Cases of MS are surging and no one knows why… the triggers revealed

It is an incurable disease that slowly attacks the brain and spinal cord, stripping patients of their mobility and bodily functions – and experts say it’s on the rise.

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, also known as MS, rises by around six per cent, according to research.

Doctors are also increasingly concerned that more younger people are being diagnosed.

MS most commonly develops between the ages of 20 and 40, but specialists say diagnoses in children and teenagers have risen in recent years – something partly linked to better scanning technology and growing awareness of early symptoms.

However, leading researchers say these factors cannot explain all of the increase. Instead, they argue that something else has caused MS cases to surge.

Until recently, that cause remained a mystery.

However, experts now believe they have pinpointed a series of potential MS triggers that could be driving the rise in new diagnoses.

Becky Lee had the warning signs of MS at just 21, but ignored them for a decade. Diagnoses in children and teenagers are now increasingly common, specialists say

Crucially, they also argue that tackling these triggers could prevent countless new cases from occurring in the future.

‘MS is becoming increasingly common,’ says Professor Ruth Dobson, a consultant neurologist at Queen Mary University London.

‘Yes, we are diagnosing it earlier and patients are living longer lives, but the rate at which diagnoses are increasing can’t be explained by these factors alone.

‘Our environment is always changing, and it’s possible that some of these recent changes could be responsible. And, if we can work out what’s causing this rise, then it’s possible we could prevent cases too.’

So, what exactly is MS? And what are the potential causes that scientists are exploring?

MS occurs when the immune system mistakenly attacks the protective coating around the body’s nerves – called myelin – damaging the brain and spinal cord. It tends to occur when patients are in their 20s or 30s and is nearly three times more common in women, for reasons that are still unclear to experts.

Early symptoms include vision problems, muscle weakness, numbness and fatigue.

Some patients may also experience changes in bladder habits, an electric-shock sensation down the spine or limbs, or even dizzy spells.

Experts say these symptoms tend to come and go, or worsen over time.

Once diagnosed, the disease’s progression can be slowed with immune-suppressing medication – but it cannot be cured.

Over time, patients can develop paralysis, blindness and loss of bladder control, while the disease also raises the risk of potentially deadly infections.

There are several different types of MS, each with varying degrees of severity.

The majority of patients have a form of the disease known as relapsing-remitting MS, where symptoms come and go.

This can eventually become secondary progressive MS, where symptoms steadily worsen over time.

About a tenth of patients have an aggressive form called primary progressive MS, where symptoms gradually worsen with no periods of remission.

Experts say it is still not known why some patients develop one form of MS and not another.

However, in recent years, experts say there have been a number of breakthroughs in understanding the potential causes of MS.

Perhaps the strongest evidence is for the link between MS and a common infection called the Epstein-Barr virus. The virus, which is typically spread through contact with saliva such as kissing, causes the common childhood illness glandular fever.

Many people will catch Epstein-Barr at some point in their lives. However, for some, the virus remains in the body, affecting the immune system and raising the risk of MS.

In 2022, landmark research concluded that patients who contract Epstein-Barr virus are at least 32 times more likely to develop MS.

‘Almost all MS patients will have had a previous Epstein-Barr virus infection,’ says Professor Dobson. ‘It seems to prime the immune system to develop MS.’

Pharmaceutical companies – including Moderna, one of the Covid vaccine firms – are now developing Epstein-Barr virus jabs in the hope of preventing MS.

Experts also believe another potential trigger is a lack of Vitamin D – a substance the body makes when sunlight hits the skin.

Often thought of as a nutrient, it actually behaves more like a hormone, helping regulate the immune system and control inflammation.

Around one in six adults and one in five children are deficient, according to official figures.

Multiple studies – including a major US paper published in 2006 – have shown that people with low Vitamin D levels face a significantly higher risk of developing MS. Scientists believe this may be because Vitamin D helps stop the immune system mistakenly attacking healthy nerves – the process that drives the disease.

However, experts say it is still unclear whether taking Vitamin D supplements can actually reduce someone’s chances of getting MS.

‘There have been two big studies exploring this,’ says Professor Dobson. ‘One found that taking Vitamin D tablets lowered the risk of MS, while the other showed it did nothing at all. So it’s still unclear. It’s possible that the protection comes from something else we get from sunlight – like UV rays.’

There is also research showing that smoking can potentially lead to MS – doubling the chance of patients developing the condition, according to some studies.

‘Smoking is linked to a number of autoimmune conditions,’ explains Professor Dobson. ‘Smoke in the lungs appears to disrupt the immune system.’

However, experts say these three factors cannot fully account for the recent rise in MS diagnoses – Epstein-Barr infections have remained stable during this period, sunlight levels have not varied significantly, while the number of smokers in Britain has fallen since 2000.

Instead, researchers argue that several other factors may be behind the rise.

One of these is childhood obesity, rates of which rose sharply in the late 1990s. In 1995, only around 11 per cent of children aged eight to ten were classed as obese. By 2003, this figure had risen to 16 per cent. Today, it is around 22 per cent.

In 2016, US researchers concluded that obese children are twice as likely to develop MS later in life as those of a normal weight.

Experts say it is possible that excess weight early in life strains the immune system, leading to MS.

‘Body weight is a big factor,’ says Professor Dobson, ‘And obese adolescents who also develop glandular fever have a particularly high risk.’

Experts say another societal change that may be, in part, responsible for the increase in MS diagnoses is the amount of ultra-processed food Britons now consume.

These artificial ingredients – found in ready meals, takeaways, cereals, sugary snacks and mass-produced bread – have increasingly made up a large proportion of the British diet since the 1970s.

Today, studies show that more than half of the calories consumed in Britain come from UPFs.

While experts say research into the link between UPFs and MS is still in its early stages, there is growing evidence that a diet high in these foods can damage the healthy functioning of the immune system.

‘It’s really challenging to work out what effect UPFs are having on MS, but it’s something that researchers are taking seriously,’ says Prof Dobson.

‘There is increasing interest in the impact these artificial foods have on the immune system. I believe we will find that regularly consuming UPFs raises the risk of MS.’

However, perhaps most interestingly, experts believe another new MS trigger could be the rise in vaping.

Around 5.4 million people in the UK now vape, according to the Office for National Statistics.

Concerningly, figures show that one in five British children aged 11 to 17 have now tried vaping, despite it being illegal for under-18s, with usage tripling in the past three years alone.

Both smoking and vaping have been proven to disrupt the immune system, which could be a possible trigger for conditions like MS. But one in five Britons under 18 have tried vaping

Research shows that vaping is significantly safer than smoking cigarettes, which trigger lung cancer and chronic obstructive pulmonary disease, or COPD – conditions that combined kill nearly 70,000 Britons every year.

However, experts say the same may not hold true for MS.

Studies show that smoking inflames cells inside the lungs, potentially causing the immune system to misfire. It also weakens the blood-brain barrier, allowing rogue immune cells to enter the brain and begin causing damage.

According to the charity the MS Trust, ‘vaping could be just as bad for the blood-brain barrier as smoking’ and ‘may be just as irritating to the lung lining cells’, meaning it could therefore be ‘bad for MS risk as well’.

Professor Dobson agrees with this analysis. ‘Vaping is a rapidly growing phenomenon,’ she says. ‘And it may well be that, while it is safer in some ways, it can also prime the immune system to trigger MS.’

However, while experts agree that MS is on the rise, they stress that the condition remains relatively rare. At present, fewer than one in 400 people in the UK have the condition.

‘Even if you have a strong family history of MS, the chances of you developing it are still low,’ Professor Dobson assures. ‘We also now have drugs that are effective at slowing MS – particularly if it’s caught early, which is why it’s important to familiarise yourself with the classic symptoms.’

She adds that, for those worried about developing MS, there are steps they can take.

‘Quitting smoking and eating healthily are just about the most important things you can do,’ she says. ‘Minimise the amount of ultra-processed foods you consume, don’t take up vaping and take a normal-strength daily Vitamin D supplement if you need it.

‘Doing these things won’t necessarily stop you from getting MS, but the research suggests they should help reduce the risk.’

‘My dizzy spells were actually MS’ 

Becky Lee experienced symptoms of multiple sclerosis, such as muscle spasms and indigestion. She now takes the prescription MS drug ofatumumab to treat the disease

Becky Lee lived with dizzy spells for eight years before she was finally diagnosed with multiple sclerosis, or MS.

When the symptoms first began, Becky, from Bristol, was 21 years old.

She also experienced indigestion – which she put down to heartburn – as well as occasional muscle spasms.

That year, Becky, a project manager, sought medical advice and was told she was suffering from clinically isolated syndrome (CIS), a condition involving inflammation and damage to the central nervous system that often precedes MS.

Although she was advised she could ‘continue living normally’, doctors warned that it could develop into the disease.

Becky’s symptoms continued to worsen and she eventually developed visual disturbances – one of the most common symptoms of MS.

‘I remember looking at signs or something in the distance and feeling like it was always slightly shaking or vibrating,’ she says.

‘I also had significant weakness on my left side. Over time, the muscle deteriorated more than normal.’

Eventually, in February 2023, Becky was diagnosed with relapsing-remitting multiple sclerosis (RRMS) – the most common form of the disease, in which symptoms flare up and then ease in cycles.

She now receives the prescription MS drug ofatumumab, a monthly injection that slows the disease’s progression.

Becky says that, even with the drug, she still suffers regular symptom flare-ups.

‘It’s unpredictable, which can make the future seem uncertain at times. Lots of people with MS probably feel the same.

‘For now, I try to focus on living my life as best as possible rather than worrying too much about what might happen.’