Is nutrition and/or exercise related with re-stenosis?

[Ernst]

First, excuse me if I write funny words, english is not my natural lanquage. I have been thinking about re-stenosis after PTA, in jugular veins. There are so many patients with re-stenosis and I believe there are many factors related with problem. Its just my observation with few operated.. but for me it seems that trend is quite positive for those who exercise and eat healthy way. Of course my thoughts might be totally wrong, but why not?

There are some studies which are quite near this subject. Re-stenosis after angioplasty but in different area, was affected with antioxidants:
http://www.ncbi.nlm.nih.gov/pubmed/14727962

"The powerful antioxidant probucol has been shown to prevent coronary restenosis after balloon angioplasty in the Multivitamins and Probucol (MVP) trial and other clinical studies."

Exercise: http://www.ncbi.nlm.nih.gov/pubmed/19853690

"Regular high-intensity interval exercise training was associated with a significant reduction in late luminal loss in the stented coronary segment. This effect was associated with increased aerobic capacity, improved endothelium function, and attenuated inflammation"

In my wife's case, it seems that her jugular veins is still open, after 3 years - at least symptoms have been away. Could it be possible that healthy life style.. nutrition and hard exercise might be related factors?

[jimmylegs]

I would tend to agree. since ms patients tend to have low normal zinc, and zinc is known to be important for wound healing, I had a look at it from that angle and found this related study.

Zinc reduces intimal hyperplasia in the rat carotid injury model (2004)
http://library.tasmc.org.il/wwwnew/Staf ... berger.pdf
"Background: The response to arterial injury following balloon dilatation is known to involve proliferative and inflammatory processes. The current widespread use of stents to maintain arterial patency not only does not eliminate but possibly exaggerates the proliferative and inflammatory phenotype and although drug-eluting stents are available, their long-term safety is yet to be determined.
Zinc is a trace element that serves as a cofactor of many enzymes. Interestingly, it has been shown to have anti-inflammatory and anti-proliferative properties. We thus sought to investigate its effect on smooth muscle cell proliferation and intimal thickening in the rat carotid artery injury model. Methods and results: Smooth muscle cells (SMC) were cultured from carotid arteries of rats and proliferation was assessed by thymidine incorporation after exposure to different concentrations of zinc. Next, carotid artery injury was induced in rats by balloon dilatation and they were either treated with I.P injections of zinc or PBS for 2 weeks until sacrifice for assessment of neointimal formation and lumen area. Zinc inhibited in vitro SMC proliferation in a dose-dependent manner. In vivo, zinc treatment resulted in a 50% reduction in neointimal area and a significant decrease in neointimal/media ratio with no significant change in lumen area.
Conclusion: Thus, zinc appears to reduce neointimal growth and should be tested by local delivery systems including stent coatings."
In general, exercise improves blood flow and the associated delivery of oxygen and nutrients to tissue. I was recently injured (not related to MS or CCSVI) and although the scenario is not the same, physical therapy has been strongly emphasized as part of the recovery process. even when I couldn't walk much, or use the stationary bike, one of the exercises I was given to do was to sit and swing my lower legs back and forth to mimic walking, and help the knee heal through the resulting pumping action on the synovial fluid in the joint.

diet and lifestyle interventions to improve zinc status would appear to be relevant..

the next two studies are more technical, and pretty recent - looks like the MMP angle is a work in progress

Matrix Metalloproteinases: A Target in In-Stent Restenosis? (2013)
http://www.karger.com/Article/FullText/346230
"Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases widely known for their ability to proteolyse extracellular matrix proteins. Unbalanced MMP activity promotes atherosclerotic processes, including vascular smooth muscle cell migration and proliferation and infiltration of inflammatory cells into the vascular wall..."

Balancing zinc deficiency leads to an improved healing of colon anastomosis in rats (2011)
http://link.springer.com/article/10.100 ... 010-1070-y
"Balancing zinc deficiency benefits wound healing of colonic anastomosis qualitatively due to an increased collagen type I/III ratio. Surprisingly, these zinc supplements, however, increased the expression of MMP 2 and MMP 8 that are supposed to impair wound healing in case of an over-expression. Thus, further investigations are needed to elucidate the influence of zinc supplementation on regulation of MMPs."

(that doesn't sound that surprising to me actually.. just because too much of something can be bad, doesn't mean that too little is good)..

I have posted elsewhere on the magnesium connection to restenosis risk. magnesium is another nutrient known to be lower in ms patients. i'll see if I can find a good post on that. also notice below under 'related topics' the items 'restenosis and nutrition' and 'diet/nutrition/lifestyle in the ccsvi paradigm'.

overall, it looks like failing to optimize nutrient status before, during, and after, could increase risk of negative outcomes.

[jimmylegs]

this 2011 post includes research titles examining nutrition for vascular health, each one a key nutrient known to be low in ms: http://www.thisisms.com/forum/post168401.html#p16841

many nutrients seen to be low in ms patients, are important for vascular health.

"Galvanising forces in vascular health and disease: is dietary zinc protective? "

"Magnesium and vascular tone and reactivity"

"The Vitamin D Epidemic and its Health Consequences..There is mounting scientific evidence that implicates vitamin D deficiency with an increased risk of type I diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and many common deadly cancers."

"C-reactive protein, dietary n-3 fatty acids, and the extent of coronary artery disease"

"Importance of both folic acid and vitamin B12 in reduction of risk of vascular disease"

more evidence that diet and lifestyle intervention that are relevant to ms, also make sense where vascular health is concerned.

[Cece]

I think a lot of the restenosis has to do with the procedure being underperformed initially and/or the veins and valves returning to their original shape over time. Exercise and nutrition would boost overall health, but there's not much that can be done to stop a jugular valve from recoiling if it wants to recoil. If someone is unable to exercise, I don't think the procedure should be avoided or would have less chance of success, assuming that anticoagulation is used. For myself, I became more able to do aerobic exercise after the procedure, and I'd bet that if my veins close up, that ability would go away again. I used to feel very ill after exercise and now that's gone. I watched your video, Ernst, it was inspiring to see how strong she is.

[jimmylegs]

re

there's not much that can be done to stop a jugular valve from recoiling if it wants to recoil.

we had some chats about magnesium a couple years ago, may be of interest:
http://www.thisisms.com/forum/chronic-c ... ml#p179362

kick-off abstract: Effect of magnesium on restenosis after percutaneous transluminal coronary angioplasty: a clinical and angiographic evaluation in a randomized patient population
A pilot study

some other titles I just found : http://scholar.google.ca/scholar?hl=en& ... 5&as_sdtp= :

Magnesium and Vascular Tone and Reactivity
http://www.karger.com/Article/Abstract/158148

Antagonistic modulatory roles of magnesium and calcium on release of endothelium-derived relaxing factor and smooth muscle tone.
http://circres.ahajournals.org/content/ ... 5.full.pdf

Withdrawal of magnesium causes vasospasm while elevated magnesium produces relaxation of tone in cerebral arteries
http://www.sciencedirect.com/science/ar ... 4080901688

I think all of this would have something to do with the tendency of a vein to recoil. my 2c.

[jimmylegs]

remember these? local magnesium supplementation delivered by the stent itself? from 2011 discussion.. http://www.thisisms.com/forum/chronic-c ... ml#p181459

Drug-eluting bioabsorbable magnesium stent (2004).
http://www.ncbi.nlm.nih.gov/pubmed/15546291
"we describe the first biodegradable stent based on a magnesium alloy that allows controlled corrosion with release to the vessel wall and the blood stream of a natural body component such as magnesium with beneficial antithrombotic, antiarrhythmic, and antiproliferative properties"

some follow-up I don't think i'd seen before now:

Early- and Long-Term Intravascular Ultrasound and Angiographic Findings After Bioabsorbable Magnesium Stent Implantation in Human Coronary Arteries (2009)
http://www.journals.elsevierhealth.com/ ... S1936-8798(09%2900069-7/abstract

[jimmylegs]

going back to exercise, one of the earliest books I picked up on yoga, going back 20+ yrs, was specifically called 'gentle yoga' and included modifications for folks with mobility issues including ms and being confined to a wheel chair: Gentle Yoga: A Guide to Low-Impact Exercise

the repeated emphasis re beneficial effect on blood flow from the tension and release from the various postures still stands out in my mind.

another author's more recent effort:
Gentle Yoga for Multiple Sclerosis: A Safe and Easy Approach to Better Health and Well-Being through Yoga

[cheerleader]

In my wife's case, it seems that her jugular veins is still open, after 3 years - at least symptoms have been away. Could it be possible that healthy life style.. nutrition and hard exercise might be related factors?

Hi Ernst--there are many factors, and as Cece said, if someone isn't correctly treated in the first place, restenosis will occur no matter what. However, in discussing this with Dr. Dake, he noted that the patients he treated who remained active and changed their lifestyles to include regular exercise and whole food diets have done the best, now four years since venoplasty--and have not restenosed. This mimics what we know about angioplasty patients....restenosis is less common in active patients who limit animal fats, dairy, and eat more produce and whole foods instead.

It's what Dr. John Cooke suggested to me way back when we started all of this--he felt endothelial health would improve venous health and increase the chances of maintaining blood flow. It's why Bill Clinton follows a heart healthy diet and exercises---his first heart procedure used his saphenous VEIN to bypass the damaged area, and it restenosed and needed to be stented. His doctor told him diet and exercise were the only way to avoid restenosis.
http://www.cnn.com/2011/HEALTH/08/18/bi ... index.html

Jeff exercises every day--a hike, a mountain bike ride, a machine--and gets his heart rate up. He follows the endothelial health program, based on Dr. Cooke's research. As JL's research shows, Mag, calcium and zinc in balance are part of it--since minerals are a big part of healthy endothelium. So far, so good for Jeff. Four years and all veins are healthy and working....he sleeps well without bladder issues any more, wakes up refreshed, works full days, goes out with friends and family, has not had an MS relapse or new symptom in 4 years. Your wife and Jeff may be anecdotal evidence, or may just be lucky---but if this can help another pwMS, I'll stay on the internet another 4 years.
cheer

[Cece]

With angioplasty patients, if angioplasty was needed because of fatty deposits in the arteries, then it makes a lot of sense to eat less fat. With venoplasty ccsvi patients, there are no fatty deposits in the veins. It's a big distinction between the two, I think, and it's one way in which what's known about angioplasty in heart disease patients can't carry over directly as knowledge about CCSVI patients.

[jimmylegs]

re veins vs arteries..
from the link above

we had some chats about magnesium a couple years ago, may be of interest:
chronic-cerebrospinal-venous-insufficiency-ccsvi-f40/topic18270.html#p179362

Magnesium ions control prostaglandin reactivity of venous smooth muscle from spontaneously hypertensive rats.
http://www.ncbi.nlm.nih.gov/pubmed/7394065
"...Recent findings from our laboratory indicate that magnesium ions ([Mg2+]o) play a role in the control of vascular tone, vascular reactivity and Ca2+ content and its distribution in blood vessels. The present study indicates that reactivity of isolated portal venous smooth muscle, obtained from spontaneously hypertensive rats, is markedly reduced in the absence of [Mg2+]. ... These new data suggest that Mg2+ may be an important and overlooked factor in the etiology of hypertensive vascular disease."

[Ernst]

I quess there is no data about CCSVI re-stenosis more accurately.. like what factors influence with it. This could be interesting area of research too. My observation is quite like cheerleader wrote: " in discussing this with Dr. Dake, he noted that the patients he treated who remained active and changed their lifestyles to include regular exercise and whole food diets have done the best, now four years since venoplasty--and have not restenosed" There are studies which show that nutrition and exercise affect to blood flow (and vascular health) in central nervous system. It would be quite interesting study and data.. about this issue - are they factors with re-stenosis? I would bet my money that they are.

[cheerleader]

With angioplasty patients, if angioplasty was needed because of fatty deposits in the arteries, then it makes a lot of sense to eat less fat. With venoplasty ccsvi patients, there are no fatty deposits in the veins. It's a big distinction between the two, I think, and it's one way in which what's known about angioplasty in heart disease patients can't carry over directly as knowledge about CCSVI patients.

Actually--that's not completely correct, Cece. The endothelium functions the same way via nitric oxide, and inflammation is the main problem in both veins and arteries. Animal fats create inflammation and raise c reactive protein levels in the serum. And we're learning that this is what leads to plaque build up in arteries and inflammation. But it also leads to stenosis and stiffness in veins. Yes, there are other factors (like collagen and malformations) but this is one area people can have an affect over via lifestyle.
http://www.ncbi.nlm.nih.gov/pubmed/17978593

Did you read the post I wrote about Bill Clinton above? It was his vein graft , not his artery, that restenosed and needed stenting, and the heart surgeon told him he needed to change his diet and exercise. Check out that post and the link. Dr. Cooke was pretty clear with us--endothelial health reduces inflammation in all blood vessels--veins and arteries. And regular exercise creates good shear stress.

here's more on shear stress vs. disturbed flow in arteries and veins.
http://physrev.physiology.org/content/91/1/327.full
cheer

[Ernst]

I found many studies about resistance training and MS.. and also how training affects brain. In MS brain usually shrinks and maybe this can be slowed or reversed with good training. For example this article is about subject: Exercising in your 70s 'may stop brain shrinkage'

Exercise boosts brains circulation and perhaps keeps blood flowing better. I feel that exercise (if possible) should be part of treatment of MS. At least scientific papers show promising results. What is the optimal way of training? Don't know.. but I quess resistance + aerobic combo is very good.

[vesta]

Swimming is by far the best for me. Maximum blood circulation, oxygen into the brain.

[cheerleader]

Not sure about optimal training, Ernst. But moving and getting blood flowing is good. Swimming is an excellent way to do that, vesta! Dr. John Cooke advocates for regular aerobic exercise to increase shear stress and nitric oxide expression. Get the heart pumping every day...that's been Jeff's mantra.

Here's a recent review from Dr. Cooke called "Go with the Flow"
http://circ.ahajournals.org/content/103/23/2773.full

Long-term exercise increases the expression of NOS in the vessel wall and augments endothelium-dependent vasodilation.20 21 In addition, both nNOS and eNOS are elevated in skeletal muscle by exercise. The article by Kojda and colleagues22 in the current issue of Circulation confirms the effect of long-term exercise on eNOS expression. This effect of exercise may be mediated by shear stress. When endothelial cells are exposed to fluid flow in culture, NOS mRNA increases.23 This increased expression of eNOS in response to fluid flow may be mediated by shear stress and/or oxidant responsive elements in the promoter region of the gene.24 25 The increased expression of NOS in the vessel wall has physiological effects. Endothelium-dependent vasodilation is enhanced by long-term exercise.19 20 Furthermore, in individuals with impaired endothelium-dependent vasodilation (as in heart failure), exercise restores endothelial response.26