Over the past decade, I’ve noticed something strange happening in my clinic.
More and more seemingly healthy young women are walking through my door and being diagnosed with the incurable degenerative brain disease multiple sclerosis (MS).
Of course, personal experience is not the same as hard evidence. But in this case the data backs me up.
Between 2000 and 2020, the number of multiple sclerosis patients in the UK doubled, rising from fewer than 100,000 to 190,000.
Every year, the number of UK patients living with the condition rises by around 6 per cent, according to research.
MS is still relatively rare. But I have gone from seeing a case every few years to seeing a good handful now.
And the rising number of new MS patients at my clinic are disproportionately female.
So what could be going on?
A large Swedish study found that people put in hospital with Covid had roughly two and a half times the risk of a later MS diagnosis
Some of it is certainly better detection. Better scans and testing mean people are diagnosed younger than ever.
Meanwhile, improved treatments also mean people with MS are living longer – so the total number naturally climbs.
But these factors can’t explain all of it. Something else is happening.
So what is MS? It’s an autoimmune disease – meaning the body’s immune system turns on itself.
In this case it attacks myelin, the protective coating around the nerves in the brain and spinal cord.
Damage that coating and the nerve signals get scrambled, leading to symptoms that range from crushing fatigue and numbness to problems with vision and, eventually, difficulty walking.
When I started out as a GP around two decades ago, MS was shrouded in mystery.
But, increasingly, we have a good understanding of what raises the risks of the disease developing.
There is some early evidence that vaping may prime the immune system in the same troubling way cigarettes do
It seems, for example, that vitamin D plays a role.
In the UK there is a striking north-south divide, with Scotland recording the highest rates of MS in the country. Experts believe this isn’t just genetics.
The further north you live, the less sunlight you get – and the less vitamin D your body can make. Many of the cells in our immune system carry vitamin D receptors, and low levels are linked to autoimmune disease.
To be clear, we don’t yet know for certain that popping a supplement will lower your risk – it may be something else in sunlight doing the work – but the link is hard to ignore.
There is also some evidence that viruses may increase the chance of an MS diagnosis.
Research now suggests that a common bug, called Epstein-Barr, which triggers glandular fever, could be responsible for many cases of MS.
Around nine in ten of us will catch Epstein-Barr at some point but, for a tiny fraction, this infection can confuse the immune system, leading it to mistakenly attack the body instead – causing MS.
And if one virus can trigger MS, what about another – Covid?
GP, author and broadcaster Dr Philippa Kaye
A large Swedish study found that people put in hospital with Covid had roughly two and a half times the risk of a later MS diagnosis.
Could this be why cases have noticeably risen in the past decade?
I’d urge caution here. The pandemic was recent, and MS usually takes years to develop, so it’s too soon to say whether Covid caused these cases or simply hurried along something already brewing.
But we do have a good idea of why cases appear to be rising in young women at a faster rate.
It’s fairly simple: Women are more likely to develop immune system conditions like MS. For every one man with MS in the UK, there are three female patients.
This is because the female immune system tends to be more reactive. It might provide a better defence against infections and protective response to vaccines, but it’s also more likely to turn against the body.
And a virus such as Epstein-Barr (or Covid) has a higher chance of tipping it into overdrive.
Men, by comparison, have less responsive immune systems, which is why they had a higher chance of dying of Covid.
So with MS cases rising across the country, it stands to reason that GPs would see a rise in female patients before they rise in men with the condition.
What can you do to lower your risk of MS?
Well, the good news is that two of the biggest MS triggers are entirely within our power to change.
The first is our expanding waistlines. Obesity raises the risk of MS – children with obesity are twice as likely to go on to develop it, and the combination of childhood obesity and glandular fever is especially dangerous.
Around 22 per cent of children in this country now have obesity, and those rates have been climbing for decades.
If needed, then losing weight, via good diet and regular exercise or with new treatments, is one of the best ways to reduce your risk of MS.
The second culprit is smoking and vaping. Smoking has long been known to raise MS risk, and thankfully smoking rates keep falling.
But vaping is booming. Around 5.4million Britons now vape, almost one in five children aged 11 to 17 have tried it, and roughly one in 20 vape regularly.
If you already smoke, switching to a vape is the safer choice. But if you don’t smoke, do not start – there is some early evidence that vaping may prime the immune system in the same troubling way cigarettes do.
And even if you are diagnosed, MS is not the outlook it once was. There is still no cure, but treatment has been transformed.
High-dose steroids can calm flare-ups, disease-modifying drugs can cut relapses and slow the condition down, and other treatments can ease specific symptoms. Start early and the long-term results are far better.
Best of all, the future looks brighter still. With Epstein-Barr now firmly in the frame, scientists are working on vaccines and antiviral drugs that could one day stop MS before it ever starts.
For the young women in my clinic – and for their daughters – that day cannot come soon enough.
