dr. David Perlmutter, MD, an experienced neurologist/nutrition-expert has seen demyelination, the hallmark feature for MS diagnosis, completely reversed when patients went on a gluten-free diet. [26, 27] He has described the discovery of MS reversal as the biggest discovery in his decades as a practicing neurologist! He has also seen the conditions dystonia, myoclonus, and even epilepsy, completely reversed after going on a gluten free diet. Dr. Perlmutter always checks for gluten sensitivity in patients he receives with MS diagnosis. He advises that all MS patients should consider trying a gluten-free diet for at least 2 weeks.

You may think that since you never had a problem with gluten in products from wheat, such as bread, that you never will. However, physicians focused on this issue have observed that with aging, everyone is more likely to develop a gluten allergy. Dr. Perlmutter suggests eliminating gluten (no more bread or pasta). For some people, to stop eating gluten can be terribly difficult. For most people, bread is a part of daily life. It can be difficult to accept the fact that a component of bread may be causing a serious disease, but the fact remains that in some cases it can. In many supermarkets there is an aisle dedicated to gluten-free food. This was in part because of results from medical research but also simply the public learning process. In a word, it may be called empirical medicine in action. We must doctor ourselves.

Dr. Marios Hadjivassiliou has repeatedly seen patients recover from chronic headaches by going on a gluten free diet. He has also witnessed dramatic demyelinations in patients that are highly sensitive to glutens. Most amazingly, Dr. Hadjiavassiliou has stated that for some patients, their gluten sensitivity exclusively presents as a neurological disorder, with no other apparent pathologies.

Vitamin D

A deficiency of vitamin D is known to be a risk factor in the development of MS. [25,36,37] Vitamin D also can reduce the risk of relapses and progression in those who already have MS. [38-41] Several studies have shown that the incidence of MS is greater in countries at high latitudes where the sunlight contains less UVB that generates vitamin D in the skin. Although the exact mechanism of benefit from vitamin D for MS is unknown, current research is studying the possible connections to the body's metabolism and immune system. Although vitamin D is produced by skin exposure to direct sunlight, small amounts are also found in oily fish. It is known to be involved in utilization of calcium, ameliorating inflammation, immune function, and prevention of a wide variety of disease. It is known to reduce the risk of many types of cancer, diabetes, asthma, flu, as well as bone diseases and autoimmune diseases. A deficiency of vitamin D is very common in people who work inside, as the greatest exposure to the UVB rays from the sun that generate vitamin D happens during the summer mid-day hours when office workers are inside.

For people with light skin in the lower 48 states of the US, a 10 - 20 minute daily exposure to direct midday summer sun (11 AM - 3 PM) on lower arms and legs can provide 5,000 - 10,000 IU which is adequate for many people. For people with dark skin, a daily exposure of lower arms and legs for up to 2 hours in midday sun may be required. To minimize sunburn, one can expose a greater skin area for a shorter time, for example, remove a T-shirt in the summer and expose your back for 5 minutes, or for dark skin, 10-20 minutes. For people at higher latitudes (e.g. Canada and northern European countries), more midday sun exposure may be required to get an adequate dose of vitamin D. If you can't get out into the sun every day, you can obtain the same amount of vitamin D by more sun exposure every few days, for example, during weekends. For these exposure times it is necessary to have direct sun exposure because the UVB that creates vitamin D is not transmitted through sunblock, clouds, or glass windows. When the body's level of vitamin D rises, the skin automatically stops creating any more so skin exposure is self-limiting.

Very little vitamin D is generated by skin exposure from the sun when it is lower than 45 degrees above the horizon which is the usual case during winter (October - March: all day; April - September: sunrise-10 AM, 4PM-sunset). Even when acquired from being outside in the winter, that sun exposure creates hardly any vitamin D because tanning is caused by a different spectrum (UVA). Therefore, supplements are necessary for most people in the northern US, Canada, and Europe in the winter. Typical doses recommended are 30 - 50 IU/pound/day (60 - 100 IU/kg/day), or 5,000 - 10,000 IU/day (adult dose). It's acceptable to take greater doses every few days, e.g. 50,000 IU once per week. Since vitamin D is fat-soluble, its level in the body builds up and falls slowly, so it is important to get tested after several months to be sure your dose is adequate. Normally the goal is to achieve levels in the range of 30 - 60 ng/ml.

A variety of treatments

Because a variety of factors, including genetic predisposition, may contribute to MS, a variety of treatments are likely to be helpful. Nutrition is likely to be an important factor. The gut microbiota are extremely important so probiotics are likely to be helpful. The National Multiple Sclerosis website describes epidemiological clusters of MS diagnosis associated with high exposure to a variety of heavy metals (mercury, lead, arsenic, cadmium, thallium).[54] Unfortunately however, chelation therapy is not commonly considered as a possible treatment for such heavy metal associated MS cases, yet chelation treatments have halted MS-like conditions. Particularly, removal of mercury dental fillings of root canals and fillings has helped some multiple sclerosis patients [55]

This all speaks loudly to our poor understanding of MS etiology. So long as treatment strategies are safe, it makes sense to try a variety of treatments starting with the least aggressive MS therapies. Vitamins have a far superior record of safety as compared to pharmaceuticals as our bodies have evolved to rely on vitamins and minerals to stay alive. It's important to note, however, that high doses of some essential nutrients (e.g. vitamin A, iron, selenium) can be toxic. Switching to an excellent diet that includes adequate amounts of essential nutrients including vitamins and minerals is therefore a high priority. Treating obesity is a priority as it is known to be a risk factor for MS. A second priority is removing all sources of toxicity, including smoke, heavy metal contamination, and toxic organic chemicals such as fire retardants and plasticizers found in many household and workplace products. A third priority is eliminating specific triggers of autoimmunity such as gluten found in wheat and other grains. A fourth priority is trying high-dose supplements of B vitamins thiamine and niacin.

Treatment with supplements of just one nutrient ("monotreatment") is less likely to be beneficial than combination treatments because a biochemical pathway is only as robust as its most rate-limiting link. In particular make sure you have adequate levels of magnesium and niacin, as they are involved in more reactions than any other mineral and vitamin. Accordingly, it is essential to try combination approaches.

Treatments and Doses for Multiple Sclerosis

Supplements (daily doses)
(The authors are researchers, not physicians. You should always work closely with your doctor in developing your personal nutritional program.)

• Niacin; 3-18g in divided doses throughout the day [9,10]
• *Glutamine; 10,000 mg or more a day, in divided doses
• Thiamine; 100-500mg injection 3x a day, followed by 2x 500mg daily oral maintenance [31-33,45,46]
• Magnesium chloride; 3x 300mg
• Vitamin D; 5,000-10,000 IU
• Vitamin C; 3,000 mg to 10,000 mg in divided doses, to bowel tolerance
• *IP6; 10x 800mg IP6 with 200mg inositol on empty stomach with water only and nothing else for subsequent 20min followed by mineral repletion with vegetables; repeat once daily ≥ 10x until no result; alternatively more aggressive IV chelation approaches under the careful monitoring and guidance of an experienced physician.
• Resveratrol; 400mg in the morning
• Zinc; 50mg
• Copper: 2 mg along with 50 mg zinc
• *Probiotics; ≥ 25 billion CFU: Lactobaccilus plantarum, Lactobaccilus acidophilus, Lactobaccilus brevis, Bifidobacterium lactis and/or Bifidobacterium longum

If in doubt about the quality of the ingredients, look for the CE mark - in the USA independent laboratory testing is not required, but it is in Europe/Canada and indicated as such with the CE mark.

Foods ([29, 30])

• *No gluten; minimal dairy (grass-fed butter and eggs are OK as long as no egg allergy)
• 3 cups leafy greens (arugula, collards, kale, etc.)
• 3 cups colorful (beets, carrots, berries)
• 3 cups sulfur-rich (broccoli, cauliflower, cabbage, kale, collards, Brussels sprouts)
• Least expensive way is homegrown non-certified organic; most convenient way is frozen
• Ideally, half your body weight in ounces of water daily, e.g. 80oz water for 160lbs; no fluoride and little chlorine.

Other

• *Fecal Microbiota Transplant [26, 27]
• *Consider mercury dental filling medical history, mercury testing, and removal of fillings

*Possibly required

Conclusion

The cause of MS is unknown, but MS patients are likely deficient in niacin. High dose niacin can be expected to be beneficial in the treatment of MS, and positive reports have previously been reported for high dose niacin administration to MS patients. The same is true for the results of high dose thiamine and thiamine deficiency, and thiamine-responsive Wernicke-Korsakoff syndrome, which dramatically resembles MS in clinical presentation. Studies are sorely needed to examine thiamine levels in MS patients. A clinical MS presentation can also be caused by heavy metal poisoning, bacterial infection, viral infection, or even gluten sensitivity. Differential diagnosis in the brain is exceptionally difficult as biopsies are generally not an option. Accordingly, it is best to consider addressing all of these possible etiologies by the safest approaches. Nutritional treatments can sometimes halt MS progression and stimulate regeneration of nerve function. Because nutritional treatments are effective and very safe, they should be tried first before drugs. Elimination of gluten and dairy (milk) can lead to dramatically positive benefits for some. This approach has been effective for many patients and deserves much more consideration as a standard part of treatment for preventing neurodegeneration in MS attacks.[26,27] An excellent diet comprising colorful and leafy green vegetables, with minimal/no meat, along with a complete regimen of vitamin and mineral supplements and probiotics, and without refined sugars and grains, can slow the progression of MS and in some cases reverse multiple sclerosis.

References

1. Noseworthy, J.H., et al., Multiple sclerosis. N Engl J Med, 2000. 343:938-52. link .

2. Bitsch, A. and W. Bruck, Differentiation of multiple sclerosis subtypes: implications for treatment. CNS Drugs, 2002. 16:405-418. link .

4. Burtchell, J. Should Multiple Sclerosis Drugs Cost $62,000 a Year? 2013. link .

5. Hartung, D.M., et al., The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail? Neurology, 2015. 84:2185-2192. link .

6. Drugs.com. Tecfidera Prices, Coupons and Patient Assistance Programs. 2018 [January 21, 2018]. link .

7. Disease Modifying Therapies for MS, N.M.S. Society, Editor. 2017. link.

8. Chen, H., et al., Hydroxycarboxylic acid receptor 2 mediates dimethyl fumarate's protective effect in EAE. J Clin Invest, 2014. 124:2188-2192. link .

9. Hoffer, A. and J. Prousky, Successful treatment of schizophrenia requires optimal daily doses of vitamin B3. Altern Med Rev, 2008. 13:287-291. link .

10. Penberthy, W.T., Pharmacological targeting of IDO-mediated tolerance for treating autoimmune disease. Curr Drug Metab, 2007. 8:245-266. link .

11. Carlson, L.A., Nicotinic acid: the broad-spectrum lipid drug. A 50th anniversary review. J Intern Med, 2005. 258:94-114. link .

12. Consumers: EU to ban dimethylfumarate (DMF) in consumer products, such as sofas and shoes, in European Commission. 2009. link .

13. Guyton, J.R. and H.E. Bays, Safety considerations with niacin therapy. Am J Cardiol, 2007. 99:22C-31C. link .

14. Park, Y.K., et al., Effectiveness of food fortification in the United States: the case of pellagra. Am J Public Health, 2000. 90:727-738. link .

15. Hoffer, A., Nutrition and schizophrenia. Can Fam Physician, 1975. 21:78-82. link .

16. Hoffer, A., A neurological form of schizophrenia. Can Med Assoc J, 1973. 108:186 passim. link .

17. Braidy, N., et al., Serum nicotinamide adenine dinucleotide levels through disease course in multiple sclerosis. Brain Res, 2013. 1537:267-272. link .

18. Mancuso, R., et al., Indoleamine 2,3 Dioxygenase (IDO) Expression and Activity in Relapsing-Remitting Multiple Sclerosis. PLoS One, 2015. 10(6): p. e0130715. link .

19. Penberthy, W.T., Nicotinamide adenine dinucleotide biology and disease. Curr Pharm Des, 2009. 15:1-2. link .

20. Rajman, L., K. Chwalek, and D.A. Sinclair, Therapeutic Potential of NAD-Boosting Molecules: The In Vivo Evidence. Cell Metab, 2018. 27:529-547. link .

21. Das, A., et al., Impairment of an Endothelial NAD(+)-H2S Signaling Network Is a Reversible Cause of Vascular Aging. Cell, 2018. 173:74-89 e20. link .

22. Wu, L.E. and D.A. Sinclair, Restoring stem cells - all you need is NAD(.). Cell Res, 2016. 26:971-972. link .

23. Moroz, N., et al., Dietary restriction involves NAD(+) -dependent mechanisms and a shift toward oxidative metabolism. Aging Cell, 2014. 13:1075-1085. link .

24. Araki, T., Y. Sasaki, and J. Milbrandt, Increased nuclear NAD biosynthesis and SIRT1 activation prevent axonal degeneration. Science, 2004. 305:1010-1013. link .

25. Thompson, A.J., et al., Multiple sclerosis. Lancet, 2018. link .

26. Perlmutter, D. and K. Loberg, Brain maker : the power of gut microbes to heal and protect your brain--for life. 2015, New York: Little, Brown and Company. ISBN-13: 978-0316380102.

27. Perlmutter, D. and K. Loberg, Grain brain : the surprising truth about wheat, carbs, and sugar--your brain's silent killers. 2013, New York, NY: Little, Brown and Co. ISBN-13: 978-0316234801.

28. Wahls, T.L. and E. Adamson, The Wahls protocol : how I beat progressive ms using Paleo principles and functional medicine. 2014, New York, New York: Avery. ISBN-13: 978-1583335543.

29. Wahls, T., Minding My Mitochondria 2nd Edition: How I overcame secondary progressive multiple sclerosis (MS) and got out of my wheelchair. 2010. ISBN-13: 978-0982175088.

30. Wahls, T.L. and E. Adamson, The Wahls protocol cooking for life : the revolutionary modern Paleo plan to treat all chronic autoimmune conditions. 2017, New York: Avery/Penguin/Random House. ISBN-13: 978-0399184772.

31. Costantini, A., et al., High dose thiamine improves fatigue in multiple sclerosis. BMJ Case Rep, 2013. 2013. link .

32. Moore, M.T., Treatment of Multiple Sclerosis with Nicotinic Acid and Vitamin B1. Archives of Internal Medicine, 1940. 65:1-20. doi:10.1001/archinte.1940.00190070011001 link .

33. Klenner, F.R., Response of Peripheral and Central Nerve Pathology to Megadoses of the Vtiamin B Complecx and Other Metabolites. Journal of Applied Nutrition, 1973. 25: p. 16-40. link .

34. Mount, H.T., Multiple Sclerosis and Other Demyelinating Diseases Canadian Medical Association Journal, 1973. 108:1356-1357. link .

35. Xiong, G.L. Wernicke-Korsakoff Syndrome Treatment & Management. 2017 Jun 09, 2017]; Available from: link .

36. Laursen, J.H., et al., Vitamin D supplementation reduces relapse rate in relapsing-remitting multiple sclerosis patients treated with natalizumab. Mult Scler Relat Disord, 2016. 10: p. 169-173. link .

37. Wood, H., Multiple sclerosis: Latitude and vitamin D influence disease course in multiple sclerosis. Nat Rev Neurol, 2017. 13:3. link .

37. Handunnetthi L, Ramagopalan SV, Ebers GC. Multiple sclerosis, vitamin D, and HLA-DRB1*15.Neurology. 2010;74:1905-1910. link .

38. Laursen, J.H., et al., Vitamin D supplementation reduces relapse rate in relapsing-remitting multiple sclerosis patients treated with natalizumab. Mult Scler Relat Disord, 2016. 10: p. 169-173. link .

39. Pierrot-Deseilligny, C. and J.C. Souberbielle, Vitamin D and multiple sclerosis: An update. Mult Scler Relat Disord, 2017. 14:35-45. link .

40. Luque-Cordoba, D. and M.D. Luque de Castro, Metabolomics: A potential way to know the role of vitamin D on multiple sclerosis. J Pharm Biomed Anal, 2017. 136:22-31. link .

41. Hartl, C., et al., Seasonal variations of 25-OH vitamin D serum levels are associated with clinical disease activity in multiple sclerosis patients. J Neurol Sci, 2017. 375:160-164. link .

42. Penberthy, W.T., The Niacin Flush Pathway in Recovery from Schizophrenia and how Arginine and Glutamine may Provide Added Benefit. J Orthomolecular Medicine, 2012. 27:2-10. link .

43. Wischmeyer, P.E., Clinical applications of L-glutamine: past, present, and future. Nutr Clin Pract, 2003. 18:377-385. link .

44. Shao, A. and J.N. Hathcock, Risk assessment for the amino acids taurine, L-glutamine and L-arginine. Regul Toxicol Pharmacol, 2008. 50:376-399. link .

45. Thomson, A.D., et al., The Royal College of Physicians report on alcohol: guidelines for managing Wernicke's encephalopathy in the accident and Emergency Department. Alcohol Alcohol, 2002. 37:513-521. link .

46. Thomson, A.D., E.J. Marshall, and D. Bell, Time to act on the inadequate management of Wernicke's encephalopathy in the UK. Alcohol Alcohol, 2013. 48:4-8. link .

47. Bort, R., How Bad Is U.S. Health Care? Among High-Income Nations, It's The Worst, Study Says, in Newsweek. July 14, 2017. link .

48. Hellman, M., U.S. Health Care Ranked Worst in the Developed World, in Time. 2014. link .

49. Schneider, R.C., et al., Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. 2017. link .

50. CDC. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. 2015; Available from: link .

51. Portal, T.S. Total number of retail prescriptions filled annually in the United States from 2013 to 2024 (in billions). 2017; Available from: link .

52. Bieganowski, P. and C. Brenner, Discoveries of nicotinamide riboside as a nutrient and conserved NRK genes establish a Preiss-Handler independent route to NAD+ in fungi and humans. Cell, 2004. 117:495-502. link .

53. Brinar, V.V. and M. Habek, Rare infections mimicking MS. Clin Neurol Neurosurg, 2010. 112:625-628. link .

54. Society, N.M.S. Clusters. January 26, 2018]; Available from: link .

55. Multiple Sclerosis and Dental Mercury: Summary and References.International Academy of Oral Medicine and Toxicoloty, 2016. link .

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

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Editorial Review Board:

Ilyès Baghli, M.D. (Algeria)
Ian Brighthope, M.D. (Australia)
Prof. Gilbert Henri Crussol (Spain)
Carolyn Dean, M.D., N.D. (USA)
Damien Downing, M.D. (United Kingdom)
Michael Ellis, M.D. (Australia)
Martin P. Gallagher, M.D., D.C. (USA)
Michael J. Gonzalez, N.M.D., D.Sc., Ph.D. (Puerto Rico)
William B. Grant, Ph.D. (USA)
Tonya S. Heyman, M.D. (USA)
Suzanne Humphries, M.D. (USA)
Ron Hunninghake, M.D. (USA)
Michael Janson, M.D. (USA)
Robert E. Jenkins, D.C. (USA)
Bo H. Jonsson, M.D., Ph.D. (Sweden)
Jeffrey J. Kotulski, D.O. (USA)
Peter H. Lauda, M.D. (Austria)
Thomas Levy, M.D., J.D. (USA)
Homer Lim, M.D. (Philippines)
Stuart Lindsey, Pharm.D. (USA)
Victor A. Marcial-Vega, M.D. (Puerto Rico)
Charles C. Mary, Jr., M.D. (USA)
Mignonne Mary, M.D. (USA)
Jun Matsuyama, M.D., Ph.D. (Japan)
Dave McCarthy, M.D. (USA)
Joseph Mercola, D.O. (USA)
Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)
Karin Munsterhjelm-Ahumada, M.D. (Finland)
Tahar Naili, M.D. (Algeria)
W. Todd Penberthy, Ph.D. (USA)
Dag Viljen Poleszynski, Ph.D. (Norway)
Jeffrey A. Ruterbusch, D.O. (USA)
Gert E. Schuitemaker, Ph.D. (Netherlands)
Thomas L. Taxman, M.D. (USA)
Jagan Nathan Vamanan, M.D. (India)
Garry Vickar, MD (USA)
Ken Walker, M.D. (Canada)
Atsuo Yanagisawa, M.D., Ph.D. (Japan)
Anne Zauderer, D.C. (USA)

Andrew W. Saul, Ph.D. (USA), Editor-In-Chief
Editor, Japanese Edition: Atsuo Yanagisawa, M.D., Ph.D. (Japan)
Robert G. Smith, Ph.D. (USA), Associate Editor
Helen Saul Case, M.S. (USA), Assistant Editor
Ralph K. Campbell, M.D. (USA), Contributing Editor
Michael S. Stewart, B.Sc.C.S. (USA), Technology Editor
Jason M. Saul, JD (USA), Legal Consultant