Empower Your Multiple Sclerosis Journey:
The Ultimate Supplement Guide for a Healthier Brain, Body, and Bones
BY DR. TERRY WAHLS
Best-selling Author, Physician, and Researcher
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Introduction
People with neurological or psychiatric conditions have different nutritional needs than those who enjoy good health. Our immune system needs fuel to remove the poorly made, underfunctioning functioning cells and replace them with healthy ones. We want our bodies to be able to repair damaged myelin. We need our bodies and brains to operate at maximum levels of health and functionality.
All of this requires more energy, more vitamins, more minerals, more protein, more essential fatty acids and more antioxidants. Improving your dietary nutrition will help, but most people with MS will benefit from a targeted supplements regimen to support the key building blocks needed for optimal health. In the following pages, I will walk you through a number of supplements to consider adding to your healing journey.
About the Author
Dr. Terry Wahls is a clinical professor of medicine at the University of Iowa where she conducts clinical trials. She is also a patient with secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain, and she now pedals her bike to work each day.
She is the author of The Wahls Protocol®: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, The Wahls Protocol®: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles (paperback), and the cookbook The Wahls Protocol® Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Dr. Wahls conducts clinical trials that test the effect of nutrition and lifestyle interventions on treating MS and other progressive health problems. Learn more about Dr. Wahls’ clinical trials here. She also teaches the public and medical community about the healing power of the Paleo diet and therapeutic lifestyle changes that restore health and vitality to our citizens.
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Vitamin D + Vitamin K2
Many clinicians and patients now know that vitamin D plays an important role in immune health, bone health and brain health. But did you know that vitamin D can also create problems?
Vitamin D has hormone-like properties. Its receptors are found throughout the body and the central nervous system, and low vitamin D blood levels are associated with increased risk of cardiovascular event, autoimmune diagnosis, and multiple sclerosis diagnosis.1-6
When ultraviolet light hits the cholesterol molecules in our skin, the skin begins the initial step in making vitamin D3 (cholecalciferol). Mushrooms that are exposed to ultraviolet light make ergocalciferol (vitamin D2). Both vitamins D3 and D2 are biologically inactive until they are activated, first by the liver, then by the kidneys, to make 1,25 dihydroxycholecalciferol, or calcitriol. This is the biologically active form of vitamin D. Calcitriol plays a major role in regulating calcium and phosphate and the mineralization of teeth and bones.
Because most people work indoors, away from sun exposure, and cover their skin with clothing or sunscreen to reduce the risk of skin cancer, many no longer get sufficient sun exposure to generate enough vitamin D3 through their skin. Physicians often measure vitamin D levels and advise their patients to take vitamin D supplements to get blood levels to the top half of the reference range.
That is helpful, but there are still major health risks that are not being sufficiently addressed.
One of these is the importance of vitamin K2, specifically menatetrenone (K2mk4) as a key partner in bone, cardiovascular, and brain health. Calcitriol, the active form of vitamin D, increases the absorption of calcium from the gut into the bloodstream. Supplemental calcium may be beneficial for bones, but the increased absorption of calcium from the gut into the bloodstream increases the risk of calcification of blood vessels, which can then increase the risk of atherosclerosis, cardiovascular, and/or cerebrovascular disease.7
Vitamin K2 is a key contributor to calcium and phosphate metabolism and is involved in the uptake of calcium and phosphate into teeth and bones, and out of blood vessel walls.8-12 Vitamin K2 is increasingly recognized as important to cardiovascular,10,12 bone,10,12 and tooth health13 as well as healthy aging.8,14,15
Vitamin K is also involved in the maturation of brain stem cells into oligodendrocytes (the cells that build and repair myelin, the “insulation on the wiring” between brain cells).20,21 Vitamin K2 levels are significantly lower in multiple sclerosis patients compared to controls.22
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We would normally get vitamin K2 from animal food sources. However, the current meat and dairy livestock farming practices in the United States have made this nearly impossible. To increase the efficiency of livestock production, meat animals and dairy cattle are typically raised in concentrated animal feeding operations (CAFOs). The natural diet of cattle consists of grasses and green plants, while hogs and chickens eat plants, insects and other smaller animals. CAFO animals, however, are fed corn, kept indoors, and don’t consume green plants. As a result, the meat and milk from these animals has very little vitamin K2, causing a significant decline in vitamin K2 intake in the typical Western diet.12
In my clinical practice I advise patients to protect their bone and tooth health by monitoring their vitamin D blood levels, with a goal of raising those numbers to the top half of the laboratory reference range. I also recommend strength training and vibration plate training for bone health, and chewing food thoroughly and avoiding added sugars and flour-based foods for tooth health. In addition, I recommend regular intake of vitamin K2, which can be found in fermented soybean, fermented black bean natto, fermented cheeses from grass-fed animals, and clarified butter in the diet.16-18 For patients who take vitamin D supplements to achieve the targeted vitamin D levels, I recommend a supplement that also includes vitamin K2. For those who get enough vitamin D through sunshine, I recommend eating natto daily or taking a vitamin K2 supplement. Taking the combination of vitamin D and vitamin K2 is associated with improved bone mineral density compared to taking only vitamin D.19
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Omega-3 Fatty Acids and MS
Are you getting enough healthy fats in your diet?
Since the 1960s, dietary fats have been associated with heart disease risk and we have been advised to reduce our intake. As a result, you may have inadvertently reduced your intake of some critical nutrients that your cells need for optimal performance.
All fats are long chains of carbons. Saturated fats have a hydrogen atom attached to every carbon, and unsaturated fats have at least one double bond between two carbons. The location of the first double bond is how we determine the fat is an omega-3, omega-6, or omega-9.
There are a few fats our bodies are unable to make on its own (that’s why we call them essential fatty acids). Humans lack the enzymes to place a double bond at the -3 or -6 carbon location,
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which is why we must eat foods containing those particular kinds of fats. These fats are essential for every cell to make healthy membranes—the fat wrapper that surrounds all of our cells, our mitochondria, and the myelin insulation around the wiring between our brain cells. Many of us are likely eating too little of these essential fats, especially if you are consuming the standard Westernized diet that is high in added sugars or processed foods. Observational studies show that diets low in essential fatty acids increase the risk of developing mood disorders,1 Alzheimer’s,2 heart disease,2,3 and autoimmune disease including psoriasis,4 inflammatory bowel disease5, rheumatoid arthritis, systemic lupus erythematosus, type 1 diabetes mellitus, and multiple sclerosis.6 Supplementation with omega-3 fatty acids in breast feeding moms reduces the risk of postpartum depression7 and improves the future mental health and cognition of the breast fed infants.8,9
Ideally, you would get these fats from the foods you eat. For the omega-6 fats, eat nuts, seeds, and avocados. Hemp, flax, and walnuts contain both omega-3 and omega-6 fats. As for the vegetarian form of omega-3, alpha linolenic acid (ALA), this type of omega-3 needs two carbons added to make docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) which are used in the brain to make myelin. But our bodies are woefully inefficient at converting ALA into EPA and DHA (only about 5% of ALA gets converted into EPA and DHA), and I prefer my patients eat wild caught fish and grass-fed grass finished meats, according to what their budgets allow.
For my patients who have an autoimmune condition, I suggest that they also take an omega-3 supplement (most will get plenty of omega-6 fat from their diets). For patients with multiple sclerosis, taking 1-4 grams of fish oil per day can help reduce the risk of relapse and potentially slow disability progression.10 This dosage was also associated with improved quality of life, reduced disease activity, and improved quality of life in patients with rheumatoid arthritis,11systemic lupus,12 and psoriasis.13
The optimal ratio of omega-6 (arachidonic acid or AA) to omega-3 (EPA and DHA) fats in your blood is 4:1. For many Americans that ratio is much too high, higher than 15:1. Cutting out processed foods, fast foods, foods fried in vegetable oils, and eating more fish and grassfinished meats will greatly improve this ratio. I usually have my patients add 1-2 grams of highquality fish oil, track their fatty acid ratios, and adjust their dose depending on the results.
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Mitochondrial Support for people with MS
Mitochondria are ancient bacteria that evolved when oxygen first emerged in the earth’s atmosphere, one of the byproducts of photosynthesis in cyanobacteria. This occurred billions of years ago, when all life was limited to single cell organisms. Those first ancient bacteria were engulfed by larger bacteria, which eventually evolved into multicellular organisms that, over centuries, evolved into mammals and, eventually, humans. We still rely on our mitochondria to fuel the chemical reactions that are essential to life.
When our mitochondria do not work well, neither do our cells. Symptoms and chronic diseases accumulate. Brain fog. Fatigue. High blood pressure. Diabetes. Heart disease. Anxiety. Depression. Macular degeneration. Parkinson’s. Rheumatoid arthritis. The longer the mitochondrial nutrition is suboptimal, the more chronic disease states will accumulate. When my patients have brain fog, mental health issues, neurologic symptoms, cardiac problems, or vision problems, I assume the mitochondria are malfunctioning and need to be resuscitated. Mitochondria generate adenosine triphosphate (ATP), which is used by your cells to drive the chemistry of life. There is increased recognition that brain cells, including neurons, astrocytes, and microglia, have very high energy needs and require lots of ATP, as do retinal cells and heart cells.
In 2004, I was in my tilt/recline wheelchair, reviewing the basic science and hoping to learn something that would help slow my decline. I read animal studies on multiple sclerosis, Parkinson’s, Alzheimer’s, Huntington’s, and ALS. In all those conditions there was excessive oxidative stress, meaning the mitochondria were not making enough ATP. I theorized that insufficient ATP was at the heart of neurodegeneration, cognitive decline in Alzheimer’s, Parkinson’s, and multiple sclerosis, and the development of progressive disability in multiple sclerosis.14-16 Mitochondrial dysfunction is also a key driver in macular degeneration and retinal aging, which are leading causes of blindness.17
In the face of nutritional inadequacy, mitochondria will triage which functions to perform and which to ignore, prioritizing immediate survival at the expense of long-term health. The result is accelerated aging, which can lead to neurodegenerative damage.18-21 Multiple sclerosis, diabetes and other neuroimmune and neurodegenerative conditions all demonstrate accelerated aging. Bruce Ames, a key nutrition scientist, was the first to study the restoration of mitochondrial function in order to delay aging and slow neurodegeneration. He focused on lipoic acid, creatine, carnitine, magnesium, zinc, and fat-soluble vitamins A, D, and K,20,21 and championed
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the targeted use of those supplements as a strategy to reduce neurodegeneration and prevent accelerated aging.
The first step towards healing the mitochondria is to “stop the bleeding” and remove any substances that could be causing harm. Long-term use of antibiotics may impact mitochondrial health; some individuals are more susceptible to certain classes of antibiotics, particularly the fluoroquinolones class of antibiotics. Quitting smoking and improving air and water quality in the home will reduce exposure to cadmium, arsenic, lead, and mercury, all of which damage key proteins in mitochondria. Pesticides and insecticides are also mitochondrial poisons that should be avoided.
As poisons are removed, steps also need to be taken to improve mitochondrial nutrition. Reduce or eliminate added sugars. Replace white flour and processed foods with non-starchy vegetables and berries. Ensure adequate protein and healthy fats. Eat the highest quality of food that your budget will allow. If you can cook your meals at home and spend a little time planning your meals each week, this dietary approach will be more affordable. I also recommend finding cooking classes and online tools to make these changes easier to implement as a family.
A quick biology lesson: The mitochondria (plural) or mitochondrion (singular) have proteins embedded in an inner membrane that facilitate the manufacturing of ATP much more efficiently than what can be made outside the mitochondria. The mitochondrion needs healthy cell membranes to hold these proteins in the correct positions, and for that they need a lot of healthy fats, particularly omega-3 fat (which most of us have too little of) and omega-6 fat (which most of us have too much of).
In addition, mitochondrial function can be boosted by some of the co-factors that support the reactions in the electron transport chain. These factors include B vitamins, riboflavin, thiamine, niacin, folate, pyridoxine, cobalamin, zinc, and magnesium.22 Ubiquinone (coenzyme Q), lipoic acid, carnitine, berberine, broccoli sprout extract, and creatine also support improved mitochondrial efficiency.22-25 Taking a blend of supplements to provide broad spectrum support can be very helpful.
Most people with mitochondrial issues benefit from a fish oil supplement, activated B vitamins, and a mix of carnitine, and lipoic acid. Many are also deficient in zinc and magnesium.
A multivitamin, multi-mineral and antioxidant support for mitochondrial function is usually helpful for people with MS. MitoMulti Complete is a multivitamin and multi-mineral supplement that includes key antioxidants lipoic acid, N acetylcysteine, resveratrol, milk thistle extract, acetyll-carnitine, green tea, huperzine A (HupA), shilajit, broccoli sprout extract, and Bacopa monnieri,
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all of which provide excellent support for your mitochondria.
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Magnesium
Magnesium is an essential mineral for teeth, bones and the nervous system,26-30 and plays a crucial role in communication across cell membranes, muscle contraction. It is also a cofactor for 300 different enzymes.30 Magnesium insufficiency is associated with neuroinflammation and increased leakiness of the blood brain barrier.28,31 Supplemental magnesium has been used as adjunct therapy for people with a wide variety of neurological and psychiatric disease states and chronic pain.29-33
So how do we improve our intake of this key nutrient?
Magnesium is the central ion in chlorophyll. Thus, a diet rich in green leafy vegetables would be a good source of magnesium. Unfortunately, most Americans have a diet that is insufficient in green leafy vegetables and also insufficient in magnesium.30 But supplementing magnesium is just part of the question—you also need to know which form of magnesium to take.
When I see a patient, I consider whether the person is troubled with mental health issues, muscle spasms, pain and/or constipation. If constipation is a major problem, then I may recommend magnesium citrate or magnesium oxide. These forms of magnesium work by pulling water into the intestines, which softens the stool and reduces the severity of constipation.
If they have neurological or psychiatric issues, they need a form of magnesium that gets into the bloodstream, across the blood brain barrier and into the brain. Magnesium threonate is the only form of magnesium that reliably crosses the blood brain barrier, and it is the preferred form of magnesium in my clinical practice.34-36 I can monitor the red blood cell magnesium level to know if the patient has optimized their magnesium level. Magnesium is particularly helpful for those with muscle spasms, spasticity, or poor sleep.
I recommend taking magnesium threonate at bedtime.
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Next-Level Supplemental Support for Multiple Sclerosis
In this section, I’ll discuss how supplemental activated B vitamins, coenzyme Q and N-acetylcysteine can further deepen the support for your mitochondria and improve your vitality.
Activated B vitamins and brain, heart and retinal health
Do you have a family history of neurological, psychiatric, or cardiovascular disease? I do—I have several uncles who developed angina in their 40s, aunts and uncles with neuroimmune problems affecting their peripheral nerves, and relatives with severe mood disorders. All these diagnoses in my family mean it’s likely I have genetic variants that affect how my body metabolizes B vitamins.
These variants are called single nucleotide mutations (SNPs). SNPs occur when a nucleotide is swapped in the DNA. Sometimes SNPs improve the vitality of the organism and are beneficial. In other cases, SNPs create inefficiencies in our chemistry and increase the probability of chronic symptoms. And sometimes, SNPs make changes that are fatal.
Let me explain how this happens. As our cells go about the business of conducting the biochemistry of life, they make RNA from DNA. RNA is then used to make proteins that facilitate the biochemistry that keeps our bodies alive and functioning. An SNP in the DNA leads to a change in RNA and the proteins it produces.
If the RNA has an error, then that error will also show up in the proteins used to make blood vessels, bones, muscles, and other structures in our eyes, heart, and brain. Error-free proteins are critical for our immune cells to continue to protect us from external and internal threats (infection and cancer, respectively).
B vitamins are a group of compounds that our cells use to facilitate the chemistry our mitochondria uses to make ATP. This energy is particularly important to the eyes, heart, and brain. When I learned more about SNPs in 2011, I realized that I likely had several that involved the B vitamin pathways because of the numerous relatives on both sides of my family with brain and heart issues, as well as two aunts with macular degeneration who are going blind. I started
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taking B vitamins at the recommendation of my neurologist in 2003 when I had severe fatigue, and they gave me a bit more energy. That’s because B vitamins support the essential chemistry of life and mitigate some of the damage done by the SNPs I must have.
The marker for the efficiency of B vitamin utilization by our cells is called homocysteine. Elevated homocysteine is toxic to brain cells39,40 and retinal cells41,42 and is a marker of insufficient B vitamin levels, which can contribute to the development of cardiovascular, neurological, and psychiatric disorders.40,43 The conventional cut off for elevated homocysteine is 15 mmol/L, though some labs place the upper level at 10mmol/L.
I recommend that my patients take a B vitamin complex that utilizes the activated forms of the vitamins, which bypass problem SNPs (linked here). The activated forms of vitamin B12 (methylcobalamin), B9, (methylfolate) and B6 (pyridoxal-5-phosphate) reduces homocysteine to more optimal levels. I also recommend activated vitamin B1 (benfotiamine), which supports brain,44 retinal45,46 and heart health47, and activated vitamin B2 (riboflavin 5 phosphate) for those with migraine and chronic headache.48,49
Other activated B vitamins that may be useful include niacin and niacinamide, which have been helpful in migraine and chronic headache22; choline, an important nutrient for cognition and mental health50,51; and biotin, which is involved the production of myelin.52
Most commercially available vitamin supplements are made with synthetic vitamins, which share many of the properties of the naturally occurring vitamins but are not quite as effective. For example, folic acid is a synthetic B vitamin used to fortify white flours and reduce the risk of neural tube defects, but it has also been associated with increased risk of cancer.37,38 This is why I always recommend activated B vitamins.
All B vitamins work together synergistically to support the physiology of our cells.53,54 I urge my patients to take a B complex to reduce the risk of insufficiency of these key vitamins and the symptoms that may cause or worsen. Activated Bs contain the entire spectrum of B vitamins to support cardiovascular, neurological, and retinal health, including vitamins B2, B6, and B12; benfotiamine, a fat soluble, more physiologically active form of thiamine; and folate as Quatrefolic®, which is proven to have greater stability, solubility, and bioavailability than calcium salt forms of 5-MTHF.
Activated Bs are an excellent way to ensure that you do not have an insufficiency of these key vitamins, even if you have a SNP that increases your vulnerability to retinal, cardiovascular, neurological, or psychiatric issues.
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CoEnzyme Q
Early in my health journey I decided that supporting my mitochondria with targeted supplements would slow my decline. At that point I was already taking B vitamins, and I added coenzyme Q. This made a noticeable difference in the severity of my fatigue.
The brain needs a lot of energy to perform all its essential functions, which is why brain cells have the most mitochondria per cell. Ubiquinone, or Coenzyme Q, is one of the proteins in the electron transport chain in the mitochondrion.
Coenzyme Q has been used as nutritional support for people with Parkinson’s, Alzheimer’s, ALS, autism, and other neurological and psychiatric diseases.56,57 If you are taking a statin to lower your cholesterol, your levels of coenzyme Q will be decreased.24 In my practice, when a patient has issues with fatigue or brain fog AND they are over the age of 50, they are likely experiencing an age-related decrease in their coenzyme Q levels. If coenzyme Q levels are low, you can’t make as much ATP. Your energy will decline; you’ll have more brain fog, be more prone to headaches and migraines, and your fertility will decline. You will also be more likely to develop heart failure and heart related symptoms, insulin resistance, pre-diabetes and diabetes. This is why I encourage my MS patients to add coenzyme Q to their regimen, particularly if they are over the age of 45. It will slow down the aging process and help protect the brain.
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N Acetylcysteine (NAC)
Are you missing this surprise powerhouse?
Sulfur is an important part of a health-promoting diet, which is why I often stress the importance of including onions and cruciferous vegetables in the diet. Your body needs sulfur to manufacture glutathione, which is the master antioxidant in our cells, as well as L-cysteine, an amino acid. (Amino acids are the building blocks for structural and functional proteins and peptides—very short amino acid sequences—that are essential to human health.) There are 20 essential amino acids (our body can’t make them on its own) and 10 conditionally essential amino acids (we can make them, but only if our body has everything it needs). L-cysteine is a conditional amino acid, but it requires sufficient levels of sulfur.
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Many people do not have sufficient sulfur in their diet, which means they cannot manufacture enough L-cysteine. The addition of N-acetyl-L-cysteine (NAC) often provides a wellness boost for those with complex chronic disease as well as those who simply want to enjoy healthier aging. It is generally a very well-tolerated way to improve cellular health.
NAC is often used as an adjuvant therapy to support detoxification, neurological function, and immune function58-60 in the treatment of many chronic neurological diseases including Parkinson’s disease, multiple sclerosis, peripheral and diabetes neuropathies, Alzheimer’s, tardive dyskinesia, and stroke.58,59 It has also been used as additional therapy for people with depression, anxiety, bipolar disorder, attention deficit disorder, obsessive-compulsive disorder, and schizophrenia.61,62 A wide variety of chronic health issues that are not related to the brain have also benefited from supplemental NAC therapy, including polycystic ovary disease, male infertility, sleep apnea, acquired immune deficiency, influenza, inflammatory bowel disease, and heavy metal detoxification59 and exposure.63 It is also used to reduce the risk of pulmonary fibrosis in patients who have persisting respiratory symptoms after COVID.64
My professors taught me to be suspicious of any compound used for so many different disease states. (However, those same professors used FDA-approved drugs for off-label indications when the science supported that use.) There do happen to be a variety of disease states that have published favorable outcomes with NAC. When a natural compound (like NAC) has been found to be helpful for many conditions, that tells me that the compound likely provides a key molecule for healthy human physiology.
In my clinical experience, many patients benefit from the addition of NAC to their supplement regimen. I do stress the need to support cellular health, brain health, immune health, and detoxification by eating more cabbage and onion family vegetables, but I also use NAC as an add-on wellness plan for my patients with any neurological, psychiatric, or autoimmune disease.
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Mental Health Support
The majority of people with MS will experience symptoms of anxiety or low mood. About half will be diagnosed with anxiety and or depression in their lifetime. Whether you have symptoms or a definitive diagnosis, anxiety and depression can negatively impact your quality of life at home, as well as your effectiveness at work.
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In this next section I will discuss the supplements I use to help support people who experience mental health symptoms. We’ll look at how microbiome disruptions contribute to the development of anxiety and or depression and what can be done about it.
HOW CANDIDA OVERGROWTH CAN LEAD TO MENTAL HEALTH ISSUES
Each individual’s microbiome is stable and unique to them, influenced by major events in early life. It’s as unique as a fingerprint. By the age of three, your microbiome community has established itself.
Unfortunately, I, like many with autoimmune disease, had a sub-optimal start to my microbiome.
I was born vaginally at term, which is a great start for a microbiome. In vaginal births, the baby is inoculated with all the bacteria that live in the mother’s vagina. Babies born via C-section are seeded with different bacterial species at birth and have a higher risk of developing chronic health problems, including autoimmune, metabolic, and mental health issues.
As I passed through my mother’s vagina, I was seeded with bifidobacterial species that thrive on the oligosaccharides in breast milk. I was born in an era when it was not fashionable to breastfeed, however, and the health benefits of breast milk were not as well known. I was formula fed, which meant I missed out on the boost my bifidobacterial species would have gotten from breast milk.
As a toddler, I had several episodes of streptococcal infections of the throat and tonsils and was given multiple rounds of penicillin before the age of three. I had my tonsils removed when I was four because of recurrent tonsillitis. Penicillin prevented the development of rheumatic fever and valvular heart disease, which I am grateful for. But each time I took penicillin, the bacteria in my bowels died and the yeast Candida albicans grew more dominant. Because all of this happened before the age of three, my microbiome was established with an overgrowth of Candida species in my bowels that will stay with me forever.
I have since learned that having an excessive amount of candida in the bowels leads to increased risk of anxiety and other mental health issues, as well as autoimmunity.65-67 Candida infections are increased in patients with MS as compared to healthy controls.68,69 In addition, Candida can create a biofilm with other bacteria and fungi that is resistant to treatment.70
Signs of Candida overgrowth that I look for in my patients are thickened toenails or fingernails, redness under the breasts, in the groin, and/or around the testicles or anus, and a history of recurrent vaginal yeast infections. Issues with mood, fatigue, and brain fog may also be associated with Candida overgrowth.
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Controlling yeasts is a lifelong commitment. Gut microbes will always revert to what the person had at age three. In addition, over the age of 50 the diversity of the gut microbiome tends to decline, more so with each decade. As this diversity declines, the risk of cognitive decline and frailty increases.
My approach (for myself and my patients) is to assess the first three years of life to better understand how the individual microbiome was established. Was the person born vaginally? Did they receive antibiotics in the first three years of life? Did they have a diet high in sugar and processed foods? Were they given multiple rounds of antibiotics?
The more questions a patient answers “yes” to, the more likely they are to have excessive Candida and other yeasts in their bowels and not enough bifidobacterial and lactobacillus species.
For these individuals, I recommend a lower carbohydrate diet (to starve the yeast), an ongoing herbal suppression of yeast, and a probiotic with multiple strains of lactobacillus and bifidobacterial species that have been shown to improve metabolic health and mood. I also try to set the expectation that this will be a lifelong intervention.
I feel much better following a low carbohydrate diet and taking an herbal candida suppression product and a probiotic. I regularly eat fermented foods like sauerkraut, and kimchi, and plenty of greens. I also rely on herbs and essential oils that have demonstrated effectiveness at restoring a healthier microbial community in the gut, including oregano oil71, ginger oil72, olive leaf73, and turmeric74.
In addition, I take a probiotic with a blend of over 10 strains of Bidifobacterium lactis and Lactobacillus rhamnosus. These species have demonstrated efficacy for rebalancing the gut immune balance;75,76 increasing production of butyrate in the bowels,77 and improving the health of the gut-immune-brain axis.78 Butyrate-producing probiotics have been shown to be beneficial to mood, general health, and disease progression in the setting of multiple sclerosis.79
I now recognize that my microbiome will always drift back towards its original state. I will always need to tend the microbial garden living in my bowels. If I eat more carbohydrates or stop the candida suppression herbs or probiotics, I do not feel as well.
How do you tend your microbial garden? There is a lot you can do to support your microbiome and increase your chances of thriving as you age.
PROBIOTICS FOR BETTER MENTAL HEALTH
Anxiety and depression are common in the setting of multiple sclerosis, and the longer you
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have multiple sclerosis, the more likely you are to develop one or both. In addition, the rates of anxiety and depression in the public have been steadily increasing. In 2001, the rate of generalized anxiety was 8 to 10% of the adult population in the United States.82 Since 2000, the rate of anxiety and depression in our society at large and in our young people has dramatically83 increased, in part due to use of smartphones and social media.84
In 2020, the COVID-19 pandemic upended everything across the globe. Businesses shut down. Schools shut down. We were isolated from one another. We could make telephone and video calls, but many of us were very lonely. During the pandemic, rates of anxiety and depression skyrocketed. It is now estimated that 30 to 40% of high school students, undergraduate students, and graduate students were afflicted.85-87 In the past few years, I have seen rising rates of debilitating anxiety and depression in both my patients and my students.
I have had issues with depression—and to a lesser extent, anxiety—since my adolescence. In retrospect, my early antibiotic usage and imbalanced gut microbiome probably contributed to this to some extent. I also experienced a serious childhood trauma: the unexpected death of my infant sister when I was just nine years old.
My mother had severe postpartum depression. The farm economy was also struggling in the 1960s and 70s, which challenged both of my parents. I experienced low mood, anxiety, and depression during high school, college, and medical school. I did not seek help. I kept my symptoms to myself. I did observe that intense exercise helped my mood somewhat, but still, I struggled.
One of my early observations was that increased sugar in my diet worsened my anxiety and depression, while a lower carbohydrate diet seemed to improve my mood. A case study found that Candida overgrowth resulted in increased symptoms of attention deficit disorder and depression, and that treatment of the Candida overgrowth with probiotics and an herbal anticandidal product reduced symptoms of depression and improved attention.80 Others have observed a connection between Candida and changes in mental health,66,81 and that Candida species are increased in multiple sclerosis patients compared to controls.68,69
Paying more attention to my diet taught me that eating low carb and taking a variety of herbal supplements to suppress Candida improved my mood, giving me more joy and less anxiety.
I recommend my patients reduce their carb intake and add anti-Candida herbal supplements to their routine. For those with generalized anxiety or depression, including those who have symptoms post-COVID or as part of an autoimmune disorder, I first explore the likelihood of Candida overgrowth in the bowels. If this turns out to be true, that person should
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take an anti-yeast herbal supplement and a specific probiotic that contains bifidobacterial and lactobacillus species. (I recommend Probiotic MD for bifidobacteria and lactobacillus rhamnosus and Probiotic Calm for lactobacillus paracasei.) Remember, because your gut will keep trying to revert back to its original state, this will be a lifelong commitment.
I also recommend following a low carbohydrate diet. The diet should contain less than 100 grams of carbohydrates, preferably less than 80 grams, daily. Note that most Americans eat 200 grams of carbohydrates or more each day, much of that in the form of added refined sugars and white flours.
I also recommend a vitamin D supplement with vitamin K2, and monitoring vitamin D levels to get the level to the top half of the reference range. I also encourage my patients with anxiety and depression to take 2-3 grams of fish oil per day, an anti-yeast herbal supplement and an activated B complex.
I take Probiotic MD and ProbioCalm to make sure my candida is under control and that I have both lactobacillus rhamnosus and lactobacillus paracasei in my gut, which helps me feel healthier and happier.
Conclusion
Targeted supplements can support mitochondrial health, optimal brain function, bone health, and improve issues like fatigue, mental health symptoms and brain fog (among many others), for people with MS. Remember, though, that our bodies rely on complex, interconnected systems of biochemistry, so it’s important to work with a professional to determine the right supplements regimen for you.
People sometimes ask me if they can just take supplements and not change their diets. It would certainly be easier in some cases! But unfortunately, the answer is no. Adding targeted supplements can accelerate your recovery, but continuing the standard Westernized diet with its high levels of added sugars and processed foods will continue to strain the mitochondria and contribute to accelerated aging and accumulation of disability.
I have been living with neurological symptoms since 1980 and MS for over 20 years. I’ve dedicated my career to helping myself and others optimize nutrition to support a healthy body and mind. My goal is to live to 120, still tending my microbial garden as well as the one in my yard.
I hope it is yours too!
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