Myasthenia Gravis Naturopathic Protocol

Myasthenia Gravis Naturopathic Protocol

This Myasthenia Gravis Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations. This Myasthenia Gravis Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.

HealthMasters Naturopath Kevin Tresize ND

Definition: Myasthenia Gravis 

Myasthenia gravis is a chronic autoimmune neuromuscular disease characterised by varying degrees of weakness of the skeletal (voluntary) muscles of the body. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Certain muscles such as those that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often, but not always, involved in the disorder. The muscles that control breathing and neck and limb movements may also be affected. Most individuals with myasthenia gravis have a normal life expectancy.

Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction - the place where nerve cells connect with the muscles they control. Normally when impulses travel down the nerve, the nerve endings release the neurotransmitter acetylcholine, which travels from the neuromuscular junction and binds to receptors that activate muscle contraction. In myasthenia gravis, antibodies block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle contraction from occurring.

In adults with myasthenia gravis, the thymus gland remains abnormally large. It contains certain clusters of immune cells indicative of lymphoid hyperplasia - a condition usually found only in the spleen and lymph nodes during an active immune response. Some individuals with myasthenia gravis develop thymomas (tumours of the thymus gland). Thymomas are generally benign, but they can become malignant. The relationship between the thymus gland and myasthenia gravis is not yet fully understood. Scientists believe the thymus gland may give incorrect instructions to developing immune cells, ultimately resulting in autoimmunity and the production of the acetylcholine receptor antibodies, thereby setting the stage for the attack on neuromuscular transmission.

Pesticide (organophosphates) exposure and intermediate Myasthenia Syndrome

Many pesticides contain organophosphates that function by inhibiting acetylcholinesterase activity, resulting in an increase in acetylcholine levels. High levels of organophosphate pesticides cause increased levels of acetylcholine to overwhelm the acetylcholine receptors, causing them to become dysfunctional (a phenomenon known as depolarization block). This results in muscle weakness, heart rhythm abnormalities, and ‘cholinergic crisis’ (increased bronchial secretions and subsequent breathing and swallowing problems), similar to what occurs following an overdose of acetylcholinesterase inhibitor medication. It is important to note that these symptoms are not related to an autoimmune response to the acetylcholine receptor. It has been estimated that approximately 3 million people are poisoned by organophosphates each year. Pesticide poisoning can manifest itself in three phases:

  • Acute phase (acute cholinergic phase). The acute phase occurs within hours of exposure and is characterised by nausea, vomiting, diarrhoea, cramps, dizziness, weakness and respiratory failure. Death is possible if respiratory failure is not addressed promptly.
  • Delayed phase (delayed neuropathy phase). A delayed phase occurs 2-3 weeks after exposure and is characterised by muscle numbness and weakness of the lower extremities followed by progressive increase in weakness of the limb muscles.
  • Intermediate myasthenia syndrome. Intermediate myasthenia syndrome (IMS) occurs within 24-96 hours, and symptoms include limb, neck, and respiratory muscle weakness, as well as motor nerve weakness. IMS can also lead to respiratory failure and death. With proper treatment, symptoms of IMS can improve within 5-18 days after initial onset.

Aetiology (Cause) / Risk factors: Myasthenia Gravis 

Major causative factors and risk factors that can contribute to the incidence of myasthenia gravis include the following:

  • Thymoma (tumour of the thymus) and/or hyperplasia of the thymus
  • Personal and/or family history of other autoimmune diseases – especially rheumatoid arthritis, scleroderma and lupus.
  • Common risks to autoimmunity are associated with myasthenia gravis, including environmental factors, smoking history, sex hormones, and exposure to certain viruses, including EBV.
  • Pesticide exposure – not autoimmunity, which requires medical management.

Signs and Symptoms: Myasthenia Gravis 

The onset of myasthenia gravis may be sudden and symptoms often are not immediately recognized. Common signs and symptoms of myasthenia gravis include

  • In most cases then first noticeable symptom is weakness of the eye muscles.
  • Muscle weakness that increases during periods of activity and improves after rest.
  • Difficulty in swallowing and slurred speech.
  • Asymmetrical ptosis (a drooping of one or both eyelids)
  • Diplopia (blurred or double vision)
  • Unstable or waddling gait
  • Weakness in arms, hands, fingers, legs, and neck
  • Change in facial expression
  • Dysphagia (difficulty in swallowing) & Shortness of breath
  • Impaired speech, often nasal due to weakness of the pharyngeal muscles
  • Generalised paralysis (including respiratory muscles – assisted ventilation may be required to sustain life)

Core Treatment: Myasthenia Gravis 

Neuro-protective antioxidants and mitochondrial support specific

Support healthy immune function (appropriate with immunosuppressive therapy)

Induce T-regulatory cells to manage autoimmunity

AND

PLUS

If with bacterial dysbiosis or candidiasis:

OR

If with digestive and/or systemic inflammation:

OR

If with recurrent or prone to infections:

If with depression

If with fatigue

Address dietary, lifestyle and environmental drivers 

  • If overweight or obese: Shake It Practitioner Weight Management Program
  • If associated with environmental toxicity: Questionnaire-guided Detoxification Program
  • If healthy weight, or for health maintenance: Wellness and Healthy Ageing Program

Alphabetical Reference of Nutritional Support: Myasthenia Gravis 

Formula Catch Phrase

Key Benefits

BCM-95™ Turmeric & Saffron for Depression

A unique combination to support a range of actions associated with depression. Can be used as a stand-alone solution or co-prescribed with pharmaceutical interventions. Also a potent broad-spectrum anti-inflammatory.

Cordyceps, Coriolus and Reishi for Immune Stimulation

Four clinically proven medicinal mushroom extracts with demonstrated potency to enhance immunity whilst reducing inflammation. Supports the resolution of chronic and/or recurrent infectious conditions, and safe for use in autoimmune diseases.

D-Ribose

D-Ribose is used in the body to make energy (ATP). As a supplement it boosts energy, increases muscle recovery and improve exercise and tolerance. It is also shown to relieve pain and fatigue in fatigue syndromes.

Enhanced Bioavailability Coenzyme Q10 150mg

Coenzyme Q10 is vital for mitochondrial function and energy production, critical to all body systems, including the neurological and immune systems.

High Bioavailability Zinc with Vitamin C

Zinc and vitamin C are amongst the most critical nutrients in healthy immunity, as both are involved in wound healing, immune balance and boost resistance to infection.

Lactobacillus paracasei LP-33® and Lactobacillus rhamnosus GG (LGG®) for Immune Control

A probiotic combination for patients requiring immune modulation, such as in allergies, eczema, and autoimmune conditions. These two clinically-trialled probiotic strains are known to help restore immune control and moderate over-active immune responses by supporting T-regulatory cell function and increasing production of anti-inflammatory cytokines such as IL-10.

Lactobacillus plantarum (HEAL 9); Lactobacillus paracasei (8700:2) and Lactobacillus rhamnosus (LGG®) to Boost Immunity

A unique combination of probiotics for patients requiring immune stimulation, particularly for those with immune insufficiency, chronic recurrent infections, post viral immune depletion and other conditions associated with low immunity. This combination enhances a variety of immune responses, including T-reg and FOXP3 expressing cells, as well as increasing NK cells and phagocytosis.

Lactobacillus plantarum 299v

An anti-inflammatory probiotic strain to reduce the signs and symptoms of IBS, to help manage IBD. The anti-inflammatory properties of 299v have also been shown to reduce systemic inflammation (hsCRP).

Lipids and Tocotrienols for Healthy Cell Membranes and Cognition

A blend of vitamin D, tocotrienols, omega-3 EFAs and phospholipids protect against inflammation, oxidative damage and support all aspects of mitochondrial structure, function and biogenesis, as well as cell membranes.

Mental and Physical Energy

A magnesium powder including mitochondrial nutrients such as N-acetyl carnitine for mental & physical energy, combined with nutrients to support thyroid and adrenal function.

Boulardii and Bi-07 for Management of Dysbiosis

S.boulardii with Bifidobacterium lactis Bi-07 is blended to address dysbiosis and help balance gut microbiota.

Vitamin D3 Capsules or Liquid

Vitamin D is essential for immune defence, as it stimulated antimicrobial peptides and WBC activity against pathogens, recruits immune defences (Th1/Th2 responses), shown to be preventative in recurrent infections and auto-immunity.

Diet and lifestyle: Myasthenia Gravis 

Dietary and lifestyle guidelines may assist in the management of myasthenia gravis:

  • Adjust eating routines. Try to eat when with best muscle strength. Take time chewing food, and take a break between bites of food. Small meals eaten several times a day may be easier to handle. Encourage eating mainly soft foods and avoid foods that require more chewing, such as raw fruits or vegetables.
  • Use safety precautions at home. Install grab bars or railings for support, such as next to the bathtub or next to steps. Keep floors clean, move any loose rugs out of normal walking routes. Keep paths, sidewalks and driveways cleared of leaves, snow and other potential debris.
  • Use electric appliances and power tools. Conserve energy with electric toothbrush, electric can openers and other electrical tools to perform tasks when possible.
  • Wear an eye patch. Consider wearing an eye patch if with double vision, which can help provide relief. Try wearing the eye patch when writing, reading or watching television. Periodically switch the eye patch to the other eye to help reduce eyestrain.

    Supportive Lifestyle Programs: Myasthenia Gravis 

    Supportive Lifestyle Program Description

    Wellness and Healthy Ageing Program

    This program recommends a low glycaemic load diet with lifestyle recommendations for exercise, relaxation, intellectual stimulation and effective stress management – all factors associated with creating a low antigenic and anti-inflammatory environment – a healthy terrain for efficient immunity. These recommendations are shown to improve health and quality of life, and aim to reduce a patients biological age.

    Metagenics Clinical Detoxification Programs

    Autoimmune diseases, including myasthenia gravis, tend to flare with gut inflammation, weakened digestion and exposure to environmental stressors and toxins. This detoxification program addresses both digestive processes, bowel health and supports effective detoxification pathways via the bowel, kidneys and lymphatic systems.

    Shake It Practitioner Weight Management Program

    This carbohydrate-restricted Ketogenic diet is a hypocaloric fat loss program for those with insulin resistance, who will usually also be overweight or obese. Reducing dietary glycaemic load will reduce insulin release and help patients lose fat, particularly visceral adipose tissue, thus helping to minimise the risk of many chronic illnesses, including autoimmune diseases such as myasthenia gravis.

    Pathology Tests: Myasthenia Gravis 

    Pathology Test Interpretation Guidlines

    Antibody test

    Serology can be performed in a blood test to identify antibodies against the acetylcholine receptor.

    Repetitive Nerve Stimulation Test

    Muscle fibres of patients with myasthenia gravis are easily fatigued, and thus do not respond as well as muscles in healthy individuals to repeated stimulation. By repeatedly stimulating a muscle with electrical impulses, the fatigability of the muscle can be measured.

    Edrophonium test

    This test requires the intravenous administration of edrophonium chloride, a drug that blocks the breakdown of acetylcholine by cholinesterase and temporarily increases the levels of acetylcholine at the neuromuscular junction. In people with myasthenia gravis edrophonium chloride will briefly relieve weakness.

    Pharmaceutical Treatments: Myasthenia Gravis 

    Whilst there is no standard therapy, myathenia gravis patients can generally be medically managed.

    • Cholinesterase inhibitors: these drugs inhibit the enzyme cholinesterase that degrades acetylcholine in the motor end plate; the neurotransmitter is therefore around longer to stimulate its receptor. E.g., pyridostigmine.

    • Immunosuppressive drugs: medications such as prednisone, cyclosporine, mycophenolate, and azathioprine may be used to reduce autoimmunity.
    • Thymectomy: the surgical removal of the thymus gland improves symptoms in more than 50% of patients, even in those without thymoma. Some patients are cured by thymectomy, suggesting that the thymus plays a significant role in the pathogenesis of myasthenia.
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