ECTRIMS: Risks and Triggers for MS

There’s a lot of progress being reported this week at ECTRIMS on the topic of MS risk factors and triggers. I think this is really important because if we knew exactly what causes MS, we might be able to prevent anyone from ever getting the disease again. But even more relevant to people who already live with MS is new evidence for risk factors that are within a person’s control and which may make their disease worse – or better.
 
For example, in a large population study by Dr. A.K. Hedström and team from Stockholm, Sweden, they confirmed that cigarette smoking increased the risk for developing MS at any age, and climbed with the amount smoked. They also found that quitting smoking completely flattened out that risk back to normal within a decade. 
 
The same team reported that smoking could increase a person’s risk of developing the kind of antibodies in their blood – called neutralizing antibodies – that can block the ability of interferon beta to reduce MS disease activity. All good reasons to quit.
 
We know genes contribute to MS risk, but that’s not the end of the story. Dr. H. Westerlind reported on a study by a team from Solna, Sweden, taking advantage of MS patient registries in Sweden, one of which dates back to the 1800’s. They took a fresh look at how much having a family member with MS increases a person’s chances of getting the disease, and they focused on identical and fraternal twins. Comparing the risk of these two groups is important because identical twins are thought to share the same genes whereas fraternal twins do not.
 
Using sophisticated analyses,  they found that the risk of an identical twin getting MS if the other twin has the disease was lower than in prior reports, but still much higher than in fraternal twins. This study suggests that that the role of genes may be more complicated than previously suspected. (Read more about genetic risks) This mystery is driving more studies looking at the interaction of genes with a person’s environment and lifestyle.
 
For example, Danish researchers Dr. A.B. Oturai and colleagues from Copenhagen looked at a group of potential risk factors, including known MS susceptibility genes, obesity in early adulthood, previous mononucleosis and high teenage alcohol consumption. They found that each of these factors contributed to lowering the age at which an individual was diagnosed with MS. A related study suggested that preventing teen obesity in people with MS susceptibility genes may reduce their risk of developing MS.
 
Recent studies have pointed to salt intake as a possible risk factor for developing MS or for making mice with MS-like disease worse. (Read more here) But new evidence presented this week by Drs. M.F. Farez and colleagues in Buenos Aires and Boston suggest that high salt intake may also increase MS exacerbation rates and MRI-detected disease activity in people who have the disease. It will be important to do further research in this area to confirm these results in larger numbers of people and to figure out what levels of salt in the diet might be considered OK for people with MS. 
 
Also discussed this week were clinical trials getting underway to test whether increasing an individual’s vitamin D levels can delay the development of MS. And the National MS Society is supporting a trial to see whether vitamin D supplements can reduce MS activity in people already diagnosed. (Read more on vitamin D)
 
Another emerging area of research is the gut microbiome – colonies of trillions of bacteria that inhabit our intestinal tracts, most of which are beneficial. The immune activity that occurs in the gut and which is related to the immune system, may help dictate other aspects of health, including the activity of an individual’s MS. A lecture by Dr. O. Borbye Pedersen of Copenhagen made it clear to me that this is a very promising field of study. If we could decipher the influence of the gut microbiome, we have the potential of altering it to treat or even prevent MS.  
 
Taken together, maybe there’s some truth to the old adage, “You are what you eat.”


**You can read abstracts for all the studies mentioned in this article by visiting the ECTRIMS 2013 Online Library**
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Nicholas

Nicholas LaRocca, PhD

Dr. Nicholas LaRocca is a clinical psychologist who has worked in the field of MS for over 30 years. He was an associate professor at Albert Einstein College of Medicine and New York Medical College before joining the Society in 1997. He currently serves as Vice President of Health Care Delivery and Policy Research in the Research Programs Department of the Society. In this role he has responsibility for Society funding of research to address the symptoms of MS, rehabilitation, epidemiology, psychosocial aspects of MS as well as health policy studies.

    37 Comments

  • Janis Smith   Oct 3, 2013 9:25 AM
    I was diagnosed at age 30. I am now 44. No one in my family has MS. I have never smoked or drank alcolhol in my life. I am overweight but did not get that way until I had my first child at the age of 24.
  • Avatar
    Quaker  Oct 3, 2013 9:28 AM
    Interesting....
    I was a heavy smoker until my mid 20s. Quit for around 20 years and then developed MS. Heavy drinker in teens and early 20s. The Navy during Nam will do that to ya.
  • Marc   Oct 3, 2013 9:34 AM
    I know this anecdotal, but like Janis - I have always been a teetotaler and have never smoked. I am a desert rat, living in the Mojave desert and (as far as I am aware) do not have MS in the family. I too am little over weight but that is only relatively recently .. I was a swimmer in high school and college.
  • Melissa   Oct 3, 2013 9:45 AM
    I was diagnosed with MS July 2013. I am a 27 years old female who abused alcohol as a teen and also up until most recently but since stopped. I Started smoking at 18 years old and just happen to quite a month before I was diagnosed. I was obese as a teen and didn't start losing weight till I was 17-18 years old. No one in my family has/had MS, as far as we know. So, I fit this profile almost to a T.
  • Jill   Oct 3, 2013 10:09 AM
    I was diagnosed at age 23 and now I am almost 40. There is in fact a total of 7 for now in my family that has it. These are all interesting facts however, whose to say. We always hear everyone is different and will react differently. Just live healthy and pray for the best.
  • Eric   Oct 3, 2013 10:30 AM
    I was diagnosed in 2005 with RRMS and currently take Betaseron. The last bad exacerbation was in Maryland. Since I've been in Texas the past two years, I haven't had any trouble. I'm a little overweight but a non-smoker and a very social drinker. I never add salt to my food, ever.
  • LULU   Oct 3, 2013 10:30 AM
    I am 34. Was diagnosed in 1999 right before I turned 20. Never smoked or drank. I am 5'3" 132 pounds. Not a soul in my family has it. Wish I knew
  • Avatar
    National MS Society  Oct 3, 2013 10:40 AM
    Please keep in mind that this article refers to some factors that research suggests may contribute to MS, not to a single cause of the disease. We do not in any way mean to imply that everyone who has MS has been exposed to these factors, nor that everyone who is exposed to them will get MS. Rather, we would like to make people aware of factors that may play a role in the disease process.
  • Chris   Oct 3, 2013 10:57 AM
    Have had MS for 15 yrs and my older sister has had MS for 25 yrs. We have a brother between us with no MS. Both our parents were smokers and Mothers smoked during pregnancy, social drinkers and relatively healthy. We WERE also social drinkers but, not a smoker nor my sister. Our brother uses tobacco products and was a social drinker. No other family members with MS. Maybe the second hand smoke has the same effect on us? Smoking during pregnancy?
  • jennifer   Oct 3, 2013 10:59 AM
    I was diagnosed when I was 19 but was told I had it since I was 14. I was always outside when I was young and nobody in my family has it.
  • Rosita   Oct 3, 2013 11:03 AM
    I was diagnosed in 2007 at the age of 32. I am overweight have been since I was a child, I have smoked, drank very little as a teenager BUT at the age of 16 I became very, very sick. I had mono, strep throat and tonsilitis at the same time and almost died. My tonsils were so big that they almost closed off my air way.Had to have emergency surgery to get them out and spent 7 days in the hospital.. Talking with my Dr's they think thats when I got MS. No one in my family has MS....
  • David G Smith   Oct 3, 2013 11:31 AM
    I am a 57 year old male who was diagnosed last month (9/5/2013) with MS. I've had tendonitis or weakness issues since I was 18 and had Mono when I was 20. I seldom have a drink but I chewed tobacco or fogged a cigar for a year in the 80's. There are no prior cases of MS in my family that I know of. I have also been diagnosed with ADHD, Chronic Fatigue and Fibromyalgia but I think it has been MS all along.
  • Cathy Mowrey   Oct 3, 2013 12:47 PM
    I was diagnosed with MS in February, 2013. I am 52 years old. Had no sympthoms prior to this diagnosis. Never smoked and only drank socially. Never ad Mono. Only salt in my cooking, never at the table. No one in my family has MS. Those that can please keep searching for a cure. God's blessing to all those who are managing this disease.
  • BECKY-78  Oct 3, 2013 1:45 PM
    Oh give me a break! I hope the MS Society didn't fund any of this research! I was diagnosed with MS at 17 years old (35 years ago)! I was a non smoker, wasn't drinking (yet), never had mono, was probably 25-30 over weight at that time and living in sunny Southern California (still do). This is an insult to knowledgable people with MS!
  • Barb   Oct 3, 2013 1:57 PM
    I was diagnosed with R/R MS at age 44 by my orthopedist. He referred me to a neurologist. I was having a lot of falls. I had total right knee replacement at 47 and now I can't seem to walk right. As a child I was overweight till about 14. I am now overweight again since I turned 50. I abused alcohol as a teen and my early 20's. Never smoked but my Dad did. Salt does seem to make me feel more fatigued. I had wondered about alcohol, as my childhood best friend also has MS.
  • Francis   Oct 3, 2013 2:08 PM
    Thank you so very much for writing this. I just want to know what to concentrate on, to do better at to help the situation with this disease.

    Gives some idea of the rationale behind diet and salt intake. Tells you that yes, your genes are susceptible, but you have some things you can control. Not a guarantee, but a hope. Thank you very much!
  • Karen Copeland   Oct 3, 2013 2:36 PM
    I'm not saying that smoking is a good thing but blaming MS on smoking is just a tad too foolish. Step out on my balcony and it is not cigarette smoke you smell. It's not MJ you smell. It's car exhaust and fumes from the industrial park down the street you smell. As you step through the door, did you know you are stepping past walls that are insulated with asbestos? A lot of older buildings are! And stepping on the lawns that are soaked with years and years of insecticide. Add to that, we drink water deliberately doused with poisons like Fluoride and every food you can think of has been, at one time or another, declared unhealthy (and thanks to Monsanto it probably is now).
    And how do you explain people with MS who have never smoked and who are rarely exposed to second hand smoke?
    A smoke screen perhaps to let you linger on smoke while denying real problems - like all the misdiagnoses that, as it turns out, should have been diagnoses of Lyme Disease or Cpn or even spinal chord injuries. Oops! I forgot. Lyme, which has been declared to be epidemic in the USA (less than half an hours drive from here, does not exist here.

    The MS Society's comment, as usual, says absolutely nothing. Which fits in pretty well with what they do - nothing. They claim to be looking for a cause, but those have found a cause and/or relief have found them on their own dollar and initiative. Meanwhile, your donated money has gone to give Mr. Savoie yet another raise in pay. Over $300,000 is a pretty big payout for non responses like the one above.
    For a group of supposedly educated people, you sure are dumb over there at ECTRIMS. Personally, I think you are not as dumb as you are obsessively greedy.
  • vonnie   Oct 3, 2013 2:39 PM
    yeah, great to know studies are being done. thankyou for any work that will help others like us. but don't we know this already. alcohol is not good for you, smoking is not good for you, antibiotics are not good for you, vaccines are not good for you, (often better than the actual disease, but that's a whole other conversation), chemical sweeteners are not good for you, packaged food is not good for you, emotional abuse is not good for you, stress is not good for you, living in a mining area is not good for you (metal overload in the close by waters) etc, but not everyone who has ms, has experienced all these, and many more people who have experienced all of these, are healthy. it seems to still be a mystery. genetics does not seem to be a factor, but has anyone looked into the diseases of our individual family ancestors and what is passed down through the generations. looks to me like we need to look way further out the box... meantime i agree with the comment - lets live/ eat well and pray for the best...
  • vonnie   Oct 3, 2013 3:58 PM
    yeah, great to know studies are being done. thankyou for any work that will help others like us. but don't we know this already. alcohol is not good for you, smoking is not good for you, antibiotics are not good for you, vaccines are not good for you, (often better than the actual disease, but that's a whole other conversation), chemical sweeteners are not good for you, packaged food is not good for you, emotional abuse is not good for you, stress is not good for you, living in a mining area is not good for you (metal overload in the close by waters) etc, but not everyone who has ms, has experienced all these, and many more people who have experienced all of these, are healthy. it seems to still be a mystery. genetics does not seem to be a factor, but has anyone looked into the diseases of our individual family ancestors and what is passed down through the generations. looks to me like we need to look way further out the box... meantime i agree with the comment - lets live/ eat well and pray for the best...
  • Leslie   Oct 3, 2013 4:50 PM
    This seems like a big waste of MONEY and as usual ads nothing new to the story. The risk factors mentioned are risk factors for the population in general. I'm surprised they didn't say people with brown eyes and hair are more at risk. Lets try dropping the auto-immune theory and concentrate on something more plausible and proven. Like the bacterial connection and the vascular one. If they really wanted to cure and "END MS" now they would concentrate their efforts on something that hasn't been pushed down peoples throats with NO END in site. STOP DOING WHATS NOT WORKING!
  • Billy Howell II   Oct 3, 2013 4:53 PM
    It's like I learned in Psychology(I'm a psych major, and I was diagnosed with MS at 24), correlation doesn't prove causation. I will agree that genetics do seem to play a factor, but the other things mentioned is like I said correlation doesn't prove causation which someone who wants to know why they got MS......this article really doesn't help out.
  • Pamela Cooley   Oct 3, 2013 5:22 PM
    Three people in my family have MS, one has passed due to the complications from RRMS. She was only 44 y/o. Yes...I agree, all the food, water and air we breath is tainted with poison. But if research was to say that...all government grants would be pulled. I am a smoker but do not drink, nor do illicit drugs. I am not on any medication for RRMS due to the lack of education physicians receive today. Most med students cheap on Board Exams....now that was on the news a while back. If they do not have a clue what is wrong with you, they say you have a "virus". Their are too many chiefs and not enough Indians in the medical profession. One hand does not know what the other hand is doing. I know. I have seen it for my own eyes. I worked as a nurse for twenty years. Research...Blah. There is a vaccine available, FDA approved for AIDS. They let the info out many years back, the FDA pulled it. So the Pharmaceutical Companies can make their millions and billions. It just goes on and on. Cure...never. For any diseases. Got make those big bucks.
  • M.Henderson   Oct 3, 2013 6:08 PM
    I was diagnosed in 1998 at age 31. My neurologists said I had probably had it since I was 20 because I had optic neuritis then and other symptoms had started but my husband was in Navy then and those Navy neurologists wanted to say it was stress since my husband was on deployment for 6 months during Persiun Gulf war. Never smoker or drinker. Had bowel problems all my life and have been diagnosed with ulcerative colitis in 2003. A couple of family members has M.S. (cousin) . Also Aunt with R.A., lupus and other medical issues. Have never been obese weigh 119 and 5'2. Former nurse and I am on Tysabri and have been for 7-8 years with great results. God is good all the time...
  • Avatar
    mwehner_2005  Oct 3, 2013 7:25 PM
    Like a lot of the reports above, I smoked very lightly from 13 - 19, drinking - family holidays only for the most part, was never obese, grew up in a semi-desert and was always extremely physically active - DH Mt bike racing, Ski Patrol, Wildland firefighter, Tree Planting, Adventure Racing. I had an IBS attack @ 23, then regulated my diet which prevented future attacks - though I was chronically constipated. Dx'd MS @ 46. One thing I have not heard is Vit D levels? @ 38 I moved to PDX, started working indoors with very little or no sunlight. 7 years later my PCP reports extremely low Vit D, and requests I start 2k mg/day (regretfully, my compliance was poor). Less than a year later ... MS. Anyone else have Vit D issues?
  • Catherine   Oct 4, 2013 12:28 AM
    I do a lot of family research, and I found someone in my tree that had MS. I previously would never have known as no one in our family knew she had MS, as it was too far back. My point is, family trees are extensive and information is easily lost. This was in the 19th century!
  • Catherine   Oct 4, 2013 12:34 AM
    All the study is saying is that smoking is a "risk" factor. Smoking does NOT cause MS. It increases your chance of getting it. If you combine enough of the risk factors, it will increase your chances of developing the disease. Maybe its useless information, but its interesting to know that MS is influenced by a range of lifestyle/environmental factors. This is of no use to anyone who has already developed MS, and serves to either confuse or make them feel guilty.
  • Rickyboop   Oct 4, 2013 6:21 AM
    Yeah it could be. But, I doesn't have to be. You really do know how to waste all that hard earned money you beg off the average Joe. What an absolute waste of time and our lives. Of course keep milking the system and continue you half assed theories. You are good at that. Instead of taking care of yourselves in the pocket. Try finding the cause nstead of continuously reinventing the wheel. I am in disbelief you all are getting away with this for over 50 years. Maybe try looking at something that seems to make more sense. CCSVI is the real deal. But, you refuse to godown that path. All you keep doing is trying to quash this. Going on year five and you still deny it exists. You all know it does exist so stop thinking we are stupid. Stop showing your ignorance.
  • Debbie   Oct 4, 2013 12:04 PM
    This study is bs. My husband was diagnosed in 1991 and soon to be 49. He never smoked and ate all his veggies. He is physically fit and walks every day although his MS doctor doesn't know how.
  • Anonymous   Oct 4, 2013 12:18 PM
    I've never smoked, and have always exercised and eaten healthy foods. There is no MS history in the family.

    Recently, someone assumed I'm a smoker because I have MS. To the general public, this devastating disease is becoming a blame-the-victim illness. It's sad that funds are being wasted to report the obvious news that smoking isn't good for people.
  • Anonymous   Oct 4, 2013 12:29 PM
    I think most of us do understand that the study is addressing risk factors. Wouldn't it make more sense to put money toward trying to pinpoint the actual causes of this terrible disease?
  • Alisdair   Oct 5, 2013 10:08 AM
    Having tried to enhance the auto immune by being VERY strict wit a diet, I now know when I have had a small amount of banded food intake as it is immediately evident. 1 year and counting..
  • shirley succamore   Oct 7, 2013 9:06 AM
    when 1 was 5 , i had a eplict fit when i was 7 had another one,
    i also when i was 6 i actually wallowed mercury out of a thermometer,
    i also had a few bumps on my head .al had trances some of which i would be
    crossing a road ,i would just ignore people.i think i had ms has a child.
    would it be possible also when 1 was 13 had had a big crash .i have no memory of that day.it was over 30 years ago still no memory
  • shirley succamore   Oct 7, 2013 9:06 AM
    when 1 was 5 , i had a eplict fit when i was 7 had another one,
    i also when i was 6 i actually wallowed mercury out of a thermometer,
    i also had a few bumps on my head .al had trances some of which i would be
    crossing a road ,i would just ignore people.i think i had ms has a child.
    would it be possible also when 1 was 13 had had a big crash .i have no memory of that day.it was over 30 years ago still no memory
  • hjmorrone  Oct 17, 2013 11:34 AM
    I am 44 years old and can trace back to age 21 for my first exacerbation but was diagnosed at age 36. I have been a smoker for over 30 years (yes, started very young) but grew up in the sun (NC) with the exception of living in MA during my prepubescent years (correlation to vitamin D deficiency?); I was actually extremely active and scuba diving for a living when diagnosed. No family history. I quit smoking approx. 4 months ago =)
  • JoAnn   Oct 17, 2013 7:47 PM
    Families devastated by this monster deserve better. More disappointment for those desperately looking for answers. My mother was diagnosed 67 years Who is benefitting from this failure to find the cure?
  • j   Oct 24, 2013 11:07 AM
    J, 10/24/13
    dignoised 12/13. age 63. Raised in MS. Worked on farm, played outside ALL the time, never smoked. Now will drink a little wine socially. Boated, camped, water skied for over 25 years. Last water skied at age 62. Vitamine D?? who knows. I am taking it now.. Although blood test were great!!!!
    Began having weakness in leg and created a limp. No one could tell me why. After test on top of test . Finaly a MRI showed lesions in my neck. Spinal tap gave back positive for MS. ON Copaxone limp is 75% better.

    Have since discovered that 6 people from the arear I grew up now have MS.. ONe being a person that was adopted and moved to this place. They are now a teenager and was diagnosed with in the past year...

    Enjoy life, live it to the fullest...We are not promised tomorrow...

    Keep up the research..
  • Octavia  Nov 2, 2013 12:18 AM
    I have heard that smoking is a factor for MS, but I have not seen if second smoke has also been considered. I grew up with a mother who smoked several packs of cigarettes a day and I lived with my parents for twenty two years breathing in the smoke around and from my mother. I never smoked in my life, so I wonder if that is one of my factors along with Mon in college and Little or no sunlight as I avoided being in the sun because I did like high heat which NE summers brought.