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Monday, January 30, 2023

Efficacy of Diet on Fatigue and Quality of Life in Multiple Sclerosis: A Systematic Review and Network Meta-analysis of Randomized Trials

 Linda G Snetselaar 1Joshua J Cheek 1Sara Shuger Fox 1Heather S Healy 1Marin L Schweizer 1Wei Bao 1John Kamholz 1Tyler J Titcomb 2


Abstract

Background and objective: Emerging evidence suggests a role for diet in multiple sclerosis (MS) care; however, owing to methodological issues and heterogeneity of dietary interventions in preliminary trials, the current state of evidence does not support dietary recommendations for MS. The objective of this study was to assess the efficacy of different dietary approaches on MS-related fatigue and quality of life (QoL) through a systematic review of the literature and network meta-analysis (NMA).

Methods: Electronic database searches were performed in May 2021. Inclusion criteria were (1) randomized trial with a dietary intervention, (2) adults with definitive MS based on McDonald criteria, (3) patient-reported outcomes for fatigue and/or QoL, and (4) minimum intervention period of 4 weeks. For each outcome, standardized mean differences (SMDs) were calculated and included in random effects NMA to determine the pooled effect of each dietary intervention relative to each of the other dietary interventions. The protocol was registered at PROSPERO (CRD42021262648).

Results: Twelve trials comparing 8 dietary interventions (low-fat, Mediterranean, ketogenic, anti-inflammatory, Paleolithic, fasting, calorie restriction, and control [usual diet]), enrolling 608 participants, were included in the primary analysis. The Paleolithic (SMD -1.27; 95% CI -1.81 to -0.74), low-fat (SMD -0.90; 95% CI -1.39 to -0.42), and Mediterranean (SMD -0.89; 95% CI -1.15 to -0.64) diets showed greater reductions in fatigue compared with control. The Paleolithic (SMD 1.01; 95% CI 0.40-1.63) and Mediterranean (SMD 0.47; 95% CI 0.08-0.86) diets showed greater improvements in physical QoL compared with control. For improving mental QoL, the Paleolithic (SMD 0.81; 95% CI 0.26-1.37) and Mediterranean (SMD 0.36; 95% CI 0.06-0.65) diets were more effective compared with control. However, the NutriGRADE credibility of evidence for all direct comparisons is very low because of most of the included trials having high or moderate risk of bias, small sample sizes, and the limited number of studies included in this NMA.

Discussion: Several dietary interventions may reduce MS-related fatigue and improve physical and mental QoL; however, because of the limitations of this NMA, which are driven by the low quality of the included trials, these findings must be confirmed in high-quality, randomized, controlled trials.


© 2022 American Academy of Neurology.


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The Focus of MS Care / Living Well with MS - Presented by: Lynn Stazzone, A.,N.P.,M.S. - Brigham Multiple Sclerosis Center

                 Shared Decision Making + MS Fatigue, Cognition, Depression and More



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Improve Your MS by Making MS Boring - Presented by Aaron Boster, MD

 


Watch
Listen
Learn
then please Share with others so they too can learn more about MS


An MS Patient's Voice - Listen with Emily Blosberg, founder of Mr. Oscar Monkey - (Pediatric MS related)

 


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• Learning about Visual Disturbances in MS

 Event date: August 27th / Published Date: September 21, 2022

Listen with Dr. Jonathan Calkwood's In-Depth discussion on Topics: • Learning about Visual Disturbances in MS (Optic Neuritis, Double-vision & Nystagmus) • Understanding Emerging Therapies, including Brand, Biosimilars, Biologics and Generics • Shared decisions & communicating with your healthcare team --- Dr. Jonathan C. Calkwood, MD , is an MS Neurologist at the Minneapolis Clinic of Neurology, Ltd. - Golden Valley, MN


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Friday, January 27, 2023

Multiple Sclerosis Prognosis and Life Expectancy

 Last updated May 5, 2022, by Marisa Wexler, MS

✅ Fact-checked by Ines Martins, PhD


Insufficient and Poor Sleep in Teen Years Increase Risk of MS: Study

 Adolescents with poor sleep up to 50% more likely to develop MS


Teenagers with poor sleep quality or insufficient sleep — those who sleep less than seven hours a night — are 40% to 50% more likely to develop multiple sclerosis (MS) later in life than those who get adequate rest, according to a Swedish population-based study.

Differences in sleep timing between schooldays (or work) and weekends (or free days) did not affect MS risk.

“Insufficient sleep and low sleep quality during adolescence seem to increase the risk of subsequently developing MS,” the researchers wrote. “Sufficient restorative sleep, needed for adequate immune functioning, may thus be another preventive factor against MS.”

The study, “Insufficient sleep during adolescence and risk of multiple sclerosis: results from a Swedish case-control study,” was published in the Journal of Neurology, Neurosurgery and Psychiatry.

Insufficient sleep cited as less than seven hours per night

Shift work, particularly at a young age, has been linked to an elevated risk of multiple sclerosis. Poor sleep quality can stimulate pro-inflammatory immune pathways and is thought to increase the risk of chronic inflammatory diseases, such as MS.

However, whether disrupted sleep patterns — namely, poor sleep duration and sleep quality — increase MS risk has not been thoroughly examined.

To investigate further, researchers in Sweden conducted a population-based study using data from the Epidemiological Investigation of Multiple Sclerosis (EIMS). This longitudinal study, launched in 2004, involves people from the general Swedish population, ages 16–70.

Because shift work during adolescence has been associated with MS risk, and the disease may alter sleep, the team focused on sleeping patterns and shift work during the age period of 15–19 years.

In total, 2,075 MS patients, with a mean age of 34.8 at diagnosis, were selected from the registry. For each MS case, two unaffected people were randomly selected and matched by age, sex, and residential area to serve as controls. Data were collected using a standardized EIMS questionnaire, which included questions about sleep.

Overall, the analysis showed that people with short sleep — those who slept less than seven hours a night during adolescence — were 40% more likely to develop MS later in life, compared with those with a standard sleep duration of 7–9 hours per night. Having a longer sleep of 10 or more hours each night did not impact that likelihood, however.

When the analysis focused only on those who slept seven hours or more on weekends (or days off), short sleep duration during schooldays (or workdays) was still linked to a 30% higher MS likelihood.

The association between MS and poor sleep remained after adjusting for smoking status, body fat content, and a history of an Epstein-Barr viral infection at age 20. Co-existing conditions at age 20 and at MS onset also did not influence these findings, nor did the total weekly mean sleep duration.

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Wednesday, January 18, 2023

Almost No Cases Found of Celiac Disease and MS in New Analysis / Investigating links between celiac disease and MS

 Prevalence of gluten-caused disease in MS patients is close to zero

by Patricia Inacio, PhD | January 18, 2023

This illustration shows the anatomy of the human digestive system.

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Celiac disease, in which the ingestion of gluten causes the immune system to attack the lining of the small intestine, is not common in people with multiple sclerosis (MS), a meta-analysis found.

While the diet-caused autoimmune disease  is estimated to affect between 0.2% and 0.7% of people in the general population, the new analysis — which reviewed 16 published studies, involving more than 30,000 individuals — demonstrated that its prevalence in the MS population was close to zero.

The researchers noted that multiple sclerosis patients “suffer from a wide range of gastrointestinal manifestations,” but found that “the odds of [celiac disease] in … MS are not high.”

The study, “Is Celiac Disease (CD) Prevalent in Patients with Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis,” was published in the journal Multiple Sclerosis International.


Investigating links between celiac disease and MS

MS is a neurological condition in which the immune system attacks and causes damage to areas of the central nervous system, comprised of the brain and spinal cord. Its exact causes are not fully understood, but people with certain autoimmune conditions are known to have a greater risk of developing MS.

Conditions that have been associated with MS include type 1 diabetes, inflammatory bowel disease, and psoriasis. However, the link between celiac disease and multiple sclerosis is less well-known.

Celiac disease is autoimmune disorder of the small intestine triggered by the ingestion of gluten, a protein found in wheat and other grains. Most people with the disorder carry genetic factors strongly linked to MS, and the disease has been associated with a greater risk of nerve damage.

Now, a team of researchers in Iran sought, for the first time, to assess the prevalence of celiac disease among people with multiple sclerosis. To do so, the researchers conducted a systematic review and meta-analysis of published studies.

Their search covered five database — PubMed, Scopus, EMBASE, Web of Science, and Google Scholar — as well as studies published outside of traditional publishing and distribution channels.

A total of 16 studies, published through October 2022, covered 31,418 patients and were used for the meta-analysis. The majority of studies were from Italy, with additional studies from the U.K., Denmark, Spain, the U.S., Argentina, Iran, Australia, and Brazil.

In total, 124 cases of possible or confirmed celiac disease were registered. The patients had a mean age of 35–55. Among the studies, five also had information about participants without MS, who served as controls. Of a total of 22,394 controls included, 22 had the disease.

Results showed that the pooled prevalence of celiac disease among MS patients was zero. Also, the likelihood of MS patients developing the gluten-related autoimmune disease was 54% lower than controls, although the results failed to reach statistical significance.

Some limitations to the study were noted by researchers, including the exclusion of works that diagnosed celiac disease via a blood sample, though this is an acceptable diagnostic test for the condition. There also were distinct control groups used across the studies.

Overall, the results from this “systematic review showed that CD [celiac disease] is not prevalent in MS cases,” the researchers concluded.


Source:  https://bit.ly/3HeYlCB   

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Digital Eye Strain -- (a good read)

 Written by Dr. Melody Huang, O.D.

What is Digital Eye Strain?

Digital eye strain describes the symptoms you experience after spending long periods on a digital device such as a computer, smartphone, or tablet. This condition is also known as computer vision syndrome, although the term digital eye strain is more inclusive of all digital devices. 

Studies estimate that 90 percent of digital device users experience digital eye strain symptoms.

Digital eye strain symptoms include:

  • Eye strain or fatigue
  • Blurry vision
  • Difficulty refocusing between near and far distances
  • Tired eyes
  • Double vision
  • Dry eyes
  • Headaches
  • Light sensitivity
  • Neck or shoulder discomfort

Causes of Digital Eye Strain

Several factors contribute to digital eye strain. These causes include:

Not using proper eyewear

Ask your eye doctor if you may benefit from a pair of computer glasses.

People with vision problems such as astigmatism, hyperopia (farsightedness), or presbyopia (age-related near vision changes) often wear glasses while using digital devices. Your doctor can also recommend special tints or coatings to make your eyes more comfortable and relieve eye strain.

Blue light exposure

Digital device screens emit a small amount of blue light, far less than the amount we get from the sun.

Some studies found that blue light exposure can contribute to digital eye strain. However, other research suggests more evidence is necessary to confirm these findings.

Glare

Glare occurs when light bounces off your digital device screen and enters your eyes. This can fatigue your eyes quickly.

Dry eyes

Several signs of digital eye strain are associated with dry eyes. Staring at a screen causes you to blink less frequently, which in turn exacerbates dry eye symptoms. Dry eye causes irritation, tired eyes, blurry vision, and light sensitivity.

Close viewing distance

The closer you hold a digital device to your face, the harder your eye muscles work to focus your vision. If you do this for prolonged periods, your eyes are more likely to fatigue.

Poor posture

Depending on how your chair, desk, and digital device are set up, your posture can contribute to eye strain. 

digital eye strain posture

Risks and Dangers of Digital Eye Strain 

Digital eye strain symptoms are usually temporary. Common symptoms include migraines, chronic neck and back pain, and disrupted sleep. The more time spent viewing digital devices, the longer your symptoms may last.

If you regularly spend time on a computer, smartphone, or tablet, there are some risks you should be aware of: 

Migraines

Digital eye strain can trigger migraine headaches in some people.

Light flickering or glare on the screen are common migraine triggers. Digital eye strain can also cause ocular migraines. Symptoms of ocular migraines include flashing lights, wavy lines in your vision, blind spots, and temporary blackout of your vision. Ocular migraines can occur with or without a headache.

Chronic neck and back pain

Poor posture while looking at a digital device can lead to more than just eye and vision symptoms.

Many people suffer neck and back pain after computer use, which can add to any discomfort from digital eye strain issues. Over time, these problems can become chronic and require medical treatment, such as chiropractic adjustments.

Disrupted sleep cycle

Studies find that exposure to blue light, especially before bedtime, can disrupt your sleep.

Try not to use your digital devices right before bed. If you cannot avoid doing so, consider using blue light blocking lenses or adjusting your device settings to filter out blue light.

There is not enough scientific evidence to demonstrate that our digital devices cause eye diseases such as cataracts or macular degeneration. While large amounts of blue light exposure can damage our eyes, the amount of exposure from our devices is quite small. The current research suggests there is no reason for people to worry that using their smartphones will cause macular degeneration or cataracts.

How to Relieve Digital Eye Strain

You may not be able to avoid looking at digital devices, but there are many things you can do to make your experience more comfortable. Here are some ways to relieve digital eye strain:

Lubricate your eyes

Instill lubricating drops throughout the day while working on a computer. Keep a bottle at your desk as a reminder to use them.

Use a humidifier

Many people work in an office or similar environment where the air is dry due to heating or air conditioning. You can purchase a humidifier to help prevent dry eye.

Blink frequently

Remind yourself to blink more often while looking at a screen. This will help distribute fresh tears across your eyes and keep them moist.

Wear glasses instead of contact lenses

Contact lenses can aggravate dry eyes. Consider wearing glasses if you plan to use a computer for extended periods.

Adjust your room lighting to minimize glare

Try to avoid any direct lighting on your digital device to reduce reflections off the screen. If you sit near a window, close the blinds or curtains if possible.

Use anti-glare protection

Use a screen cover that reduces glare on your digital device. If you have computer glasses, an anti-reflective coating reduces glare off the surface of your lenses.

Consider blue light blocking lenses

Research shows mixed results on whether or not blue light glasses relieve digital eye strain.

Even so, many eye doctors are still recommending blue light blocking glasses or blue light screen protectors for digital devices. Studies have not shown any disadvantage of using blue light blocking lenses.

Continue reading

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Friday, January 13, 2023

Microbial Cocktails Are More Than a Gut Feeling

 January 12, 2023

Targeted manipulation of bacteria could boost immunity and help sufferers of chronic diseases and allergies.


In 2023, our understanding of the microbes that live inside the human gut will lead to new ideas for medicine. Today, we know that gut microbes help develop and sustain our immune system. They do that by producing high levels of three types of short-chain fatty acid molecules: acetic acid, propionic acid, and butyric acid (or butyrate). The last of these, butyrate, promotes the activity of immune cells called regulatory T cells, or T regs. These cells are specialists at turning off the activity of other immune cells, which is vital to keep the immune system from damaging the body. The other short-chain fatty acids also affect immune cells, as well as the cells of the gut lining, although these other processes are not as well understood. 

Roughly speaking, high levels of fatty acid molecules quiet the immune system, creating an “anti-inflammatory” environment—not only locally in the gut, but for the whole body. There are many situations in which this function is important, including to manage or prevent allergies. 


Allergies are caused by undesirable immune responses against things that are mistakenly seen as harmful—what we might think of as overreactions of the immune system—so something that helps dampen immune responses or helps the body develop the capacity to do so could be helpful in preventing allergies.


There is some evidence that gut microbes do precisely this, helping the immune system develop in a way that doesn’t allow for allergies. For example, mice given a high-fiber diet produced high levels of short-chain fatty acids in their gut, which correlated with being less likely to develop a mouse version of asthma. A small study of young children also found that those with allergies had lower levels of short-chain fatty acids in their feces. Crucially, however, these observations are only correlations. We are at the frontier of knowledge here. 


In 2023, our understanding of gut microbes will deepen through the development of technology. First, laboratory hardware will be used to rapidly sequence large amounts of genetic material. Second, we have now developed computer hardware and software that will allow us to sort through all the different microbial gene sequences, seek patterns in the data and correlate results with other factors, such as a person’s diet or state of health. The endeavor to understand the human microbiome has become a flagship enterprise for big data science. 


Probiotics—foods or supplements with live bacteria added—are one prospect for manipulating the microbiome. There is some evidence they may ease the symptoms of an ongoing illness, such as irritable bowel syndrome, or perhaps help avoid the side effects of taking antibiotics. But the relevant authorities across Europe and the US have yet to approve any probiotic as a medicine. 


Right now, there’s a deep scientific problem: With immense variability in the precise makeup of each person’s gut microbes, we don’t really know what a “healthy” one is. A core set of various bacteria seems important, and there must be an absence of anything obviously dangerous. But beyond this, little is clear. Rather than a few types of microbes being needed, perhaps what’s important is an overarching ecology. When we understand this clearly, we will be able to design and manufacture healthy microbe cocktails that can be administered as medicine. 

ARTICLE SOURCE



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