For patients who mainly report having digestive and similar issues, it’s so important for health care practitioners to fully appreciate and also look closely at the neurologic, neuroimmune and inflammatory nature of the condition.
The central nervous system (CNS) is an important regulator of the gastrointestinal (GI) tract and CNS dysfunction can manifest in significant and disabling GI-related symptoms. We know that our gut-brain axis incorporates bi-directional signals from the CNS, autonomic nervous system, enteric nervous system, gut microbiota, and the body’s immune system to respond to the dynamic needs of human physiology. So when something on this “information highway” goes awry, there is significant potential for the blood-brain barrier (BBB) to be breached and other problems to take hold – which points further to the importance of maintaining a healthy microbiome.
Researchers have long-studied the relationship of the microbiome and multiple sclerosis, for example.1 And in this recent abstract, scientists looked at a host of neuroinflammatory diseases that can potentially cause GI dysfunction, including primary CNS conditions such as multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein-associated disorder, and autoimmune encephalitis (AE). Additionally, peripheral nervous system (PNS) diseases that may impact the gut include: Guillain-Barre syndrome; chronic inflammatory demyelinating polyneuropathy; acute sensory-autonomic neuropathy/acute motor-sensory-autonomic neuropathy; acute autonomic ganglionopathy; myasthenia gravis; and acute autonomic neuropathy with paraneoplastic syndrome. Finally, collagen diseases, such as Sjogren syndrome and systemic sclerosis, and celiac disease affect both the CNS and PNS.
The investigators’ key takeaway from this study is that many neuro-associated GI dysfunctions actually “may predate or present concurrently with brain, spinal cord or peripheral nerve dysfunction.” Given their symptoms, patients initially may seek counsel from their primary care physicians or gastroenterologists, potentially delaying the appropriate neurological diagnosis. As the study scientists concluded “awareness of these phenomena among general practitioners and collaboration between gastroenterologists and neurologists are highly recommended in order for their early diagnosis and optimal management, as well as for systematic documentation of their presentations and treatment.”2
With a multi-symptom disease such as multiple sclerosis, it is critical for us to evaluate each issue and regularly communicate with any other consulting physicians for the most comprehensive assessment of any condition. And as we have consistently advised, patients with any neurological diagnosis must be fully informed about the benefits of adhering to a healthy diet. As we have often noted, we really are what we eat - and research continues to point at the gut microbiome as the foundation of not just our digestive health, but ultimately at our brain’s wellbeing too.
For more about nutritional approaches in MS, please visit our Medical Resources section to download our comprehensive guide.
Dr. Suzanne Gazda
1 The microbiome in multiple sclerosis.
2 Sakakibara R. (2021). Gastrointestinal dysfunction in neuroinflammatory diseases: Multiple sclerosis, neuromyelitis optica, acute autonomic ganglionopathy and related conditions. Autonomic neuroscience : basic & clinical, 232, 102795. Advance online publication. https://doi.org/10.1016/j.autneu.2021.102795