I live in a high rate area...

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I live in a high rate area...

Postby wilson » Wed Mar 19, 2008 6:36 pm

In Colorado, 1 out of every 750 people is diagnosed having MS. That is far above the norm of 1 out of every 2000 diagnosed on the American continent. Has there been any studies done that show you may increase your chances of disability due to MS if you continue to stay in the high rate area? Or to put it another way... Should I leave this state or does it not matter now since I have been diagnosed?

Thank you
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Postby gwa » Wed Mar 19, 2008 7:00 pm

When I was diagnosed we lived in Nebraska and stayed there for another few years. Then we moved to many places with various climates and none of them helped me with my symptoms.

Unless you just want to get out of Colorado, I see no reason to move, except for the snow and ice which can be problematic if you aren't walking well.

Personally I felt best when we lived in Alaska and the weather was well below zero. I feel less well when there is a lot of humidity and heat.

I really think the most important thing about where to live is where you have some friends or relatives that can help you if you need help. Also, you need to be around some good hospitals and physicians, which you have access to in Colorado.

Good luck.

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Postby dignan » Wed Mar 19, 2008 8:02 pm

Since we're talking about MS, of course nothing will be clear. I found a couple of Pubmed abstracts that seem relevant. Both studies, for different reasons, seem to suggest that the latitude connection with MS may not be quite as clear as is commonly thought.

Geographic variation of MS incidence in two prospective studies of US women.

Neurology. 1999 Nov 10;53 ( 8 ):1711-8
Hernán MA, Olek MJ, Ascherio A.
Department of Epidemiology, Harvard School of Public Health, Boston, MA 02115, USA.

OBJECTIVE: To estimate the incidence of MS and its relation to latitude in two ongoing prospective studies of US women.

BACKGROUND: A higher incidence of MS has been found in northern areas compared with southern areas of the United States and other countries, but the attenuation of this gradient in Europe in the last few decades and the consideration of ethnic factors have led some authors to question the existence of a strong association between MS and latitude.

METHODS: The authors identified new cases of MS among participants in the Nurses' Health Study (NHS), which took place between 1976 and 1994, and in the Nurses' Health Study II (NHS II), which took place between 1989 and 1995. The NHS included women born between 1920 and 1946, and the NHS II included women born between 1947 and 1964.

RESULTS: The incidence of MS among NHS participants (181 definite/probable patients) increased significantly with latitude (p = 0.03, trend). Adjusted rate ratios were 3.5 (95% CI, 1.1, 11.3) for the north and 2.7 (95% CI, 0.8, 8.9) for the middle tiers relative to the southern tier. Among NHS II women (131 definite/probable patients), no association between latitude and MS was found (p = 0.89, trend). Adjusted rate ratios were 0.8 (95% CI, 0.4, 1.6) for the northern areas and 0.9 (95%, 0.4, 1.8 ) for the middle areas, relative to the southern areas.

CONCLUSION: The association between latitude and risk of MS in the United States was corroborated, but there was an attenuation of the north-south gradient over time. If confirmed, this finding could provide new clues to identifying environmental causes of the disease.

Pubmed link

The use of standardized incidence and prevalence rates in epidemiological studies on multiple sclerosis. A meta-analysis study.

Neuroepidemiology. 2003 Jan-Feb;22(1):65-74.
Zivadinov R, Iona L, Monti-Bragadin L, Bosco A, Jurjevic A, Taus C, Cazzato G, Zorzon M.
Department of Clinical Medicine and Neurology, University of Trieste, Italy. zivadinov@hotmail.com

OBJECTIVE: To demonstrate whether or not the age and sex adjustment of incidence and prevalence rates in multiple sclerosis (MS) could allow more reliable comparison between epidemiological studies performed in different areas of the world and to establish if the latitude gradient theory could be confirmed after the standardization for age and sex distribution.

METHODS: A meta-analysis of population-based incidence and prevalence studies on MS from 1980 through 1998 using the terms 'multiple sclerosis', 'prevalence' and 'incidence' in the bibliographic databases MEDLINE and EMBASE was performed. We included studies that reported the diagnostic criteria, number of cases and the population studied, the date of the study, the latitude, and the age- and sex-specific crude incidence and prevalence rates. According to the inclusion criteria, 69 of 127 papers on prevalence and 22 of 70 papers on incidence were considered for age adjustment and 27 prevalence and 8 incidence studies for sex adjustment. The mean incidence and prevalencerates and the 95% confidence intervals age- and sex-adjusted to the World and the European standard populations were calculated.

RESULTS: The Spearman rank correlation and the multiple regression analyses indicated that age adjustment to standard populations could overcome the limitations in comparing the crude prevalence and incidence rates of different epidemiological studies on MS. When the mean crude and age- and sex-adjusted prevalence and age-adjusted incidence rates were stratified by latitude (from south to north), the latitudinal gradient, which was highly significant for the crude rates, became less remarkable for the age- and sex-adjusted prevalence rates and not significant for the age-adjusted incidence rates.

CONCLUSIONS: The crude incidence and prevalence rates in epidemiological studies on MS should be age- and sex-adjusted to a common standard population to permit a more reliable comparison among studies performed in different countries. Our findings support the opinion that the latitude does not play a key role in determining the onset of MS. Whenever possible, the crude incidence and prevalence rates should be adjusted to the ethnic origin and migration characteristics.

Pubmed link
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Postby Lyon » Thu Mar 20, 2008 6:25 am

Hi Wilson,
As the others said, it seems that after the age of about 14, destiny has already been determined and moving to an area of lower MS incidence afterwards has never shown to have any effect on disease progress.
Last edited by Lyon on Fri Mar 21, 2008 4:40 am, edited 1 time in total.
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Postby AllyB » Thu Mar 20, 2008 2:59 pm

Hi there

I am a good example of what the others are saying - I was born in Ireland, raised in Scotland (very high ms rate) and moved to South Africa in my 20's.
I was diagnosed when I was 34 - about 1o years after moving to a very warm and sunny climate where the ms rate is very low - about 3000 people out of a population of 45 million! So although I have had plenty of sunshine for many years now, it came too late for me, if, in fact, climate is really relevent...
Go figure :roll:
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Postby cheerleader » Thu Mar 20, 2008 3:17 pm

hey Wilson-

Like folks have said, moving now won't change the MS dx. I suppose the silver lining to the cloud of living in Colorado with MS is that you have amazing resources available to you with the Rocky Mountain center and all the MS organizations. You'll have alot of support in your neighborhood. And Coloradans know what MS is all about.

My husband was born and raised in the San Francisco Bay Area, always had lots of sunshine and outdoor activities as a child (he's got the basal cells to prove it). I don't think the northern hemispere incidence of MS is about sunshine and vit. D, but might be more about migratory patterns of birds and spirochete parasites....
http://www.pubmedcentral.nih.gov/articl ... tid=149400

such a mystery..
Husband dx RRMS 3/07
dx dual jugular vein stenosis (CCSVI) 4/09
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Another anecdotal variant from the sunshine/Vit. D theory

Postby Longing4Cheese » Thu Mar 20, 2008 5:49 pm

I, too, was raised in the S.F. Bay Area, specifically in Palo Alto, which has the best weather of any place I've lived. (I used to think that one must simply prefer the weather of one's hometown, but with some more experience I decided, nope, Palo Alto simply has lovely weather!) Spring stretches on for months, summer is not too long but is usually sunny and hot (a couple of heat waves so you know you've had some summer), and then fall is very long and slides gracefully into a middle-California winter (S.F. is approximately in the middle of the state...people forget that).

So, when I was growing up in the 1970s, in this safe and lazy college town, we children spent all our time outdoors, riding bikes and skateboarding and swimming and climbing trees and fences and rooftops. I've never been as brown as I was in my childhood (oh, and my mother took me to beaches, including nude beaches, almost every weekend, from age ~ 2 to ~ 7).

I do remember using some sunscreen -- actually, "sun tan lotion" -- this was before most people knew about the dangers of UV rays. But mostly we'd run around in the sun without protection.

If this weren't enough VITAMIN D creation, consider this: I used to drink GALLONS of milk per week. We'd buy 6 or 7 half gallon cartons of Vitamin D fortified lowfat milk at the beginning of the week, and by the end of the week my mom would be warning me to leave her enough milk to put a little in her morning coffee. I gulped down huge glasses of the stuff, as cold as possible.

So, while I'm happy to read about sun exposure (and therefore vit D) being a suppressor of the development of MS, I tend to be skeptical, though I recognize that I do not represent a statistical trend in myself. However, I am biased to believe that regional differences are probably caused by other, more significant factors, like DIET, exposure to various viruses and bacteria in childhood, availability of health care (and therefore diagnosis), etc. If you told me that people who were raised with cats had a higher incidence, I wouldn't scoff -- I'd ask to see the data.

By the way -- one of my best friends from childhood was diagnosed with RRMS last year, almost the same time that I was. I would LOVE to know how to get information about the rate of MS in the Silicon Valley area, just for kicks.

jack sprat
still Longing4Cheese
(but homemade, turmeric-infused hummus is a passable substitute)
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Postby daisy » Thu Mar 20, 2008 7:56 pm

Wilson -

There are some theories that Colorado has a higher rate due to tick exposure and lyme's disease. By no stretch is lyme the cause of all MS in Colorado but it's probably a consideration for the higher rate.

You might consider getting a lyme western blott by igenex just to double check.

MS bites - I say leave no stone unturned in trying to improve your situation.
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Postby Loriyas » Fri Mar 21, 2008 5:52 am

Okay, I'll chime in here with just the opposite experience. I lived in Ohio all of my life and was diagnosed in Columbus 5 1/2 years ago. We moved to Florida 4 1/2 years ago after vacationing here and realizing I felt much better. I attribute it to the sunshine and warm weather (which doesn't bother me). It is a big change to make a move like that, but for me it was well worth it. I don't know if it will make you feel better to be in a different climate as it did me. One thing you could do is visit a place that you might be considering and see if you notice anything with regard to you MS. May not be long enough to tell for you but it was for me.

You do have lots of resources available to you now which is a huge positive. But you can find other resources where you move to and if not you can always make a trip on occasion to the doc you are seeing now and find someone locally for the day-to-day things. Plus, I think if you are up for making a move that in itself can be exciting and positive for you. I believe that MS can't define EVERYTHING in my life.

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I agree with Longing4Cheese

Postby lyndacarol » Fri Mar 21, 2008 7:02 am

I agree with Longing4Cheese who said
So, while I'm happy to read about sun exposure (and therefore vit D) being a suppressor of the development of MS, I tend to be skeptical, though I recognize that I do not represent a statistical trend in myself. However, I am biased to believe that regional differences are probably caused by other, more significant factors, like DIET, exposure to various viruses and bacteria in childhood, availability of health care (and therefore diagnosis), etc.

In fact, I think it is more likely that the difference in MS incidence is due to more mucus-causing viruses passed around in the heated and confined spaces of colder climates. After all, don't most of us experience at least a temporarily worsening with a cold or mucus-producing virus?

After taking 8000IU of vitamin D daily for a year and 6000IU daily since without seeing any change in MS symptoms (except negative ones), I do not think it's the D. (I also spent most of my youth outdoors!)
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Postby Lyon » Fri Mar 21, 2008 7:04 am

dignan wrote:Both studies, for different reasons, seem to suggest that the latitude connection with MS may not be quite as clear as is commonly thought.
Hi dignan,
It seems to me that what those incidence and other incidence studies show is that MS incidence is primarily owed to a non static factor.

I don't think that point is lost on researchers but obviously they've never been able to come up with a non static factor which fulfilled the needed requirements.

Of course, like everyone else around here, I've got my pre-conceived notions that I try to justify with my version of self fulfilling prophecies, but these are my thoughts on the most basic and long standing components of MS research.

MS researchers have long thought that they only had three options to explore in the course of their search for the primary cause of increased incidence of MS. Their limitation to the following three factors is the primary reason that attempts to make sense of MS incidence has always been such a conundrum.

1. Genetic factors. Although it would be foolish to say that genetics plays no part in MS, genetic changes aren't a primary cause. Genetic changes couldn't have happened nearly quickly enough to explain the increasing incidence of MS.

2. Non infectious environmental factors. Considering the amount of research expended to date, a definite pattern pointing to specific MS inducing substances would have long ago been obvious. Of course the suspicions of things like Vit D shortfalls and mercury amalgam come to mind, but there are good reasons that they remain unproven.

3. Infectious environmental factors. It seems that this factor is the most aggravating for researchers due to the fact that they have always "almost, but not quite" been capable of providing the needed answers. Some factors seem painfully obvious (relationship of the presences of the British troops in the Faroes) and at the same time excruciatingly impossible (after this amount of time and world travel, and with it in mind that the primary goal of an infectious agent is to spread, the infectious agent AND MS incidence would be more equally distributed amongst the world populations by now).

The longstanding conundrum for MS researchers is that (in their understanding) the primary cause of MS HAS TO BE, yet obviously isn't a genetic, non infectious environmental or infectious environmental cause.

I'm convinced that recently an, as of yet unaccepted, but entirely new option has been offered to researchers who are investigating the primary cause of the noted increased incidence of MS.

4. The evolved dependence and the loss of the continued existence of a historically inevitable and unavoidable infection, which more specifically might be considered the loss of their chemical and otherwise, means of evading elimination by the human immune system

Obviously I'm talking about the invariable and unavoidable parasitic infections (specifically helminths) which had plagued mankind since life began, and the effect that their loss might have had on the human system when those historical parasite infections started disappearing for the first time among the inhabitants of what we now call the "developed" world.

While there is no doubt that eliminating human parasites eliminates far more human suffering than their loss and the addition of the autoimmune/inflammatory diseases could ever cause http://news.yahoo.com/s/hsn/20080320/hl ... sanitation
maybe we still need to seriously consider that there might be a price to pay when we eliminate something which had been a factor in our immune system through human evolution?
Currently, the areas with the least access to improved sanitation are West and Central Africa (36 percent coverage), South Asia (37 percent), and Eastern and Southern Africa (38 percent). Of the 2.6 billion people who don't have access to improved sanitation, two billion (77 percent) live in rural areas.
Is it REALLY only coincidence that MS is not a consideration in the above named areas?
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Postby itsjustme » Fri Mar 21, 2008 9:32 am

This is all so very frustrating! I keep going back to one the definitive examples of non-pragmatic thinking:

Dolly is an elephant.
Dolly is pink.
Therefore, all elephants are pink.

Personally, for the causative agent of MS, I revert back to the ol' San Fransisco Sour Dough bread obstacle. That is to say, no matter where you try to grow this strain of yeast (with such unique flavor properties), it never tastes the same. You can try to mimic conditions perfectly, eliminate all variables and you end up with the same unsuccessful results. It only grows "properly" in San Fransisco.

Having said that, in regards to MS, I think there is some communicative pathogen (e.g. EBV,mono), that thrives mostly in these higher latitude environments. Throw in a genetic pre-disposition to MS and my theory stands as plausible.

Aargh! At least we don't have a shortage of possible theories...
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Postby dignan » Fri Mar 21, 2008 10:08 am

Bob, do you know what helminth incidence rates are in different countries? It would be interesting to map helminths and MS rates.
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Postby Lyon » Fri Mar 21, 2008 12:55 pm

dignan wrote:Bob, do you know what helminth incidence rates are in different countries? It would be interesting to map helminths and MS rates.
That is a good idea dignan!

I don't know offhand of one single source for that information but I have seen tidbits of that kind of information in journal articles and I should start compiling it, if nothing else for my own interest......with it in mind that the actual worldwide helminth presence is the actual underlying non static part of the equation (theoretically).

Case in point (no one will want to read the whole article, I only submit it to support my point) http://www.msu.edu/~lyonro/deworming.pdf If loss of evolutionary normal is THE factor there are millions of people in these areas of Mexico who were treated against helminths before the age of puberty and there will be (or already is) evident a dramatic increase in autoimmune incidence in these areas of Mexico ie: a study done in that area five years ago will be dramatically changed this year ie: the MS geographic gradient will have become drastically less distinct in that area if compared by those two incidence data.

I'll pull the links for both these articles in a couple of days. This isn't the best article to describe current Mexican MS occurance, but I'm finding that most are in Spanish and I nolo do speakay Spanishay http://www.msu.edu/~lyonro/msmexico.pdf

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Postby Wonderfulworld » Fri Mar 21, 2008 2:38 pm

And to throw my area of fascination into the ring...gout and MS are mutually exclusive..............
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