However, if too much of this enzyme antagonist is present, the cells remain discharged for too long and the muscles become more or less paralysed. This is a 'cholinergic crisis' in which heart and breathing may stop. A modern complication is the additional antagonistic action of fluoride on this enzyme. Fluoridated water may trigger a crisis or contribute to the long-term deterioration. This also applies to commercial liquids, such as soft drinks, soymilk or reconstituted 100% fruit juices in countries where water fluoridation is practised.
It has been stated that myasthenia gravis has manifested after exposure to crop sprays with chemicals which have an antagonistic effect on acetylcholinesterase.
To test the theory that antibodies clog up muscle receptors serum from a myasthenia gravis patient was injected into mice, which promptly developed M .G. symptoms. The same electrical symptoms as in myasthenia gravis could also be produced in healthy human muscle when exposed to the serum of a myasthenia gravis patient.
This is as far as the conventional medical understanding of myasthenia gravis goes. The cause of the main event, the blocking of the muscle receptors by antibodies, is not known. There is also at present no attempt to overcome this disorder with nutritional therapy.
A wide variety of vitamins and minerals are involved in muscle activity, partly in energy production and partly in the synthesis of proteins and neurotransmitters. The main B-vitamins are essential for energy production in the muscles and some improvement in myasthenia gravis has been reported with B-complex supplementation so that, for instance, less of the enzyme-blocking drug was required.
In experiments with separately administered vitamins B1, B2, B6, C, E, pantothenic acid and choline (as from lecithin) were reported to be beneficial in myasthenia gravis. Conversely, myasthenia gravis like symptoms could be produced in monkeys and humans by making them deficient in the vitamins B1, B6 and pantothenic acid.
During World War 2 myasthenia gravis developed in prisoners of war in Singapore, which was attributed to malnutrition. A high-vitamin nutritious diet with plenty of yeast and liver soon restored these patients to normal. In Europe were reports of almost an epidemic of myasthenia gravis following the war. Also other myasthenia gravis cases have been reported with more or less permanent remissions as long as a highly nutritious diet was used.
In addition to the general effect on energy production and protein synthesis, several vitamins have been shown to have a specific relationship with myasthenia gravis
Vitamin B1, working together with manganese, is the key vitamin for the synthesis of acetylcholine in the nerve endings. A lack of this vitamin, therefore, can cause a reduced signal from nerves to muscles and, with this, muscle weakness and other neurological complications. Vitamin B1 also helps acetylcholine to bind to receptors. It also has a significant role in nerve excitation and enhances the effects of acetylcholine. Furthermore, with low vitamin B1 levels lactic acid accumulates in the muscles and causes fatigue, deficiency can also lead to nerve degeneration.
Vitamin B2 is important for tissue respiration, for the storage of glycogen in muscles and liver as well as for the metabolism of glycine, an amino acid linked with myasthenia gravis. A deficiency lowers the resistance to stress. Vitamin B6 is essential for the synthesis of neurotransmitters and receptors.
Pantothenic acid supplies the acetyl part in the synthesis of acetylcholine. It opposes the effects of substances that are known to block receptors. Pantothenic acid is the anti-stress vitamin, most important for healthy adrenal glands, which are especially weak with myasthenia gravis
Vitamin C is another anti-stress vitamin. It is essential for collagen synthesis. Collagen is the connective tissue between muscle cells, cementing them together. Vitamin C is involved with the use of glycogen in muscles, with muscle contractions and exercise tolerance. It affects muscle metabolism and the functioning of muscle membranes. Together with folic acid it is involved with the synthesis of neurotransmitters and steroid hormones. It has a mild anticholinesterase activity and this enhances the action of the reduced amount of acetylcholine that finds a receptor. A study on 2000 smokers revealed that their vitamin C blood levels were 40% lower than those of non-smokers. Myasthenia gravis patients reported increased muscle weakness after smoking.
Vitamin B12 and folic acid are required for the synthesis of choline before forming acetylcholine. Vitamin A is needed for the immune system, to produce steroid hormones and to protect the thymus and adrenal glands from the effects of stress. Vitamin A deficient rats developed weakness of the head and leg muscles. The importance of the stress-protective vitamins can be seen in the observation that myasthenia gravis frequently develops during or after a period of intense stress.
Vitamin E is important to protect cell membranes from damage through oxidation and peroxidation, while a deficiency causes changes in muscle protein with swelling and fragmentation of individual muscle fibres, leading to muscle weakness, dystrophy and paralysis. It is directly involved with the energy metabolism of muscles, deficiency causes increased amounts of muscle protein to break down and be expelled with the urine as it happens in myasthenia gravis
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