Multiple Sclerosis

Perhaps one of the most extraordinary examples of harnessing the power of the gut bacteria to address inflammatory diseases that impact the brain is seen in a patient like Carlos.

Carlos, forty-three, came to see me in June 2014. He needed a cane to stand and had episodes of feeling as if his legs wouldn’t work and that he could lose his balance easily. When I asked him about his medical history, he told me about one morning back in 1998 when he woke up feeling “drunk and dizzy.” When we went to see a neurologist, an MRI scan of his brain was performed, but the results came back as normal. Carlos remained unsteady for the next two weeks and then began to feel better. Two weeks after that, while exercising he felt as if ants were crawling down his back. His vision blurred and, hoping to find another opinion about his symptoms, he went to see a naturopath. That’s when he began taking various nutritional supplements and indeed he felt a little better thereafter.

Three years later he had the sudden onset of “numbness in both legs from the waist down.” Again he was given a new round of nutritional supplements and after three more months, he felt somewhat improved. Two years later he had another episode and this similarly resolved itself with more supplements. In 2010, however, he began noticing a progressive decline in his balance and, despite various nutritional supplements, his deterioration continued—rapidly. By 2014, Carlos went through more tests with a neurologist, including another MRI scan of his brain. And this time, his results revealed aggressive abnormalities, especially in the deep white matter of his brain seen in both hemispheres and even in the brainstem. These findings, in addition to abnormalities noted in an MRI of his cervical spine, a lumbar puncture, and electrical testing results, all pointed to a diagnosis of multiple sclerosis.

MS is an inflammatory disease characterized by damaged nerves in the brain and spinal cord. The insulating covers of these nerve cells, called the myelin, become impaired, and so the nervous system breaks down and results in wide range of symptoms—physical, cognitive, and even psychiatric. Scientists have long puzzled over what causes multiple sclerosis, though it’s generally thought to result from a glitch in the immune system. We just don’t know what triggers this glitch, which leads the body to attack its own nerve cells. And yet epidemiological studies have determined that living in an urban environment is a significant risk factor for having this autoimmune disease— just like the increased risk for developing Alzheimer’s disease in urban, Westernized settings.

Could multiple sclerosis—and, for that matter, every neurological condition—be directly related to changes that have occurred in the gut’s bacterial community? Over the past several years, I’ve noticed that MS patients almost always were either born by C- section, not breast-fed, or treated with antibiotics for some illness early in life. (In fact, new research published in 2013 showed that the risk of MS was reduced by 42 percent in people who were breast-fed.) In reviewing Carlos’s early life experience, once again I found the same pattern to his history: he’d only been breast-fed for several days.

I explained to Carlos that we now understand the role of gut bacteria in modulating the immune system, and that recent animal research clearly had identified changes in gut bacteria as possibly playing an important role in this disease. I then offered a plan of action, telling him that I wanted to start a program of probiotic enemas. He agreed without hesitation, administering probiotic-filled enemas two to three times each week. Two weeks later, I received a phone call from him. He indicated that he was walking more comfortably and had now gone for days without the use of a cane! One month later we spoke on the phone again. He was continuing his probiotic enemas three times weekly and felt that he had “stabilized.”

At that point I discussed with him the idea of rebuilding a healthy gut population through a revolutionary new procedure called fecal microbial transplantation, or FMT, and he agreed to do so (it’s currently not available in the U.S. for treating MS). He chose a clinic in England where the procedure is routinely performed on an array of immune and inflammatory problems. Before he left, I asked Carlos to carefully chronicle his experience in a journal and report back to me.

One month after Carlos returned from England we again spoke on the phone. He reported that after his second treatment with fecal transplantation (he received a total of 10) he noted that his walking was dramatically improved and that it remained that way. He told me, “I am walking so well that other people don’t know there is anything wrong.”

He was so excited about his improvement that he sent me a video of himself walking unassisted. I was thrilled to see how much he had improved and grateful that he allowed me to use the video in my lectures

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