[HN Gopher] Multiple Sclerosis Causality
       ___________________________________________________________________
        
       Multiple Sclerosis Causality
        
       Author : nabla9
       Score  : 617 points
       Date   : 2022-01-14 17:31 UTC (1 days ago)
        
 (HTM) web link (www.science.org)
 (TXT) w3m dump (www.science.org)
        
       | mirekrusin wrote:
       | Is anybody testing for virus/bacteria vs virus/bacteria
       | interactions?
        
       | sonicggg wrote:
       | Cause is still not well explained. EBV is such an ubiquitous
       | virus, more than 90% of all adults worldwide have been infected
       | with it. Most will never know. Why is that just a tiny percentage
       | develop MS?
        
         | rewgs wrote:
         | Welcome to the immune system :p
         | 
         | Most people don't develop food allergies. Especially most
         | adults if they don't have a family history of it/didn't have
         | any food allergies as children. Those that do typically only
         | develop 1 or 2.
         | 
         | I can't imagine how infinitesimally small the odds of this
         | happening to me are, and yet here I am, at age 31, with nearly
         | 30 food allergies that all activated about a year ago,
         | seemingly overnight. No known cause, and after a year of
         | researching the immune system and just how depressingly little
         | medical science knows about it, I doubt I'll ever know, let
         | alone receive a treatment that will allow me to eat like a
         | normal person again.
         | 
         | And that's just one way in which the immune system can go
         | haywire. There's MS and all the dozens of other (auto)immune
         | issues -- so many that some don't even have a name. It is truly
         | baffling, but the immune system has gotta be one of the single
         | most complex systems known to man. There's a whole lot of ways
         | something like that can break.
        
           | dd36 wrote:
           | Pardon my ignorance, does this mean you won't have allergies
           | if you take an immunosuppressive drug?
        
         | killjoywashere wrote:
         | EBV is associated with a lot of things that involve a tiny
         | percentage of the population. Nasopharyngeal carcinoma,
         | Hodgkin's lymphoma. Non-Hodgkin's lymphomas. Post-transplant
         | lymphoproliferative disease. Burkitt's lymphoma. Oral hairy
         | leukoplakia. Related viruses are associated with other
         | diseases, e.g. HHV-8 and Kaposi's Sarcoma, primary effusion
         | lymphoma, and Castleman's disease.
        
           | jessriedel wrote:
           | Is there an estimate anywhere of the total health burden of
           | EBV, making reasonable assumptions about causality for the
           | diseases you describe? Would be very interesting to know so
           | you could compare it to the risk of a future EBV vaccine.
        
             | throwawaylinux wrote:
             | What are the reasonable assumptions about causality?
        
             | Metacelsus wrote:
             | I calculated it on my blog a few months ago: Every year, it
             | causes the loss of 4.6 million disability-adjusted life
             | years due to cancers alone, and another ~2 million to
             | autoimmune diseases like multiple sclerosis.
             | 
             | https://denovo.substack.com/p/epstein-barr-virus-more-
             | maladi...
        
         | scotty79 wrote:
         | Why only a small percentage of those who contracted polio got
         | paralysis? Interesting, but for now let's settle on eradicating
         | ebv to hell
        
         | malloc2048 wrote:
         | Good question, if I am correct there is also a higher chance to
         | develop MS if you are a woman and if you live in the northern
         | hemisphere and some parts of Australia and New Zealand.
         | 
         | Also if you are of Northern European descent the risk is higher
         | if I remember correctly.
         | 
         | Possibly it's a mix of many things and you have to be one of
         | the unlucky people where that mix triggers something in the
         | immune system and the disease develops.
         | 
         | I am very unlucky in that regard.
         | 
         | According to my doctors the number of autoimmune diseases I
         | have is rare in a single person.
         | 
         | I have a sysmetic autoimmune disease (Rheumatoid Artritis) and
         | autoimmune diseases in my kidneys, liver,thyroid, skin and
         | mouth.
         | 
         | So somehow multipe times there were events in my life where a
         | mix of things caused my immune system to turn against me.
         | 
         | A little off-topic, but to give an impression of how that works
         | out in daily life, in case you are also diagnosed with an
         | autoimmune disease.
         | 
         | If you are lucky, there is good medication and you will hardly
         | notice you're ill, except for the checkups with your doctor
         | 
         | I also know some autoimmune diseases can (become) pretty
         | aggressive, but n=1, most people I know with autoimmune
         | diseases have a decent quality of life.
         | 
         | Fortunately, in my case also for each disease there is
         | medication that either supresses the inflammation or the
         | protects my body against the effects of the auto-immune
         | response.
         | 
         | So I take my pills and a bi-weekly injection with a biological
         | and I can continue to live with a decent quality of life.
         | 
         | Except for one important thing, my main remaining symptom is
         | that I have a lot less energy than most people and need much
         | more sleep.
         | 
         | Despite that all inflammation parameters in my blood show no
         | signs of inflammation or activity of the disease, my body
         | somehow loses energy to something.
         | 
         | This seems to be a complaint of many autoimmune illness
         | sufferers, no signs of activity of the ilness, but more tired
         | than before the disease came into their life.
         | 
         | Hopefully there will soon be more developments in this area of
         | medicine.
        
           | someotherperson wrote:
           | > if I am correct there is also a higher chance to develop MS
           | if you are a woman and if you live in the northern hemisphere
           | and some parts of Australia and New Zealand. Also if you are
           | of Northern European descent the risk is higher if I remember
           | correctly.
           | 
           | I believe this has been largely disregarded. The higher
           | incidence rate in Europe/Anglosphere was a consequence of
           | higher testing and accurate diagnoses, coupled with the
           | ability to provide treatment.
        
           | supperburg wrote:
           | Yes, inflammatory signals can and do pull metabolic levers,
           | something that is criminally under appreciated, and this can
           | manifest as feeling tired somehow. There is absolutely a
           | connection.
        
         | jessriedel wrote:
         | This question, though very worthwhile, doesn't necessarily need
         | to be answered. Vaccines for EBV are under development. If we
         | stop most EBV infections, we can stop most MS.
        
           | lamontcg wrote:
           | Doesn't help you if you've already got a persistent EBV
           | infection though, and the host immune response to EBV may be
           | something that you want to avoid stimulating if you've
           | already got it in you and can't get it out.
           | 
           | Something like CRISPR/Cas9 editing may be the way to treat
           | persistent EBV and other herpesvirus infections.
        
             | bluGill wrote:
             | Maybe, though it appears that covid vaccines help clear
             | long covid, so maybe not. Until we have a vaccine we cannot
             | study this to see how or if it works.
        
               | lamontcg wrote:
               | Persistent EBV and long COVID are very unlikely to share
               | any mechanisms, those are apples and oranges.
               | 
               | With little protein expression, training T-cells to
               | identify viral MHC-epitopes is unlikely to ever clear
               | something like EBV. There's no proteins, there's no
               | virions, there's no proteases, the better target is the
               | genome itself:
               | 
               | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445958/
        
               | scotty79 wrote:
               | New vaccine to ebv targets also the proteins exposed
               | during latent phase.
        
           | sonicggg wrote:
           | Vaccine is no guarantee though, just look at Covid. DW was
           | recently covering breakthrough cases that led to Long Covid.
           | You're speculating now.
        
             | boondaburrah wrote:
             | Right but when was the last time anyone you know got polio?
             | Vaccines aren't 100% effective but if we can get the
             | average susceptibility to the virus in the population down
             | far enough (even though it'll never be complete) there's a
             | threshold where the virus can have a hard enough time
             | hopping that it really makes a difference.
        
             | bagacrap wrote:
             | I don't see where gp assumed a vaccine will be effective.
             | Note "if".
        
           | Metacelsus wrote:
           | Yeah, but will the vaccines be effective? EBV is amazingly
           | good at immune evasion. Prior antibodies don't protect
           | against re-infection.
        
       | Miner49er wrote:
       | From my understanding, the leading theory of what causes
       | autoimmune diseases is viruses. The immune system responds to the
       | virus and ends up mistakenly attacking the body as well. This
       | seems to support that, and shows that different viruses cause
       | different autoimmune diseases.
       | 
       | More info: https://www.nature.com/articles/d41586-021-01835-w
        
         | jjcon wrote:
         | Any thoughts as to why autoimmune diseases are (or at least
         | seem) more prevelent in the 1st world?
        
           | epgui wrote:
           | Broadly speaking, the hygiene hypothesis is the current
           | leading explanation.
           | 
           | To make an analogy, in AI/ML terms, it amounts to a training
           | set problem: you're not exposed to a diverse enough set of
           | microbes and pathogens, or you're exposed to a biased sample,
           | or you're not exposed to enough microbes.
           | 
           | Your immune system's role is to act as a classifier to
           | discriminate between good and bad, self and non-self. When
           | you have a bad training set, you increase the odds that good
           | things will be identified as bad, or that self antigen will
           | be recognized as foreign.
        
           | Broken_Hippo wrote:
           | If your country doesn't have a medical system that will
           | detect such things in the general population and does not
           | have a system to get the numbers for statistics, how are you
           | going to know how prevalent something is?
           | 
           | We don't know how common lots of things are in 1st world
           | countries either, simply because we don't track.
        
           | dham wrote:
           | Parasites. When you start getting rid of parasites in 3rd
           | world communities, auto immune issues start to crop up. It's
           | thought that since the body isn't fighting off parasites then
           | it sits idle and starts attacking itself. It kind of makes
           | sense from a purely evolutionary perspective. There's
           | actually been treatments for some auto immune diseases that
           | involve giving a relatively harmless parasite to people.
        
           | f6v wrote:
           | They're just probably under-diagnosed in the 3rd world.
        
           | colechristensen wrote:
           | Four candidates: hygiene, better diagnostics, different
           | exposures, longer safer lives.
        
         | atombender wrote:
         | There's also some really compelling evidence that psoriasis is
         | caused by _bacteria_. Psoriasis is often described as
         | autoimmune, but is probably better described as _immune-
         | mediated_ disorder. Unlike autoimmune disorders like MS and
         | lupus, psoriasis doesn 't involve the body "attacking" itself.
         | 
         | Specifically, streptococcus bacteria such as _Streptoccocus
         | pyogenes_ , also called Group A Streptococcus, which is
         | primarily responsible for rheumatic fever and scarlet fever in
         | developing countries, and more commonly known in the West for
         | causing strep throat (streptococcal pharyngitis).
         | 
         | We already know with almost certainty that _S. pyogenes_
         | triggers a form of psoriasis called guttate, which in 60% of
         | cases resolves on its own within 1-3 months. But in the
         | remaining cases, it turns chronic. It can also come and go:
         | spontaneously resolving and then coming back a few months
         | after.
         | 
         | What's particular about strep is that it appears that it can
         | lie dormant in the body. The tonsils of psoriasis sufferers
         | have been found to contain strep bacteria, and a recent meta-
         | study concluded that a tonsillectomy can significantly improve
         | psoriasis in about 70% of patients who undergo the procedure;
         | so it's likely that the tonsils act as a reservoir for
         | continuous reactivation. (Apparently, people who have a
         | tonsillectomy as a child are also less likely to develop
         | psoriasis.) Strep bacteria are also thought to evade
         | serological detection by hiding in biofilm, from which they
         | periodically emerge to reactivate the immune response.
         | 
         | As to why only some people develop psoriasis, the explanation
         | might be some kind of genetic predisposition. Psoriasis is
         | often explained as maybe being caused by "cross talk" between
         | the adaptive and innate immune systems.
         | 
         | Some papers:
         | 
         | Streptococcus pyogenes-induced cutaneous lymphocyte antigen-
         | positive T cell-dependent epidermal cell activation triggers
         | TH17 responses in patients with guttate psoriasis
         | https://pubmed.ncbi.nlm.nih.gov/27056267/
         | 
         | Group A streptococcal pharyngitis: Immune responses involved in
         | bacterial clearance and GAS-associated immunopathologies
         | https://pubmed.ncbi.nlm.nih.gov/28951419/
         | 
         | Psoriasis, chronic tonsillitis, and biofilms: Tonsillar
         | pathologic findings supporting a microbial hypothesis
         | https://pubmed.ncbi.nlm.nih.gov/29554401/
         | 
         | Psoriasis, chronic tonsillitis, and biofilms: Tonsillar
         | pathologic findings supporting a microbial hypothesis
         | https://pubmed.ncbi.nlm.nih.gov/29554401/
         | 
         | Tonsillectomy and the subsequent risk of psoriasis: A
         | nationwide population-based cohort study
         | https://pubmed.ncbi.nlm.nih.gov/33548305/
         | 
         | Mechanisms of microbial pathogenesis and the role of the skin
         | microbiome in psoriasis: A review
         | https://pubmed.ncbi.nlm.nih.gov/30981296/
        
         | f6v wrote:
         | I've been reading recent research on MS and other autoimmune
         | conditions. I also study APS1 in my PhD at the moment (caused
         | by AIRE gene deficiency). I'm definitely not an expert, but I
         | don't think it's a leading theory. As always in biology,
         | autoimmune diseases probably have dozens different causes. Many
         | of them might be environmental or genetic. Better yet a
         | combination of the two.
        
       | deltaonefour wrote:
       | If MS is a faulty immune response from EBV, wouldn't a vaccine
       | theoretically and potentially trigger this same faulty immune
       | response?
       | 
       | There are obviously other causative factors influencing MS. One
       | is EBV, the other is likely a specific type of immune system.
        
         | croes wrote:
         | EBV stays in the human body, a vaccine wouldn't.
        
           | Metacelsus wrote:
           | Some vaccines (like VZV vaccine) persist in the body.
        
             | panabee wrote:
             | are you on twitter?
             | 
             | your blog is highly educational. i'm interested in learning
             | more about EBV and other viruses.
             | 
             | for instance, given that VZV is common but not every
             | infection causes shingles, how does VZV pass koch's
             | postulates to establish causality?
             | 
             | similar question applies to SARS-CoV-2 and CRS.
        
           | deltaonefour wrote:
           | The immune system upon reacting to EBV or a vaccine should
           | theoretically eliminate EBV on contact so it won't stay in
           | your body?
           | 
           | Are you implying that that a vaccine cannot eliminate EBV?
           | 
           | Additionally, a faulty immune response also means your immune
           | system can't differentiate between EBV and your nerve cells.
           | So theoretically speaking even if there's no EBV in your body
           | having MS means that your body thinks EBV is in your body
           | even if it's not. A vaccine in my mind could still induce
           | this reaction.
        
             | croes wrote:
             | I meant that it's unlikely that a EBV vaccine triggers the
             | same response as EBV because EBV stays and the vaccine
             | wouldn't.
             | 
             | Same with the Corona vaccines unlike this implies
             | https://news.ycombinator.com/item?id=29942670
        
         | vintermann wrote:
         | Climate is also a known factor. MS is more prevalent in
         | temperate climates. A study from some years back suggested that
         | if you move before the age of 15 or so, you get the risk of
         | your new climate instead.
        
         | epgui wrote:
         | Short answer is no.
         | 
         | Long answer is that the question is premature (we need to
         | answer more mechanistic questions first, and then we need to
         | have an actual potential vaccine strategy to talk about) and
         | there is currently no particular reason to suspect this.
        
         | adnmcq999 wrote:
         | That's why I won't MRNA
        
       | kisamoto wrote:
       | I will read this but as someone who has had a family member
       | diagnosed with MS if there are other connections or papers people
       | can recommend I would be very grateful.
        
       | steelframe wrote:
       | This might explain why between 1992 and 2017 interferons were the
       | go-to treatment for MS. Interferons (IFNs) are a group of
       | signaling proteins made and released by host cells in response to
       | the presence of several viruses. A virus-infected cell will
       | release interferons causing nearby cells to heighten their anti-
       | viral defenses.
       | 
       | After my diagnosis I personally went on Avonex (an interferon) in
       | 2000, which was the only disease-modifying treatment (DMT) for MS
       | at the time. My neurologist told me that they had no idea why
       | interferons worked for MS, but they proved to be relatively safe
       | and effective as slowing both clinical and symptomatic
       | progression of MS. Naturally I asked the question to all my
       | doctors, "Can a virus in the CNS be involved in triggering
       | T-cells to cross the blood-brain barrier?" They would usually
       | respond, "That's as good an explanation as any."
       | 
       | So I religiously stayed on interferons through to 2014, when the
       | FDA approved an oral medication for MS. By that time I was really
       | getting tired of the constant injections (I hate needles), and my
       | MS had caused minimal problems for me up to that time, so I
       | decided to give the non-interferon DMT it a try. The clinal trial
       | data for this non-interferon medication looked promising. But in
       | the year I was on the non-interferon DMT my MS progressed, and I
       | didn't go back to interferons until after things culminated in a
       | serious attack (relapse). I currently live with a lot of symptoms
       | from new lesions that formed in my spinal cord in that year I was
       | off interferons.
       | 
       | This experience had an impact on how I approach problems in
       | general. These days I'm a lot more likely to stick with
       | technology that is tried and true for any particular problem,
       | even if that older technology is a little painful to set up and
       | use. If it's been working fine up until now, don't rock the boat
       | just because another option has come along.
       | 
       | Of course this doesn't mean I'm inclined to always only ever use
       | old technology. If something very clearly superior comes along
       | that has overhelming evidence of effectiveness, I'm open to
       | changing. In 2017 I made the switch to Ocrelizumab, which is a
       | monoclonal antibody that knocks down your B cells. The data from
       | that was so compelling that I realized that was the right thing
       | to move to from interferons. In hindsight, that has been a much
       | better move than my disastrous experiment with the oral meds.
       | 
       | This recent study relating to EBV confirms my personal suspicions
       | about the role of a virus in the development and progression of
       | MS. Hopefully what this means is that therapies will come along
       | that specifically target proteins only in EBV so that I can get
       | my B cells back, since one of the consequences that a medical
       | study I was in last year revealed is that my body doesn't produce
       | antibodies in response to the COVID vaccine. I'd really like to
       | get antibodies again, since I imagine that could give me more
       | protection than what I get from the other immune cells I have.
        
       | gregwebs wrote:
       | Dr. Terry Walhs was diagnosed with MS and became wheel chair
       | bound. She came up with a protocol that was able to reverse her
       | MS. I recall from previous interviews that her theory was that MS
       | was a disease of the mitochondria. https://terrywahls.com/
        
         | _qua wrote:
         | And what's the theory for why supposedly successful treatment
         | is not embraced by the medical community? Is it not more likely
         | that her diagnosis was incorrect, or her course was atypical
         | than that she independently discovered a cure which is rejected
         | by the medical community at large?
        
           | Broken_Hippo wrote:
           | In many circles, the Wahl's protocol (basically diet) is
           | considered a scam. Diet does not cure MS. Governments and
           | health insurances surely would rather pay for food every
           | month than pay the costs of current medications.
           | 
           | On the other hand, medications have greatly improved quality
           | of life for MS patients over the last 20 years or so. Folks
           | diagnosed today aren't in the same dire boat as someone 30
           | years ago.
        
             | gregwebs wrote:
             | As a counterpoint example someone close to me was diagnosed
             | with irritable bowel syndrome and told by doctors that
             | there was no treatment and that diet did not help. When she
             | adopted a paleo like diet with no other changes the IBD
             | symptoms went away permanently almost immediately. Another
             | counterpoint is that I was told by doctors when I was
             | younger that diet was not a treatment for acne. This advice
             | being based entirely on a single study with a single
             | dietary intervention.
             | 
             | I think you have a mistaken understanding of what it takes
             | to change one's diet. A government handout wouldn't help in
             | the slightest. It also doesn't help for a doctor to give
             | someone a list of foods to eat or not eat.
        
               | Broken_Hippo wrote:
               | Diet is not a cure for MS. Period.
               | 
               | A single diet might not be a cure for IBS, but IBS
               | affects a digestive organ. Obviously, what you eat is
               | going to affect a digestive organ, regardless of disease,
               | and it seems obvious that a few folks have trigger foods.
               | 
               | And honestly, if diet were an easy way to cure acne, it'd
               | be prescribed more. Just because you got one thing as a
               | youth doesn't make the opposite true.
        
           | gregwebs wrote:
           | I don't think our medical system has any mechanism to achieve
           | high compliance for major dietary changes, so it's very
           | difficult to study. Drugs are very easy to study.
           | 
           | It's still an N of 1 case report from a medical evidence
           | point of view so not likely to be widely applicable.
        
         | Broken_Hippo wrote:
         | the Walhs protocol is generally recognized as a scam. Diet does
         | not cure MS. If it did, diet would be first line treatment as
         | it would be _much_ cheaper to simply pay for someone 's food
         | than the most effective MS treatments we have. Those treatments
         | are solely responsible for the increase in an MS patient's
         | quality of life (over time) because they actually prevent some
         | damage. Some, not all - they are not a cure.
         | 
         | And FWIW: It isn't uncommon for someone with MS to use a
         | wheelchair temporarily. OR a cane. I was half blind for 6
         | weeks, but that went away years ago. I spent time with numb
         | hands, which has mostly (but not totally) gone away. If my legs
         | had been affected - you guessed it, I might have used a
         | wheelchair for a bit. All of this means that it can seem like a
         | "cure" works when it is really just the way the disease course
         | goes for lots of folks.
        
           | gregwebs wrote:
           | It doesn't seem like you have spent any time understanding Dr
           | Wahls information. It took her six years to be able to ride a
           | bicycle.
           | 
           | I don't know anyone with MS whose disease course went to
           | effectively cured years, but I admit to being ignorant on the
           | subject.
        
             | Broken_Hippo wrote:
             | I don't need to do that personally. If the professionals
             | can't replicate results, then it is a sham [1]. They are
             | selling snake oil and books full of promise they can't back
             | up. She doesn't tend to mention that she had chemo, which
             | you probably understand wipes out the immune system. It
             | isn't uncommon to have little disease activity after that.
             | You probably also don't realize that she didn't use a
             | wheelchair because she _couldn 't_ walk, but because of
             | fatigue. Fatigue and balance issues are really common in
             | MS: It'd easily keep you off of a bicycle. There are
             | medicines that help fatigue and sometimes this does ease
             | even if you've had MS for years. There is also a good deal
             | of overlap with depression/mood disorders and MS - which
             | you might understand can come with their own fatigue.
             | 
             | And when I speak of fatigue, I'm speaking of "Oops, I
             | showered today and I can't do anything else" sort of
             | disabling fatigue.
             | 
             | Diet is not a cure for MS, and we should really quit
             | pushing sham cures from folks preying on other people's
             | feelings of hopelessness. Which, as you can imagine, is
             | pretty common with MS. The most horrifying part of this is
             | that it keeps folks from trying things that actually are
             | proven to improve quality of life in the long run:
             | MEdications. Medications actually prevent relapses. Diet
             | does not.
             | 
             | At most, diet is important in the same way it is important
             | for everyone else: Most folks have slightly better outcomes
             | if they, in general, eat healthy and are active. This isn't
             | special to MS nor do you need to follow some strict diet.
             | 
             | [1] https://en.wikipedia.org/wiki/Terry_Wahls
        
               | gregwebs wrote:
               | Your citation doesn't backup your name calling: there is
               | no information about failed attempts at replicating her
               | results. There is an on-going study with 100 participants
               | on the Wahls protocol. [1]
               | 
               | If I had taken your point of view, I wouldn't have cured
               | my psoriasis. I wouldn't have witnessed someone curing
               | their irritable bowel syndrome. I would have kept taking
               | antibiotics instead of addressing acne with other
               | techniques. In all cases, these were "sham" cures not
               | proven by science according to your POV. In all cases
               | these are now slowly being recognized as valid approaches
               | for treating the disease.
               | 
               | By your reasoning every medical treatment that is
               | accepted today would have to have previously been a
               | "sham" before it was accepted.
               | 
               | What worked for Dr. Wahls might not work for others as
               | well as it did for herself, but it did work for her. Name
               | calling doesn't un-publish her case report [2] or halt
               | the ongoing study of her protocol [1].
               | 
               | [1] https://clinicaltrials.gov/ct2/show/NCT02914964
               | 
               | [2] https://terrywahls.com/wp-
               | content/uploads/2014/01/Case-Repor...
        
               | _qua wrote:
               | Doctors who feel they discovered a radical treatment but
               | can't convince their colleagues and then create a sales
               | website with training courses and products are highly
               | correlated with quackery.
        
       | scotty79 wrote:
       | I wonder how many viruses infecting humans we know nothing about
       | just because they don't cause any obvious symptoms.
        
       | NerdyNumbersGuy wrote:
       | This featured quite heavily in todays issue of The RECC'E I put
       | out this morning! Worth a quick read if you like quick- fact
       | insights https://email.recce.news/a7i9l9x8y1
        
       | mactournier wrote:
       | Contrary to the HN title, the paper is not about causal
       | inference, it is a case-control study. A good primer on the
       | limitations of case-control studies can be found here:
       | https://www.medicalnewstoday.com/articles/280936#limitations
        
         | letmevoteplease wrote:
         | The abstract of the study states, "These findings cannot be
         | explained by any known risk factor for MS and suggest EBV as
         | the leading cause of MS."
        
         | axlee wrote:
         | Your contrarian approach is detrimental to proper research.
         | Authors have found a very strong link that cannot be explained
         | by any other risk factors. What risk factors are you suggesting
         | they should look into?
        
       | Metacelsus wrote:
       | For more on EBV, I've discussed it on my blog here:
       | https://denovo.substack.com/p/epstein-barr-virus-more-maladi...
       | 
       | (It doesn't just cause MS!)
        
       | brechmos wrote:
       | What is interesting is that Epstein-Barr has been reported to be
       | related to Multiple Sclerosis since the early 1980s.
       | 
       | https://pubmed.ncbi.nlm.nih.gov/?term=epstein+barr+multiple+...
       | 
       | It is great if there is new information and if this leads to
       | knowledge on how to reduce the chance of getting MS.
        
       | cheaprentalyeti wrote:
       | I saw this news item last night, posted next to that one...
       | 
       | "Study finds hydroxychloroquine delays disability for least
       | treatable form of multiple sclerosis" [0]
       | 
       | [0]: https://medicalxpress.com/news/2022-01-hydroxychloroquine-
       | di...
        
         | xadhominemx wrote:
         | Probably not
        
         | degosuke wrote:
         | The link returns 404.
        
           | pkaye wrote:
           | The link was missing the final "l".
           | 
           | https://medicalxpress.com/news/2022-01-hydroxychloroquine-
           | di...
        
           | cheaprentalyeti wrote:
           | Ah, a typo, an 'l' was missing.
           | 
           | https://medicalxpress.com/news/2022-01-hydroxychloroquine-
           | di...
        
       | [deleted]
        
       | obert wrote:
       | Glad that we might eventually get rid of diseases from starting,
       | but when it comes to a cure, research is unbalanced towards
       | treating instead, because it makes more money.
        
       | clord wrote:
       | I wonder if MS is like the EBV version of shingles: if you don't
       | get it early, when you do, it's a much worse disease. Most people
       | pick it up early, but those who manage to avoid it and then get
       | it late are in danger. Another instance of hygiene hypothesis.
        
         | [deleted]
        
         | vintermann wrote:
         | MS isn't, but yes, Epstein-Barr virus is more serious if you
         | first catch it as an adult. That will likely knock you out with
         | mononucleosis, a.k.a kissing sickness, for a few weeks. Fatigue
         | can linger a lot longer.
        
           | latortuga wrote:
           | Definitely my experience. I had it as an adult at 26 and it
           | absolutely knocked me out for weeks. I lost a ton of weight
           | from having no appetite and having a constant sore throat.
           | Sleeping was also terrible because I couldn't breathe easily.
           | I think I missed 3 or 4 weeks of work and even when I started
           | back I could only work half days for awhile at my not-
           | strenuous desk job.
        
       | deltaonefour wrote:
       | This is a bit off topic but I have a question about causality.
       | 
       | Is causality really a fuzzy concept? For example I assume if
       | action A causes event B I assume the connection is 100%. Can we
       | really say that action A has a 30% chance of causing event B?
       | 
       | I ask because the more I think about it, when someone says action
       | A causes a 30% chance of event B occurring what he is technically
       | saying is action A is one causative factor that must occur and
       | that we're missing information about other causative factors.
       | 
       | In the case of this article. A causative link is established
       | between EBV and MS to a fuzzy probable degree. This seems to me
       | that technically what's actually occurring is that a fuzzy causal
       | link simply means that there are other causative factors we don't
       | yet know about, and likely this is a specific type of immune
       | system that reacts to EBV in a certain way.
       | 
       | Would my assessment be accurate? All causal connections are
       | either 100% and any fuzziness just means we're missing
       | information about other joint causal events that must occur to
       | trigger the outcome. Does anyone who's a statistician know?
        
         | csee wrote:
         | This is more in the domain of philosophy than statistics.
         | 
         | I wrote something in response, but then saw that the Wiki
         | article on causality was far better than what I wrote, so have
         | a look at that.
         | 
         | https://en.wikipedia.org/wiki/Causality
         | 
         | https://en.wikipedia.org/wiki/Necessity_and_sufficiency
        
         | dataflow wrote:
         | > Is causality really a fuzzy concept? For example I assume if
         | action A causes event B I assume the connection is 100%. Can we
         | really say that action A has a 30% chance of causing event B?
         | 
         | The world is probabilistic at the quantum level so I don't see
         | how it could be otherwise.
         | 
         | > I ask because the more I think about it, when someone says
         | action A causes a 30% chance of event B occurring what he is
         | technically saying is action A is one causative factor that
         | must occur and that we're missing information about other
         | causative factors.
         | 
         | To my knowledge this has been physically disproven:
         | https://en.wikipedia.org/wiki/Hidden-variable_theory#Bell's_...
         | 
         | (Note I'm just responding to your philosophical question, not
         | the biological one. In particular I'm not suggesting anything
         | about the practical relevance of quantum effects to the biology
         | discussion here, or lack thereof.)
        
           | beaconstudios wrote:
           | this doesn't occur above the quantum level though.
        
         | echelon wrote:
         | > we're missing information about other causative factors.
         | 
         | Welcome to biology.
         | 
         | Perhaps EBV is particularly immunogenic, but it has to
         | reactivate in the presence of CD8+ T-cells or CD20+ B-cells
         | along with some other self-signal or co-infection. Perhaps
         | there's a chain of immune signaling that must happen upstream
         | in other immune cell populations.
         | 
         | Perhaps other agents can trigger autoimmune behavior in these
         | cells, and EBV isn't strictly required. Maybe other viruses in
         | the herpesvirus family (HSV, zoster, etc.) There could be more
         | than one set of causes, and they might not even look similar.
         | 
         | In the crazy absurd limit, maybe nothing at all. Maybe
         | autoimmunity sporadically arises with no causal agent. Random
         | radiation hits the cell at the wrong time.
         | 
         | All or none of these could be the case. Diseases can have a
         | multitude of causes, sometimes with complex interactions and
         | interdependencies, sometimes not. With cancer it's a
         | progression of increasingly worse state changes, and that could
         | be the case here too.
        
         | sva_ wrote:
         | > All causal connections are either 100% and any fuzziness just
         | means we're missing information about other joint causal events
         | that must occur to trigger the outcome.
         | 
         | I think one theory is, that the immune system has a way of
         | approximating the surface of a protein, and in this way
         | recognizes what to build antibodies against. This process could
         | be a source of fuzziness as the "protein signatures" of a virus
         | may vary from person to person. There is also the question how
         | those signatures are stored and retrieved in the immune system,
         | and why they -presumably- lead to the immune system
         | misrecognizing myelin sheaths as a threat (in some people, some
         | of the time.)
        
         | gwern wrote:
         | Is it helpful to ask about 'percentages' here? Is oxygen 0% or
         | 100% of the cause of you posting here? What about gravity?
         | 
         | Whenever you have a causal question, often taking a Pearlean
         | perspective and asking about _interventions_ would be more
         | useful. For example, there is an EBV vaccine being worked on
         | right now. If you believe OP that EBV infection is a necessary
         | but not sufficient condition for 90% of MS cases, then it would
         | be reasonable to say something like  "if we intervened by
         | making everyone got the EBV vaccine, then there would be ~90%
         | fewer MS cases than in the counterfactual universe where
         | everything else was the same but no one got the EBV vaccine."
         | That sounds much more interesting and meaningful to me than
         | talking about how "EBV is necessary but not sufficient".
        
         | peter303 wrote:
         | There was a similar debate in the 1880s. Dr. Robert Koch
         | claimed some diseases were caused by bacteria and developed a
         | procedure to prove it. The germ theory of disease was
         | controversial until then.
         | 
         | Its suspected several diseases without known causes may be
         | caused by a bacterium, virus or protein. But lack the evidence
         | to satisfy the Koch postulates. These diseases include some
         | cancers and many human nervous system diseases.
        
         | beaconstudios wrote:
         | simple, 1:1 causality (if I flick a light switch, the light
         | turns off) is not fuzzy at all. Complex causality is more
         | complex (obviously) and most things in real life have complex
         | causality.
        
       | Mezzie wrote:
       | I have MS and my first relapse was a pretty textbook case of
       | transverse myelitis of the sort that the EBV can cause.
       | 
       | I know some people have been asking about why that might be the
       | case when a ton of people have EBV, and I think the causality may
       | go the other way: Those of us with something wrong are more
       | likely to both have EBV complications _and_ MS.
       | 
       | There are other viruses like this as well (ones that most people
       | get/have but aren't dangerous). I was on one medication where I
       | needed to be tested monthly because if I got one particular
       | (normally harmless) virus, the suppression caused by the
       | medication meant I would probably die.
       | 
       | There's pretty clearly some sort of relation between the state of
       | one's immune system + how it deals with 'benign' viruses + auto-
       | immunity, and I'm excited to see what the future holds, but for
       | now it's a cool confirmation of something a lot of MSers have
       | talked about amongst ourselves for a while.
        
         | jessriedel wrote:
         | > I think the causality may go the other way: Those of us with
         | something wrong are more likely to both have EBV complications
         | and MS.
         | 
         | I'm unsure, but it sounds like you're hypothesizing that EBV
         | infections does not cause MS symptoms, and that instead some
         | some third factor causes both, so that preventing EBV infection
         | would not prevent MS. The paper being discussed specifically
         | considers and rejects this possibility with pretty strong
         | evidence. Indeed, that is the main contribution of the paper.
         | (The fact that 99% of MS sufferers have EBV, way higher than
         | the 90% baseline in the general population, has been known for
         | a while.)
        
           | csdvrx wrote:
           | Or that people who can't clear EBV may be unable to due to
           | some deficiency that also cause them to get MS
           | 
           | Still a super interesting paper
        
           | Mezzie wrote:
           | That's why I shouldn't read articles instead of taking a nap.
           | Thanks!
        
           | loudtieblahblah wrote:
           | There's other factors too.
           | 
           | All MS suffer-ers have low VitD.(as does just about everyone
           | with an autoimmune issue).
           | 
           | They all have low uric acid too.
           | 
           | Almost all MS sufferers (same more most autoimmune) can also
           | trace their disorder back to an extreme stress event too -
           | divorce, loss of a loved one, falling into health anxiety,
           | etc..
           | 
           | Are these causes or effects?
           | 
           | I'm guessing there's compounding factors.
        
         | roganartu wrote:
         | > There are other viruses like this as well (ones that most
         | people get/have but aren't dangerous). I was on one medication
         | where I needed to be tested monthly because if I got one
         | particular (normally harmless) virus, the suppression caused by
         | the medication meant I would probably die.
         | 
         | For those curious, I'm going to guess and say this might've
         | been Tysabri (natalizumab) and that the virus in question is
         | JCV (John Cunningham virus). After approximately two years on
         | Tysabri, people who test positive for JCV antibodies (approx
         | half the population of the US) have an extremely high chance of
         | developing an often-fatal brain infection called PML
         | (Progressive Multifocal Leukoencephalopathy).
         | 
         | Tysabri was originally pulled by the FDA due to PML deaths back
         | in the early 2000s, but later got reapproved after the link to
         | JCV was discovered. Nowadays patients get tested for JCV
         | antibodies every 6 months. The treatment is considered quite
         | safe now, with the caveat that if you test positive you cannot
         | get Tysabri anymore. Most people don't switch from negative to
         | positive, but it happens occasionally.
         | 
         | Source: my wife has a rare form of MS and has been on Tysabri
         | for about 5 years now, relapse free. Modern MS drugs are a
         | scientific marvel.
        
           | loudtieblahblah wrote:
           | Monthly 3-4 day fasts - combined with a healthy diet in
           | between (Mediterranean for ex) do wonders for autoimmune
           | issues as well.
           | 
           | It was found fasting kills off old immune cells and activates
           | stem cells to make new ones.
           | 
           | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7474734/
           | 
           | https://pubmed.ncbi.nlm.nih.gov/31442401/
           | 
           | https://www.nejm.org/doi/10.1056/NEJMra1905136
           | 
           | http://www.cell.com/cell-stem-
           | cell/abstract/S1934-5909(14)00...
           | 
           | In plain English
           | 
           | https://www.forbes.com/sites/stevensalzberg/2014/12/30/can-a.
           | ..
           | 
           | https://www.medicalnewstoday.com/articles/277860#In-
           | mice,-pr...
        
           | 2dvisio wrote:
           | Confirm. My brother is was on Tysabri for more than 5 and
           | recently got confirmation of JCV. The checkup is however more
           | regular. Blood test + MRI + symptoms check every three
           | months, as if done less regularly would increase massively
           | the risk. If JCV flare up is detected they'll need to
           | flush/wash the Tysabri away from his bloodstream.
           | 
           | He also got a severe mononucleosis infection before being
           | diagnosed, and at that time we all thought that could have
           | been the cause.
        
           | Mezzie wrote:
           | Bingo!
        
         | supperburg wrote:
         | Well said. I said the immune system should be to blame in the
         | previous thread and was downvoted to hell. But it's true.
         | What's more, it's highly under appreciated that the immune
         | system is extremely ancient and it does a lot more than the
         | typical things associated with it like destroying tissue. It
         | pulls deep metabolic levers that can make critical cells,
         | including brain cells, latent. It can do many amazing things.
         | In the future, the immune system won't be known for immunity --
         | it will be known as something like the second nervous system
         | and will be associated with the nth great wave of medical
         | progress when we finally conquer it and all the hundreds of
         | diseases it causes. Diseases we don't even have a name for now,
         | I know for a fact.
        
           | the_decider wrote:
           | An immunological biomarker aasociated with MS had been
           | discovered a few years back, but sadly nothing came of that
           | research. https://www.nature.com/articles/s41598-017-04439-5
        
             | supperburg wrote:
             | I think even if we find some markers it won't be enough. It
             | will take a full blown revolution in how we measure human
             | anatomy in a clinical setting. That's why it's taken so
             | long.
        
         | Broken_Hippo wrote:
         | To be fair: I have MS. I've never had EBV with symptoms that I
         | know of - which is absolutely normal. When folks catch it as
         | children, there are generally zero to no symptoms. And I'm not
         | alone, judging by activity on MS related sites.
         | 
         | I wouldn't take the word of "a lot of MSers" - I mean, there
         | are folks that push the scam WAHLS protocol (diet) as a cure,
         | too. Unless the folks are researchers, an MSer's thoughts about
         | what causes the disease are often just as baseless as a non-
         | MSer.
        
         | dtech wrote:
         | > I think the causality may go the other way
         | 
         | The whole point of the article is that this isn't the case.
        
       | xdrone wrote:
       | Here's a John McDougall talk, he had some close ties to Dr Swank,
       | known for a lot of early MS research.
       | 
       | https://www.youtube.com/watch?v=fmZdI8jinIw
       | 
       | tldw: When your stomach layer is compromised, unprocessed food
       | gets into your body. Food like animal protein, similar to our
       | proteins, get attacked by the immune system, some of your cells
       | are also mistakenly attacked.
       | 
       | Anyone with the compromised stomach is at greater risk for auto
       | immune diseases. For example look of rates of ms among celiac or
       | crohn's sufferers.
       | 
       | Same goes for type 1 diabetics, also autoimmune. Research
       | suggests casein from dairy gets in the body, your immune system
       | accidentally attacks your pancreas insulin making cells.
       | 
       | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518798/
        
         | sumosudo wrote:
         | All the health problems of modern society can be diminished
         | greatly by ensuring the proper functioning of the gut.
        
           | bagacrap wrote:
           | please tell me how to ensure proper function of my gut
        
       | howinteresting wrote:
       | This study appears to suggest that MS is essentially "long
       | Epstein-Barr." Terrifying if the same pattern holds for covid,
       | given the number of people who have some sequelae (the most
       | conservative estimates are 2-5% for "serious" post-viral
       | symptoms, which would be hundreds of millions of people
       | worldwide). There will be an extraordinary amount of suffering,
       | not to mention radical shifts in economic and public policy.
        
         | axg11 wrote:
         | The study really doesn't suggest that. All it suggests is that
         | EBV seropositive people are much more likely to develop MS than
         | the seronegative minor population.
         | 
         | As for long COVID, the data quality is very variable. I'd like
         | to see a controlled study that compares recovery from COVID vs.
         | other respiratory viruses.
        
           | howinteresting wrote:
           | It's pretty clear that the causal explanation is the only
           | reasonable one here. (Besides, at least for covid, not
           | everyone who contracts the virus develops antibodies for it:
           | https://journals.asm.org/doi/10.1128/Spectrum.00904-21 )
           | 
           | There's a reason I quoted conservative estimates of long
           | covid. The 2% is from this ONS study: https://www.ons.gov.uk/
           | peoplepopulationandcommunity/healthan.... The high end of
           | estimates is 10-30%, which would mean the end of our current
           | era of civilization.
        
         | vintermann wrote:
         | That sounds unlikely. Epstein-Barr is a herpesvirus, and it's
         | persistent - once you catch it, it stays latent in your body
         | and you'll shed it through your saliva periodically for life.
         | 
         | As far as I can find, coronaviruses have no way to pull that
         | trick. Once your immune system gets rid of it, it's gone and
         | not coming back unless you're infected again by a sufficiently
         | unrecognizable relative.
        
           | Tagbert wrote:
           | Like my uncle, Oscar? He looks nothing like anyone else in
           | the family and looks out of place in family photos. I'm
           | pretty sure he is antivax, too.
        
         | kmeisthax wrote:
         | There's another paper from June of last year[0] that proposed a
         | long COVID explanation: Epstein-Barr reactivation. I haven't
         | seen any follow-up work yet, but if both that and this paper
         | have any predictive power to them[1] we might start seeing a
         | cohort of "long long COVID[2]": people who got COVID, didn't
         | recover, and then progressed to MS.
         | 
         | [0] https://pubmed.ncbi.nlm.nih.gov/34204243/
         | 
         | [1] I'm particularly worried about the "EBV reactivation"
         | theory as COVID-related studies have been used as a vehicle for
         | many medical frauds.
         | 
         | [2] As per ISO standards long long COVID must have an infection
         | duration represented with at least a 64-bit machine integer
        
         | stefan_ wrote:
         | There are lots of viruses that persist forever. You can get
         | chickenpox as a kid then die of shingles as a retiree. Measles
         | might give you only mild symptoms then 6-15 _years_ after
         | reactivate and cause Subacute sclerosing panencephalitis
         | (SSPE), a fatal brain inflammation with all the interesting
         | symptoms that implies (starting out with mood swings
         | progressing into dementia, muscle spasms and blindness).
         | 
         | Think of this the next time some brain dead person starts
         | talking about the "unknown long term effects of the vaccine" -
         | we know what has long term effects, and it's freaking live
         | viruses!
        
         | f38zf5vdt wrote:
         | Coronaviruses do a weird thing where their viral RNA persists
         | in cells long after the initial infection. [1] No one knows if
         | this has a bearing on long COVID or not.
         | 
         | [1] https://www.nature.com/articles/s41592-021-01145-z
        
           | jonnycomputer wrote:
           | Yeah, I don't trust the viruses not to do sneaky shit. Not at
           | all.
        
           | vintermann wrote:
           | It's not a terribly weird thing for a virus to do, but as far
           | as I know (just an interested amateur) coronaviruses can't
           | use this to stay latent.
        
             | f38zf5vdt wrote:
             | We don't really know. A recent manuscript submitted to
             | Nature shows minute persistence in various tissues as long
             | as 230 days or more post-infection. [1] RNA is fragile, if
             | the infection is completely cleared or not integrated into
             | the genome in some way we would not expect it to persist.
             | 
             | [1] https://assets.researchsquare.com/files/rs-1139035/v1_c
             | overe... (Figure 1)
        
             | howinteresting wrote:
             | I would be hesitant to generalize from existing
             | coronaviruses to SARS-2. As the sibling comment points out,
             | SARS-2 has been shown to persist in every organ of the body
             | well after initial infection.
        
       | dm319 wrote:
       | Here's a link to the article [0].
       | 
       | Just a bit of background - 95% of humans will experience
       | infection with EBV at some point in their lives. Once you're
       | infected, it remains latent, only flaring up in particular
       | circumstances. MS is an autoimmune disease, like many others, and
       | this paper does not imply that EBV directly causes MS. Obviously,
       | as so many more people have EBV than have MS, EBV infection does
       | not completely explain why people get MS.
       | 
       | Just to put a small caveat to the paper. The comparison is to EBV
       | 'seronegative' population - this is a minority of people (i.e.
       | people who do not have evidence of being infected with EBV). You
       | could argue this is an 'unusual' population in the first place
       | and there's something about them that provides protection from
       | MS.
       | 
       | Another point is that EBV is a risk factor, there are other risk
       | factors known too. I think the key to understanding a lot of
       | autoimmune diseases is to understand how our adaptive immune
       | system works. Our immune response is a very complex cell-to-cell
       | interaction between millions of cells all with different roles,
       | and how the immune system decides whether something is a threat
       | or not is not, and how to respond to it, is not yet clear.
       | 
       | [0] https://www.science.org/doi/10.1126/science.abj8222
        
         | jonnycomputer wrote:
         | I think this is may be one reason they used CMV infection as a
         | control. Unless you think that the people who don't get CMV are
         | not special, but the ones who don't get EBV are...
        
           | dm319 wrote:
           | Yes that's a good point.
        
         | hda111 wrote:
         | Had a similar thought when reading the headline. It's like
         | saying drinking water causes MS.
        
           | philshem wrote:
           | 100.0% of people consume H2O. There is no control group.
        
         | moneywoes wrote:
         | As someone with an autoimmune disease, is there anything I can
         | do to prevent getting more? Iirc having one is a risk factor
         | for others
        
           | kennethh wrote:
           | I had Ulcerative colitis for 20 years and managed to get rid
           | of it by changing the diet. I used the carnivore diet, ie eat
           | mostly meat, egg, fish (animal products). Cutting out
           | processed foods, sugar (only 70% dark chocolate) and seed
           | oils. I would recommend trying it for a couple of months and
           | see if it helps, and if you do not notice any difference you
           | have not lost anything. I lost 10% of my body weight without
           | ever being hungry so that might be a nice side effect also.
        
             | dncornholio wrote:
             | Carnivore diet seems like a perfect excuse for people who
             | don't want to eat their veggies. If you could provide any
             | proven benefits of this diet that other diets don't
             | provide, I'll change my mind.
        
             | Broken_Hippo wrote:
             | To be absolutely fair to readers: Please speak to your
             | doctor before deciding on a diet to "cure" an illness,
             | especially since fatty foods can trigger attacks for some
             | folks. Ulcerative colitis has no actual cure, and this is
             | one way one person has managed it a bit better. It might
             | not be recommended for you.
             | 
             | (Sorry, i'm in this thread because I have MS, and there are
             | lots of scam diets claiming to cure it. They don't - at
             | all. They mostly just make folks feel like they have
             | control).
        
             | mb_72 wrote:
             | Crohn's sufferer here. I have lost track of the times
             | people have said "I tried this diet, and then my Crohns /
             | UC went away".. and then some time later their symptoms
             | reappeared. My understanding (via own reading and
             | discussion with my doctor) is that there is just as much
             | evidence against as for a meat-based diet .... or any kind
             | of diet.
             | 
             | As my specialist put it "if there was a common diet that
             | cured people, we would know about it already". Anecdotally
             | one never knows if their UC/Crohn's improves because of
             | their diet or it's just part of the ups and downs of those
             | diseases.
             | 
             | That said, I'm happy in general if I hear a fellow UC /
             | Crohn's sufferer seems to have found something that works
             | for them, especially something that is better for you than
             | steroids and other treatments with severe side-effects.
        
               | jopsen wrote:
               | Yeah, it's also my take that one should be careful
               | correlating ups and downs to things eaten -- it might as
               | well be stress or just bad luck.
               | 
               | That said, if I can get some placebo effect benefits from
               | believing that reducing processed food helps, it might be
               | worth doing -- if nothing else it reduces cancer risks :)
        
           | mpreda wrote:
           | [this is not medical advice] Some things that may modulate
           | the immune system are: vitamin D3, intestinal worms,
           | exercise, diet / fasting, and gradual stimulation of the
           | immune response ("desensitisation").
        
             | trulyme wrote:
             | Off-topic: interesting that we often see IANAL, but very
             | rarely IANAD (I am not a doctor) around here. Either
             | there's a lot of doctors here, or people are more
             | comfortable giving medical than legal advice, which is
             | weird, as medical advice can have very serious
             | consequences.
        
               | pbhjpbhj wrote:
               | I think it's just default recognised that you're not
               | getting a doctor's medical advice, particularly not for
               | you, through an internet forum. So, someone would have to
               | tell you they are a doctor, and you'd still not get their
               | _medical_ advice unless you had a consultation with them.
               | That last bit being similar to lawyers reminding people
               | "IAAL but I'm not _your_ lawyer ".
        
             | johnisgood wrote:
             | Propolis and Cinnamomum verum are great immunomodulators
             | for autoimmune diseases. Echinacea is sold as an immune
             | system booster, and it is a firm nope.
        
           | dm319 wrote:
           | I'm afraid this is out of my scope of understanding. Once the
           | immune system determines something is non-self, the immune
           | system can often self-propagate the response. It eventually
           | enters a tolerance phase where it aims to just 'control' the
           | threat.
           | 
           | There are some known modulators of the immune system, but the
           | medical forms can be especially blunt tools (i.e. steroids).
           | Locally directed treatment is better, and maybe in the future
           | we'll have specially crafted cells that can inhibit a
           | specific response for particular antigens.
           | 
           | There is a long and slightly-controversial link between
           | stress (and lots of other environmental factors) affecting
           | the immune system. I'm not familiar with the literature.
        
             | manwe150 wrote:
             | I recently learned (also from HN) that wild-type measles
             | can often destroy your bodies pre-existing immunities to
             | most past threats. I wonder if we will someday be able to
             | trigger a similar effect with a synthetic virus, wiping the
             | immune memory, then re-vaccinate to get back immunity
             | afterwards. But it is practically just science fiction
             | stuff now, as far as I know.
        
           | Broken_Hippo wrote:
           | Nope. Since we aren't certain what _causes_ most things, we
           | can 't really prevent them. (This research isn't saying they
           | know what causes MS, to be clear).
           | 
           | Realistically, the best thing you can do is basic health
           | stuff. Get activity, eat a variety of healthy foods, and so
           | on. As you can, anyway. Mostly because this stuff improves
           | your outcome if you happen to get another (and probably helps
           | with the one you have - I have MS, and this basic stuff tends
           | to help outcomes)
        
           | kortex wrote:
           | Helminth therapy is supposed to help moderate it. I did it to
           | get a handle on my asthma and allergies and it worked quite
           | well. There's various websites and support groups which
           | detail the process and why it works etc.
           | 
           | There's a bit of squick factor to get over but it is worth it
           | for the relief.
           | 
           | https://helminthictherapywiki.org/wiki/index.php/Helminthic_.
           | ..
        
         | dekhn wrote:
         | At least part of the adaptive immune system is implemented in
         | the thymus. As an infant, the thymus makes examples of nearly
         | every type of cell in the body and uses it as negative labelled
         | examples to tune the false positive detector so it doesn't
         | identify self as threat. From an information theory
         | perspective, that's pretty extraordinary (you don't normally
         | expect differentiated cells in an organ to act like cells from
         | another organ).
         | 
         | Another part of the adaptive immune system randomly shuffles
         | different regions of genes together to produce enormous
         | diversity (searching for a rare example of something that
         | "works"), then picks the proteins from those genes that work
         | best and distributes them throughout the body.
         | 
         | Pretty amazing stuff.
        
           | dm319 wrote:
           | Yes, it's really fascinating stuff. Just to add to that,
           | cells must present a continuous sample of their proteasome on
           | the cell surface in the form of a short peptide 9-12 amino
           | acids long. T cells will recognise when the cell is producing
           | protein it shouldn't be (i.e. because it became cancerous or
           | infected with a virus), even if only one amino acid is
           | incorrect.
           | 
           | It learns this in the thymus, which has a bizarre gene called
           | AIRE which switches on genes from all over the body,
           | essentially creating a representation of the entire body in
           | the thymus gland as a sort of sandbox before they are let
           | out.
           | 
           | However, we don't have enough T cells to recognise every
           | possible sequence of 11 amino acids (which would weigh around
           | 1.5 tons), so T cells must be so-called 'cross-reactive'[1].
           | And therefore other factors must go into how T cells respond
           | to abnormalities.
           | 
           | [1] https://www.nature.com/articles/nri3279
        
             | dekhn wrote:
             | yep, i was referring to AIRE without naming it. I saw a
             | talk about it years ago and it blew my mind. In retrospect,
             | it seems to just sort of fall out from the way you'd expect
             | adaptive immunity to evolve, though.
        
               | hallway_monitor wrote:
               | I don't see many YouTube links posted here, but this
               | Kurzgeasgt video blew my mind on this topic. Our immune
               | system really is amazing.
               | 
               | https://www.youtube.com/watch?v=LmpuerlbJu0
        
               | whatshisface wrote:
               | I would have expected it to send out T-cells around the
               | fetal body to pick up protein signatures. I'm surprised
               | that it makes them all in one place.
        
               | amluto wrote:
               | What an excellent idea!
               | 
               | https://en.m.wikipedia.org/wiki/Peripheral_tolerance
        
               | dekhn wrote:
               | Thanks, I had forgotten about this and had actually mixed
               | parts of it up with in-thymic training
        
               | csdvrx wrote:
               | Why go samples all the files from all over the filesystem
               | if they are deterministically created from a piece of
               | code you've got a copy of?
        
               | k12sosse wrote:
               | To check for corruption, I suppose (validation).
        
           | rubicon33 wrote:
           | Where can I read more about this? Can you recommend a book or
           | something?
        
           | mdswanson wrote:
           | Can't help but to highly recommend the recent book by Philipp
           | Dettmer, Immune: A Journey Into The Mysterious System That
           | Keeps You Alive. It's fantastic and very readable: https://ww
           | w.amazon.com/dp/B08XTNHRR5/ref=cm_sw_em_r_mt_dp_FX...
        
           | whatshisface wrote:
           | What's the connection to information theory?
        
             | d0mine wrote:
             | On information theory [unrelated to the discussion]: both
             | digital information (stored in DNA --4-letters) and analog
             | information (epigenome) can be manipulated for various
             | effects e.g., "Lifespan: Why We Age--and Why We Don't Have
             | To" by Sinclair https://www.amazon.com/dp/B07N4C6LGR/
        
             | dekhn wrote:
             | sorry, I shouldn't have thrown that in there.
        
         | birdyrooster wrote:
         | I guess titling the article "Multiple Sclerosis Causality" and
         | then immediately going into EBV correlation seems like
         | implication to me.
        
           | [deleted]
        
         | user90349083 wrote:
         | For anyone dealing with an acute bout of Epstein-Barr Virus, I
         | used 3 teaspoons a day of monolaurin for three weeks to kick
         | it. Research monolaurin, it's fascinating stuff as an antiviral
         | and I can personally attest to its effectiveness.
        
           | csdvrx wrote:
           | Or get actual antivirals. IIRC the same thing that's
           | prescribed for HSV works on EBV
        
             | user90349083 wrote:
             | Some people prefer God's medicine to man's medicine. To
             | each his own
        
               | taneq wrote:
               | If God is what it says on the tin then man's medicine
               | _is_ God 's medicine. In fact if anything in this world
               | isn't God's then God isn't both omniscient and
               | omnipotent.
        
               | user90349083 wrote:
               | Monolaurin is found in human breast milk and coconuts.
               | Acyclovir and Ganciclovir were synthesized by humans in a
               | lab
        
               | danachow wrote:
               | Acyclovir is shown to decrease viral replication in vivo.
               | There is no such evidence for monolaurin. So there's
               | that.
        
               | pbhjpbhj wrote:
               | Human breast milk is also synthesised by humans!
               | 
               | But, more seriously, don't you believe human medicine to
               | be inspired by God? What about other human activity?
        
               | dtech wrote:
               | I never understood this argument. If God was against
               | these medicines, why would He allow them to exist?...
        
       | aserdf wrote:
       | there is an experimental[0] treatment for MS, the "immune system
       | reboot". i am a layperson but my understanding is stem cells are
       | taken from the patient, the immune system is "destroyed" through
       | immunosuppressants and the stem cells are then used to rebuild a
       | "naive" immune system in the patient.
       | 
       | based on the info in the OP, i wonder if the MS result from EBV
       | is random; what is the probability of a rebooted immune system to
       | follow the same path after exposure?
       | 
       | [0] - https://www.nih.gov/news-events/nih-research-
       | matters/immune-...
        
         | wswope wrote:
         | The initial susceptibility is mostly going to be predetermined
         | by the MHC, and therefore remain the mostly the same. However,
         | the pathological outcome is ostensibly a product of certain
         | strains of pathogens plus luck of the draw on somatic
         | hypermutation in response to said pathogen.
        
           | whatshisface wrote:
           | For something as rare as MS, "spin again" is ninety percent
           | of a cure.
        
       | holidayacct wrote:
        
       | sabujp wrote:
       | I was wondering what the genetic factors are that cause EBV to
       | push people to get MS and found this excellent paper [1] (see the
       | genetic susceptibility section).
       | 
       | [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6334604/
       | 
       | [2]
       | https://www.google.com/search?q=genetic+factors+that+cause+E...
        
       | wtetzner wrote:
       | An interesting talk about someone who was able to reverse a lot
       | of her MS symptoms with a change in diet:
       | https://www.youtube.com/watch?v=KLjgBLwH3Wc
        
         | moneywoes wrote:
         | So basically no wheat, milk and processed foods?
        
           | omreaderhn wrote:
           | I skimmed through the presentation and I'm not sure how you
           | arrived at that as your takeaway. The dietary advice given in
           | there is much more complex than that.
        
         | epgui wrote:
         | Biochemist here: I would advise to exercise strong caution when
         | looking at dietary changes in the context of MS.
         | 
         | A lot of advice gives people the illusion that they have more
         | control over their illness than they actually do, and a lot of
         | the diets cause unnecessary harm (as a heuristic: the more
         | things you cut out, the higher the potential for harm).
         | 
         | That said, healthy eating and regular physical exercise is
         | always a good idea, and even more so if you have any existing
         | illness.
        
           | Broken_Hippo wrote:
           | Thank you!
           | 
           | A lot of scam diets promise to cure MS. Books are sold. But
           | the only real way to lessen the harm of the disease is
           | through a combination of a modern medicine and luck (I've had
           | both).
           | 
           | Agree on the general healthy eating and activity, though.
        
         | Broken_Hippo wrote:
         | The Wahls protocol is a scam. It is not a cure for MS.
         | 
         | Most folks with MS have RRMS - RR stands for relapsing
         | remitting. Basically, you have a "flare" - when your body
         | attacks your nerves. You have symptoms for a while, and then
         | they start to go away. For context: I woke up one morning half
         | blind. I could tell if there was a red object, but I couldn't
         | make out what it was. Everything I could see out of my left eye
         | was fuzzy. I couldn't make out the big "E" on the eye chart.
         | 
         | But then, the lesion heals. You might be left with some damage,
         | but a lot of it goes away. My vision returned and the optic
         | nerve healed well. My vision is actually better in that eye
         | than the other one. I have lingering numbness in my hands from
         | time to time, but nothing like the fingertip-to-elbow pins and
         | needles from a flare (I barely notice).
         | 
         | All this means that a change in diet might seem to make your MS
         | better. It definitely makes folks feel like they have control.
         | But clinically, it does nothing. You are taking a big risk by
         | doing this. What does work are modern DMTs - disease modifying
         | treatments.
        
           | garganzol wrote:
           | It is not a scam. As you said, it is just not the ultimate
           | treatment for MS. But it is a tool for MS management.
           | 
           | Protocols like this are important parts of treatment for many
           | people with similar conditions: T2DM, neuropathy, CFS/ME,
           | Alzheimer, Parkinson, POTS.
           | 
           | I want to stress that many people with conditions adjacent to
           | MS do not experience that relapsing-remitting nature of a
           | disease. And they confirm an immediate improvement when they
           | swap junk processed foods with more natural choices.
        
         | garganzol wrote:
         | According to numerous observations, neurodegenerative diseases
         | and the lack of energy (adenosine triphosphate, ATP) are
         | tightly interconnected.
         | 
         | Thanks for posting. And yes, there is mitochondria involved,
         | once again.
        
         | DantesKite wrote:
         | Anecdotally I'm aware of someone who was able to reverse a lot
         | of their symptoms with high doses of Vitamin D.
         | 
         | There's a biochemist here giving advice about being cautious.
         | That goes without saying, but it always strikes me as
         | disingenuous careerism to recommend people with terrible
         | illnesses to not experiment. That's the bedrock of scientific
         | inquiry.
         | 
         | It may be the case there's nothing out there that can help
         | alleviate MS even a little, but it's worth trying, especially
         | if the cost is low and the burden of the disease is high.
        
           | garganzol wrote:
           | I confirm the effects of vitamin D3 with my own observations.
           | 
           | Vitamin D3 is an adaptogen for the immune system, it is an
           | antioxidant in mitochondria, it plays so many different
           | roles.
           | 
           | No wonder it has such a beneficial effect on MS and CFS/ME
           | patients who suffer from autoimmunity and mitochondrial
           | manifestations. Vitamin D3 alone is not the ultimate cure per
           | se, but it is a part of a possible cure for sure.
           | 
           | Note of caution to those who supplement vitamin D3 for more
           | than 2 months: always add vitamin K2 MK-7 to the mix to avoid
           | the possible development of arterial calcification.
        
           | Broken_Hippo wrote:
           | _There's a biochemist here giving advice about being
           | cautious. That goes without saying, but it always strikes me
           | as disingenuous careerism to recommend people with terrible
           | illnesses to not experiment. That's the bedrock of scientific
           | inquiry._
           | 
           | It isn't a bedrock of scientific inquiry if you aren't
           | actually studying things. In fact, with MS it can make you so
           | much worse off than you would be. People start the diets _as
           | a substitute for proven medicine_. No diet has been proven to
           | prevent a relapse, lessen their impact, nor cause you to have
           | fewer relapse. With MS, every relapse you have increases your
           | chances of disability and most relapses leaves effects. I
           | lost hand strength and my fingertips have different feeling,
           | for example, even though most of the numbness went away.
           | Proven medicine has lessened the number of relapses folks
           | have and often makes them milder: With the best medicine, we
           | haven 't prevented relapses entirely - though a lot of
           | neurologists treat a single relapse as a sign to switch
           | medications to something that'll work better for you.
           | 
           | I'll add that it isn't always worth trying. You aren't doing
           | science unless you are part of a trial. Eating a strict diet
           | isn't generally cheaper and takes time that you might not
           | even have the energy for - all for something science hasn't
           | been able to prove works. Just ancedotal stuff from random
           | people without anything to back it up. I suspect the diet
           | might just have a similar effect that weed does with
           | spasticity: It doesn't medically cure some it, but people
           | report being less bothered by them. And if that's the case,
           | any dietary change would work and you probably shouldn't give
           | money to the ones claiming miracles.
        
       | dmitryminkovsky wrote:
       | > and the team identified 1566 matched controls for them.
       | 
       | Can anyone please shed some light on this? How would this work?
        
       | onemoresoop wrote:
       | Interestingly, Moderna has some trial for mRna vaccine for
       | Epstein-Barr virus [0]
       | 
       | [0]- https://www.clinicaltrialsarena.com/news/moderna-ebv-
       | vaccine...
        
       | animanoir wrote:
       | I wish I was still a virgin.
        
       | cjensen wrote:
       | It's weird to me that they say 35 of the 801 MS cases were
       | negative then positive before getting MS. The control group had
       | 107 of 1566 were negative, but they don't bother to tell us how
       | many of them ended up positive.
       | 
       | I assume enlisting is a high-risk place to get EBV, and without
       | info on the control I don't see how you can draw conclusions. But
       | I'm basing this on the summary rather than the actual article:
       | does the article have the info?
        
         | couchand wrote:
         | It's well known that (1) most people have EBV some time in
         | their life, and (2) most people don't have MS. The news that
         | any number of people who don't develop MS get EBV would be
         | mundane.
        
       | asdfasgasdgasdg wrote:
       | Moderna are trialing an EBV vaccine. If it's successful, I wonder
       | if we will see an end to MS. A cure would be great but failing
       | that a prevention is almost as good.
        
       | reedf1 wrote:
       | Terrifying - I was EBV positive 4 years ago. It does not mention
       | an association between EBV severity and MS, but I was very
       | symptomatic and had post viral fatigue for around a year. I had
       | no idea about the MS association!
        
         | danuker wrote:
         | > According to epidemiological studies, the EBV is estimated to
         | be positive in more than 90% of the world's populations
         | 
         | - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6008310/
         | 
         | > A total of 2.8 million people are estimated to live with MS
         | worldwide (35.9 per 100,000 population)
         | 
         | - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7720355/
         | 
         | Given that you have EBV, I guess you're in the unlucky 90%,
         | increasing your odds from 359 in a million to a ...whopping...
         | 399 in a million.
        
           | BobbyJo wrote:
           | Since the risk for the non-EBV group is 32x less, you'd be
           | increasing your odds from like 11 in a million to 399 in a
           | million no?
        
             | andi999 wrote:
             | If you knew you were negative yes, if the status was
             | unknown then not.
        
         | shadowgovt wrote:
         | If you're EBV-positive, you're in good company... It infects
         | something like 90% of the human population.
         | 
         | Makes me wonder how many virii are out there that haven't been
         | identified by modern medicine because their spread vector is so
         | low-impact that they never even trigger symptoms. A virus like
         | that would become real indistinguishable from "behavior of the
         | human body" in not very much time if its infectivity was high.
        
           | bigbillheck wrote:
           | There's the anelloviruses which are at least as prevalent and
           | nobody really knows what they do.
        
           | axg11 wrote:
           | Great question. A related question: how many undiscovered
           | viruses exist that are beneficial to the host?
        
           | csdvrx wrote:
           | > A virus like that would become real indistinguishable from
           | "behavior of the human body" in not very much time if its
           | infectivity was high.
           | 
           | My weird theory: how can we know then if aging (or its
           | acceleration or the diseases usually linked to it) isn't the
           | result of some infection that's super contagious and infects
           | 100% of the people,
        
             | inter_netuser wrote:
             | Because it's very unlikely the same pathogen or disease
             | would affect shrimp and humans in the exact same way.
        
             | raylad wrote:
             | It's not weird, it's the same idea I had back in the 1970s,
             | but at that time things like retroviruses weren't known or
             | understood.
             | 
             | Now we know about endogenous retroviruses, and yes, they
             | have infected everyone (going back millions of years) and
             | yes, they do become more active in aging and are
             | responsible for cancers and causing cellular senescence via
             | DNA damage through retrotransposon activity.
             | 
             | You can inhibit them with some of the same anti-retrovirals
             | that work on HIV. Or nutritionally what may work is: high
             | doses of cyanidin plus NAD precursors to stimulate SIRT6,
             | which normally prevents at least one of these endogenous
             | retroviruses, LINE1, from being expressed.
        
               | csdvrx wrote:
               | Super interesting. Please tell me more, like what you are
               | taking besides that.
               | 
               | I find it especially interesting how some multicellular
               | macro organisms like jellyfish (one of the oldest
               | ancestor of all non insect animals) have no aging, while
               | humans and most other animals do.
               | 
               | Could it be that their immune system or simply their
               | evolutionary path prevented them from being exposed to
               | such endoviruses, that may simply be too omnipresent (or
               | long integrated) in about every other species to be
               | selected out? (They could also present an advantage at
               | the population scale, by ensuring a quick turnover and
               | therefore more genetic evolution simply by filtering out
               | not just the unadvantageous gene but the older adults,
               | thus offering more opportunities for the new generation
               | to replace them faster)
               | 
               | This could be supported if jellyfish had less
               | requirements for evolution, like a stable ecological
               | niche - something I have no idea about!
        
         | arbuge wrote:
         | Calm down... from the article:
         | 
         | "Note, though, that EBV would then be in the "necessary but not
         | sufficient" category. There's something about the interaction
         | of particular human immune systems with EBV infection that
         | pushes things over into the pathological state of multiple
         | sclerosis, and we don't really know how to identify these
         | people. But that fits with what we know about infectious
         | disease in general - everyone's different. The situation with
         | Guillian-Barre is similar - a small number of people tip over
         | into neurological pathology, for reasons unknown, and that one
         | also often seems to follow some sort of viral infection."
        
           | jka wrote:
           | That's a good quote, thank you.
           | 
           | About the use of "calm down" as an instruction: while your
           | sentiment is good (to reduce another person's anxiety), it's
           | not always possible for someone to follow that when it is
           | received as an instruction. It's tricky to estimate other
           | people's emotional state based on text, and for them to infer
           | your tone. I'm overexplaining and sure that you probably
           | understand all that; but it feels worth mentioning.
        
             | jonnycomputer wrote:
             | True. My first reaction to the directive, was that it was
             | rude. Reading more of the context attenuated that
             | impression, but I still think it could have been phrased
             | less ... paternalistically?
        
               | jka wrote:
               | You could be onto something there, yep.
        
               | jonnycomputer wrote:
               | Communication is hard.
        
               | zepto wrote:
               | It is, but there are some easy heuristics before you get
               | to the hard stuff.
               | 
               | One is that telling people how they should feel about
               | things is usually irritating.
        
               | jka wrote:
               | It certainly is.
               | 
               | Here's a (probably totally unrelated) comment that I
               | think is good food for thought:
               | https://news.ycombinator.com/item?id=29917158
        
               | jonnycomputer wrote:
               | Interesting.
        
               | jka wrote:
               | :)
        
             | dwmbt wrote:
             | > About the use of "calm down" as an instruction: while
             | your sentiment is good (to reduce another person's
             | anxiety), it's not always possible for someone to follow
             | that when it is received as an instruction.
             | 
             | this is a pet peeve of mine. something i picked up when i
             | was a counselor at a special needs camp was the idea that
             | everyone (regardless of where you lie on any spectrum) has
             | a unique sensitivity to criticism. it's important to NOT
             | treat people how you would like to receive criticism, but
             | to assess how you think they would best consume and digest
             | it. obviously, this is extremely difficult on the internet
             | and i'm just nitpicking but i had an altercation with my
             | sibling earlier when they told me to 'calm down' so i'm
             | still on edge about it.
             | 
             | i'm sure OP doesn't need to hear this but typically i find
             | that a good alternative is to nudge someone into
             | rationality. not to say that the parent comment is
             | irrational, but when you simply show someone why they may
             | be overreacting, they may very well 'calm down' all by
             | themselves. if said person refuses to acknowledge your
             | rationale, it's likely they aren't welcome to any criticism
             | at all and won't be 'calming down' in any capacity.
        
         | RspecMAuthortah wrote:
         | How do you even test for EBV? The GP I asked laughed it off
         | when I was living in Canada basically saying I am already
         | positive and no need to test.
        
           | currency wrote:
           | This was a study conducted by the military on soldiers. They
           | all contributed three blood samples over a period of time
           | that were tested for a large number of conditions. EBV was
           | the only one that contributed to MS.
        
           | rmind wrote:
           | If you want to test whether you already _had_ EBV, then it
           | would be a test for Immunoglobulin G (IgG) antibodies to the
           | EBV viral capsid antigen (VCA). It shows whether the virus
           | has established the latency in your body. Most laboratories
           | would just label it as  "EBV IgG", so just ask for that.
           | 
           | If you are in your 30 or older, then you most likely have had
           | it already.
        
             | panabee wrote:
             | thanks for sharing.
             | 
             | does this test for EBV in both latent and lytic phases?
             | 
             | EBV seems very adept at evading the immune system. does
             | this also impact our ability to perform accurate detection
             | (i.e., could current methods yield false negatives)?
        
               | rmind wrote:
               | EBV VCA IgG antibodies remain present for the rest of
               | your life, as your immune system maintains certain
               | antibody levels to keep the virus in check (it's a
               | delicate host-virus balance).
               | 
               | EBV VCA IgM indicates a primary EBV infection and these
               | antibodies remain for a few months, until seroconversion
               | happens. They might not necessarily be present
               | immediately. During the primary infection, the virus is
               | in active lytic replication which can accurately be shown
               | by an EBV PCR test.
               | 
               | Once the virus establishes latency, EBV PCR will be
               | negative. It may occasionally become positive when EBV
               | reactivates, but it may also reactivate in other
               | compartments i.e. it infects more than just B-cells and
               | the standard PCR test wouldn't show that. There are more
               | antibodies involved and the whole thing is more complex
               | than just the lytic and latent cycles.. the immune system
               | is very complex.
        
               | csdvrx wrote:
               | They have like 2 separate tests: one for old EBV (IGG)
               | and one for new EBV (IGM or maybe it's the other way
               | around?)
               | 
               | IDK about false positive though
        
           | cestith wrote:
           | There are at least two tests for it, or at least there were
           | in the mid 1990s. One's a quick clinical test with lots of
           | false negatives than can be done in-office but unless it's a
           | campus healthcare clinic at a university they probably don't
           | bother. The other is a more sensitive lab test that takes a
           | few days. If you're having a really serious set of symptoms
           | they may test to confirm it's not something else. If it's a
           | minor case, two weeks of bedrest fix a lot of issues in a
           | young adult and you do probably already have it anyway.
        
           | epgui wrote:
           | You can test for pretty much anything in a research setting.
           | 
           | In a clinical setting, doctors will rely a lot on heuristics
           | and practical considerations, and there may not be any
           | clinical testing available.
        
             | bluGill wrote:
             | Even if there is a test, sometimes it is insanely expensive
             | and so they won't give it if they can find any other way to
             | decide.
        
         | lalaland1125 wrote:
         | One important thing to note is that EBV is extremely prevalent.
         | Almost everyone gets it eventually and very few of those people
         | develop MS.
        
           | jonnycomputer wrote:
           | But a lot of people don't really develop severe symptoms
           | either, right?
        
             | Broken_Hippo wrote:
             | Many if not most folks dont' even realize they get it
             | because they catch EBV as a child. In children, it
             | generally causes no symptoms or symptoms so mild that they
             | are dismissed as a normal childhood virus. You know, the
             | sort you miss 2 days of school for and then go on. This is
             | the reason most folks don't know they've had it.
             | 
             | When we get older - teens and adults -, we are more likely
             | to have it develop into mono or other things that
             | realistically make your life difficult for a while.
        
             | cestith wrote:
             | Some develop no noticeable symptoms and many develop mainly
             | annoying ones for a few weeks to a few months. I had the
             | misfortune to develop symptoms from infectious
             | mononucleosis shortly after minor surgery. My GP and
             | surgeon kept giving me antibiotics and sending me back to
             | uni. Finally after several months of fatigue, nausea, and
             | depressed appetite I wandered into campus health jaundiced
             | with a 104o F fever and a temporarily enlarged liver. I
             | ended up withdrawing from that semester and retroactively
             | from the previous one. I was ordered into a month of
             | bedrest and half a year of decreased physical activity
             | while recovering. So I guess we could say there's a wide
             | range of severity, partly depending on how soon it's
             | addressed.
        
             | marvin wrote:
             | When I had it, my doctor said that if I was a professional
             | athlete, the standard outcome would be to just consider the
             | current season lost and switch focus to getting well again
             | in time for the next.
             | 
             | I was relatively useless for two weeks and then spent the
             | next four months getting back to my normal energy levels.
             | "Severe" is a question of definitions, I think. I wouldn't
             | consider that kind of illness severe, but it certainly put
             | a dent in things for a while. Properly inconvenient, I'd
             | say. I think this degree is pretty common.
        
         | peter303 wrote:
         | Possibly a co-factor, since many get EBV and few MS.
        
         | nefitty wrote:
         | The article says EBV is prevalent and is probably necessary but
         | not sufficient for MS. If I was in that position I would look
         | at my gene test results for any markers that correlate with MS.
         | The more of those markers, the more intensely I would
         | prioritize following relevant interventions.
        
           | nradov wrote:
           | What are the relevant interventions? Which genes correlate
           | with MS?
        
             | nefitty wrote:
             | That's the independent study part. I wish I could be more
             | help but that research is time and money intensive, and not
             | guaranteed to be fruitful. It also involves review of
             | multiple studies, sometimes several dozen. Then it's about
             | seeing which ones are relevant to an individual's specific
             | genetic mutations.
             | 
             | I'm currently going through dozens of reports from
             | SelfDecode, and that's after massive amounts of work on
             | their end. I think I'm out a few hundred bucks so far, but
             | it is an amazing service. I will soon seek their genetic
             | consultation service, which is about $1k, and their lab
             | testing service.
        
               | mwint wrote:
               | Genuinely curious, what's your ultimate goal here? What
               | do you optimize for? Total life-years, sum quality-of-
               | life, etc.?
               | 
               | Seems like picking out the diseases you don't want to
               | get/die from is a way to go nuts; curious how you're
               | thinking about this.
        
         | f38zf5vdt wrote:
         | If you're going to develop MS as an adult after getting EBV
         | mononucleosis, it's likely that it will be soon (5-10 years)
         | after you have the initial infection as an adult. There's only
         | a long delay in children according to one study. [1] Every
         | passing year the probability of getting MS should decay after
         | that.
         | 
         | Female sex and EBV mononucleosis during adolescence are the
         | biggest risk factors.
         | 
         | [1] https://nn.neurology.org/content/4/3/e308
        
           | config_yml wrote:
           | Interesting. My sister and I both had mononucleosis before
           | puberty, and she was diagnosed with MS in her late twenties.
        
           | Broken_Hippo wrote:
           | Scores of folks with MS never had mono. I'm one of those. It
           | isn't mono that is the risk factor, but EBV itself.
        
         | [deleted]
        
         | [deleted]
        
         | cjensen wrote:
         | EBV causes more severe symptoms the older you are. So everyone
         | here who remembers getting it and it being terrible? That's
         | because you got it as an adult. If you get it as a kid, it can
         | be asymptomatic.
         | 
         | I got it at 36 and had a fever that leveled me for 3 weeks.
         | Between "wait 1 week before bothering your doctor" and multiple
         | rounds of tests, they didn't even diagnose it as EBV until the
         | 3rd week.
        
           | csdvrx wrote:
           | I got at 21 IIRC and I was in bed for a few weeks and the
           | doctor started fearing I had a blood cancer or something
           | given how abnormal the tests were until he finally got the
           | idea to test for EBV and it came back super positive.
           | 
           | Never before was I so happy to get tested positive for
           | something lol
           | 
           | It's been a few years and I think I'm fine but due to hedonic
           | adaptation etc maybe for all I know I operate at like 70% of
           | my previous capacity and don't even realize it
           | 
           | So I'm super interested in all that new research and I can't
           | wait until we get mRNA vaccines against EBV!!
        
         | MaximumYComb wrote:
         | Wow, I was also EBV positive ~4 years ago (45 months), was
         | symptomatic and I had post viral fatigue for around a year. It
         | was 12 months before I could do light physical training and it
         | was around 2.5 years before I could train physically at high
         | intensity.
        
           | csdvrx wrote:
           | Do you have a baseline to compare or are you only relying on
           | your memory?
           | 
           | I got it at 21 and now I fear I may operate at a lower
           | overall potential since I don't have a baseline to compare to
        
         | Severian wrote:
         | Found this in my news feed, so this timely. Good news I guess!
         | 
         | https://www.forbes.com/sites/roberthart/2022/01/14/moderna-s...
        
           | Miner49er wrote:
           | Is there any evidence that the vaccine wouldn't also cause
           | MS? From my understanding, MS is caused by the immune
           | response, and the vaccine would trigger a similar (or same?)
           | immune response.
        
         | garganzol wrote:
         | There is one more condition you may be interested in: CFS/ME.
         | It manifests itself primarily as a chronic fatigue and is
         | believed to onset after a trigger event: virus, intoxication,
         | hypoxia, stress, and the like.
         | 
         | I talked to some people with MS and most of them told me the
         | same story: the trigger event, followed by some time, then
         | onset of a full-blown MS.
         | 
         | I wonder: are those diseases really different? Or maybe this is
         | the very same disease but with a bit different outcomes:
         | myalgic encephalopathy vs sclerous plaques. Both are driven by
         | the inflammation, both have the same initiating sequence.
         | 
         | What leads me to strongly suspect that it may be just different
         | manifestations of the same disease is the involvement of
         | mitochondria in both MS and CFS/ME.
        
           | kennethh wrote:
           | In Bergen in Norway we had a big outbreak of Giardia parasite
           | and a lot of people got CFS/ME after that. The Giardia was
           | big because the parasites came into the drinking water from
           | one of the water sources. I myself had this for of this for
           | many years afterwards but one do not notice it since before
           | you get rid of it. I was able to function normally but
           | totally lacked energy, and everything was a chore. It was
           | like the feeling the first time one drinks coffee and
           | experience the way the fog clears up.
           | 
           | Conclusion. The study shows that Giardia duodenalis may
           | induce CFS persisting as long as five years after the
           | infection. Obstructive sleep apnoea/hypopnoea syndrome,
           | depression and anxiety were important differential diagnoses,
           | or possibly comorbidities, to post-infectious fatigue in this
           | study.
           | 
           | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598369/#:~:tex.
           | ...
           | 
           | Also very impressed with google when searching for: giardia
           | leads to CFS
        
           | rmind wrote:
           | Back in 1980s, there were proposals for a "chronic
           | mononucleosis" or "chronic mononucleosis syndrome" as a
           | diagnosis / standard disease. There were very comprehensive
           | studies trying to investigate the patients who had chronic
           | fatigue and other long lasting debilitating symptoms. After a
           | good decade of studies, the research community found that
           | this group of patients is very consistent (their complaints,
           | symptoms, etiology), but failed to prove EBV as a cause
           | (although the studies did not disprove it either) or at least
           | come up with a clear serological diagnostic criteria. So, in
           | 1990s they decided to define a generic Chronic Fatigue
           | Syndrome (CFS) as a standardized disease. Other viruses and
           | pathogens can cause CFS/ME and a broader definition would
           | sometimes include even psychosomatic patients, so as a result
           | CFS/ME has been quite discredited.
           | 
           | Diagnostic techniques evolved and research progressed. In the
           | recent decade, new studies are very close to proving that EBV
           | is indeed a likely cause of CFS/ME (well, one segment, as
           | there are other causes too). Reference:
           | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7912523/
        
           | radicalbyte wrote:
           | I have this pet theory that CFS/ME is what a lot of long-
           | covid patients are suffering. I knew a few people who have
           | been affected by it, and it really limits them. Just as long-
           | covid seems to.
        
             | garganzol wrote:
             | I came to the same conclusion as well. Moreover, I was
             | somewhat successful in healing post-viral CFS/ME using the
             | therapy targeted at mitochondria with large doses of B1 and
             | B3 vitamins [1].
             | 
             | [1] https://news.ycombinator.com/item?id=29138006
        
               | PaulKeeble wrote:
               | Its worth noting that 80% of those the develop post viral
               | conditions just recover, we don't know why. It is
               | unlikely your intervention is the reason you recovered,
               | the majority of people do even if they do nothing at all.
               | We do know that those that rest and stay below their
               | energy budget have a better chance but that is about it,
               | nothing else has shown efficacy.
        
               | garganzol wrote:
               | Intervention was only applied to people who did not
               | recover by themselves. But almost all of them recovered
               | after intervention which leads me to believe that we are
               | onto something here.
        
               | csdvrx wrote:
               | > using the therapy targeted at mitochondria with large
               | doses of B1 and B3 vitamins
               | 
               | commercially available under the brand names... "Red
               | Bull" and "Monster"
        
               | garganzol wrote:
               | Nope. They do not contain the key element - vitamin B1
               | which is also called thiamine. Instead, they do contain
               | large doses of caffeine which is known to abruptly
               | inhibit thiamine absorption in the body leading to
               | mitochondrial ETC inhibition when a person has deficit.
               | 
               | Then comes sugar - those drinks contain too much of it
               | causing the unneeded insulin spikes. Sugar free variants
               | are even worse - they (esp. aspartame) cause the insulin
               | spikes as well but lead to insulin resistance progression
               | much faster [1]. By the way, Insulin resistance and
               | hyperlipidemia are hallmark signs of mitochondrial
               | dysfunction.
               | 
               | Yes, they do contain some 10-20 mg of B3 (nicotinamide)
               | and that's it. Not enough for the treatment; other key
               | elements are missing.
               | 
               | That's why people with CFS/ME condition do not feel
               | better after energy drinks, usually they feel even worse.
               | 
               | [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014832/
        
               | csdvrx wrote:
               | Super interesting thank you!
               | 
               | They already have B3 B6 B12 (my mistake about M1)
               | 
               | So the energy drinks should contain B1 or be taken with
               | B1, is that what you say? If they don't already have B1,
               | why is it so given the other vitamin B? Could it be for a
               | good reason?
               | 
               | About insulin resistance, Monster contains sucralose and
               | acetasulfame. It's not clear if the effect reported with
               | aspartame also happen with these. Still, a super
               | interesting thing to check - one of the many reasons I
               | love HN!
        
           | thewebcount wrote:
           | And along with CFS/ME, also look up POTS, MCAS/MCAD, and EDS.
           | My wife had a very bad bout of mono in late high school and
           | 15 years later developed POTS, MCAS, and what the
           | rheumatologist called "unspecified connective tissue
           | disorder," which seems like a mild case of EDS. After 10-15
           | years of trying treatments, she's significantly worse off.
           | :-/
           | 
           | There are tons of people (mostly women) out there with this
           | set of conditions, and they're only starting to be taken
           | seriously. It's a set of life-altering conditions and dealing
           | with the medical system when you have it can be infuriating
           | and exhausting. I hope you don't have any of these things.
        
             | garganzol wrote:
             | POTS, MCAD-like (hyperlipidemia) and inflammatory
             | conditions are triggered by CFS/ME as well.
             | 
             | I am really puzzled: are we dealing with the same thing but
             | under different names?
             | 
             | For reference, NSAIDs combined with high-dose vitamin
             | therapy help to resolve those conditions in people with
             | CFS/ME.
        
             | mturmon wrote:
             | My wife also has MCAS, POTS, and a connective tissue
             | disorder that is not at the level of EDS. Was diagnosed
             | about 4 years ago and is on treatments to suppress some
             | immune responses, that has been helpful at taking the edge
             | off some symptoms. It was like tumblers clicking into place
             | when she saw a specialist and got the diagnosis, so many
             | rather disparate, long-term symptoms all from the same
             | cause.
        
       | aljungberg wrote:
       | The parallel to Guillan Barre Syndrome seems intuitive. MS and
       | GBS are both autoimmune disorders which damage myelin. MS is
       | slower and chronic while GBS is acute and rarely relapses. What
       | if MS is a low grade persistent immune response to a chronic
       | viral infection such that those bad antibodies are created in
       | small amounts indefinitely?
        
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