Thursday, 1 December 2011

Research: Prevent MS-Smoking is Not Good For You

D'hooghe MB et al. Alcohol, coffee, fish, smoking and disease progression in multiple sclerosis.

Background:
Certain lifestyles might influence disease activity in multiple sclerosis (MS).

Objectives:  To investigate the consumption of alcoholic beverages, caffeinated drinks, fish and cigarette smoking in relation to disability progression in relapsing onset and progressive onset MS.

Methods:  We conducted a cross-sectional survey amongst individuals with MS, registered by the Flemish MS society in Belgium. A time-to-event analysis was performed with time to Expanded Disability Status Scale (EDSS) 6 (requiring a cane or support to walk for a distance of 100m) as outcome measure. Hazard ratios for the time from onset and from birth were adjusted for age at onset, gender and immunomodulatory treatment.

Results:  Data of 1372 persons with definite MS were collected. In the relapsing onset group, a decreased risk for reaching EDSS 6 was found in regular consumers of alcohol, wine, coffee and fish compared with those who never consumed these substances. Cigarette smoking was associated with an enhanced risk for reaching EDSS 6. In the progressive onset group, no association with the risk of reaching EDSS 6 was found, except for the type of fish. Preference for fatty fish was associated with an increased risk to reach EDSS 6, when lean fish was taken as the reference category.

Conclusion:  Consumption of alcoholic beverages, coffee and fish were inversely (the more you have the less you get) associated with progression of disability in relapsing onset MS, but not in progressive onset MS. These findings allow to support the hypothesis that different mechanisms might underlie progression of disability in relapsing and progressive onset MS.

As we have been saying for sometime smoking is not good for you..,but you know this already.

14 comments:

  1. I'm Ok with the fact that smoking is bad but I don´t quite get the fat fish angle. I thought fat fish was god for you withh all these Omega-3s swimming around. >-->>
    So I do get a bit suspicious regarding these kind of findings, how can you be really sure that it's the fat fish that gives you a problem. You cannto be feeding people with only fish can you??

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  2. Assuming this is a causual relationship, any idea why alcohol and coffee would be beneficial in RRMS? Also am I correct in guessing that the effect size is relatively small?

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  3. Dr Mouse,

    I hear that Prof G is in Marbella at an MS conference. Seems unfair that he's sunning himself while you're in rainy London holding the fort. Hope he remembers to bring you back a present. Keep up the good work.

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  4. I'm also interested in learning more about the connection between fish and the increase in progression of disability in progressive MS. Please don't tell me I have to give up salmon sushi and smoked lox when I become secondary progressive! :(

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  5. Re: "I hear that Prof G is in Marbella at an MS conference."

    Yep, all work and no play. Sitting-in on a congress at present and posting this comment. The focus of the meeting is personalised medicine and MS.

    What I realise is that the MS field is drowning or choking in dogma. We seriously need to rethink MS and how to tackle the disease.

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  6. Re: " I thought fat fish was god for you withh all these Omega-3s swimming around."

    Yes, eating fatty fish is associated with a reduced rate of progression, i.e. slower to get to EDSS 6.0 or needing a walking stick.

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  7. Re: ".. any idea why alcohol and coffee would be beneficial in RRMS?"

    No idea at all. There are some anti-oxidants and potential neuroprotectants in wine, particularly red wine.

    The active substance in red wine is resveratrol (see Bastianetto et al. Neuroprotective abilities of resveratrol and other red wine constituents against nitric oxide-related toxicity in cultured hippocampal neurons. Br J Pharmacol. 2000 October; 131(4): 711–720.)

    Coffee drinking is interesting. Did you know coffee consumption is associated with a reduced risk of developing Parkinson's disease another neurodegenerative disease. May be there is a common pathway between these two diseases.

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  8. "I realise is that the MS field is drowning or choking in dogma. We seriously need to rethink MS and how to tackle the disease."

    Prof G,

    These comments always leave me confused. Should I be positive - good that new approaches are being considered, or negative - what's gone before has been a waste and we are looking at years / decades of different research? What do you mean by dogma?

    Thanks.

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  9. Red wine is mostly known for its beneficial role in the cardiovascular system. But assuming a vascular aspect in MS would require abandoning of the current dogma...of immune malfunction.

    that's what dogma is.

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  10. Re: "These comments always leave me confused. Should I be positive - good that new approaches are being considered, or negative - what's gone before has been a waste and we are looking at years / decades of different research? What do you mean by dogma?"

    It is just that some of the things we accept as being facts are not really. A pathology lecture this morning left me the clear impression that what we accept as being pathological may not necessarily be and there is little consensus about what come first in MS. I think we need to step back and simply rethink some of the things we take as being fact. For example, the role of the immune system in MS. Is inflammation driving the disease or is it in response to what causes the disease?

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  11. Maybe people with low EDSS drink more coffee and alcohol?

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  12. Prof G it says that a preference for fatty fish over lean fish is associated with a higher risk of EDSS 6

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  13. "It is just that some of the things we accept as being facts are not really. A pathology lecture this morning left me the clear impression that what we accept as being pathological may not necessarily be and there is little consensus about what come first in MS. I think we need to step back and simply rethink some of the things we take as being fact. For example, the role of the immune system in MS. Is inflammation driving the disease or is it in response to what causes the disease?"

    Many thanks for responding. This is what I find most valuable about this blog - having an opportunity to discuss things with you (about issues I don't really understand).

    My reading of your comment is that you think that (possibly) inflammation / the involvement of the immune system may be secondary / a response.

    I agree on the issue of facts. Perhaps 2012 should be the year to pin down a fact - specifically what kick this disease off. Without this it's difficult to know that the treatments currently in trial will have long term impact on the disease i.e. will shutting down inflammation stop neuro-degeneration etc.

    By coincidence, interesting article on the MSRC website today:

    http://www.msrc.co.uk/index.cfm/fuseaction/show/pageid/2479

    Dr C thinks that we can turn off the inflammation. He and others seem to think that the focus now needs to be on neuro-protection / repair. May be highly effective anti-inflammatories + neuro-protective agents is the right strategy. Still doesn't seem to answer the question about why the immune system goes awry. Perhaps controlling EBV / ridding the body of EBV is the answer? Perhaps there's a completely differnet answer to what the disease is about. Frustrating disease for patients and researchers. Roll on 2012, I sense a good year for MS research.

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  14. Apparently MS could be correlated to reduced noradrenaline levels: http://www.ahealthblog.com/reduced-levels-of-noradrenaline-associated-with-multiple-sclerosis.html

    Caffeine Is supposed to raise noradrenaline production.

    Could this be a valid explanation?

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