Welcome to the TAHOMA CLINIC (425) 264-0059

Tahoma Talk, Tuesdays at the Tahoma Clinic, Renton, WA

We are seeking participants for our Bursitis Study

Transdermal Histamine in Multiple Sclerosis

Part Two: A Proposed Theoretical Basis for Its Use

George Gillson, MD, PhD, Jonathan V. Wright, MD, Elaine DeLack, RN, and George Ballasiotes, BSc, Pharm

Gut Function in MS
Constipation is a common complaint of MS sufferers. For example, 68 percent of 280 patients surveyed by Weber⁹⁵ reported constipation or fecal incontinence. These symptoms may reflect CNS damage as well as enteric nervous system (ENS) dysfunction.⁹⁶ (Reference 96 is an overview of the ENS.)

Other aspects of gut function impairment in MS are less well recognized. These include impaired digestion and assimilation of nutrients. Gupta⁹⁷ reported evidence of fat malabsorption and protein maldigestion in 40 percent of 52 MS patients. Xylose malabsorption was seen in 27 percent, and B12 malabsorption in 12 percent. Absorption of fat- soluble vitamins A and beta carotene was also impaired to a certain extent. Iarosh noted endoscopic atrophic changes, gastritis, and ulcerations consistent with achlorhydria in 32 MS patients.⁹⁸ The total number of MS patients in that study was 89, but selection criteria for endoscopy were not given.

Over the past 25 years, one of the authors (JW) has observed abnormal gastric acid secretion, as assayed by Heidelberg capsule,⁹⁹ in approximately 70 percent of patients with MS, although these findings have never been published. Recently Gillson found severe hypochlorhydria or achlorhydria in 9 of 14 (64%) patients with MS, also using the Heidelberg capsule. Fasting plasma essential amino acid levels were also measured in 12 unselected patients with MS, prior to their starting histamine treatment. Ten of 12 had at least five abnormal values (out of 10 measured).

A small number of MS patients at our (JW/GG) clinic recently had both a Heidelberg assay as well as measurement of fasting plasma essential amino acids, including histidine. Six of six patients had low values on six or more of the 10 essential amino acids measured. Five of the six had histidine levels very close to the low end of the normal range, and five of six patients were achlorhydric or severely hypochlorhydric. Five of these six patients have had a favorable response to exogenous histamine therapy.

Little has been written about plasma amino acid levels in MS. Oriente¹⁰⁰ noted significantly decreased histidine, methionine, and valine levels in nine patients with progressive systemic sclerosis (equivalent to MS in the Russian literature) compared to 15 controls. A study by Ivanokov¹⁰¹ on 45 MS patients reported "marked deaminoacidemia tending to hypoaminoacidemia." The abstract did not elaborate regarding which amino acids were measured. Quereshi¹⁰² noted decreased levels of methionine, valine, phenylalanine, and lysine in 12 patients with MS versus 12 controls. A total of 24 amino acids were measured in the study, and the levels of other amino acids were "more or less the same in the two groups" according to the abstract, although histidine was not mentioned specifically.

Overall, the present work supports published abnormalities of amino acid levels in general in MS patients. Our work and one previous study also show decreased histidine levels in MS; findings from two previous studies are equivocal. Nyhan reported five cases of hypohistidinemia in males without MS. Interestingly, all had CNS abnormalities.¹⁰³

Evidence of malabsorption of other nutrients, such as zinc¹⁰⁴ and copper^104,105 has also been reported in MS. Both zinc and copper deficiency have been tied to histidine depletion in dogs,¹⁰⁶ and copper deficiency has been linked to demyelination, as mentioned earlier. Copper is also a mast cell stabilizer.^107,108 A possible connection between CNS histidine deficiency, copper deficiency, mast cell degranulation, and demyelination might, therefore, be worth investigating.

Next -> Proposed Connections