And Why You Shouldn't Obsess about Them

Introduction

When trying to make sense of the many medical theories surrounding the risk factors for multiple sclerosis (MS), it's easy to feel lost in a sea of conflicting information. From genetics to lifestyle factors, each theory promises to clarify the root cause of this complex neurological disease. But what if the answers to MS lie not in the research laboratory but within your biography?

In this blog post, we'll challenge the current scientific theories of MS. We’ll invite you to review them with the eye of a researcher. You’ll learn how to seek out the "white crows" that defy the current explanations of MS. We’ll show why you shouldn’t obsess too much over the risk factors. And along the way you may find new insights into the root cause of your MS.

Risk Factors are Not the Root Cause of MS

When we try to summarize the current theories of MS, the cause of MS looks something like this:

risk factors for multiple sclerosis

This model paints a picture of randomness and inevitability, attributing the disease to a haphazard mix of genetics, lifestyle habits, and sheer bad luck. But as we peel back the layers of this narrative, we're confronted with a stark reality:

Science hasn’t yet found the cause of the disease!

The lack of effective treatments [of MS], may be related to an inability to identify its cause currently.” [1]

“Our incomplete understanding of the causes and pathways involved in the onset and progression of multiple sclerosis limits our ability to effectively treat this complex neurological disease…”  [2]

Treating Risk Factors is Not the Same as Treating the Root Cause of MS

The root cause of a disease is what precedes and gives rise to the disease. Without a cause, a disease cannot occur [3,4]. Risk factors are not causal factors. Instead, they are ‘things’ that have been found in common in some people with MS, but not all.

This seems obvious, but that simple explanation gets lost in all the discussions on the internet about risk factors! Eliminating all the ‘risk factors’ from your life, which I’ve seen many of my clients try to do, may improve parts of the disease, but it will not cure MS. We’ve got to look deeper for that.

And only you have the key, in your biography, to what was happening before onset. This is why I invite you to become your own researcher - so you can discover the root cause of your MS for yourself.

To start and to think like an objective researcher, you’ll need to look for exceptions to separate risk from true cause. In science, this is called finding the white crow.

“If you wish to upset the law that all crows are black…it is enough if you prove one single crow to be white.”

― William James [5]

Why do we need to separate causal from merely a risk factor? Simple—it keeps us all from falling into the trap of trying to fix or treat the risk factors as a means to cure MS. That doesn’t work. But more on that later…

Current Risk Factors Theories and Why They Aren’t That Important

Let’s review some of the current theories of MS and make sure science hasn’t ignored some obvious white crows. These are the most recent assumptions in science:

MS Risk Factors of Onset: “Tobacco smoking, low vitamin D levels and/or low sun exposure, Epstein Barr Virus (EBV) seropositivity and a history of infectious mononucleosis may increase the risk of developing MS.” [6]

MS Risk Factors of Relapse: "Evidence suggests that MSR [relapse] is influenced by age, sex, pregnancy, serum levels of Vitamin D, interactions between genetic and environmental factors, and infectious diseases.” [7]

Taking a few of these in detail, we find the following (for those less drawn to research, you can skip over this bit and go directly to “So where do we go from here?”)

Genetic Predisposition and MS

One of the hot areas for research on the root cause of MS is genetics. Upon reviewing the latest research, however, it turns out that genes contribute very little to MS. In fact, only about 1-5% of MS cases carry the genes identified as increasing MS susceptibility [8]. Interestingly, this is a much lower percentage than in some other diseases [9].

And while research has found that certain genetic codes may increase the risk of MS [10,11], many people have those same codes and never develop the disease. Thus, genetics research has not found a universal cause.

But this lab-based research on family genetics misses a possible key influencer of MS in families - families pass along much more than just their genes! Whole branches of psychology look at the influence of family on predisposition to certain problems and diseases. This includes how family dynamics - such as how a family is organized, and its attitudes and beliefs - can be passed down through generations [12] shaping who we believe ourselves to be [13].

How has your family influenced expectations regarding who you believe you need to be?

Finally, studies conclude that lifestyle and environmental factors (including stress and mindset, which we’ll focus on in another blog) play a much bigger role in predicting disease onset and progression than do genes [14], including genetic studies [10,11]. Yet, the causal relationships between lifestyle, environmental factors, and MS remains unclear [6].

Low Vitamin D and MS

FACT: People with lower levels of Vitamin D have an increased risk of MS [15,16]

Scientific Hypothesis:Countries near the equator have significantly fewer cases than countries further away and in the northern hemisphere because they have more sunlight.”

A few of my clients seem to have improved some of their symptoms of MS by taking large quantities of vitamin D. But only a few. Like many in the medical field, they have succumbed to this hypothesis made common since at least the year 2000 [17]. Unfortunately, the research in the last 20 years, and the mixed results of my clients, do not support this hypothesis.

What is wrong with the Lower Levels of Vitamin D Hypothesis: Sun exposure and vitamin D levels don’t explain why some people with low vitamin D don’t get the disease and why some people with healthy levels do:

  • India has higher rates of vitamin D deficiency but lower rates of MS [18].
  • Australia has one of the highest rates of MS (the top 6 in 2019), yet their levels of vitamin D are considered “adequate” [19].
  • Black and Hispanic populations have the highest rates of vitamin D deficiency and also some of the lowest rates of MS, with no differences in vitamin D levels between those who have or don’t have MS [16,20].
  • Countries closer to the equator are now reporting an uptick in cases of MS. Some of this increase is due to better diagnostics and reporting, but a lot of it represents a genuine increase in the disease [21], and cannot be tied to vitamin D levels [19].

It turns out that people with MS generally have higher levels of vitamin D than people who don’t, because this risk factor is so well known that doctors commonly recommend supplementing with vitamin D [22]. Regrettably, there is little evidence that high-dose supplementation reduces MS progression, relapses, or important symptoms [23,24]. There is evidence, however, that supplementing with vitamin D may reduce inflammation and oxidative stress, which is probably why doctors recommend supplementing with it but don’t prescribe it as an MS treatment.

These rigorous findings contradict the claims of some books and websites promoting high-dose vitamin D as a cure-all. One popular approach, the Coimbra Protocol, lists a bunch of research on their website supposedly showing it works for MS. But only one of the studies is on MS, and that one wasn’t even peer-reviewed or published in a medical journal, but rather a newspaper article about a talk the author gave.  

It might be worth noting that rather than low vitamin D levels causing a host of diseases, another review suggested that low D might instead be the result of illness [25]. This makes sense when you consider that being diagnosed with a serious disease can lead to feelings of stress, worry, anxiety, and depression, all of which have been found to reduce vitamin D levels [26]. So, in this case, low vitamin D is not causative; it doesn’t even seem to be a clear risk factor. However, it could be the result of being diagnosed and experiencing MS.

Short Note on Diet and MS

This same thought process as written above for vitamin D can be applied to anti-inflammatory diets. While anti-inflammatory and restrictive diets help many people diagnosed with MS, some people report no difference in symptoms. Additionally, there is no evidence these diets treat the root cause of the inflammation; rather they reduce the existing inflammation [27]. Yes, eating a healthy diet is associated with better quality of life and can reduce symptom severity. But diet alone will not eliminate the disease [28]. And ‘SAD’ food choices, though a risk factor, did not cause the onset of MS.

Consequently, as with vitamin D, it’s a good idea to eat a healthy diet but obsessing over food will not cure the disease, it will only add to your stress, which itself can cause inflammation and lower vitamin D levels.

Women and MS

FACT: People with lower levels of Vitamin D have an increased risk of MS [15,16]

Scientific Hypothesis:Countries near the equator have significantly fewer cases than countries further away and in the northern hemisphere because they have more sunlight.”

While looking at chromosomes or hormones is tempting, the significant fluctuations of the ratio of women to men in different countries, at different times, and different latitudes doesn’t support this hypothesis.

  • At the beginning of the 1900s, there was an almost one-to-one ratio of women to men diagnosed with MS in the US. The number of women diagnosed relative to men began to increase rapidly in the 1950s and continues to this day [33].
  • Chromosomes are stable throughout life. However, the ratio of women to men increases with age. Diagnosis in early childhood is about 1.2 girls to every 1 boy, while diagnosis between 12-18 years of age goes up to 2.8 girls for every 1 boy [34,35]. The ratio of adult women with MS to men with MS consistently increases throughout the adult years [36].
  • One study showed an increase in the ratio of women to men with MS over the past 70 years in northern latitudes, while not changing at all in southern latitudes [30].
  • Sweden’s ratio of women to men seems to have doubled in people born in the 1970’s and then drastically lowered again for those born in the 80’s and beyond [37].

Yes, women in highly developed northern countries typically get MS at rates much higher than men. But what else, other than blaming hormones or X chromosomes, might explain this difference? Could it be due to a shift in the role of women in society? Cultural differences between northern and southern latitudes? Might these be a clue?

Epstein-Barr Virus (EBV) and MS

FACT: A huge majority of people who develop MS have the Epstein-Barr virus (EBV) [38]

Scientific Hypothesis: EBV causes MS

We’ve discussed this relationship in an earlier blog.

In summary, there are people diagnosed with MS who never contracted EBV and vice versa. The famous paper that got this whole hypothesis started reported that 97% of people who do not have MS also carry EBV while 99.9% with MS do [38]. They used that small difference to claim that having the EBV virus increased the risk of MS by 32 times!

A more detailed review of the original paper found only a very small association between EBV and MS when the study started. The main risk of MS was found among people who had contracted the virus within the 5 years prior to diagnosis [39] and not if the time period between the two is greater.

So if EBV becomes more important within the 5 years prior to onset, other than a viral load increase, what might have tipped the body into MSing? If you read the paper, the participants in the study were all new military recruits with all the pressures and stressors of their environment (all active-duty, some with combat and other traumatic experiences!) Might that biographical detail contribute to the body getting sick?

Additional Risk Factors

We can go on and on with risk factors found in both conventional and alternative medicine, such as being overweight, smoking, not detoxing properly, the health of your microbiome, mercury from dental fillings, candida overgrowth… even electromagnetic fields.

I encourage you to find the white crows for all these additional risk factors, just as I’ve done in the examples above. Google Scholar (https://scholar.google.com/) is a great resource for finding reliable information. When you look through the search results, make sure the paper you’re interested in has been “Cited by” a good number of other papers. That “Cited by” number is an informal indication of how important other authors think that paper is.

Most importantly, I invite you to stop feeling guilty, like you did this to yourself because you didn’t eat a perfectly balanced meal your entire life. The evidence does not support blaming yourself!

So where do we go from here?

To begin, we need to realize that having low vitamin D, being a woman, or being exposed to a virus may add physical stress to our bodies, but that doesn’t mean that they caused the disease. Nor does it mean that treating these physical stressors will cure the disease!

What if your MS is not random? What if medicine doesn’t know the cause only because they aren’t looking in the right places? To find the cause, you need to be like Sherlock Holmes or Detective Benoit Blanc. Get curious about your life, collect and examine the evidence, and see for yourself whether life events might be related to your MS.

So let’s put on your researcher hat once again and start getting clues to:  

  • Why you got those specific symptoms of MS, why on that side of your body, and at that time in your life.
  • Why did you get MS and not your partner or your siblings?  
  • If your disease has progressed, why did it do so at that particular time in your life and not a few years before or a few years later?  
  • Why do your symptoms get worse when they do? For example, for many of my clients, their symptoms get way worse when others are watching or when they are in a hurry, and they get way better when they are at home or when they’ve had a few glasses of alcohol. Hmmm.

If you review the risk factors again, you’ll notice none of them can answer these questions! And that’s because they aren’t causal.

Finding the Root Cause of Your MS

So, my suggestion to you is to keep a journal and have it handy. Dedicate several pages to create a timeline of what was happening in your life up to 2 years before the first symptoms. Get as detailed as you can. Look at old calendars, emails, and texts if they existed, and talk to family and friends. Ask them and yourself what big storms were brewing then. What big storms resolved during that time, and which ones didn’t. Keep coming back to the timeline to fill in more details as you remember them. This is important.

Then start tracking what was going on when your symptoms get better, or when they get worse. For example, jot down, “When I am in a rush, or afraid I will be late, I get the MS hugs.” Or “My MS sleeps or fatigue is always worse on Saturdays but never on Tuesdays.” Hmmm. Jot that down. After you do this for a while, you may start to notice certain patterns. This is good!

You may find, as others have, that some of the situations that trigger worsening symptoms now, match or mirror some of the situations you were going through before the disease started! This process of recognizing patterns in symptom fluctuations can help you figure out the root cause of your disease.

You might find the connections between past and present by looking for echoes of key emotions, behaviors, feelings about a situation, an attitude, the comfort foods you were eating then, or even particular people.

So pay attention to your life and fill up your journal! Then you’ll be well prepared for seeing how the topic of our next blog posts can support your discovery of what caused you MS and what you can do about it!

Stay tuned!!

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Post coauthored by Eva M Clark, MSc and Michelle Fauver, PhD

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