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This amazing post was written by Dr. Terry Wahls, a clinical professor of medicine at the University of Iowa. She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. You can learn more about her work from her website, www.terrywahls.com.
The standard treatment for multiple sclerosis is disease-modifying drug therapy. But does it delay the transition to walker or wheelchair dependence? Does it help patients become well?
Multiple sclerosis is like most autoimmune conditions: a progressive illness. Damage accumulates over time, as does disability. That is why conventional neurologists push their patients so hard to take disease-modifying drugs–they know that within ten years of diagnosis, half of those newly diagnosed will be unable to work due to severe fatigue and that one-third will have difficulty with walking and will require a cane, walker, or wheelchair.
But do the drugs really lengthen the time between diagnosis and becoming wheelchair dependent or bedbound? That is an incredibly important question to ask and more importantly to answer.
Do Multiple Sclerosis Drugs Work?
The newest biologic drugs – such as Tysabri, Tecfidera, Gylenia, Plegridy, Aubagio, Lemtrade – are designed to block specific steps in immune pathways. These drugs have been tested and found to be twice as effective as older drugs at reducing the rate at which new lesions appear on the brain and spinal cord MRIs. They also reduce the number of acute hospitalizations.
Neurologists hoped that reducing the number of relapses and new lesions as seen in MRIs would lengthen the time to becoming wheelchair dependent or bedbound. But do these drugs – which often cost $50,000 to $100,000 per year and are prescribed for life — change the long-term outlook for the patient?
Do they affect the pace of decline or prevent patients from becoming wheelchair bound and or bedridden? That is the real goal of therapy, not reducing the number of lesions in the brain, but rather maintaining function.
The Research: Drugs Don’t Prevent Becoming Wheelchair Dependent
In a study of patients who used the interferon drug Betaseron over a 16-year period, scientists found that taking the drug had no effect on how long it took for a patient to become walker or wheelchair dependent or bedbound. Dr. George Ebers, an MS researcher at John Radcliff Hospital, discussed the issue of drug therapy related to clinical outcomes and MS research and observed that there are no studies that demonstrate that drugs change the rate or severity of the disability.
He further noted that the FDA does not require long-term monitoring of disability status, including time to a walker, wheelchair dependence, or bedridden state. He called on the government to require after-market surveillance and force the drug companies to report how these drugs impact time to needing a walker or wheelchair or becoming bedbound. So far that has not happened.
Other Autoimmune Disease: Do the Treatments Work?
What about other autoimmune diseases? What can we learn about how well these potent biologic drugs help with those diseases? Four million Americans have rheumatoid arthritis (RA), which has been treated since the 1990s with biologic drugs such as Remicade, Enbrel, and Humira (these are also used to treat inflammatory bowel disease).
Though the goal of these drug treatments is remission, the actual remission rate remains quite low–about 8% (Predictors and persistence of new-onset clinical remission in rheumatoid arthritis patients). Furthermore, 50% of patients discontinue the biologic therapy within five years because of disease progression or adverse drug events (Long-Term Drug Survival of TNF Inhibitor Therapy in RA Patients: A Systematic Review of European National Drug Registers).
Autoimmune Drug Side Effects
The side effects of biologic drugs are extensive. When we block the immune function so effectively that we can turn serious autoimmune diseases off, we are also turning off the immune cells that repair and maintain our bodies. The adverse effects — you can find them listed on drug inserts or recited in TV ads — range from mildly annoying to life-threatening.
Here are just a few: infections, heart problems, skin problems, kidney damage, liver damage, and progressive multifocal leukoencephalopathy, or PML. PML is the activation of a virus that destroys brain tissue, leading to serious and rapid brain problems and even more severe and profound disability.
Should You Stop The Drug?
The longer you are on a biologic, the higher the risk of developing PML. The risk is highest with Tysabri, but is still a concern for other biologics as well, including lemtrada, aubagio, Gilenya, and tecfidera. It will also occur, but much less frequently, with interferons and Copaxone.
If you are on disease-modifying drugs, don’t stop them abruptly – this can worsen the disease state and lead to a severe flare. The same thing can happen if you have a “cheat meal” after successfully quieting your disease with diet and lifestyle changes.
I have seen this happen with many children. They use diet and lifestyle to quiet their disease activity without the disease-modifying drugs. Their improvement surprises the family and physician: Symptoms are steadily diminished, energy is better, the mood is better, pain is less, and the inflammatory bowel disease or rheumatoid arthritis or multiple sclerosis go into remission.
This improvement can last a long time, so long that the family may grow complacent. Everything is going so well — the autoimmune problems are in the past, or so it seems – and the parents start to feel bad about all the fun foods the child is being “deprived” of.
Since the child is doing well, it no longer seems critical to be so stringent on the diet and lifestyle program. Then a special event comes along, like a birthday party or holiday, and the parents agree it’s OK for the child to eat cake and ice cream or pizza that the other children are enjoying.
Using Diet and Lifestyle to Manage Autoimmune Disease Flare-ups
The result is always a severe flare of the autoimmune disease. The next MRI often shows a brain filled with new lesions; the colonoscopy shows active bleeding in the bowels or the joints are hot and swollen. The physician’s explanation to the family is that the diet and lifestyle changes don’t work.
I have a different perspective. A disease flare that occurs when you have “cheat meals” is evidence that diet and lifestyle changes do work. Stopping the therapy that was reducing or removing the symptoms your disease causes a flare. For this reason, I do not advise abruptly stopping disease-modifying drugs.
If you aren’t on medication, the best option is starting 100% on diet and lifestyle changes. If you are already taking disease-modifying drugs, the situation is more complicated. We discuss how to approach this at the seminar.
The biologic drug business is huge, and the proof of its efficacy is small. Every year, the number of people with MS and autoimmune diseases grows, and they are younger and younger at diagnosis. We cannot afford the drug-only approach as individuals, family, state, or national governments.
Instead, we must help people improve their health and vitality, lower their symptoms, lessen their disability, and decrease the need for these high-cost drugs.
Eating home-cooked meals based on a plan designed specifically for your brain is the most powerful next step you can take. My book, The Wahls Protocol Cooking for Life, gives you that plan and teaches you how easy it can be to prepare delicious meals in less than 30 minutes.