Amyothropic Aateral Sclerosis
Amyothropic Lateral Sclerosis (ALS) LOU GEHRIG’S DISEASE
ALS, also known as Lou Gehrig’s disease, is the most common neurodegenerative disease of adult onset involving the motor neuron system. It is a fatal disorder and is characterized by progressive skeletal muscle weakness and wasting or atrophy, spasticity, and fasciculations as a result of degeneration of both the upper and motor neurons. This culminates in respiratory paralysis and death.
There are several kinds of ALS, which include sporadic, familial, and Western Pacific with or without Parkinsonism-dementia complex.
Most ALS cases are sporadic, and only 5-10% of cases are considered to be familial. There are multiple gene mutations which will not be discussed here in great detail. Approximately 20% of all cases of familial ALS are due to a mutation in the copper/zinc superoxide dismutase-1 gene (SOD gene).
The peak onset is between 55 and 75 years old. The estimated annual incidence is about 2 per 100,000 in the population, although this is higher in the United States. In the United States there are approximately 30,000 Americans that currently have the disease.
I my opinion the cause of ALS is multifactorial. These include genetic susceptibility to different neuronal insults and immunologic alterations, as well as external factors.
The current theories include glutamate induced excitotoxicity, oxidative injury which is free radial damage, mitochondrial dysfunction, cytoskeletal alterations, neuroinflammation, and autoimmunity.
Of these, the leading theory is excitotoxicity induced by glutamate, the major excitatory neurotransmitter, which may disrupt intracellular calcium homeostasis, resulting in motor neuron death.
Riluzole, a glutamate inhibitor, is currently FDA approved for slowing of ALS progressions. Unfortunately, randomized controlled trials show it to be of little efficacy for a few months. The drug is associated with many side effects.
AN INTEGRATIVE APPROACH TO ALS:
As mentioned above, ALS is multifactorial. That being said, I feel that there are genes involved, autoimmunity occurring, chronic infections, environmental toxins, inflammation, free radicals and oxidative stress, with resulting glutamate toxicity and cell death.
CAUSES OF ALS
VERTEBRAL COLUMN ABNORMALITIES:
Many patients with ALS suffer from chronic neck or back injuries that have damaged the para spinal blood vessels creating a spinal cord that is barely getting enough oxygen. Patients with degenerative joint disease, as well as disc disease have been shown to have elevated cytokines, especially TNF alpha increased.
The elevated levels of tumor necrosis factor are picked up by the microglia where increased levels of superoxide are generated leading to increased glutamate levels and their death. There is damage to the blood vessels around the cord with low oxygen levels. It is my attempts in these cases are to first measure tumor necrosis factor and then lower it with alternative integrative therapies.
A primary contributor to ALS is endotoxins from bacteria, yeast, and parasites in the intestinal tract that pass into the blood and lands and finally reach the cerebrospinal fluid. Once in the cerebrospinal fluid, these endotoxins are phagocytized (grabbed up) by the microglia that surround the motoneurons. Once these endotoxins get into the microglia they cause them to secrete further inflammatory chemicals that injury and kill motoneurons.
The goal of the treatment here is to get rid of these poison producing bacteria, and strengthen and heal the inner lining of the intestines. We are also attempting to repair the damaged blood vessels leading into the spinal cord, remove the inflammation within the spinal cord, and support the motor neurons return to health.
TOXIC HEAVY METALS:
Heavy metals such as all aluminum, lead, cadmium, mercury, uranium, nickel, and arsenic has been shown to be toxic to the motor neuron. This is especially true of mercury. With these metals there is increased microglia activation with inflammation and subsequent increased glutamate and neuronal death.
I feel that dental amalgams should be evaluated and removed if possible. Vaccines containing mercury should not be used and obviously fish with mercury should be avoided.
ELEMENT EXCITOTOXINS: MSG (GLUTAMATE), ASPARTAME (NUTRASWEET):
Excitotoxicity mediated by glutamate has been implicated as a cause of this progressive degeneration. Studies have shown that defects in neurotransmitter glutamate transport may be an important component of chronic neurotoxicity in ALS. Studies have shown that the chronic inhibition of glutamate uptake produces a model of slow neurotoxicity. Other studies have shown that oxidative glutamate toxicity can be a component of this toxicity cascade.
Monosodium glutamate (MSG) was discovered in 1908, by a chemistry professor at the Imperial University of Tokyo. Years ago, during World War II our soldiers got a taste of Japanese foods to which MSG had been added as seasoning. This began America’s love affair with MSG and its being brought to the United States. While there are very low levels of free glutamate found in foods of all kinds these are not the problem nature put them there for a good purpose. Contrarily, hundreds of thousands of metric tons of MSG are produced and added to our food every year. In most cases, MSG is hidden by including it as part of the ingredients on the label.
Researches feel that MSG becomes a neurological poison, in those people that are genetically susceptible. They cannot clear the glutamate.
Is the answer to block glutamate? That is how the drug and medical industry thinks.
When you go to your doctor he uses a drug called Riluzole that is approved by the FDA for ALS to block glutamate. It blocks the effects of glutamate by decreasing glutamate release and blocking the ability of glutamate to bind the receptors which decreases the excitotoxicity that leads to cell death. Unfortunately, it has been shown to prolong survival times in ALS patients by only two months.
I counsel my patients to avoid foods high in glutamate; you must make sure that no MSG has been added. Soy products are among the worse.
- Monosodium glutamate
- Yeast extracts
- Hydrolyzed protein
- Natural pork flavorings
- Bouillon and broth
- Soup stock
- Whey protein concentrate
- Whey protein
- Natural flavors
- Calcium caseinate
- Yeast food
- Corn gluten
- Natural chicken flavoring
- Barley malt
- Textured protein
- Autolyzed yeast
- Soy protein isolate
- Soy sauce
- Soy protein
- Soy concentrate
- Anything fermented
MAKE WISE FOOD CHOICES:
I suggest an organically based non GMO low trans fat diet Ketogenic diet, as described elsewhere in this monograph
These include pesticides, alkalis, dioxin, insoluble solvents, as well as alkylphenols. Remember Gulf War soldiers have an increased 50% rate of ALS. These are all evaluated and detoxified from the patient.
We are now finding that chronic cerebrospinal venous insufficiency (CCSVI) can be found in the veins draining the brain. Specifically, this is in the jugular and azygos veins. Patients with stenosis of these veins have undergone angioplasty with some significant results. It is thought that the stenosis occur because of biofilm from infections such as Lyme.
I ALSO USE A 19000 gauss magnet PEMF AND MICRCURRENT TO BREAK THIS UP ALONG WITH NATURAL BLOOD THINNERS TO BREAKDOWN THE BIOFILM
Because of the evidence of CCSVI and infections, I feel that ALS patients should undergo testing. The testing includes the test for Lyme, ehrlichia, Babesia, Bartonella, mycoplasma pneumoniae (Gulf War), chlamydia and others. In addition to this, several patients have been shown to have viruses and for that reason, I check Epstein Barr virus, HHV-6 virus, echovirus, retrovirus, CMV virus, as well as possibly West Nile and herpes virus.
Mold has mycotoxins which can also cause glutamate and nerve death and if suspected this is evaluated in my patients.
Parasites such as toxoplasmosis and a recently protomyxzoa coined FL1953 has been found to be in ALS patients. I routinely refer my patients for this study. If it is positive and there is evidence of biofilm and infections they are treated appropriately.
THE DENTAL ISSUE:
I feel that dental health is extremely important and I am not in favor of these critically ill people maintaining their root canals, especially if they are malfunctioning. I refer to a biologic dentist for further evaluations. In addition to this, I feel that the amalgams which are 50% mercury should be removed.
I test patients for mineral, vitamin, as well as hormone imbalances. Also, critically important is autoimmune studies, especially if they are being provoked by certain foods.
Within all our cells are little energy factories called mitochondria that produce high energy molecules called ATP. The first phase of energy production is called Complex 1 which is blocked by the kind of mutant SOD1 that characterizes ALS.
It has since been found that KETONES can restore Complex 1 function so that the mitochondria can continue producing energy for the muscles. Studies have shown that a ketogenic diet produced a 3.5 fold increase in circulating ketones and the ketogenic mice maintain their muscle strength longer than the standard diet fed mice. In addition, they had significantly more motor neurons at the end of the study than the controlled mice.
We teach patients how to maintain a Ketogenic diet to maintain optimum ketone levels, as well as blood sugar levels. In addition to the Ketogenic diet, the addition of pyruvate supplementation to assist aerobic metabolism may slow the progression of symptoms and improve motor performance.
TREHALOSE, a sweet tasting sugar substitute with neuroprotective qualities may also confer benefits. Very minute concentrations of trehalose in neurons can reduce the aggregate formation of misfolded proteins.
GLUCOSE AND ALS:
In the early stages of ALS there is impaired glucose tolerance. Interestingly, but not surprisingly, heavy metals, pesticides, smoking, endotoxins and other toxic insults can cause low blood sugar or called hypoglycemia. In advanced stages, hyper high blood sugar predominates. In the early stages in patients with low blood sugar six meals a day can help with providing more energy to the body.
With ALS, there is also increase in advanced glycation end products (AGEs) from glucose binding with proteins and causing structural injury. The glycation of proteins results in abnormalities in neurons, enzymes, and DNA. The process is both caused by and increase in free radicals and oxidative stress which is bad for neuron.
With the ketogenic diet, ketone bodies are used as alternative fuel as opposed to glucose.
Ketone bodies have been found to protect cells in various neurodegenerative diseases such as epilepsy, stroke, traumatic brain injury and cancer. The ketones are also antiinflammatory and reduce oxygen free radicals. This is especially important in ALS where antioxidants can diminish with increasing age.
My patients are placed on a ketogenic diet because of several studies showing this. I specifically like medium chain triglycerides along with sugar reduction.
OMEGA-3 FATTY ACIDS:
DHA (docosahexaenoic acid) inhibits the flow to release glutamate by astrocytes and its subsequent excitotoxicity to neurons. DHA also plays a role in astrocyte signaling during oxygen and glucose deprivation. DHA also plays a role in the regulation of the brain derived neurotrophic factor (BDNF), which is involved in the development of new neurons. These are also measured.
MEASURING MITOCHONDRIAL FUNCTION:
I perform tests to evaluate mitochondrial dysfunction, as well as Krebs cycle intermediates. If the patient has high free radicals or lipid peroxide a and low levels of certain antioxidants, then this is replaced. Oxidative stress control is very important.
The ratio of fats to carbohydrates and protein in a ketogenic diet.
The ketogenic diet is a 4-1 ratio of dietary fats to combine carbohydrates and protein. It is important to keep in mind that the lower the intake of carbohydrates, which is sugar, the more effective it will be.
I ALSO RECOMMEND PATIENTS GETTING KETOCAL DRINK AND DRINK THAT PERIODICALLY DURING THE DAY. The patient then monitors themselves for ketone production, as well as blood sugar.
We are looking at 39 key organic acids, GI function, cellular energy, neurotransmitters, vitamins, minerals, and cofactors, as well as fatty acids to optimize the patient.
SUMMARY: Of integrated therapies.
Obviously, from the often mentioned monograph ALS is multifactorial.
In my medical opinion a small amount is genetic and in the majority of the cases worldwide are due to environmental epigenomics influences.
There is evidence of mitochondrial dysfunction, abnormal glutamate transport, abnormal superoxide dismutase, autoimmune disease, infection, heavy metals, autoimmune dysfunction, as will as biofilm and chronic cerebrospinal venous insufficiency.
I ADDRESS ALL OF THESE CONCERNS
I block the NMDA RECEPTOR WITH LITIUM and other natural substances WHICH LOWERS GLUTAMATE AND PROTECTS THE CELL.
The patient has in depth testing to evaluate the above abnormalities. In addition to testing, I always refer to a biologic dentist to address the dental issues which include amalgams and possible malfunctioning root canals, which I do not feel are healthy for the body.
If there is evidence of infection, or electromagnetic radiation, or mitochondrial dysfunction, these all addressed.
Other modalities that I use include pulsed electromagnetic frequency which is a 19,000 Gauss-Sine WAVE PEMF magnet, proton therapy, ozone intravenously, hyperbaric oxygen, intravenous detoxification, bioidentical hormones, and balancing of the gut, as well as food allergies, and evaluation of autoimmunity.
If Trans Doppler reveals evidence of jugular or azygos vein abnormality then this might be compatible with chronic cerebrospinal venous insufficiency (CCSVI) which can be addressed.
My integrative treatment of ALS is personalized. The objective is to maintain mitochondrial function while lowering free radical load and inflammation. I believe that the evaluation of toxins, infections, spinal abnormalities, as well as dental issues are extremely important.
I also use intravenous glutathione, Myers cocktail, glutathione , and other nutritionally , as well as DHA and hormones to improve brain health. In addition to this, intravenous ozone is used under an investigational research board study. I also use pemf magnet therapy, hyperbaric oxygen treatments, photon therapy and others.
Best in health,
Dean R. Silver, M.D.