Vaping, Part 3: Combined risks – oils and TRP channel activators.

The risks of vaping may be additive, inhaling oils may increase risk of exogenous lipoid pneumonia (ELP), and inhaling TRP channel activators may increase risk of oxidative stress of cells or mitochondria. See part 1 Vaping and TRP Channel Activators, and part 2 Vaping Risks: ELP pneumonia and Oils, for the first two parts of the series.

Inhaling something accidentally is called aspirating and may occur while trying to swallow saliva, food or beverages, or during vomiting, especially for someone with weak muscles as may occur during chronic illness or with aging. Inhaling vape mixtures is purposeful and the original goal was to reduce health risks known to be associated with toxins caused by burning tobacco or an herb. Tobacco also has known carcinogens which would be removed from a product made with only the nicotine such as nicotine gums, lozenges or a nicotine patch.

Nicotine and cannabinoids can have health benefits, while toxins found in smoke can increase oxidative stress and may cause symptoms such as digestive problems, eczema, in addition to respiratory problems such as a chronic cough or bronchitis. Finding a safer way to consume nicotine or cannabinoids would be desirable however vaping may not be the solution, or not yet.

Flavorings that add odor are unnecessary for a product that isn’t inhaled through the nose, but an antioxidant preservative such as vitamin E and emulsifiers* such as glycerine are added to preserve and stabilize the mixture. Safer substitutes might not be available as other substances that preserve and emulsify might affect the lungs negatively also. Air is for inhaling, not emulsifiers. Vitamin E is oil based, antioxidants that are water based are available such as vitamin C, but then how would it stay mixed with an oil based cannabinoid or nicotine which dissolves better in oil or alcohol?

Nicotine can dissolve in water better than cannabinoids (2) and original vaping mixtures were made for nicotine rather than the cannabinoids THC or CBD. Vaping devices are available for powdered herb which heat the herb at a lower temperature than burning it, the problem with that method is that some of the beneficial cannabinoids in some strains of medicinal marijuana are only produced at higher temperatures so the vaped medicine may not provide the full symptom relief that smoking the strain would provide to a patient.

Trying to remove the glycerine from a nicotine vape mixture might not be fully protective against health risks either. The risk may involve a combination of the nicotine and the glycerine, as suggested in an murine based study of e-cigarette chemicals. Chronic exposure to a mixture containing nicotine and propylene glycol** (3 weeks for 20 minutes per day) was found to slow mucociliary clearing while exposure to the propylene glycol did not. Acute exposure (one week for 20 minutes per day) to either mixture did not cause slower mucociliary clearing. The size of particles effects clearance with larger particle size being more likely to remain in the lungs and smaller particles more likely to be exhaled. (4)

Nicotine also can act as a TRP channel activator (3) so the combination of some of the flavoring chemicals or the nicotine and cannabinoids may be opening the cell membrane’s TRP channels and allowing the glycerin or glycol to enter and accumulate to a level that inhibits cell function, causing Exogenous Lipoid Pneumonia or other health problems.

Pregnant women are advised to avoid use of vaped products (and to avoid smoke from tobacco or marijuana). An animal based study did find negative effects on lung alveoli development in newborn animals exposed to e-cigarette vape mixtures for the first ten days of their lives. Reduced weight gain was also noted. The negative effects were seen in the group exposed to nicotine and propylene glycol mixtures rather than the group exposed only to propylene glycol. (6)

If there is a take home point it may be that “Smoking is bad, mmmkay,”*** consider trying the nicotine patch, gum or lozenges, — but avoiding nicotine, smoking, or vaping during pregnancy is advised.

Cannabinoids are needed for fertility for females and males in a U shape curve – too little can cause infertility and too much can cause infertility. CBD is non-euphoria causing and is equivalent to the 2-AG form that is found in greater amounts during normal health than the THC equivalent called anandamide. Neither is recommended currently for use during pregnancy however genetic differences may cause a deficiency. Chocolate and some other legal food sources are available. Non-euphoria producing cannabinoids are the most abundant in plants and are also found in human breast milk and are important for stimulating the infant’s appetite and growth rate. We need cannabinoids in every cell of the body for many functions.. See the post Clinical Endocannabinoid Deficiency, (CED), and Phospholipids, for more information about symptoms or conditions that may be associated with a lack of cannabinoids and a list of legal food sources.

Footnotes:

*Glycerine is a natural emulsifier, helping to keep a water and oil mixture mixed without needing to shake it – picture an oil and vinegar salad dressing that separates into two layers compared to mayonnaise which has egg yolk as the emulsifier to keep the oil and water mixed together. (1)

** Glycerine/glycerin is also known as glycerol and glycols are similar chemically to glycerol. Some forms are more toxic to humans or animals than other forms. They are sweet syrupy liquids and may be consumed by animals if spilled in the form of antifreeze which would be toxic. (5)

*** South Park, paraphrase of a quote by the school guidance counselor Mr. Mackey.

Series:

Reference List

  1. Pat Thomas, Read the Label: Emulsifiers, TheEcologist.org, Dec 14, 2008, https://theecologist.org/2008/dec/14/read-label-emulsifiers
  2. Nicotine, Chemistry Encyclopedia, http://www.chemistryexplained.com/Ne-Nu/Nicotine.html
  3. Feng Z, Li W, Ward A, et al. A C. elegans model of nicotine-dependent behavior: regulation by TRP-family channels. Cell. 2006;127(3):621–633. doi:10.1016/j.cell.2006.09.035 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2859215/
  4. Laube BL, Afshar-Mohajer N, Koehler K, et al. Acute and chronic in vivo effects of exposure to nicotine and propylene glycol from an E-cigarette on mucociliary clearance in a murine model. Inhal Toxicol. 2017;29(5):197–205. doi:10.1080/08958378.2017.1336585 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553614/
  5. 14.6: Glycols and Glycerol, The Basics of General, Organic, and Biological Chemistry, (Ball DW, et al.) Chemistry LibreTexts, Last Updated, Aug 12, 2019 https://chem.libretexts.org/Bookshelves/Introductory_Chemistry/Book%3A_The_Basics_of_GOB_Chemistry_(Ball_et_al.)/14%3A_Organic_Compounds_of_Oxygen/14.06_Glycols_and_Glycerol
  6. McGrath-Morrow SA, Hayashi M, Aherrera A, et al. The effects of electronic cigarette emissions on systemic cotinine levels, weight and postnatal lung growth in neonatal mice. PLoS One. 2015;10:e0118344.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4338219/

Vaping and TRP channel activators.

Vaping is a slang term used to describe a method for inhaling tobacco or other herbs without literally burning them with a flame. Electric heating devices turn volatile chemicals within the tobacco or herb into a vapor (gaseous form of the chemical) that can be inhaled. Typically smokers of tobacco don’t draw the smoke of cigarettes or a pipe deeply into the lungs while smokers of marijuana do tend to inhale and hold the smoke. Either type of smoking does create toxins from the act of burning the herb/tobacco leaf.

Electric vaping cartridges heat a liquid mixture that may contain nicotine from tobacco or THC/CBD from marijuana possibly along with other chemicals to help keep the mixture mixed (emulsifying oils such as glycerine) or chemicals that add a flavor and/or odor. The goal of vaping was to reduce the health risks that are linked to carcinogens in tobacco or to the chemicals that are created during burning a substance (too many decorative candles in a poorly ventilated home can also be a health hazard). Unfortunately there have been health problems and even some deaths linked to vaping nicotine or cannabinoid containing vape products.

Health risks have been linked to the glycerine (exogenous lipoid pneumonia (ELP), a type of pneumonia caused by excess fats/lipids in lung cells) (2), however other health problems have also occurred. No one chemical has been found that can be linked to all of the health problems or deaths that have occurred. (1) In addition to the type of pneumonia attributed to the glycerine content, several of the chemicals used to add flavor to vape products have been linked to various negative health symptoms.

Cinnamon contains cinnamaldehyde which has been found to be a health risk in vape products. (7) Risks have also been linked to o-vanillin, found naturally in vanilla, and pentanedione (found in honey). Other potentially harmful chemicals were also a frequent problem when fifty flavored vape products were tested 92% were positive for diacetyl, acetylpropionyl, or acetoin. (9) Glycerine may be harmful as a fatty substance that doesn’t belong in the lungs but may also be acting as modulators or activators of TRPV channels. (glycerine/glycerol) (12) Butter flavorings use 2-3-Pentanedione which has already been associated with lung problems associated with microwave popcorn. (13)

More complex flavors include several flavoring chemicals in combination, and risk may also increase from combinations or increased total quantity of the chemicals used as flavorings. Products available for sale may not be subject to regulation or labeling requirements so what a vape liquid contains may not be available to a consumer or a medical professional.

Natural phytonutrients found in vanilla and cinnamon add fragrance and health benefits, however when inhaled deeply into the lungs they may be overactivating cells due to their ability to open channels through cell membrane walls which allows excess calcium to enter the cell, or through the membranes of mitochondria found within cells. Cinnamaldehyde and vanillin are both TRP channel activators. TRP channels are portals through the cell membrane wall or in the membrane of organelles within the cell such as mitochondria, the main energy producing part of every cell. The TRPA1 channel is a type associated with coughing and mucous production. (8) Ethyl vanillin activates TRPA1 channels (10) and more typically vanillin is known to activate TRPV channels (the V stands for vanilloid). (11)

Vitamin E content in vape mixtures has also been linked with health risks associated with vaping. (4) Vitamin E can act as a preservative against oxidation, or spoilage of the oil content in a mixture, and it may also act as a TRP channel modulator – affecting the ability of other chemicals to open TRP channels. Vitamin E might help keep them closed in some tested conditions. (5) Cannabinoids can also act as TRP channel activators. (6) The non-euphoria producing cannabinoid known as CBD activates TRPV1 channels and the euphoria producing cannabinoid in marijuana known as THC activates the TRPA1 channels. (11)

Normally the fragrance of foods is sensed within the nose. The tongue and the lungs have no scent receptors. The cinnamon smells fragrant in small amounts but sniff a large amount and you may sneeze and your nose will likely start dripping with extra mucous production. Extra mucous production is a protective mechanism to keep potentially harmful or irritating chemicals from being inhaled into the lungs.

Horseradish has a very pungent smell and hot pepper simply burns when eaten or when it gets on delicate mucous membranes and eating either will also cause increased mucous production and release – in other words – a runny nose. Horseradish and hot pepper also contain potent TRP channel activators – they are causing mucous to be released. Extra mucous production is normal for your nose, it can just drip or be blown out, but deep within your lungs too much mucous production can cause the lungs to overfill and it may lead to pneumonia or Chronic Obstructive Pulmonary Disease (COPD) also involves lungs that are too full of liquid. COPD patients are recommended to avoid use of e-cigarettes as they may increase the inflammatory response of COPD lung cells (3)

The simplest take home point might be to avoid flavors in vape products altogether – the lungs can’t smell them, neither can your tongue, only your nose can. Unless you are inhaling through your nose, where mucous membranes are designed to prevent entry of toxic chemicals and TRP channel activators, then it would likely be safest to avoid sweetened or flavored vape products and avoiding unregulated products helps reduce the risk of unknown ingredients present in unknown amounts. An article on Healthline includes a long list of specific chemicals found in vape products that may have health risks. The article reviews other known health risks and includes links to the research articles. See: Is Vaping Bad for You? And 12 Other FAQs. (9)

*Vaping is not recommended during pregnancy due to the health hazards that are known, and the many unknowns about the health risks to a developing baby.

Continued:

Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.

Things that may overstimulate TRP channels.

For more information and reference list about TRP channels see G3: Relaxation & Stress, and G5: Preeclampsia & TRP Channels.

Reference List

  1. Health Canada, Information Update – Health Canada warns of potential risk of pulmonary illness associated with vaping products, Oct. 11, 2019, hc.media.sc@canada.ca; https://www.newswire.ca/news-releases/information-update-health-canada-warns-of-potential-risk-of-pulmonary-illness-associated-with-vaping-products-867534807.html
  2. Viswam D, Trotter S, Burge PS, Walters GI, Respiratory failure caused by lipoid pneumonia from vaping e-cigarettes. BMJ Publishing Group Limited 2018 http://dx.doi.org/10.1136/bcr-2018-224350 , https://casereports.bmj.com/content/2018/bcr-2018-224350
  3. Heightened response to e-cigarettes in COPD, European Respiratory Society, https://openres.ersjournals.com/content/5/1/00192-2018
  4. Brueck H, Vaping is leading to a spate of lung injuries, comas, and death. Lung experts say oils like vitamin E may be partially to blame. Insider, Sep 19, 2019, https://www.insider.com/why-is-vaping-dangerous-for-your-lun
  5. Nazıroğlu M, Özgül C, Vitamin E modulates oxidative stress and protein kinase C activator (PMA)-induced TRPM2 channel gate in dorsal root ganglion of rats. C. J Bioenerg Biomembr (2013) 45: 541. https://doi.org/10.1007/s10863-013-9524-x https://link.springer.com/article/10.1007/s10863-013-9524-x
  6. Muller C, Morales P, Reggio PH. Cannabinoid Ligands Targeting TRP Channels. Front Mol Neurosci. 2019;11:487. Published 2019 Jan 15. doi:10.3389/fnmol.2018.00487 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6340993/
  7. Clapp PW, Lavrich KS, van Heusden CA, et al., Cinnamaldehyde in flavored e-cigarette liquids temporarily suppresses bronchial epithelial cell ciliary motility by dysregulation of mitochondrial function. American Journal of Physiology-Lung Cellular and Molecular PhysiologyVol. 316, No. 3, https://www.physiology.org/doi/abs/10.1152/ajplung.00304.2018?journalCode=ajplung
  8. Geppetti P, Patacchini R, Nassini R, Materazzi S, Cough: The Emerging Role of the TRPA1 Channel. Lung (2010) 188(Suppl 1): 63. https://doi.org/10.1007/s00408-009-9201-3 https://link.springer.com/article/10.1007/s00408-009-9201-3
  9. Is Vaping Bad for You? And 12 Other FAQs, Healthline https://www.healthline.com/health/is-vaping-bad-for-you
  10. Wu SW, Fowler DK, Shaffer FJ, Lindberg JEM, Peters JH. Ethyl Vanillin Activates TRPA1. J Pharmacol Exp Ther. 2017;362(3):368–377. doi:10.1124/jpet.116.239384 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539581/
  11. Premkumar LS. Transient receptor potential channels as targets for phytochemicals. ACS Chem Neurosci. 2014;5(11):1117–1130. doi:10.1021/cn500094a https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240255/
  12. Kahn-Kirby AH, Dantzker JLM, Apicella AJ, et al., Specific Polyunsaturated Fatty Acids Drive TRPV-Dependent Sensory Signaling In Vivo. Cell, Vol 119, Issue 6, 17 Dec. 2004, pp 889-900 https://www.sciencedirect.com/science/article/pii/S0092867404010475#!
  13. CDC – Flavorings-Related Lung Disease: Exposures to Flavoring Chemicals, NIOSH Workplace Safety and Health Topic, https://www.cdc.gov/niosh/topics/flavorings/exposure.html

Good news/Bad news about Multiple sclerosis research

The good news about Multiple sclerosis (MS) research is that there seems to have been a major breakthrough in treatment, the bad news is that research regarding demyelinating disorders which includes MS seems to have slowed down (1) – finding a solution, a medical answer, that isn’t politically approved of or one that is able to be easily patent protected may be the reason for the bad news. Finding an answer that you don’t like shouldn’t mean we stop asking the question. Work is progressing on genetic modification of mitochondrial DNA differences that can cause demyelination disorders and success has been seen in animal models for disease. Aging increases the risk for different types of mitochondrial DNA changes that can cause a variety of symptoms and diseases. (mitoTALENS/session by Moraes/28)

(Ubiquitin (a protein, not the same as CoQ10/ubiquinone, an electron carrying quinone involved in energy metabolism, 29) is needed for identifying which mitochondria are damaged and need to be recycled in the normal way, by autophagy/mitophagy, which involves the debris being taken into a container particle called lysosomes – imagine a cellular vacuum cleaner that can then recycle any useful material and discard any non-useful, potentially toxic material. See the session on Mitochondria in Parkinson’s Disease/Youle: 28)

Cannabinoids seem to be the good news treatment for MS in humans, whether as purified extracts of medical marijuana or as the whole product which can contain many cannabinoids and medically active terpenes.  An overview published in 2016 regarding the role of cannabinoids in neurology in various types of autoimmune disease: (2). An overview of the role of cannabinoids in neuroinflammatory conditions published in 2008: (3). An opinion article published in 2018 regarding the potential role of cannabidiol ( a non-euphoric cannabinoid) to improve mobility for patients with Multiple sclerosis: (4).

What is Multiple sclerosis?

Multiple sclerosis is a chronic condition that seems to be autoimmune in nature where the body is breaking down the protective coating around the branching segments between nerves. The coating is called the myelin sheath and it acts a little like the plastic coating around an extension cord. Myelin on a nerve fiber or plastic on an extension cord keeps the electrical signals on the inside and out of danger of creating sparks elsewhere along the path of the cord or nerve fiber.

What are cannabinoids?

Cannabinoids are directly involved in making strong and flexible cell membranes as they are building blocks that make up portions of the membrane, like bricks in a wall. They can also be signaling chemicals that can be activated when released from the membrane. Excess calcium inside of a cell can be a signal that causes the release of cannabinoids. Once they are released they break down into their two basic components, phospholipids and a free fatty acid, often arachidonic acid. The problem is two part – 1) both of the components of cannabinoids once they are released from the membrane can become signaling chemicals that can lead to increased inflammation, NSAID pain killers (aspirin, naproxen, ibuprofen helped reduce level of fatigue experienced by MS patients) may help block the negative effects of excess free arachidonic acid (21); 2) if too many bricks are released from the wall, then the wall may no longer function – the plastic coating on the extension cord may allow sparks through that can be a risk for an electrical fire. In the case of Multiple sclerosis the nerve damage and lack of myelin sheathing around nerve fibers causes difficulties with muscle control and the patient may have increasing difficulty walking and doing other normal daily tasks.

Preventing the increased release of cannabinoids from the membrane walls would likely to the best plan for preventing the resulting increase in inflammatory signaling chemicals they form and the reduction in membrane function. The amount of cannabinoids present can cause opposite effects, small or medium amounts can have beneficial effects while large amounts may have significantly different effects. Mitochondria are the main energy production center of the cell, where sugar is turned into a usable form of energy with the chemical shorthand name ATP or ADP. Both are phosphochemicals differing in the number of phosphate groups, adenosine tri-phosphate and adenosine di-phosphate. The amount of calcium within the cell and within the mitochondria may be different and cannabinoid can affect the movement across the mitochondrial membrane and cause differenct effects depending on the amount of calcium in each area and the amount of cannabinoids that are present. It’s complicated is the short story. This article goes into a longer  but still simplified description of the chemistry. (23)

And part of the point is that having adequate cannabinoids and adequate phosphonutrients and adequate but not excessive calcium are all important for cellular health and the ability to produce energy – and to not be fatigued – excessively tired all of the time. And in order to have adequate calcium but not excessive the cells need adequate magnesium and adequate protein and phosphonutrients in order to hold it ready for use – like taxicabs circling the block ready to discharge magnesium as a free ion when and where it is needed. The topic of magnesium, and the need for protein and phosphonutrients was introduced in a recent post. Magnesium blocks entry of excess calcium from being able to enter the interior of the cell, where it can cause increased release of cannabinoids from their storage positions within the cell membranes. Ibuprofen, but not other NSAIDs such as naproxen, also help reduce the amount of breakdown of cannabinoids. (pp 82-83, 24)

What are oligodendrocytes?

A type of specialized brain cell called oligodendrocytes are responsible for building or repairing the myelin sheath. Multiple sclerosis involves increased loss of oligodendrocytes. The specialized cells have calcium permeable glutamate receptors and are more susceptible to oxidative stress than average cells so they are particularly at risk for being damaged by ongoing emotional or physical stress or a traumatic brain injury. (6) Sphingomyelin is one of the building blocks of the myelin sheath, (7),  and is formed by oligodendrocytes. (8)

The body is complicated and needs many/all of the nutrients for optimal health. More nutrients and other lifestyle issues that may benefit myelin production or increase risk are discussed in a list of tips for regenerating myelin, phosphatidylserine, a phospholipid, is one of the recommendations; other conditions that may include myelin breakdown besides Multiple sclerosis are also mentioned: (22). 

Problems with vitamin D availability may also be involved in the body being more prone to autoimmune reactions by the immune system (attack on our own healthy cells instead of only attacking foreign or damaged cells); and on the natural building or repair of the myelin sheath. (5) And just to keep things interesting – iron is important but too much within the oligodendrocytes may increase risk for MS; polyunsaturated fats are also important but their reactivity may increase risk to the oligodendrocytes from oxidative stress; lack of Nrf2 may be involved in the susceptibility to oxidative stress in the development of MS due to damage to the oligodendrocytes; and the oligodendrocytes have an abundance of calcium permeable glutamate receptors so excess glutamate may increase risk of excess calcium entry into the cells which can lead to cell death. (8)

Summary points for protecting oligodendrocytes –

  • all nutrients are important, (22), but balance is also important.
  • Avoid excess emotional and physical stress if possible.
  • Adequate iron is important because the oligodendrocytes need more than average in order to be able to make the myelin sheath. Some patients may have an underlying genetic difference that leads to their needing supplementation of a well absorbed form of iron throughout their life. Genetic screening and individualized metabolic guidance may be needed for optimal treatment of patients with MS as it may have differing causes. A true autoimmune antibody/antigen has not been identified. (10)
  • In general however, avoid excess iron (fortified breakfast cereals and meats for example; men and menopausal women who eat large servings of very iron-fortified foods or large servings of iron rich meats can be more at risk for iron overload. Donating blood occasionally can benefit society and may help protect against the risk of iron overload for people who do not menstruate. Food sources of iron and more information about donating blood: (9) Iron overload can be a cancer risk and tends to be more common than iron deficiency in the non-menstruating population.(11))
  • and avoid excess free glutamate (frequently used in seasonings and naturally found in fermented products such as soy sauce. It is in many processed foods, (12)).
  • Eat a balance of omega 3, (22), and omega 6 polyunsaturated fatty acids.
  • Eat plenty of antioxidant rich foods regularly that also include Nrf2 promoting phytonutrients and other phospholipid containing nutrients. Here is some Nrf2 promoting foods and menu ideas: G10: Nrf2 Promoting Foods.
  • And cannabinoids or other phospholipid/phosphonutrient containing foods include these, many of which are also Nrf2 promoting foods:

Food Sources of Phospholipids and other phospho-nutrients, a partial list:

Hemp seed kernels and oil; Artemisia turanica/wormwood leaf; amaranth seed; asparagus; avocado fruit or the inner kernel, dried and powdered; beans/legumes; cardamom seeds and powder; carrots; celery stalks and leaves; cocoa beans and cocoa powder, baker’s chocolate, dark chocolate and to a lesser amount milk chocolate and chocolate syrup; coconut; cumin seed/powder; fennel seed, flax seed, pine nuts; sesame seeds, pumpkin seed kernels, squash seeds; butternut squash and pumpkin; gingko leaf; grapefruit and orange juice with the pulp; Jerusalem artichoke (this is a root vegetable rather than a green artichoke); lettuce, spinach and mustard leaves and other leafy green vegetables and herbs; nuts/peanuts, cashews, walnuts; oats; okra seeds; onion root, leek leaves, garlic;  parsnip root; pomegranate seeds and pomegranate peel extract;rice, white or brown but the bran is the best source; rosemary; sorghum;  sweet potato or yam; buckwheat (a seed botanically that is not wheat and is gluten free); wheat. (G.26)

The current treatments for Multiple sclerosis are very costly, and may not help all patients while also tending to cause negative side effects.

Returning to the original question – why has the ratio of research being published about demyelinating disorders declined since 2013? It is possible that the answer might be that medical marijuana or a recommendation to eat more dark cocoa and beans, nuts, and seeds is not as profitable as the older MS treatments may average $60,000 per year and newer treatments cost 25-60% more than that, (13), which would be an average prescription cost of $75,000-96,000 per year per patient with Multiple sclerosis. Good quality cocoa is expensive but can fit within most grocery budgets. Being a medical marijuana patient might cost around $12,000 per year for a patient using it several times each day. Use of ibuprofen daily might cost a few hundred dollars per year depending on the amount used and whether it was a name brand or off brand. (21(24) (Note – long term use of ibuprofen may cause intestinal problems, ginger (about 1/2 teaspoon) can be healing for the intestines and help with pain relief as well as ibuprofen and provided better pain relief when used in combination with ibuprofen in a study with arthritis patients. Ginger may be reducing inflammation by reducing the amount of cannabinoid breakdown to free arachidonic acids and preventing transformation into inflammatory eicosanoids. (27))

Efficacy and negative side effects are also worth considering – for that $60,000-96,000/year price tag only half of the patients may gain health benefits while many will experience negative side effects in addition to needing time and copays for office visits to receive some types of treatments. Fewer than half of patients receiving interferon-β treatment were found to benefit medically and many experienced side effects. (13)

The pharmaceutical industry frequently does medical research involving new drug treatments. The use of medical marijuana for the treatment of Multiple sclerosis or other demyelinating disorders is not legal at the Federal level as the herb is still scheduled as a substance with no medical benefit. Private research in states that have legalized medical use could possibly be performed however. Enrolling patients would likely need to be by self selection though, and for comparison purposes an experimental group of patients could be given a phospholipid rich diet plan to follow and a control group of patients receiving standard pharmaceutical treatments could also be followed to compare health outcomes with the current standard of care.

How many patients have Multiple sclerosis?

More math – there are about 400,000 people in the U.S. with Multiple sclerosis and about 10,000 newly diagnosed patients each year. (14) Averaging the cost of standard treatments to $78,000 per year would mean the 400,000 patients require $31,200,000,000 per year in pharmaceutical care. Thirty one billion dollars would buy a lot of cocoa. The number of patients living with the condition globally is estimated to be around 2.3 million people. (15) If they all received treatment at the average U.S. cost it would require $179.4 billion in care.

People living farther from the equator tend to have a greater risk for developing Multiple sclerosis so vitamin D deficiency may be involved.

Looking at the global distribution map on the link does visually suggest that vitamin D deficiency may be involved – it is not as much of a risk for nations around the equator where more sunshine would consistently be available.  Genetic differences may also be involved as it is more of a risk for Caucasians and people of central and northern European descent. It is rare for Inuits, Aborigines and Maoris. (14) (The Inuit native diet is rich in vitamin D from seafood sources.) A map of distribution risk across the U.S. also suggests a sunshine factor – rates below the 37th parallel are reduced compared to farther north. (15)

Sphingomyelin is found in the diet but needs to be made by the oligodendrocytes.

Why discuss eating cocoa or sources of phospholipids or vitamin D? Why not just eat sphingomyelin? We do eat some but our digestive systems break it down into smaller types of fats, (16), and then our oligodendrocytes have to rebuild it. Sphingomyelin tends to be found with cholesterol within the body, and both can affect the digestion of the other. (16)

Genetic differences may be involved in risk for MS. Variations in genes involved in Vitamin D metabolism may be a risk factor. There also may be differences in the cannabinoid metabolism involved or in other metabolic pathways.

Vitamin D can be made out of cholesterol when our skin is exposed to adequate sunshine. Genetic differences in vitamin D metabolism may be why some people are more prone to developing multiple sclerosis than others – speculatively. Genetic differences in vitamin D metabolism have been studied in relation with multiple sclerosis risk and a correlation was found however studies with supplementation have been inconclusive. (17) One nutrient solutions can not solve multiple nutrient problems – adequate iron but not too much, adequate balance of polyunsaturated fats to promote health without increasing inflammation, avoiding excess free dietary glutamate, and having adequate phospholipids and Nrf2 promoting foods in the diet may also all be important – in addition to having adequate vitamin D in the diet or from sunshine or tanning lights.

Vegetarian based diets include many foods that help reduce inflammation & protect against oxidative stress, & may save money.

Some more good news – a vegetarian based diet can provide many of those dietary factors and save money (about $750/year, (18)) compared to a meat based diet (which tends to be more inflammatory – i.e. oxidative stress promoting). More math – the economical vegetarian diet (2015 U.S. prices) was estimated to cost about $2,762/year which would add up to $6,353 million per year for the 2.3 million global population of people with MS instead of the $179.4 billion that would be needed for current pharmaceutical treatments for Multiple sclerosis. Phosholipid rich, Nrf2 promoting foods can also provide a good balance of omega 3 fatty acids and include sources of vitamin D and iron and tend to include many high quality vegetarian sources of protein such as nuts, beans, and seeds.

Cocoa has been found to reduce fatigue for MS patients and is a good source of phospholipids and Nrf2 promoting flavonoids.

Better news – cocoa, which is made from a bean that is rich in flavonoids, which are Nrf2 promoting phytonutrients, G10: Nrf2 Promoting Foods, and is a good source of phospholipids, (G.26), has been found to help reduce fatigue levels in patients with Multiple sclerosis while not increasing high blood sugar risk factors. (19)

Skip the sugar if possible, Insulin resistance may increase breakdown of the myelin sheath.

I add a spoonful of dark cocoa powder (unsweetened Baking cocoa) to my coffee – like mocha coffee without the syrup. Once you stop using sugar your taste buds adjust to not needing as much sweet taste – or add a little sugar or honey but artificial sweeteners may not be that helpful because the sweet taste is still signaling the body to increase insulin levels which then increases appetite and studies have found snacking calories are then increased -resulting in no overall reduction in calorie intake. Avoiding insulin resistance, frequently a problem with Type 2 Diabetes and Metabolic Syndrome, may also help protect against Multiple sclerosis risk as it may have something to do with the breakdown of the myelin sheath. (20)

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. Thanks./ 

  1. James Lyons-Weiler, *A graph of all research studies regarding demylinating disorders such as Multiple sclerosis as a ratio of all medical research studies over time – there has been a significant decrease in the ratio since 2013. The graph begins with approximately 4/100,000 studies in 1944, peaks at approximately 46/100,000 in 1998/1999 and drops to approximately 7/100,000 in 2017/2018.   https://twitter.com/lifebiomedguru/status/1021794538682236929 (1)
  2. Katz D, Katz I, Shoenfeld Y,  Mini Review, Open Access, Cannabis and Autoimmunity – The Neurologic Perspective: A Brief Review. June 2, 2016, J Neurology, Neuromedicine. http://www.jneurology.com/articles/cannabis-and-autoimmunity–the-neurologic-perspective-a-brief-review.html (2)
  3. G. A. Cabral, L. Griffin-Thomas, Cannabinoids as Therapeutic Agents for Ablating Neuroinflammatory Disease. Endocr Metab Immune Disord Drug Targets. 2008 Sep; 8(3): 159–172.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2750822/ (3)
  4. Thorston Rudroff, Jacob Sosnoff,Cannabidiol to Improve Mobility in People with Multiple Sclerosis. Opinion Article, Front. Neurol., 22 March 2018.   https://www.frontiersin.org/articles/10.3389/fneur.2018.00183/full (4)
  5. Cell-based study reveals that vitamin D can drive the activity of neural stem cells that promote myelin repair, MS Society of Canada, March 30, 2015, https://mssociety.ca/research-news/article/cell-based-study-reveals-that-vitamin-d-can-drive-the-activity-of-neural-stem-cells-that-promote-myelin-repair (5)
  6. Attila Köfalvi, Cannabinoids and the Brain, Springer Science & Business MediaDec 22, 2007, pp 342 and 344, https://books.google.com/books?id=ZNIorLciZCoC&pg=PA342&lpg=PA342&dq=myelin+sheath+cannabinoid+metabolite&source=bl&ots=t0vcsRm2HK&sig=oDbCl2JBArCt9s5KT8xawwBrv5M&hl=en&sa=X&ved=0ahUKEwjf2MS3xbrcAhUBI6wKHdIEDbUQ6AEISDAE#v=onepage&q=myelin%20sheath%20cannabinoid%20metabolite&f=false (6)
  7. ElenaPosse de Chaves, Simonetta Sipione, Sphingolipids and gangliosides of the nervous system in membrane function and dysfunction. Frontiers in Membrane Biochemistry, FEBS Letters, Vol 584, Issue 9, 3 May 2010, Pages 1748-1759, ScienceDirect,   https://www.sciencedirect.com/science/article/pii/S0014579309010564
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  8. Arundhati Jana, Kalipada Pahan, Sphingolipids in Multiple sclerosisNeuromolecular Med. 2010 Dec; 12(4): 351–361.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987401/ (8)
  9. Iron-Rich Food-List of Meats, Vegetables and Meals, American Red Cross, https://www.redcrossblood.org/donate-blood/blood-donation-process/before-during-after/iron-blood-donation/iron-rich-foods.html (9)
  10. Susan J. van Rensburg,Maritha J. Kotze, Ronald van Toorn, The conundrum of iron in multiple sclerosis – time for an individualised approach. Metab Brain Dis. 2012 Sep; 27(3): 239–253.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3402663/ (10)

  11. Iron: The Double-Edged Sword, The Physician’s Committee for Responsible Medicine, https://www.pcrm.org/health/cancer-resources/diet-cancer/nutrition/iron-the-double-edged-sword (11)
  12. Dr. Amy Yasko, Detecting Neuro-Provoking Foodshttp://www.dramyyasko.com/wp-content/files_flutter/1279663001Neuroprovokers8.pdf (12)
  13. Daniel M. Hartung, PharmD, MPH, Dennis N. Bourdette, MD, Sharia M. Ahmed, MPH, Ruth H. Whitham, MD, The cost of multiple sclerosis drugs in the US and the pharmaceutical industry: Too big to fail?,  Neurology. 2015 May 26; 84(21): 2185–2192. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451044/ (13)

  14. MS Statistics, multiplesclerosis.net, https://multiplesclerosis.net/what-is-ms/statistics/ (14)
  15. Multiple sclerosis: Facts, Statistics, and You, healthline.com, https://www.healthline.com/health/multiple-sclerosis/facts-statistics-infographic#2 (15)
  16. Åke Nilsson, Rui-Dong Duan, Absorption and Lipoprotein Transport of Sphingomyelin, January 2006, The Journal of Lipid Research, 47, 154-171http://www.jlr.org/content/47/1/154.full (16)
  17. Shoemaker TJ, Mowry EM, A review of vitamin D supplementation as disease-modifying therapy. Multiple Sclerosis Journal, Volume: 24 issue: 1, page(s): 6-11 Jan 182018, http://journals.sagepub.com/doi/full/10.1177/1352458517738131 (17)
  18. Justin Caba, A Vegetarian Diet Can Save You Around $750 Each Year When Compared To A Meat-Eating Diet. Oct. 9, 2015, MedicalDaily.com, https://www.medicaldaily.com/vegetarian-diet-can-save-you-around-750-each-year-when-compared-meat-eating-diet-356670 (18)
  19. S. Coe, E. Axelsson, V. Murphy, M. Santos, J. Collett, M. Clegg, H. Izadi, J.M. Harrison, E. Buckingham, H. Dawes, Flavonoid rich dark cocoa may improve fatigue in people with multiple sclerosis, yet has no effect on glycaemic response: An exploratory trial. Clinical Nutrition ESPEN, Oct. 2017, Volume 21, Pages 20–25   https://clinicalnutritionespen.com/article/S2405-4577(17)30280-2/abstract (19)
  20. Kristina Fiore, Does Insulin Resistance Degrade Myelin? – Imaging study suggests insulin resistance is linked to loss of myelin., Oct. 23, 2015, MedPageToday.com, https://www.medpagetoday.com/meetingcoverage/sfn/54260 (20)
  21. Sara Palumbo, Chapter 7 Pathogenesis and Progression of Multiple Sclerosis: The Role of Arachidonic Acid–Mediated Neuroinflammation. from the book edited by Zagon IS, McLaughlin PJ, editors. Multiple Sclerosis: Perspectives in Treatment and Pathogenesis [Internet]. Brisbane (AU): Codon Publications; 2017 Nov 27. https://www.ncbi.nlm.nih.gov/books/NBK470143/ (21)
  22. Jordan Fallis, 27 Proven Ways to Promote the Regeneration of Myelin. Feb. 18, 2017, Optimal Living Dynamics,  https://www.optimallivingdynamics.com/blog/25-proven-ways-to-promote-the-regeneration-of-myelin (22
  23. Adrian Devitt-Lee, CBD Science: How Cannabinoids Work at the Cellular Level to Keep You Healthy, Project CBD,  Dec. 15, 2016, alternet.org, https://www.alternet.org/drugs/cbd-science-mitochondria-mysteries-homeostasis-renewal-endocannabinoid-system (23)
  24. Editors, Emmanuel S. Onaivi, Takayuki Sugiura, Vincenzo Di Marzo, Endocannabinoids: The Brain and Body’s Marijuana and Beyond, (Taylor & Francis Group, 2006, Florida), pages 82 and 83 are from Chapter 3, by: E.S. Onaivi, H. Ishiguro, P. W. Zhang, Z. Lin, B. E. Akinshola, C. M. Leanoard, S. S. Chirwa, J. Gong, and G. R. Uhl, Chapter 3, Endocannabinoid Receptor Genetics and Marijuana Use. https://www.crcpress.com/Endocannabinoids-The-Brain-and-Bodys-Marijuana-and-Beyond/Onaivi-Sugiura-Di-Marzo/9780415300087 (24)
  25. J. Depew, RD, G10: Nrf2 Promoting Foods, 2018, effectivecare.info, G10: Nrf2 Promoting Foods. Particularly helpful for an overview of plant phytonutrients groups: Maria de Lourdes Reis Giada, Chapter 4: Food Phenolic Compounds: Main Classes, Sources and Their Antioxidant Power, Biochemistry, Genetics and Molecular Biology » “Oxidative Stress and Chronic Degenerative Diseases – A Role for Antioxidants”, book edited by José A. Morales-González, ISBN 978-953-51-1123-8, Published: May 22, 2013    https://www.intechopen.com/books/oxidative-stress-and-chronic-degenerative-diseases-a-role-for-antioxidants/food-phenolic-compounds-main-classes-sources-and-their-antioxidant-power (G10.11)
  26. Arlen Frank, Chemistry of Plant Phosphorus Compounds, Elsevier, Jun 3, 2013, https://books.google.com/books/about/Chemistry_of_Plant_Phosphorus_Compounds.html?id=6btpFSV1T2YC (G.26)
  27. Ginger Decreases Colon Inflammation, Prime Endoscopy Bristol, Oct. 12, 2011,  http://www.primeendoscopybristol.co.uk/ginger-decreases-colon-inflammation/ (27) 
  28. From Pediatric Encephalopathy to Alzheimer’s: Linking Mitochondria to Neurological Diseases. 2016 Neurobiology of Disease Workshops, Neuronline.sfn.org, http://neuronline.sfn.org/Articles/Scientific-Research/2017/From-Pediatric-Encephalopathy-to-Alzheimers (28)