There is still so much about the world of bacteria and other microbes inside our gastrointestinal tract, or gut, that we need to discover. We are just beginning to explore this internal domain, and, in the past several years, scientists have made some interesting observations. The entirety of bacteria and other microbes living within each of us—also called our microbiome—is unique to each of us. This microbiome can be influenced by where we live (developed country v.s. developing country), what we eat (more animal products v.s. more vegetables) and what medications we take (for example, antibiotics used to treat bacterial infections in our body may also kill some of the “friendly” bacteria in our gut).
You have probably heard that statistic that up to to 70% of your immune system resides in your gut. What does this really mean? The longest portion of our gut is [ironically] called the small intestine. In an adult male it averages 20 feet in length, but if it were completely spread out it would cover roughly 2,700 square feet (about the size of a tennis court). This area is home to a large portion of immune cells. Communication between our immune cells and the usual bacteria in our gut, means that our immune system recognizes these bacteria as “friendly.” When rogue bacteria invade our gut we can get a stomachache, or worse, but the “friendly” bacterial residents co-exist peacefully with us, and even contribute to our well-being.
Do changes in the types of bacteria in our intestinal tracts influence our health or do changes in our health affect our intestinal bacteria? It may be a little of both. Scientist have noticed differences in the types of bacteria present in the intestinal tracts of people with inflammatory bowel disease. Other autoimmune diseases, such as type I diabetes mellitus and rheumatoaid arthritis, may also be impacted by the intestinal microbial milieu. The communication between our gut bacteria and our immune system goes beyond helping our immune system to recognize the bacteria as “friendly”—these interactions may influence immune cells throughout our body. How might gut microbes affect MS, and how in turn might MS affect our gut microbiome?
In mice, gut bacteria may play a key role in the development of an MS-like disease (EAE). When animals from a spontaneous mouse-model of MS are raised in a sterile, germ-free environment, they show either no symptoms, or very mild symptoms of the disease. However, when gut bacteria from mice reared in less sterile conditions are re-introduced into the gut of these germ-free mice, they develop the MS-like disease. This is not a simple cause and effect but a complex relationship. The bacteria from mice raised in relatively normal conditions do not cause MS, but they do seem to be required for the development of MS. Furthermore, introduction of a mixture of “good” bacteria into the intestinal tract of another mouse model of MS, may have a beneficial effect. Mice treated with this specific probiotic mixture show suppression of immune signals usually associated with MS.
In humans the role of gut “flora” in the development of MS is currently a topic of great interest. A preliminary report from a recent American Academy of Neurology meeting describes differences in the bacterial species residing in the gut of people with or without MS. Certain gut species (called Archaea) were found at higher levels in MS patients compared to people without MS. Moreover, two anti-inflammoratory bacterial species (Butyricimonas and Lachnospiraceae) were found at lower levels in MS patients, but their levels were increased by MS treatment. At this same meeting, a Boston-based research group presented preliminary evidence of an association between levels of vitamin D in the blood of people with MS and levels of a gut bacteria, ruminococcaceae, thought to have anti-inflammatory effects. This may be another reason to consider a vitamin D supplement.
Just as you may talk to your doctor about taking a vitamin D supplement to ameliorate your MS symptoms, you may want to ask your physician whether you should supplement the good bacteria in your gut. You can accomplish this by taking a probiotic supplement or by making a few additions to your diet. Probiotic foods include not only yogurt and keifer but sauerkraut, Korean kimchee, Japanese miso or nato and Idonesian tempeh. How exactly the intestinal microbiome may affect MS remains to be seen, but research into this area will undoubtedly increase our understanding of how the human microbiome interacts with the immune system, which may have a significant impact on our understanding of immune disorders, like MS.
Mobility aids and assistive devices can improve your quality of life and allow you to accomplish tasks more independently. These devices range from smaller tools, such as adaptive toothbrushes and cutlery, to larger equipment, such as scooters and electric wheelchairs. When you decide to use one of these implements, you may want to consider that not only can they make your day easier, but safer too. Assistive devices help you conserve energy, an important consideration when living with MS, and, in the case of mobility aids, an assistive device may even help prevent potential falls.
Your physician may refer you to an occupational therapist, physical therapist, physiatrist or speech/language pathologist to evaluate your needs and to prescribe you an assistive device. You can decide which tools are best for you. Depending on your needs, we have included a list of devices below that you may want to consider.
Tools for everyday living
- Writing and Reading
- Special grips enable you to hold a pen or drawing implement comfortably and securely. Lensesand magnifying instruments may help you to overcome certain visual challenges associated with MS
- Grooming and Dressing
- Button and zipper hooks can be used to fasten clothes. You might also want to consider looking for clothing or shoes with Velcro. Combs, brushes, and toothbrushes can be fitted with easier-to-hold handles.
- Cooking and Housekeeping
- Devices such as electric can openers, rocker knives that minimize wrist motion and strength needed to cut, and cookware designed for those with limited hand, wrist, and forearm strength, help make cooking more manageable. Heavy lifting and bending involved in housekeeping can be reduced by placing cleaning supplies and equipment on wheels and by using long handled dusters and brooms. In addition, reachers can help grasp objects on shelves, pantries, and closets.
- Using your Computer and Mobile Device
- Software on your existing computer may already possess features for adaptation. For example, the Windows 8 operating system has options for screen magnification, screen contrast, and on-screen keyboards (see link to Ease of Access settings). Using the Windows operating system and a microphone, you can also teach your computer how to recognize and respond to your voice with speech recognition. Other hardware, such as touch screens, joysticks or trackballs allow more comfortable interaction with your computer.
- You can change settings on your cell phone, or ask tech-savvy friend or family member to set up voice recognition and speed dialing. Under the “settings” area of your smartphone you may also find options for changing the contrast, text size and screen magnifications. Also, using a hands-free headset or the speakerphone setting on your cell phone may talking on the phone easier.
Adapting your home
- Bathing and Showering
- Tub and wall grab bars can help you get in and out of the bathtub more easily, and help you to balance while in the shower.
Getting around comfortably & safely
- Braces, canes, or walkers can provide stability and support when you need it. Wheelchairs and electric scooters increase mobility when you need additional assistance. Transfer boards and lifts can help you get in and out of bed, the tub, your wheelchair, or your automobile.
- After assessment by an occupational therapist, driving may be safely accomplished with the help of hand controls, low-energy steering wheels, and other driving aids.
Be sure to discuss the possibility of utilizing mobility aids and assistive devices with your physician at your next visit, and inquire about whether it would be of benefit to be referred to a therapist or physiatrist for further evaluation.
When you practice a new cognitive skill, like learning a language, or perform a new motor skill, like learning to swim, you activate pathways in your brain in new ways. We have long known that, when you learn or practice new skills, your brain creates new connections between neurons (called synapses) or modifies existing connections. Several recent studies implicate certain brain cells called oligodendrocytes, and the myelin sheaths they create around our neurons, as also playing an important role in learning or performance enhancement.
Much of the myelination of our brain occurs during early development. During this period, immature cells called oligodendrocyte progenitor cells (OPCs) grow into mature oligodendrocytes, which then produce the myelin sheaths that envelop neurons. A sizeable population of OPCs exists in the adult brain as well, and they can mature into oligodendrocytes after brain injury or demyelination. Indeed, remyelination may occur in the early stages of MS, but in later stages this remyelination fails.
The brain is made up of white and grey matter. Grey matter includes the cell bodies, dendrites, axon terminals of neurons, and the synapses between neurons, while white matter contains the neuronal axon, and the myelin sheaths surrounding them. connections between neurons—are important for learning and brain plasticity. Current research suggests that new myelination, mediated by oligodedrocytes, also plays an important role in learning and adaptation.
Other than helping to recover from injury or disease, is there another role for these OPCs in the adult brain? The answer appears to be “yes”—the OPCs that develop into oligodendrocytes to create myelin may play a role in learning or performance improvement. Additional myelin observed in certain parts of the brain has been associated with various pursuits, such as learning to play the piano. The brain includes both grey matter (which contains the neuronal cell bodies) and white matter (which contains the myelinated portion of the neuron, and oligodendrocytes). Previous studies have shown changes in the grey matter during learning, but more recent MRI studies tracked changes in the white matter of people practicing complex tasks.
When we practice and learn complex tasks, what changes are occurring on the cellular level in these “white matter” regions of our brain? To answer this, two recent studies focused on the role of this “white matter” in motor skill learning, or performance enhancement in mice.
In a recent study, McKenzie and colleagues genetically engineered a strain of mice that could be treated to inactivate the myelination process by blocking the production of new oligodendrocytes. In these mice, the scientists could decrease the number of new oligodendrocytes formed in the brain, without affecting existing oligodendrocytes. The scientists then tested the ability of both the normal and genetically engineered mice to learn a complex new task—running on wheels with unevenly-placed missing rungs. In normal mice, this task increased the number of new oligodendrocytes in their brains, relative to mice who have never experienced wheel running before, and to mice without a wheel. Mice that had a limited ability to produce new oligodendrocytes could not adapt as well to this complex wheel task, and could not run as fast. Hence, it appears that myelin creation by new oligodendrocytes is important in learning a new motor skill.
Another study looked more closely at the changes going on at the cellular level in the mouse brain in response to performance enhancement. Erin Gibson and colleagues bred mice in which certain neurons could be stimulated by shining blue light on them, using small optical fibers implanted in the brain. Stimulation of a specific region of the mice’s brain caused them to move parts of the body that the brain region controlled. Activation of these neurons by the light resulted in an increase in new cells, including a significant number of OPCs, in the brain regions that were activated. Furthermore, this neuronal stimulation appeared to influence oligodendrocyte maturation, and myelin sheath thickness. These cellular changes were also associated with enhanced motor function. Most striking, when the formation of oligodendrocytes was blocked in these mice, there was no effect of the light stimulation on myelination and no enhancement of motor function. Therefore, it seems that new oligodendrocyte formation mediates the effects of activated neurons on myelination and enhanced motor performance.
These scientists examined how new myelin producing cells, or new myelin, might be instrumental in learning and adaptation. But how might the neural activity that leads to learning or adaptation increase myelination? Uncovering how myelination is regulated by activated neurons is an important piece of this puzzle. What secreted molecules might the neurons—activated by learning or other stimulation—be sending to the oligodendrocytes to cause them to produce myelin? Could we use these molecules to stimulate myelination, or the generation of more oligodendrocytes, in other situations? Understanding how to encourage the myelination of neurons could potentially help us design new treatments for remyelination of neuronal circuits affected by multiple sclerosis.
Jan Scholz, Miriam C Klein, Timothy E J Behrens, and Heidi Johansen-Berg. Training induces changes in white-matter architecture. Nature Neuroscience 12, 1370 – 1371 (2009)
Ian A. McKenzie, David Ohayon, Huiliang Li, Joana Paes de Faria, Ben Emery, Koujiro Tohyama, William D. Richardson. Motor skill learning requires active central myelination. Science 17 October 2014: Vol. 346 no. 6207 pp. 318-322
Erin M. Gibson, David Purger, Christopher W. Mount, Andrea K. Goldstein, Grant L. Lin, Lauren S. Wood,Ingrid Inema, Sarah E. Miller, Gregor Bieri, J. Bradley Zuchero, Ben A. Barres, Pamelyn J. Woo, Hannes Vogel, Michelle Monje. Neuronal Activity Promotes Oligodendrogenesis and Adaptive Myelination in the Mammalian Brain. Science 2 May 2014: Vol. 344 no. 6183
T. Burrell. Brain boosting: It’s not just grey matter that matters. NewScientist. 2015.Feb 21: 30-33
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