My thoughts about chronic cerebrospinal venous insufficiency – CCSVI and liberation treatment November 23, 2009Posted by Rebecca Hoover in Diet - the right diet for MS, what you need to eat.
The chronic cerebrospinal venous insufficiency (CCSVI) theory and related liberation surgery (also a procedure) to remove blood vessel blockages have spurred great hope for those with MS. It is my belief this hope is well-founded but it is important to pay attention to two issues. First, it is important to understand what the blockages mean in practical terms. Second it is important to understand what additional treatment is likely to be necessary even if the surgery or procedure can be used.
CCSVI essentially identifies blockages in blood vessels as a problem causing MS symptoms. This is not the first time, however, blockages have been identified as a problem in MS. Roy L. Swank, M.D., a professor emeritus of neurology and world wide expert in MS, long ago stated that blockages caused by saturated fat were the cause of MS symptoms. In fact, Professor Swank identified blockages not in larger blood vessels but in very small blood vessels surrounding the brain and spinal cord. Also, many articles in medical journals have discussed vein problems related to MS. For example, some articles point out that problems with small veins in eyes seem to precede optic neuritis in MS.
The widespread nature of blockages suggests the second issue. Even if blockages are leading to MS symptoms, the blockage problem is probably far more widespread than can be surgically corrected in full. This means that diet, exercise, etc. changes will still be needed to prevent future blockages and help treat the many thousands of current blockages too small to be surgically corrected. These self-help changes are not surprising because they are also required to treat some heart problems and varicose veins which also involve blood vessel problems.
The likelihood that dietary changes, for example, will continue to be important in managing MS is highlighted by a study released in 2009 from South Africa that showed that saturated fat in the blood of those with MS is related to the severity of MS symptoms. The study showed that as saturated fats in the blood increased, MS symptoms and disability also increased. Those with lower levels of saturated fats in their blood had fewer MS symptoms and lower levels of disability. Given this, we all obviously want to keep the level of saturated fat in our blood as low as possible.
It should be noted that it appears that poor diet, including too much saturated fat and not enough healthy foods such as fish, fruits and vegetables, contributes to both blood vessel problems and MS. Accordingly, if one wishes to address both blood vessel problems and MS, diet is the place to start. A healthy MS diet is key.
The so-called CCSVI liberation surgery or procedure is being conducted in two ways. In Italy, a Dr. Paolo Zamboni is using balloons to stretch only a very small number veins that are supposedly too narrow. At Stanford University in the United States, Dr. Michael Dake used stents to open the veins. The jugular veins in the neck are often opened using one of the two methods as is the azygous vein which drains blood from the chest and abdominal area. The method used by Dr. Dake causes more pain than the method used by Dr. Zamboni. Also, the use of stents is high risk. One woman in her 50’s died from a stroke shortly after Dr. Dake performed his surgery on her and gave her blood thinners. In another case, the stent Dr. Dake placed in a man in his 20’s slipped out of placed, traveled to his heart and required emergency open heart surgery. After these two incidents, Stanford stopped the experiments conducted by Dr. Dake.
The article on liberation surgery published in December 2009 suggested the surgeries done in Italy may provide relatively modest improvements, contrary to initial hopes for major improvements. For example, the rather poorly designed study (it was not blinded) did not show statistically significant improvements in post-operative relapse rate. The article did state that post-operative Multiple Sclerosis Functional Composite scores that measured disability had statistically significant improvements. Likewise, the number of patients with relapsing/remitting MS who stayed relapse free increased but re-blockage of the veins “liberated” often occurred within 18 months. The CCSVI procedure seemed to offer little benefit for primary and secondary progressive MS.
In summary, the procedure seems to offer fewer benefits than a recent study showed for patients receiving Vitamin D3 supplements of 14,000 I.U. each day. Unfortunately, the design of the Zamboni study needs to kept in mind as well. The study design was problematic enough the benefits that were found may not stand the test of time. Future studies may not be able to show the surgery produces the claimed benefits.
It should be mentioned that the modest benefits that may be provided by the procedure are not surprising. Since vein problems in MS are widespread, unblocking a couple of large veins would probably not solve the overall dysfunction in MS.
Much more research on the liberation procedure and whether it can actually help reduce MS symptoms is needed. The great benefit of the study is that it focuses attention once again on the role of veins in MS disease process. Therein lies our hope.
While all of us wait for additional information on CCSVI surgeries, we all can take steps to decrease blockages right now. The best non-surgical method that I know of to do this has been suggested by George Jelinek, M.D., a professor of medicine from Australia. His website Overcoming Multiple Sclerosis still offers important and timely information for those with multiple sclerosis. Taking the steps recommended by Professor Jelinek will help prevent and resolve blockages.
It is wonderful to have a new focus on hope for those with MS. At the same time, it is important to remember that many who have never had a CCSVI procedure are living full and vigorous lives, with no visible disability despite having MS and not taking any MS medications, There has been far too much emphasis on doom, gloom and pessimism. Let’s all hope the possibility of surgical treatment will spur those all with MS to start making the diet and other lifestyle changes likely to be needed to help heal MS. We all need to grit our teeth and promise ourselves we will make the lifestyle changes that scientific studies show will probably help us heal or keep us healthy. Hope, it seems, generally comes with some effort.
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Please remember to consult with your doctors about how to stay as healthy as possible. Nothing here should be interpreted as medical advice. Instead, please use the information you find here in your discussions with your doctor.
Copyright 2009 Rebecca Hoover