Whole Body Cryotherapy for Multiple Sclerosis: Application, Effects, and Suggested Treatment Regimens
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INTRODUCTION: MEDICAL USE REQUIRES SUPERVISION BY A DOCTOR Based on theoretical knowledge, clinical studies and experience the indication list for whole body cryotherapy has been increasingly justified and expanded over the last 6 years to include a variety of health disorders. The terminology has also been adjusted to distinguish between talking about healthy subjects (cryostimulation) versus patients (cryotherapy). For some health conditions, the benefits of whole body cryotherapy have been proven to the point that recommendations to incorporate it in the treatment regimen are given by medical professionals with confidence. These conditions include inflammatory rheumatic diseases(rheumatoid arthritis and ankylosing spondylitis), degenerative rheumatic diseases (osteoarthritis) and chronic pains of various causes. The most common expectations from incorporating cryotherapy in treating the named disorders are reduction in inflammatory activity and pain. Numerous clinical observations have now been published that underline the positive effect of whole body cryotherapy also in people diagnosed with multiple sclerosis (MS). The reported benefits include slowing of the disease progression, possibly, by impacting the underlying inflammation, and relieving its symptoms, such as pain and fatigue. Data also shows that whole body cryotherapy improves the antioxidant capacity of the organism, helping reduce oxidative stress. It is known to cause degenerative changes in the nervous system that are often involved with MS on top of the immune-mediated disfunction. As a result, whole body cryotherapy is reported to be potentially instrumental in improving the overall well-being of multiple sclerosis patients. Nevertheless, regardless of the available proof of benefits, it must be noted that one needs a medical license to give any medical advice or, moreover, to prescribe a treatment. All cryocenters that do not have the credentials to practice medicine must ALWAYS stress that whole body cryotherapy is an adjuvant option that must be considered in every individual case by a doctor.
WHAT IS MULTIPLE SCLEROSIS Multiple sclerosis is an immune-mediated chronic inflammatory disease of the central nervous system – brain and spinal cord. In MS, the immune system attacks the protective sheath (myelin) covering nerve fibers. The resulting nerve damage disrupts communication between the brain and the body. The symptoms can include tingling or pain in different parts of the body, impaired coordination, dizziness, fatigue, slurred speech, double vision, or loss of vision.
In addition to the immune-mediated disfunction, degenerative changes in the nervous system can occur in which oxidative stress can be regarded as a trigger.
Signs and symptoms of multiple sclerosis vary widely and depend on the amount of nerve damage and which nerves are affected. Some people may experience long periods of remission, also with regression of symptoms, while others may lose the ability to walk independently or at all, due to permanent damage or deterioration of the nerves. There is no cure for multiple sclerosis, but treatments can help manage symptoms, speed recovery from attacks, and even modify the course of the disease.
THE SIZE OF THE PROBLEM
In numbers, multiple sclerosis does not compare with arthritis or other widespread painful disorders. If 1 out of 4 US adults suffers from some form of rheumatic disease, only 1 in 300 to 350 gets diagnosed with MS. In the United States, it is about 1 million people.
Most people with MS experience their first symptoms and are diagnosed between the ages of 15 and 50, and women are 3 times more likely to have MS than men.
Regardless of the numbers, there are at least 3 reasons to talk about MS:
- The truly damaging effect on the well-being of those affected and their families.
- The dramatically increased risk of developing the disease if somebody in the family has it (in this case, preventive measures are important to take as early as possible).
- The fact that almost half of the multiple sclerosis cases worldwide are registered in the US where poor eating habits and life-style choices contribute to the increased risks of developing a disability in a big way.
- The number of people diagnosed with multiple sclerosis has been growing by about 2.5% per year since 2010, at more than double the speed of the world population growth. In 2013, P. Browne et al called it a “growing global problem with widespread inequity.”
THE RISK FACTORS AND THEIR MANAGEMENT Researchers have studied a variety of possible causes for multiple sclerosis, and a combination of factors appears to be involved: - Genetic susceptibility. No compelling candidate genes for MS have been identified just yet and the exact mechanisms remain unclear. Nevertheless, genetic studies have clearly shown that the increased frequency of MS seen within families is a result of relatives. sharing DNA. - Slow-acting viruses that could remain dormant for many years, such as measles, herpes, human T-cell lymphoma, and Epstein-Barr may lead to development of MS in genetically susceptible people. - Vitamin D deficiency. Studies suggest that low levels of vitamin D may increase the risk of MS. Besides, it is known that populations living closer to the equator experience a lower incidence of multiple sclerosis. - Obesity and poor diet (high intake of saturated fats and salt), known to increase the number of inflammatory cells in the body. - Smoking. Data shows that women who smoke are 1.6 times more likely to develop MS than women who are non-smokers. Individuals with MS who smoke also appear to be at a much greater risk of experiencing a more rapid progression of their disease.
THE IMPORTANCE OF TREATMENT Although multiple sclerosis cannot be cured, treatments can help manage symptoms, speed up recovery from attacks, and even alter the course of the disease. Once MS is diagnosed, a long-term disease modifying therapy is CRUCIAL, since disease activity and damage continues within the central nervous system even when no new symptoms are present. When a patient begins treatment EARLY in their disease course, the progression of the disease is slowed, possibly delaying any related disability, and the number and severity of symptom flare-ups is reduced. It also decreases the number of active lesions*seen on magnetic resonance imaging(MRI).
* In MS, the term lesion refers to an area of damage or scarring (sclerosis) in the central nervous system caused by inflammation that results from the immune system attacking the myelin sheath around nerves. Lesions are sometimes also called plaques.
As in all disorders, only an INTEGRATIVE APPROACH to treatment can provide true relief and lasting results, and one’s doctor should be the one to come up with the best treatment regimen for the patient’s needs.
In addition to medication, the plan may include: - Stem cell therapy. - Deep brain stimulation. - Exercise and numerous physical therapies. - Acupuncture. - Chiropractic care. - Massage. - Pulsed electromagnetic field (PEMF) for “pins and needles” sensation that often comes with MS. - Cannabis, and many more.
Whole body cryotherapy is also increasingly recommended as an “adjuvant therapy in the treatment of diseases with oxidative stress background, since it improves the antioxidant capacity of the organism” (4) and as a pain relieving and cooling treatment prior to exercise (5), as physical activity in multiple sclerosis patients can alleviate hyperthermia. The anti-inflammatory benefits of WBC could also be instrumental in slowing the progression of the disease. As with numerous other health conditions, your cryocenter may be able to help, for as long as the importance of an oversight by a health professional is understood and stressed and no medical advice or a recovery promise is given. Multiple sclerosis is a complex condition in which damage of the nervous system keeps occurring even when in the phase of symptom remission.
THE ROLE OF CRYOTHERAPY The below quoted studies show that whole body cryotherapy can ease multiple sclerosis symptoms, while pre-workout cooling can also reduce exercise-induced overheating of the body. There is evidence that multiple sclerosis is not only characterized by immune mediated inflammatory reactions but also by neurodegenerative processes. Therefore, researchers have studied the ways of not only reducing inflammation but also neutralizing oxidative stress and excitotoxicity, thinking that it might represent a therapeutic approach to provide neuroprotection.
Oxidative stress is the result of an imbalance of free radicals in the body. They damage proteins, lipids, and nucleic acids, which in turn causes inflammation. The inflammation results in demyelination of the central nervous system and has a bearing on how severe a patient's multiple sclerosis is.
In several consecutive studies led by Elzbieta Miller1,2,3,4, researchers compared changes in total antioxidative status (TAS) and activity of chosen antioxidative enzymes, such as SOD (superoxide dismutase), in patients with MS before and after using wholebody cryotherapy. The results demonstrated that two weeks of cryotherapy once daily resulted in a significant increase of total antioxidative status in comparison to the reference group that did not use whole body cryotherapy. There was also statistically significant increase of the activities of SOD in erythrocytes obtained from the whole-body cryotherapy study group. It was concluded that expositions to extremely low temperatures used in cryotherapy improve the antioxidant capacity of the body; therefore, whole body cryotherapy might be a solution to suppress oxidative stress in MS patients. Another study (5) demonstrated that cooling before exercise improved multiple sclerosis patients’ functional and exercise capability, as it reduced the damaging effect of post-exercise hyperthermia. CRYOTHERAPY PROTOCOLS FOR MULTIPLE SCLEROSIS Due to the complex nature of the disease, more than in other cases, it is of KEY IMPORTANCE to determine the individually required and tolerable dose of whole body exposure to cold depending on the person’s ability to adequately react to the extreme cold stimuli. Refer to the Intake Process described in the Cryotherapy Safety Module for guidelines.
An open ongoing cooperation between the patient and their doctor about whether and how to use whole body cryotherapy is an ABSOLUTE REQUIREMENT. WBC should not be seen as a replacement but as a potentially beneficial supplement to other therapies. The treatments that were already applied before should be continued. Any changes, if at all, should only be carried out with the doctor’s consent. According to the previous experience, a whole body cryotherapy course may be considered twice a year for 2 to 3 weeks with one or two exposures per day, mainly in association with gymnastic exercises that specifically consider the individual symptomatology. The recommendation for the therapeutic course should be based on the acquired knowledge that the improvement in state is approximately linear to the duration of therapy. Although cold treatments for a shorter period than the described2 to 3 weeks can also produce already good success, they do
not achieve all that is possible. Numerous studies have concluded that the results start showing after 10 consecutive treatments but are most sustainable after 20. It must also be ensured that upon improvement in condition the physical load does not exceed the range of well-being. The reduction in symptoms after whole body cryotherapy can unfortunately induce such urge.
Zimmer Medizin Systeme reports that their clinics that followed the researchers’ suggestions and started applying whole body cryotherapy in people with multiple sclerosis observed the following results (6): - The status after whole body cold exposure was described by most patients as pleasant. - The entire spectrum of symptoms was relieved. - Spasms were reduced and gymnastic exercises could be carried out more precisely. - Patients felt stronger, fatigued less quickly, and were mentally more active. - The motor system, perambulation, and mobility were improved, and disturbances in equilibrium were reduced. - Pains were eased or even eliminated (this mainly concerned secondary pain that primarily came from postural troubles of the spine, muscular straining, and inordinate stressing of the joints). - The afflicted individuals referred to the state achieved after the cold therapy as a clear increase in quality of life.
OTHER CONSIDERATIONS FOR MORE NOTICEABLE RESULTS It is important to remember that multiple sclerosis treatment requires a complex and individualized approach, considering the symptoms and the course of the disease of the patient.Although there are general recommendations on how to manage the symptoms naturally and prevent or reduce flare-ups, only a doctor is qualified to give such advice. Your cryocenter may raise the awareness of possible strategies and suggest that the client talks to their doctor about them.
According to Multiple Sclerosis Association of America (mymsaa.org), National Multiple SclerosisSociety (nationalmssociety.org), overcomingms.org, neurologyadvisor.com, medicalnewstoday.com, and multiplesclerosisnewstoday.com, the following factors play a major role in slowing the progression and managing the symptoms of multiple sclerosis: - The “Overcoming Multiple Sclerosis” diet. - Sun exposure and vitamin D supplements. - Taking antioxidants. - Maintaining physical activity. - Stress management.
The OMS (Overcoming Multiple Sclerosis) diet Multiple studies have demonstrated that a healthy and balanced diet may help significantly improve MS symptoms — for example, lift fatigue, maintain regular bowel and bladder functions, improve the health of skin, bones, teeth and gums, strengthen the heart, and improve muscle strength and flexibility. A healthy diet also helps control weight and reduce the risk of heart disease and osteoporosis. There is no evidence supporting superiority of one specific diet, but there are common benefits in several. For the best results, people with MS should consult with their personal physician before making any changes to best meet their individual needs and preferences. A balanced diet for people with MS should include: - Fish high in Omega-3 fatty acids, such as salmon, herring, mackerel, tuna, sardines, and lake trout (Omega-3 deficiency is thought to contribute to symptoms). - Other unsaturated fats (e.g. flaxseed oil). - Skinless chicken or turkey and lean meats trimmed of visible fat. - Beans, lentils, and nuts. - Fruit and vegetables (about five a day). - Whole-grain products (three to four servings a day). Several long-term studies have demonstrated a close connection between saturated fats (such as those in meat and dairy) and the development and progression of MS. On the contrary, a 34-year study by Prof. Roy Swank has proven that people with MS consuming a diet LOW in saturated fat have dramatically better health outcomes. For this reason, foods that should be avoided include:
- Foods high in saturated fat, such as red meat. - Butter, cheese, and other full-fat dairy products, due to proteins in cow’s milk that are thought to have a generally toxic effect on nervous tissue.
The importance of sufficient levels of vitamin D It is proven that exposure to sunlight can reduce the incidence and severity of MS. When the sun's UVB rays hit the skin, they produce vitamin D, a hormone that is important for good health generally, but particularly for people with MS, because it dampens overactive immune responses and protects brain cells. Unfortunately, in many parts of the world, sunlight is too scarce, or UVB levels are too low, to produce enough vitamin D. 1 billion people across the world are vitamin D deficient. The result should be above 150 nmol/L (60 ng/mL in the USA). Research has shown that people with MS have lower levels of vitamin D and that vitamin D levels are even lower during MS relapses. Consequently, a vitamin D level test should be performed immediately upon being diagnosed with MS and supplementation may be necessary.
Antioxidants Since oxidative stress is a major contributor to inflammation in people with multiple sclerosis, taking antioxidants may also slow disease progression. New research offers hope for MS patients after finding that even a common over-the-counter antioxidant may help to slow the condition. For example, studies performed by Rebecca Spain, MD, MSPH, from the VA Portland Healthcare System and Oregon Health and Science University, have linked lipoic acid to decreased inflammation, as well as decreased optic nerve and spinal cord atrophy. Other common antioxidants include vitamins A and E, as well as coenzyme Q10. The importance of movement Although exercise is beneficial and strongly recommended to people with MS, multiple sclerosis patients tend to avoid physical activity, due to some symptoms, such as lack of coordination, as well as exercise-induced hyperthermia. Studies show that exercise not only improves function but also reduces depression, improves mood and general well-being in people suffering from multiple sclerosis, and that walkable distance increases with regular treadmill training: - In people with mild MS, exercise improves fitness and function. - In people experiencing moderate to severe disability, it helps maintain function. - In people with significant disability, movement improves muscle power, exercise tolerance and mobility-related abilities(such as walking). There is also indirect evidence that exercise may modify the course of MS through a neuroprotective effect: - Two proteins, brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF), help repair neurons in MS. Physical activity significantly boosts these proteins - people with MS who exercise show increased levels of neurotrophic factors. - Exercise helps prevent cognitive decline. Those who exercise the most show the least amount of brain shrinkage. - Movement exercise has a better effect on spasm and increased tone than just stretching. - Core postural strength helps correct balance problems that threaten stability.
- Muscle strength protects from injury. - Exercise counteracts the effects of deconditioning.
If exercise-induced hyperthermia is an issue, it can be managed using pre-exercise cooling of the body, such as cryotherapy. Stress management Stress triggers relapses which is why adopting practices such as spending time outdoors, in nature, or any form of meditation is important for people with multiple sclerosis. The clinical evidence for meditation's health benefits is enormous and growing rapidly.
Preventing the risk of developing MS for family members There is a genetic element to multiple sclerosis which means that children, siblings, and other relatives of people with MS are at a greater risk of developing it, too. If a MS patent has an identical twin, there is a 25% chance that the twin brother or sister will also develop it. A sibling or a child of someone with MS has an increased chance of 1 in 10 of developing the same disorder, as opposed to the general number of just 1 in 300 to 350. While these numbers can be frightening, it is important to remember that the discussed above lifestyle changes and non-medical therapies like whole body cryotherapy can significantly reduce the overall risk of developing MS. SOURCES 1. Elzbieta Miller, Małgorzata Mrowicka, Katarzyna Malinowska, Krystian Zołyński, Józef Kedziora. Effects of the whole-body cryotherapy on a total antioxidative status and activities of some antioxidative enzymes in blood of patients with multiple sclerosis. Preliminary study. The Journal of Medical Investigation 2010 https://www.ncbi.nlm.nih.gov/pubmed/20299758
2. Elzbieta Miller, Małgorzata Mrowicka, Katarzyna Malinowska, Józef Kedziora, Ireneusz Majsterek. The effects of whole-body cryotherapy and melatonin supplementation on total antioxidative status and some antioxidative enzymes in multiple sclerosis patients. Polski Merkuriusz Lekarski 2011 https://www.ncbi.nlm.nih.gov/pubmed/21991843
3. Elżbieta Miller, Małgorzata Mrowicka,Katarzyna Malinowska, Jerzy Mrowicki, Joanna Saluk-Juszczak, Józef Kędziora. Effects of whole-body cryotherapy on a total antioxidative status and activities of antioxidative enzymes in blood of depressive multiple sclerosis patients. Comparative Study. The World Journal of Biological Psychiatry 2011 https://pubmed.ncbi.nlm.nih.gov/21083503/
4. Elżbieta Miller, Łukasz Markiewicz, Joanna Saluk, Ireneusz Majsterek. Effect of short-term cryostimulation on antioxidative status and its clinical applications in humans. European Journal of Applied Physiology 2012 https://www.ncbi.nlm.nih.gov/pubmed/21874554
5. Antonia Kaltsatou, AndreasD. Flouris. Impact of pre-cooling therapy on the physical performance and functional capacity of multiple sclerosis patients: A systematic review. Multiple sclerosis and related disorders 2019
6. Prof. Dr. Sc. Med. Winfried Papenfuß. Power from the Cold. Whole body cryotherapy at -110° C, a short-lasting physical therapy with a long-lasting effect. 5th, revised and expanded edition January 2016, ISBN 978-3-938912- 08-9
Disclaimer: This article is a summary of available publications and some well- known practices that have proven to be effective in managing symptoms of multiple sclerosis. At the same time, every condition is different, and the result depends on many factors. By no means should this document serve as a success guarantee or as a replacement for medical advice.