The multiple sclerosis companion: answers to the most frequently asked questions from people with MS
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[2023]
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Contents Part I 1 MS: Understanding the Disease What Is MS? A First Overview 1.1 Jennifer’s Story 1.2 First Things First: A Few Facts and Figures About MS 1.3 How the Central Nervous System Is Structured: Anatomy 1.3.1 The Central Nervous System: Brain and Spinal Cord 1.3.2 Corpus Callosum and Spinal Cord 1.4 Immune System and its Influence on the Central Nervous System: The Consequences 1.4.1 When the Body Attacks Itself: Autoimmune Disease 1.4.2 Nerve Cell: Dendrites, Axon and its Sheath, the 1.5 1.6 Myelin 1.4.3 Short Circuit in the Nervous System and Its Consequences 1.4.4 Iceberg Model: Disease Activity and Inflammatory Activity How Multiple Sclerosis Manifests Itself: MS Relapse and Typical Symptoms 1.5.1 “Typical” MS Symptoms 1.5.2 MS Can Be Overlooked at First How the Disease Can Run Its Course 3 3 6 7 7 7 10 10 11 12 13 14 15 17 17 ix
Contents X 2 3 Do I Really Have MS? 2.1 The Path to Diagnosis 2.1.1 Important Diagnostic Criteria: Spatial and Dissemination in Time 19 2.2 What Tests Are Used to Detect MS: Methods 2.2.1 Questions About Questions: What the Anamnesis Can Do 2.2.2 When Your Doctor Swings the Hammer: The Neurological Examination 2.2.3 Measuring the “Cable Run” Electrically: The “EPs” 2.2.4 For the Earliest Possible Detection: The MRI 2.2.5 More Than Just Water: CSF Examination and Oligoclonal Bands 2.2.6 CIS: The Clinically Isolated Syndrome 2.2.7 Changed Diagnostic Criteria Since 2017 19 19 20 21 21 21 22 22 23 24 A Trip into Our Immune System 25 3.1 The Players in Our Immune System: Lymphocytes, Antibodies and Others 25 3.1.1 The Stem Cell in the Bone Marrow: The “Mother” of the Immune System 26 3.1.2 The Lymphoid and the Myeloid Progenitor Cell 27 3.1.3 The White Blood Cells: “The Police” in the Blood 27 3.1.4 The Innate Immune System: Granulocytes, Monocytes and Macrophages 28 3.1.5 The Acquired Immune System: T and В Lymphocytes 28 3.1.6 Friend or Foe: The Maturation Process ofT Lymphocytes and Immunological Imprinting 29 3.1.7 The В Lymphocytes and the Perfect Defence 31 3.1.8 The Phagocytes: “Big Eaters” 31 3.1.9 T Lymphocyte Activation: Here We Go! 33 3.1.10 The Counterparts: The Regulatory T Lymphocytes 33 3.1.11 В Lymphocyte Activation, Plasma Cells and Custom-Made Antibodies 33 3.1.12 Reminder: The Memory Cell 36 3.2 The Inflammatory Attack Against the Nervous System 38 3.2.1 Activated T Lymphocytes Invade the Brain 38
Contents 3.2.2 3.2.3 3.2.4 4 T Lymphocytes in Imbalance: The T-Regulatory Cells Are Weakening 39 The Attack Against the Myelin: Common Cause with the В Lymphocytes 41 В-Cell Nests: A New Discovery Why MRI? 4.1 4.2 4.3 4.4 4.5 4.6 My MRI Report: Not a Closed Book! Anatomical Terms You Should Know 4.2.1 The Brain in Slices: The Axial Sectional Plane in MRI 47 4.2.2 Cortex, White Matter and Ventricles: Where Do I Find What? 48 4.2.3 The Brain in Longitudinal Section: The Corpus Callosum and the Roof of the Cerebellum in Focus 48 4.2.4 All Good Things Come in Threes: The Coronal Plane 49 Where MS Sits in the Body How the MRI Works 4.4.1 Magnetic Fieldand Hydrogen Atoms 4.4.2 High-Frequency Pulse (HF Pulse) and Hydrogen Atoms 53 4.4.3 The Image Contrast: How the Different Images Are Created 54 How to Read the MRI: The Image Contrasts 4.5.1 The Image Contrast T1 and T2 4.5.2 Tl-Weighted Images: MS Lesions Can Hide 4.5.3 T2-Weighted Images: Here You Can See More 4.5.4 TheT2 Special Forms: T2-FLAIR, PD andDIR Sequence 4.5.5 T2-PD: Proton Weighted 4.5.6 T2-FLAIR: For a Good Overview 4.5.7 The DIR Sequence: Shows Lesions in the Cerebral Cortex 4.5.8 In a Nutshell Why the Contrast Medium Is Important 4.6.1 The MRI Procedure xi 43 45 45 46 50 52 52 54 55 56 57 58 58 59 59 60 62 62
xii Contents Tl-Weighted Images: Fresh Acute MS Lesions Particularly Visible 4.6.3 Age Determination of MS Lesions Possible Thanks to Contrast Agent 4.6.4 Early Diagnosis Thanks to Contrast Agent “Black Holes”, “Footprints”, Brain Atrophy: And What They Mean 64 4.7.1 The Healing Process After Acute Inflammation: Black Holes and Footprints 4.7.2 When the Brain Changes: Brain Atrophy When an MRI Is Necessary: The “MRI for Diagnosis” and the “Follow-Up MRI” 4.8.1 The MRI for Diagnosis 4.8.2 The MRI for Follow-Up Typical MRI Images in MS 4.9.1 Corpus Callosum Lesions 4.9.2 Brainstem Lesions 4.9.3 Cock’s Comb-Like White Matter Lesions, Also Called “Dawson Fingers” 4.9.4 Black Holes 4.9.5 New Contrast-Absorbing Lesions (Fig. 4.26) 4.9.6 Lesion in the Cervical Spinal Cord(Fig. 4.27) 4.9.7 Brain Atrophy (Fig. 4.28) 4.9.8 The MRI Report: Nota Closed Book! 4.6.2 4.7 4.8 4.9 5 The Most Important Things About the Cerebrospinal Fluid 5.1 Basics of the Cerebrospinal Fluid 5.1.1 Cerebrospinal Fluid: What It Is and Where It Comes From 77 5.1.2 Blood and Cerebrospinal Fluid: Two Separate Areas 78 5.2 How a Lumbar Puncture Works 5.2.1 Practical Procedure 5.2.2 After That . 5.3 What the Lumbar Puncture Tells Us: The Evaluation 5.3.1 The CSF Examination: Cell Count, Total Protein, Sugar and Lactate 5.3.2 Blood-Brain Barrier Function: Albumin Shows What Is Going On 62 63 64 64 66 67 67 68 70 70 70 71 72 73 74 75 76 77 79 79 79 80 80 81
Contents The Albumin Quotient Antibodies Made in the CNS Itself: The IgG Quotient 5.3.5 The Reiber Diagram 5.3.6 Deviations Upwards on the Vertical: Too Much IgG in the CSF 5.3.7 Deviations to the Right on the Horizontal Axis: Too Much Albumin in the CSF 84 5.3.8 And Now a Few Examples: The Normal Finding 5.3.9 MS-Typical Findings: Intrathecal IgG Production 5.3.10 Another MS-Typical Constellation 5.3.11 Isoelectric Focusing and Oligoclonal Bands (OCBs) 5.3.3 5.3.4 Part II xiii 81 82 82 83 85 85 86 87 MS: Understanding the Therapy 6 How MS Is Treated 93 7 What To Do in an Acute MS Attack 95 95 7.1 7.2 Cortisone Pulse Therapy: How Is It Done? Plasma Exchange Treatment: Plasmapheresis and Immunoadsorption 96 8 I’m Fine: Why Therapy? 9 MS Therapy Yesterday and Today Development of the MS Therapy Landscape Interferons and Glatiramer Acetate Natalizumab and Fingolimod for Escalation Alternative in Tablet Form: Teriflunomide and Dimethyl Fumarate 100 9.5 Long-Acting Interferon: PEG Interferon 9.6 Antibody Therapies: Alemtuzumab and Ocrelizumab 9.7 Cladribine: Oral Pulse Therapy 9.8 Siponimod Approved for SPMS 9.9 Ozanimod and Ponesimod 9.10 Ofatumumab 9.1 9.2 9.3 9.4 97 99 99 100 100 101 101 101 101 102 102
xiv Contents 9.11 9.12 9.13 10 How the Progression of the Disease Can Be Influenced: The MS Drugs in Detail 10.1 10.2 10.3 10.4 10.5 11 Natalizumab (s.c.) Diroximel Fumarate Therapy Goal Today: Individual Therapy—Something for Everyone 9.13.1 Therapy Concept: Basic and Escalation Therapy 9.13.2 New Therapy Concept: Therapy Decisions Based on Prognosis 9.13.3 Prognosis Assessment: There Are Risk Factors 9.13.4 Individual Therapy Decision 9.13.5 “Hit Hard and Early” and “Treat to Target” 9.13.6 Individual Therapy: Take Life Situation into Account The Approved Drugs in Detail How What Works 10.2.1 Interferons and Glatiramer Acetate 10.2.2 Natalizumab 10.2.3 Fingolimod 10.2.4 Teriflunomide 10.2.5 Dimethyl Fumarate 10.2.6 Alemtuzumab 10.2.7 Cladribine 10.2.8 Ocrelizumab 10.2.9 Siponimod 10.2.10 Ozanimod 10.2.11 Ofatumumab 10.2.12 Natalizumab Subcutaneous (s.c.) 10.2.13 Ponesimod 10.2.14 Diroximel Fumarate No Effect Without Side Effect JCV and PML: What Is It? Regulatory Studies, Expert Information and “Real-World Data” The Therapy Goal Has a Name: NEDA 11.1 Paraclinical Course Parameters: MRI 11.2 Dreams of the Future: Neurofilaments 11.3 Clinical Course Parameters: Relapse Rate and Disability Progression 118 102. 102 102 103 103 104 104 105 105 107 107 108 108 108 109 109 109 HO HO HO Hl Hl 112 112 112 112 113 113 114 117 117 118
Contents 11.4 11.5 11.6 The EDSS Score Shows Disability Progression The Hidden Symptoms: Fatigue and Cognition In a Nutshell 12 MS and Vaccinations 12.1 12.2 12.3 Active and Passive Vaccination Why Is the Vaccination Issue So Important in MS Now? Distance Good: All Good 13 MS and the Desire to Have Children 13.1 13.2 Part III The Importance of Pregnancy Registers and MS MS Is Not a Hereditary Disease From Self-Experimentation to Case Reports The Intestine in the Focus of Research 15 Forest Fire MS 15.1 15.2 Our Diet Has Changed: “Western Diet” Ready-Made Products: ChemistryReplaces Nature Create Awareness “Blue Zones”: Healthy Ageing 17 Nutrition Works 17.1 17.2 17.3 17.4 17.5 121 121 122 123 125 126 127 131 131 133 135 135 The MS Numbers Are Increasing Not Victims of Our Genes: Environmental Factors in Our Sights 136 16 Western Diet and Blue Zones 16.1 16.2 16.3 16.4 119 120 120 MS: And What You Can Do Yourself 14 Self-Initiative Helps 14.1 14.2 XV Dietary Fibre and Secondary Plant Compounds Effects of the Plant-Based Diet The “China Study” Chinas Shift to the “Western Diet” and Its Consequences What Can a Plant-Based Mediterranean Diet Do? 139 140 140 141 142 145 145 146 146 147 148
xvi 18 Contents The Intestine and Its Inhabitants 18.1 What Does the Gastrointestinal Tract Look Like? 18.2 Three Layers: Mucosa, Connective Tissue and Musculature 18.3 The Intestine Has Its Own Nervous System: The “Enteric Nervous System” 153 18.4 The Intestine and Its Own Immune System: The “GALT” 18.5 The Intestine Has Immense Possibilities for Interaction 151 151 152 19 Microbiota and Microbiome 19.1 Bacteria in the Majority 19.2 Our Intestine: A Giant “Bioreactor” 157 157 158 20 How the Microbiome Develops 20.1 A Healthy Intestine = Eubiosis, a Diseased Intestine = Dysbiosis 161 161 21 How Bacteria Can Be Identified 21.1 Micro biome Analysis by “Next-Generation Sequencing” (NGS) 163 21.2 Species Richness of the Microbiota 163 22 The Stool Transplant 22.1 FMT and Practical Implementation 22.2 FMT and Consequences 165 166 166 23 The Bowel and MS: What Does Scientific Research Say? 23.1 Animal MS Studies on Mice: “EAE” 23.2 Does MS Start in the Gut? 23.3 Gut Bacteria and MS 23.4 The Metabolic Products of the Bacteria and MS 23.5 High-Fibre Diet: Energy Source for the Intestinal Cells 23.6 Short-Chain Fatty Acids and Immune System 23.7 Nutrition and Microbiota 23.8 Back to the Western Diet 23.9 Many Studies, Many Pieces of the Puzzle 23.10 Just Give It a Try 23.11 Propionate: As a Food Supplement 169 170 170 170 172 173 173 174 175 175 176 176 154 155 164
Contents 24 Vitamin D: Sense and Nonsense 24.1 What Vitamin D Can Do 24.2 Where Vitamin D Comes from 24.3 In-House Production 24.4 Own Production Has a Hard Time in the Northern Climes 182 24.5 Let Us Start with the Sun 24.6 From the Sun to Vitamin D Administration (Vitamin D Substitution) 183 24.7 About Calcidiol Units and Standard Values 24.8 Which Vitamin D? 24.9 How Much Vitamin D3 for Which Target Value? 24.10 Effects of Vitamin D on the Immune System 24.11 Effect of the Sun 24.12 Current Vitamin D Study xvii 179 179 180 180 182 183 184 184 185 186 186 25 Action Plan and Recipes to Follow 25.1 Plant-Based Does Not Mean: No More Meat! 25.2 Our Attitude Is Crucial 25-3 High-Fibre Plant-Based with Good Oils Is Key! 25.4 What You Should Eat 25.5 What You Should Avoid 25-6 No “Rush Jobs” 25.7 What If. 25.8 Is There Anything Missing for the Start? 25.9 Recipes to Try Out: The Small “Starter Set” 189 189 190 190 191 192 192 193 194 194 26 The Most Important Recommendations Summarised 26.1 Nutritional Optimisation 26.2 Sun and Vitamin D3 26.3 Movement and Relaxation 26.4 In Conclusion 209 209 209 210 211 Glossary 213 Bibliography 217 Index 225 |
| adam_txt |
Contents Part I 1 MS: Understanding the Disease What Is MS? A First Overview 1.1 Jennifer’s Story 1.2 First Things First: A Few Facts and Figures About MS 1.3 How the Central Nervous System Is Structured: Anatomy 1.3.1 The Central Nervous System: Brain and Spinal Cord 1.3.2 Corpus Callosum and Spinal Cord 1.4 Immune System and its Influence on the Central Nervous System: The Consequences 1.4.1 When the Body Attacks Itself: Autoimmune Disease 1.4.2 Nerve Cell: Dendrites, Axon and its Sheath, the 1.5 1.6 Myelin 1.4.3 Short Circuit in the Nervous System and Its Consequences 1.4.4 Iceberg Model: Disease Activity and Inflammatory Activity How Multiple Sclerosis Manifests Itself: MS Relapse and Typical Symptoms 1.5.1 “Typical” MS Symptoms 1.5.2 MS Can Be Overlooked at First How the Disease Can Run Its Course 3 3 6 7 7 7 10 10 11 12 13 14 15 17 17 ix
Contents X 2 3 Do I Really Have MS? 2.1 The Path to Diagnosis 2.1.1 Important Diagnostic Criteria: Spatial and Dissemination in Time 19 2.2 What Tests Are Used to Detect MS: Methods 2.2.1 Questions About Questions: What the Anamnesis Can Do 2.2.2 When Your Doctor Swings the Hammer: The Neurological Examination 2.2.3 Measuring the “Cable Run” Electrically: The “EPs” 2.2.4 For the Earliest Possible Detection: The MRI 2.2.5 More Than Just Water: CSF Examination and Oligoclonal Bands 2.2.6 CIS: The Clinically Isolated Syndrome 2.2.7 Changed Diagnostic Criteria Since 2017 19 19 20 21 21 21 22 22 23 24 A Trip into Our Immune System 25 3.1 The Players in Our Immune System: Lymphocytes, Antibodies and Others 25 3.1.1 The Stem Cell in the Bone Marrow: The “Mother” of the Immune System 26 3.1.2 The Lymphoid and the Myeloid Progenitor Cell 27 3.1.3 The White Blood Cells: “The Police” in the Blood 27 3.1.4 The Innate Immune System: Granulocytes, Monocytes and Macrophages 28 3.1.5 The Acquired Immune System: T and В Lymphocytes 28 3.1.6 Friend or Foe: The Maturation Process ofT Lymphocytes and Immunological Imprinting 29 3.1.7 The В Lymphocytes and the Perfect Defence 31 3.1.8 The Phagocytes: “Big Eaters” 31 3.1.9 T Lymphocyte Activation: Here We Go! 33 3.1.10 The Counterparts: The Regulatory T Lymphocytes 33 3.1.11 В Lymphocyte Activation, Plasma Cells and Custom-Made Antibodies 33 3.1.12 Reminder: The Memory Cell 36 3.2 The Inflammatory Attack Against the Nervous System 38 3.2.1 Activated T Lymphocytes Invade the Brain 38
Contents 3.2.2 3.2.3 3.2.4 4 T Lymphocytes in Imbalance: The T-Regulatory Cells Are Weakening 39 The Attack Against the Myelin: Common Cause with the В Lymphocytes 41 В-Cell Nests: A New Discovery Why MRI? 4.1 4.2 4.3 4.4 4.5 4.6 My MRI Report: Not a Closed Book! Anatomical Terms You Should Know 4.2.1 The Brain in Slices: The Axial Sectional Plane in MRI 47 4.2.2 Cortex, White Matter and Ventricles: Where Do I Find What? 48 4.2.3 The Brain in Longitudinal Section: The Corpus Callosum and the Roof of the Cerebellum in Focus 48 4.2.4 All Good Things Come in Threes: The Coronal Plane 49 Where MS Sits in the Body How the MRI Works 4.4.1 Magnetic Fieldand Hydrogen Atoms 4.4.2 High-Frequency Pulse (HF Pulse) and Hydrogen Atoms 53 4.4.3 The Image Contrast: How the Different Images Are Created 54 How to Read the MRI: The Image Contrasts 4.5.1 The Image Contrast T1 and T2 4.5.2 Tl-Weighted Images: MS Lesions Can Hide 4.5.3 T2-Weighted Images: Here You Can See More 4.5.4 TheT2 Special Forms: T2-FLAIR, PD andDIR Sequence 4.5.5 T2-PD: Proton Weighted 4.5.6 T2-FLAIR: For a Good Overview 4.5.7 The DIR Sequence: Shows Lesions in the Cerebral Cortex 4.5.8 In a Nutshell Why the Contrast Medium Is Important 4.6.1 The MRI Procedure xi 43 45 45 46 50 52 52 54 55 56 57 58 58 59 59 60 62 62
xii Contents Tl-Weighted Images: Fresh Acute MS Lesions Particularly Visible 4.6.3 Age Determination of MS Lesions Possible Thanks to Contrast Agent 4.6.4 Early Diagnosis Thanks to Contrast Agent “Black Holes”, “Footprints”, Brain Atrophy: And What They Mean 64 4.7.1 The Healing Process After Acute Inflammation: Black Holes and Footprints 4.7.2 When the Brain Changes: Brain Atrophy When an MRI Is Necessary: The “MRI for Diagnosis” and the “Follow-Up MRI” 4.8.1 The MRI for Diagnosis 4.8.2 The MRI for Follow-Up Typical MRI Images in MS 4.9.1 Corpus Callosum Lesions 4.9.2 Brainstem Lesions 4.9.3 Cock’s Comb-Like White Matter Lesions, Also Called “Dawson Fingers” 4.9.4 Black Holes 4.9.5 New Contrast-Absorbing Lesions (Fig. 4.26) 4.9.6 Lesion in the Cervical Spinal Cord(Fig. 4.27) 4.9.7 Brain Atrophy (Fig. 4.28) 4.9.8 The MRI Report: Nota Closed Book! 4.6.2 4.7 4.8 4.9 5 The Most Important Things About the Cerebrospinal Fluid 5.1 Basics of the Cerebrospinal Fluid 5.1.1 Cerebrospinal Fluid: What It Is and Where It Comes From 77 5.1.2 Blood and Cerebrospinal Fluid: Two Separate Areas 78 5.2 How a Lumbar Puncture Works 5.2.1 Practical Procedure 5.2.2 After That . 5.3 What the Lumbar Puncture Tells Us: The Evaluation 5.3.1 The CSF Examination: Cell Count, Total Protein, Sugar and Lactate 5.3.2 Blood-Brain Barrier Function: Albumin Shows What Is Going On 62 63 64 64 66 67 67 68 70 70 70 71 72 73 74 75 76 77 79 79 79 80 80 81
Contents The Albumin Quotient Antibodies Made in the CNS Itself: The IgG Quotient 5.3.5 The Reiber Diagram 5.3.6 Deviations Upwards on the Vertical: Too Much IgG in the CSF 5.3.7 Deviations to the Right on the Horizontal Axis: Too Much Albumin in the CSF 84 5.3.8 And Now a Few Examples: The Normal Finding 5.3.9 MS-Typical Findings: Intrathecal IgG Production 5.3.10 Another MS-Typical Constellation 5.3.11 Isoelectric Focusing and Oligoclonal Bands (OCBs) 5.3.3 5.3.4 Part II xiii 81 82 82 83 85 85 86 87 MS: Understanding the Therapy 6 How MS Is Treated 93 7 What To Do in an Acute MS Attack 95 95 7.1 7.2 Cortisone Pulse Therapy: How Is It Done? Plasma Exchange Treatment: Plasmapheresis and Immunoadsorption 96 8 I’m Fine: Why Therapy? 9 MS Therapy Yesterday and Today Development of the MS Therapy Landscape Interferons and Glatiramer Acetate Natalizumab and Fingolimod for Escalation Alternative in Tablet Form: Teriflunomide and Dimethyl Fumarate 100 9.5 Long-Acting Interferon: PEG Interferon 9.6 Antibody Therapies: Alemtuzumab and Ocrelizumab 9.7 Cladribine: Oral Pulse Therapy 9.8 Siponimod Approved for SPMS 9.9 Ozanimod and Ponesimod 9.10 Ofatumumab 9.1 9.2 9.3 9.4 97 99 99 100 100 101 101 101 101 102 102
xiv Contents 9.11 9.12 9.13 10 How the Progression of the Disease Can Be Influenced: The MS Drugs in Detail 10.1 10.2 10.3 10.4 10.5 11 Natalizumab (s.c.) Diroximel Fumarate Therapy Goal Today: Individual Therapy—Something for Everyone 9.13.1 Therapy Concept: Basic and Escalation Therapy 9.13.2 New Therapy Concept: Therapy Decisions Based on Prognosis 9.13.3 Prognosis Assessment: There Are Risk Factors 9.13.4 Individual Therapy Decision 9.13.5 “Hit Hard and Early” and “Treat to Target” 9.13.6 Individual Therapy: Take Life Situation into Account The Approved Drugs in Detail How What Works 10.2.1 Interferons and Glatiramer Acetate 10.2.2 Natalizumab 10.2.3 Fingolimod 10.2.4 Teriflunomide 10.2.5 Dimethyl Fumarate 10.2.6 Alemtuzumab 10.2.7 Cladribine 10.2.8 Ocrelizumab 10.2.9 Siponimod 10.2.10 Ozanimod 10.2.11 Ofatumumab 10.2.12 Natalizumab Subcutaneous (s.c.) 10.2.13 Ponesimod 10.2.14 Diroximel Fumarate No Effect Without Side Effect JCV and PML: What Is It? Regulatory Studies, Expert Information and “Real-World Data” The Therapy Goal Has a Name: NEDA 11.1 Paraclinical Course Parameters: MRI 11.2 Dreams of the Future: Neurofilaments 11.3 Clinical Course Parameters: Relapse Rate and Disability Progression 118 102. 102 102 103 103 104 104 105 105 107 107 108 108 108 109 109 109 HO HO HO Hl Hl 112 112 112 112 113 113 114 117 117 118
Contents 11.4 11.5 11.6 The EDSS Score Shows Disability Progression The Hidden Symptoms: Fatigue and Cognition In a Nutshell 12 MS and Vaccinations 12.1 12.2 12.3 Active and Passive Vaccination Why Is the Vaccination Issue So Important in MS Now? Distance Good: All Good 13 MS and the Desire to Have Children 13.1 13.2 Part III The Importance of Pregnancy Registers and MS MS Is Not a Hereditary Disease From Self-Experimentation to Case Reports The Intestine in the Focus of Research 15 Forest Fire MS 15.1 15.2 Our Diet Has Changed: “Western Diet” Ready-Made Products: ChemistryReplaces Nature Create Awareness “Blue Zones”: Healthy Ageing 17 Nutrition Works 17.1 17.2 17.3 17.4 17.5 121 121 122 123 125 126 127 131 131 133 135 135 The MS Numbers Are Increasing Not Victims of Our Genes: Environmental Factors in Our Sights 136 16 Western Diet and Blue Zones 16.1 16.2 16.3 16.4 119 120 120 MS: And What You Can Do Yourself 14 Self-Initiative Helps 14.1 14.2 XV Dietary Fibre and Secondary Plant Compounds Effects of the Plant-Based Diet The “China Study” Chinas Shift to the “Western Diet” and Its Consequences What Can a Plant-Based Mediterranean Diet Do? 139 140 140 141 142 145 145 146 146 147 148
xvi 18 Contents The Intestine and Its Inhabitants 18.1 What Does the Gastrointestinal Tract Look Like? 18.2 Three Layers: Mucosa, Connective Tissue and Musculature 18.3 The Intestine Has Its Own Nervous System: The “Enteric Nervous System” 153 18.4 The Intestine and Its Own Immune System: The “GALT” 18.5 The Intestine Has Immense Possibilities for Interaction 151 151 152 19 Microbiota and Microbiome 19.1 Bacteria in the Majority 19.2 Our Intestine: A Giant “Bioreactor” 157 157 158 20 How the Microbiome Develops 20.1 A Healthy Intestine = Eubiosis, a Diseased Intestine = Dysbiosis 161 161 21 How Bacteria Can Be Identified 21.1 Micro biome Analysis by “Next-Generation Sequencing” (NGS) 163 21.2 Species Richness of the Microbiota 163 22 The Stool Transplant 22.1 FMT and Practical Implementation 22.2 FMT and Consequences 165 166 166 23 The Bowel and MS: What Does Scientific Research Say? 23.1 Animal MS Studies on Mice: “EAE” 23.2 Does MS Start in the Gut? 23.3 Gut Bacteria and MS 23.4 The Metabolic Products of the Bacteria and MS 23.5 High-Fibre Diet: Energy Source for the Intestinal Cells 23.6 Short-Chain Fatty Acids and Immune System 23.7 Nutrition and Microbiota 23.8 Back to the Western Diet 23.9 Many Studies, Many Pieces of the Puzzle 23.10 Just Give It a Try 23.11 Propionate: As a Food Supplement 169 170 170 170 172 173 173 174 175 175 176 176 154 155 164
Contents 24 Vitamin D: Sense and Nonsense 24.1 What Vitamin D Can Do 24.2 Where Vitamin D Comes from 24.3 In-House Production 24.4 Own Production Has a Hard Time in the Northern Climes 182 24.5 Let Us Start with the Sun 24.6 From the Sun to Vitamin D Administration (Vitamin D Substitution) 183 24.7 About Calcidiol Units and Standard Values 24.8 Which Vitamin D? 24.9 How Much Vitamin D3 for Which Target Value? 24.10 Effects of Vitamin D on the Immune System 24.11 Effect of the Sun 24.12 Current Vitamin D Study xvii 179 179 180 180 182 183 184 184 185 186 186 25 Action Plan and Recipes to Follow 25.1 Plant-Based Does Not Mean: No More Meat! 25.2 Our Attitude Is Crucial 25-3 High-Fibre Plant-Based with Good Oils Is Key! 25.4 What You Should Eat 25.5 What You Should Avoid 25-6 No “Rush Jobs” 25.7 What If. 25.8 Is There Anything Missing for the Start? 25.9 Recipes to Try Out: The Small “Starter Set” 189 189 190 190 191 192 192 193 194 194 26 The Most Important Recommendations Summarised 26.1 Nutritional Optimisation 26.2 Sun and Vitamin D3 26.3 Movement and Relaxation 26.4 In Conclusion 209 209 209 210 211 Glossary 213 Bibliography 217 Index 225 |
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| format | Book |
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| genre | (DE-588)4048476-2 Ratgeber gnd-content |
| genre_facet | Ratgeber |
| id | DE-604.BV049458692 |
| illustrated | Illustrated |
| index_date | 2024-07-03T23:14:20Z |
| indexdate | 2024-12-09T13:08:16Z |
| institution | BVB |
| institution_GND | (DE-588)1065168780 |
| isbn | 9783662675397 |
| language | English |
| oai_aleph_id | oai:aleph.bib-bvb.de:BVB01-034804456 |
| oclc_num | 1379241939 |
| open_access_boolean | |
| owner | DE-384 |
| owner_facet | DE-384 |
| physical | xx, 230 Seiten Illustrationen 23.5 cm x 15.5 cm |
| publishDate | 2023 |
| publishDateSearch | 2023 |
| publishDateSort | 2023 |
| publisher | Springer |
| record_format | marc |
| spelling | Friedrich, Anke 1964- Verfasser (DE-588)1227077599 aut The multiple sclerosis companion answers to the most frequently asked questions from people with MS Anke Friedrich Berlin Springer [2023] xx, 230 Seiten Illustrationen 23.5 cm x 15.5 cm txt rdacontent n rdamedia nc rdacarrier Multiple Sklerose (DE-588)4040693-3 gnd rswk-swf (DE-588)4048476-2 Ratgeber gnd-content Multiple Sklerose (DE-588)4040693-3 s DE-604 Springer-Verlag GmbH (DE-588)1065168780 pbl Erscheint auch als Online-Ausgabe 978-3-662-67540-3 X:MVB text/html http://deposit.dnb.de/cgi-bin/dokserv?id=9abffb345d974ea2b94634c2da3682c4&prov=M&dok_var=1&dok_ext=htm Inhaltstext Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034804456&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis 1\p vlb 20230509 DE-101 https://d-nb.info/provenance/plan#vlb |
| spellingShingle | Friedrich, Anke 1964- The multiple sclerosis companion answers to the most frequently asked questions from people with MS Multiple Sklerose (DE-588)4040693-3 gnd |
| subject_GND | (DE-588)4040693-3 (DE-588)4048476-2 |
| title | The multiple sclerosis companion answers to the most frequently asked questions from people with MS |
| title_auth | The multiple sclerosis companion answers to the most frequently asked questions from people with MS |
| title_exact_search | The multiple sclerosis companion answers to the most frequently asked questions from people with MS |
| title_exact_search_txtP | The multiple sclerosis companion answers to the most frequently asked questions from people with MS |
| title_full | The multiple sclerosis companion answers to the most frequently asked questions from people with MS Anke Friedrich |
| title_fullStr | The multiple sclerosis companion answers to the most frequently asked questions from people with MS Anke Friedrich |
| title_full_unstemmed | The multiple sclerosis companion answers to the most frequently asked questions from people with MS Anke Friedrich |
| title_short | The multiple sclerosis companion |
| title_sort | the multiple sclerosis companion answers to the most frequently asked questions from people with ms |
| title_sub | answers to the most frequently asked questions from people with MS |
| topic | Multiple Sklerose (DE-588)4040693-3 gnd |
| topic_facet | Multiple Sklerose Ratgeber |
| url | http://deposit.dnb.de/cgi-bin/dokserv?id=9abffb345d974ea2b94634c2da3682c4&prov=M&dok_var=1&dok_ext=htm http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034804456&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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