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ARTICLES: Milton Alter, Esther Kahana, Nelly Zilber, Ariel Miller for the Israeli MS Study Group Multiple sclerosis frequency in Israel’s diverse populations Neurology 2006; 66: 1061-1066 [Abstract] [Full text] [PDF]

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Multiple sclerosis frequency in Israel’s diverse populations

Klaus Lauer   (18 July 2006)

Reply from the authors

Milton Alter, Esther Kahana, Nelly Zilber, Ariel Miller, for the Israeli Multiple Sclerosis Study Group   (18 July 2006)

Multiple sclerosis frequency in Israel’s diverse populations 18 July 2006
Klaus Lauer, MD Eulerweg 4, D-64347 Griesheim, Germany Send Correspondence to journal: Re: Multiple sclerosis frequency in Israel’s diverse populations Drklauslauer{at}aol.com Klaus Lauer	In their recent paper on the multiple sclerosis (MS) prevalence in Israel, Alter et al reported a gradient from the Native Israeli and the Europe/America-born population over the immigrants from North Africa/Asia and Christian Arabs, to the native Moslem Arabs, Druze and Bedouins. [1] The authors exclude genetic factors and the low UV/low vitamin D hypothesis as causally relevant. However, they focus on a socio-economic gradient between the European/American and African/Asian lifestyle and mention a larger family size in the latter may favor early infection and protection from MS. Although their reasoning appears plausible, the authors do not further discuss environmental factors such as diet [2] which is fundamentally different between European/American and North African Jews. In ecological [2] and case-control [3] studies, the hypothesis was raised that the ingestion during childhood of smoked and nitrate/nitrite-cured meat products is a risk factor for MS in a multifactorial context. In the culinary literature, the predilection of Jews from Eastern Europe, and later from Western and Central Europe and North America, for smoked meat varieties was emphasized. [4] Dishes like smoked brisket, smoked goose, smoked frankfurters and Vienna sausages, and a variety of smoked fishes give an impression of that attitude. In contrast, diet in North African Jews is similar to the general food pattern in North Africa and the Middle East with a much higher weight on vegetables. Drying in the hot sun prevails for meat preservation [5], whereas smoking is virtually unknown. Christian Arabs in Israel consume pork [6] but the type of preservation has to be shown. Details such as temperature and duration of the smoking process and interaction with intenstinal abnormalities during childhood infections should be studied in future epidemiological investigations. The study among Orthodox Jews having large families, proposed by the authors, might be able to disentangle a possible role of infections and these dietary features in MS. References 1.Alter M, Kahana E, Zilber N, for the Israeli MS Study Group. Multiple sclerosis frequency in Israel's diverse population. Neurology 2006;66:1061-1066. 2.Lauer K. Diet and multiple sclerosis. Neurology 1997;49 (Suppl.2):55-61 3.Geilenkeuser M, Griesenbeck K, Firnhaber W, Lauer K. The intake of defined meat products in multiple sclerosis (MS): a case-control study. J Neurol 2002;249 (Suppl.1):204. Abstract. 4.Rose E. The new complete international Jewish cookbook. London: Robson Books, 1992. 5.Goldstein J. Saffron shores. Jewish cooking of the southern Mediterranean. San Francisco CA: Chronicle Books, 2002. 6.Nathan J. The foods of Israel today. New York: Alfred A.Knopf, 2001. Disclosure: The author reports no conflicts of interest.
Reply from the authors 18 July 2006
Milton Alter, Hahnemann 100 Lancaster Avenue Wynnewood, PA 19096, Esther Kahana, Nelly Zilber, Ariel Miller, for the Israeli Multiple Sclerosis Study Group Send Correspondence to journal: Re: Reply from the authors MAlter5280{at}aol.com Milton Alter, et al.	We thank Dr. Lauer for his comments and assure him that we recognize the likelihood that the array of possible geoclimatic, sociocultural and genetic factors that may influence MS susceptibility is large. Far from our excluding genetic factors, as he suggested, we mention that one our colleagues is already collecting genetic information from MS patients of diverse ethnic origin in Israel and controls (A. Miller MD). We did cite reports implicating both actinic exposure and vitamin D in the etiology of MS. We did not mention smoked and nitrate/nitrite-cured meat products and smoked fish. We appreciate him calling attention other plausible causative agents in an already complex array of possibilities. To shorten the article, we actually deleted several pages of still other possible factors that might play a role in MS etiology. WE also appreciated Dr. Lauer’s citation of references to cook books of Jewish cuisine that readers of Neurology may enjoy when not doing science. Disclosures: The article to which this letter refers was supported by grant RG3647-A-8, the National Multiple Sclerosis Society of USA. The authors report no conflicts of interest.