What Is the Cause of ALS?

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What Is the Cause of ALS?

Lou Gehrig’s disease, known as amyotrophic lateral sclerosis or ALS, strikes healthy, middle-aged people seemingly at random. Of the major neurodegenerative diseases, it has the least hope for treatment and survival. Although mental capabilities stay intact, ALS paralyzes people, often from the outside in, and most patients die within three years when they can no longer breathe or swallow. At any given time, an estimated 30,000 are fighting for their life with it in this country. We each have about a 1 in 400 chance of developing this dreaded disease.

ALS is more common than generally recognized, with an incidence rate now close to that of multiple sclerosis. What causes it? 50 years ago scientists found that the rate of ALS among the indigenous peoples on the island of Guam was 100 times that found in the rest of the world, potentially offering a clue into the cause of the disease. So, instead of 1 in 400, in some villages in Guam, 1 in 3 adults died of the disease!

Cycad trees were suspected, since the powdered seeds were a dietary staple of the natives, and there were reports of livestock showing neurological disease after eating from it. And indeed, a new neurotoxin was found in the seeds, called BMAA. Maybe that’s what was causing such high levels of ALS? But the amount of BMAA in the seeds people ate was so small that it was calculated that people would have to eat a thousand kilograms a day to get a toxic dose—that’s around a ton of seeds daily. So, the whole cycad theory was thrown out and the trail went cold.

But then, famed neurologist Oliver Sachs and colleagues had an idea. Cycad seeds were not all the natives ate. They also ate fruit bats (also known as flying foxes) who ate cycad tree seeds. So, maybe this is a case of biomagnification up the food chain, as about a “ton’s” worth of BMAA does accumulate in the flesh of flying foxes.

The final nail in the coffin was the detection of high levels of BMAA in the brains of six out of six native victims of the disease on autopsy, but not in control brains of healthy people that died. So, with the final puzzle piece apparently in place, the solution was found to this mysterious cluster on some exotic tropical isle of ALS/PDC, so-called because the form of ALS attacking people in Guam also had signs of Parkinson’s disease and dementia; so, they called it ALS parkinsonism dementia complex. So, when the researchers were choosing a comparison group of control brains, they also included two cases of Alzheimer’s disease. But these brains had BMAA in their brains too. And not only that, but these were Alzheimer’s victims in Canada, on the opposite side of the globe. So, the researchers ran more autopsies and found no BMAA in the control brains, but BMAA detected in all the Canadian Alzheimer’s victims tested.

Canadians don’t eat fruit bats. What was going on? Well, the neurotoxin isn’t made by the bats, it’s made by the trees, although Canadians don’t eat cycad trees either. It turns out that cycad trees don’t make the neurotoxin either; it’s actually a blue-green algae that grows in the roots of the cycad trees which makes the BMAA that gets in the seeds, which gets in the bats, that finally gets into the people. And it’s not just this specific type of blue-green algae, but nearly all types of blue-green algae found all over the world produce BMAA. Up until only about a decade ago, we thought this neurotoxin was confined to this one weird tropical tree, but now we know the neurotoxin is created by algae throughout the world: from Europe to the U.S., Australia, the Middle East, and elsewhere.

If these neurotoxin-producing blue-green algae are ubiquitous throughout the world, maybe BMAA is a cause of progressive neurodegenerative diseases including ALS worldwide. Researchers in Miami put it to the test and found BMAA in the brains of Floridians who died from sporadic Alzheimer’s disease and ALS, but not in the brains of those that died of a different neurodegenerative disease called Huntington’s, which we know is caused by a genetic mutation, not some neurotoxin. They found significant levels of BMAA in 49 out of 50 samples from 12 Alzheimer’s patients and 13 ALS patients. The results (shown in the my video ALS: Fishing for Answers) for American Alzheimer’s and ALS patients from the Atlantic southeast and from Canadian Alzheimer’s patients from the Pacific Northwest suggested that exposure to BMAA was widespread. The same thing was then found in the brains of those dying from Parkinson’s disease. You can apparently even pick up more BMAA in the hair of live ALS patients compared to controls.

So, is BMAA present in Florida seafood? Yes, in freshwater fishes and shellfish, like oysters and bass, and out in the ocean as well. Some of the fishes, shrimps, and crabs had levels of BMAA comparable to those found in the fruit bats of Guam.

In the U.S., fish may be the fruit bats.

Maybe the ice bucket challenge should be to not serve seafood in them. See my video Diet and Amyotrophic Lateral Sclerosis (ALS) for more.

Diet may also play a role in other neurodegenerative disorders:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


86 responses to “What Is the Cause of ALS?

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    1. My cousin died of ALS, so I especially appreciate your discussion of this horrible disease. Of course, it has occurred to me that there might be a genetic component to it, although I have never heard of such a thing. I’m really glad I’m a vegetarian – (almost vegan), and the more I read your blog, the more grateful I am! This was a good reminder to me to continue to avoid “anything with a face”. But for me, this does raise the question of whether seaweed products might pose a threat regarding ALS? Thank you!!!

    2. If you have any time at all for pleomorphism in relation to single celled organisms and various other ‘bits’ of organic life you might conclude that consuming algae is consuming an organism on the growth side of the organic bell curve and so will not harm you whereas ingesting the same micro food via a dead animal (i.e. on the decaying arc or what Cousens calls the composting arc will do just that to you- hasten your own death and decay. The message then is that it is always good (as God said) to eat plants including single celled ones but not after they have been ingested by an animal in circumstances where you kill the macro-organism to ingest its micro (anti) nutrient parts. By the same token galactose in plants won’t harm you but it will in milk and vitamin deficiency from an animal free diet is just rubbish.

        1. B12 deficiency is also a concern in the elderly – meat-eating or not – and is routinely tested for in nursing homes and assisted care facilities. It can look like dementia. Among other symptoms.

    3. I did a little research and found out that blue green algae, which includes spirulina, is not really algae, but cyanobacteria. Some cyanobacteria contain toxic amounts of BMAA. Others, like spirulina, are supposedly edible, but who knows, plus they may be contaminated = careful!

      Brown algae, like kelp, are in a completely different biological kingdom called chromista. They are not bacteria, and they are not closely related to blue green “algae.” I see no reference to them containing BMAA.

      Green algae, like chlorella, are actually in the plant kingdom, just like oats, peas, beans and barley. They do not contain BMMA.

    4. I contacted Green Vibrance, a very popular nutraceutical company, who uses spirulina in their product…Here is there answer

      Dear Michael,

      It is a wonder humankind makes any progress whatsoever. There are so many of us creating so much history that I is impossible to anyone to know everything. As a result, outdated fears often become recycled as a previously ignorant person discovers an old corner of history that has been resolved.

      On the topic of BMAA, fears of its neurotoxicity arose several years ago shortly after the turn of the century following a somewhat shoddy piece of research. That work unwisely cast doubt on all blue green algae as a source of BMAA after testing only a very limited number of strains. Although spirulina was not tested, it was maligned in the minds of the lay public after the research was picked up by the media simply because it is a blue green alga. It was subsequently shown that spirulina is genetically incapable of producing BMAA. Commercial production also prevents exposure to other possible sources of BMAA. Nevertheless, and solely to put buyers concerns to rest, spirulina growers regularly test for BMAA simply so they can show zero BMAA on the certificates of analysis that accompany shipments of spirulina powder. Indeed no research group has as yet demonstrated that cyanobacteria can substantially produce BMAA under laboratory or commercial growing conditions.

      BMAA can be found more widely dispersed in the outside world, in various sea foods, soils and plants. In certain regions, it can indeed be associated with increased incidence of neurodegenerative diseases. So although there is value in becoming informed about BMAA, the focus need not be on commercial spirulina-containing dietary supplements.

      Very best regards,
      cid:image010.jpg@01CE2AE4.B2928560
      Mark Timon

      M.S. Clinical Nutrition
      Founder/Formulator/R&D
      Vibrant Health
      A Vibrant Health, 1 Waterview Dr., Ste 103, Shelton, CT 06484
      P: (716) 432-1688
      mtimon@vibranthealth.com
      http://www.vibranthealth.com

      1. Let me share this piece of information with everyone:

        “In a 2005 article in Proceedings of the National Academy of Sciences, Cox and several colleagues reported testing 30 laboratory strains of cyanobacteria and finding that 95% of the genera tested produced BMAA.16 “We realized that once we published this result, it was going to shake a lot of trees,” says Cox. It could mean a paradigm shift for a field that has invested a lot of money studying the genetics of ALS rather than environmental triggers.”

        The 2012 article can be read in its entirety here:
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295368/

        Thank you.

  1. From what I have read, breathing in the air in this part of the globe, where BMAA is present
    in shellfish and algae, can be just as bad as eating the fish, shellfish, and algae. You could be pure vegan and still succumb to it, under this theory.

  2. Should I stop taking blue green algae pills? Is seaweed affected? This sparks so so so many questions! I hope you do a follow up since algae is a plant and and and…..

    1. From reading the book , “How Not To Die ” I purchased Algae Omega with 715 mg of omega -3 . Based on this article , should I discontinue this supplement ?

    2. No, Cyanobacteria don’t produce enough DHA or EPA to be used. Schizochytrium is used to produce the DHA/EPA supplement that I use. The growing conditions are carefully controlled.

  3. I don’t quite understand this.

    More information please.

    Is BMAA more common than it used to be?

    Is the algae that produces BMAA more common than it used to be, and if so why? Pollution?

    By the way, I have never trusted those blue-green algae supplements. It does not seem natural to eat algae, and I have read that some people do not react well to it.

    What else has BMAA in it that we should avoid eating?

    1. blue algae is more and more common because of pollutants (for example mineral supply) and destroying of normal ecosystems in ocean, so yes it’s more common that it was 100 years ago.
      No, you wrong, algae itself has too little toxin to be dangerous.
      And yes we have to eat less seafood.
      The big fish that actually eat other fishes like salmon or tuna will be more dangerous than the little who eat only algae.

  4. So, persons who have ALS and Alzheimers are found to have elevated levels of BMAA but others without the diseases don’t. But given how seemingly ubiquitous the sources are for BMAA, why do only some people seem to have toxic levels? My relative who died from ALS recently probably only ate the same amount of fish and seafood that we all do over here on the east coast of Canada. What is making this difference between individuals with similar diets? Definitely perplexing!

    1. There is almost certainly a genetic component to it. There are numerous genetic polymorphisms that exist, causing different levels of functioning in pump proteins that help to keep the blood brain barrier running properly, as well as numerous detoxification enzymes that act to prevent chemicals from harming us. Personally I know after doing 23andme that I have a number of pumps and enzymes that function at a suboptimal rate. I’m glad my family never at fish and that I never had a taste for it. My cousin died of ALS, he loved everything about the sea. Maybe he had the same mutations I had, and the neurotoxin accumulated in his brain. It’s too soon to know, but I’m quite glad I’m vegan, bioaccumulation is scary stuff.

  5. Question to NutrionFacts: Many vitamin B12 supplements are cyanocobalamin based, sourced from cyanobacteria a blue-green algae. Is there a potential concern related to Vitamin B12 supplementation (cyanocobalamin form) and BMAA exposure?

    I believe Dr. Greger recommends the cyanocobalamin form of B12 over the mythlcobalamin form for shelf stability reasons.

    1. David, I did a fair amount of research, but found nothing suggesting that Cyanocobalamin is derived from Cyanobacteria (blue green algae). The ‘cyano’ prefix utlized with this particular type of B12 is presumably due to the use of potassium cyanide (in minute, non toxic amounts) in producing this particular cobalamin. I did find the following info which suggests that a genetically engineered bacteria (Propionibacterium freudenreichii) is used in producing commercial B12 : “Several probiotic bacterial species such as Lactic-acid bacetria (LAB)- Lactobacillus spp.(species), Propionibacterium spp. or Bifidobacterium spp. can produce B12 and other B-vitamins. Whole genome sequencing is used to identify particular bacterial strains or a community of different bacteria in the human body that produce B12. Two species that possess all the genes for B12 synthesis are Propionibacterium freudenreichii (A genetically-engineered strain of this bacteria is used to make B12 commercially) and Lactobacillus reuteri (naturally found in most human intestine).” https://www.quora.com/Exactly-what-kind-of-bacteria-produces-Vitamin-B12-and-under-what-kind-of-natural-habitat-and-climatic-conditions-does-it-thrive-in

  6. My ex died of ALS. Coincidentaly, (or not), he did take blue green algae supplements some 15 years prior that a friend was selling through a multi-level marketing scheme and were reported to be ‘toxin free’ .

  7. Is there a list somewhere that tells which forms of seafood are the highest in BMAA? I eat 98% vegan, but try to eat a tin of sardines once a week (small fish low on the food chain) to get Omega 3 and vitamin D (since I can’t take D supplements as they give me terrible hot flashes for some unknown reason). Thanks for your wonderful website; wouldn’t want to have to live without it – it’s on par with PBS and NPR in my life! :)

  8. Unrelated question about this new system…besides the email option, is there a way to comment that doesn’t involve having to complete the form every time? Trivial I know, but annoying.

    1. VeteTater: I’m not sure as I’m still learning this system myself. But I think you can create an account using the Login/Register link in the upper right corner of the screen. Once you are logged in, you do not have to keep filling out the form each time you comment.

      However, what I don’t know is if this site and/or wordpress will remember that you are logged in the next time you turn on your computer and come to this site. If you give this a go and then find out that you have to log in every time, let me know and I will pass that information on.

          1. I liked the Disqus system better too. And miss the unique identifier displayed beside the folks, like Thea, who are Nutrition Facts volunteers. Now with no identifier, it’s not possible to know who the Nutrition Facts staff are.

            I also wonder why Disqus was dumped over this new approach.

            1. Dave: You wanted to know why was disqus dumped? Disqus was not perfect. My understanding is that there were enough issues with disqus that staff wanted to try another platform.

              Thanks for your feedback!

  9. Dear Dr Greger you’ve set us on fire with this ALS article. What shall we do with our B12s and algae oil Omega 3s . Please enlighten us! I think the matter is serious !

    1. Agreed. This is a serious matter to consider for those who’ve been consuming Algae derived Omega 3 and algae derived B12. Perhaps the potential risks outweigh the benefits?

  10. When I go on pub med and search for articles on fish consumption and longevity, I find many that indicate that eating fish improves metabolism, lengthens life, improves cholesterol, etc. I couldn’t find one that indicated a shorter life span with fish consumption.
    John S

    1. John S: The connection may be subtle? For example, this page links fish eating to ALS, and I think people with ALS die sooner.

      Or take the old “Breaking Medical News” from PCRM from a couple of years ago. Fish is linked to diabetes and we know that people with diabetes tend to not live as long. I’m speculating here, but maybe the link is indirect enough that finding the right studies is difficult. Or designing studies correctly to highlight the risk is difficult.

      ———— From PCRM:

      Increased Mercury Leads to Increased Risk of Diabetes

      People exposed to mercury in young adulthood are more likely to develop diabetes later in life, according to a new study published by the American Diabetes Association. Researchers followed 2,875 Americans for an average of 18 years. Those who were exposed to the most mercury were 65 percent more likely to develop diabetes, compared with those who had the least mercury exposure. According to the U.S. Environmental Protection Agency, the most common way Americans are exposed to mercury is through eating fish.

      He K, Xun P, Liu K, Morris S, Reis J, Guallar E. Mercury exposure in young adulthood and incidence of diabetes later in life: the CARDIA trace element study. Diabetes Care. Published ahead of print February 19, 2013.

  11. My father passed away due to ALS. He very, very rarely ate seafood. He ate processed fish sticks or fried shrimp a few times per year, if that, and lobster tail once every few years. He also did not live in an area abundant in seafood or consume any animals that would have had a diet rich in algae or fish.

    With that said, I applaud any efforts to try to find causative links between anything and ALS.

  12. Yikes! I take Chlorella regularly, but have never sourced it. Sounds like its benefits are not worth the risk of BMAA contamination.

  13. .
    Are You Concerned About Your Algae-based DHA/EPA Pills????

    Several people have expressed their concern about their supplements. Dr. Greger says that BMAA is made by blue-green algae and the EPA/DHA is from golden algae.

    So, NO WORRIES!

  14. Thank you, Thea, for eliminating our worries about DHA/EPA algae derived supplements. Are we able to put our concerns about B12 , cyanocobalamin-derived, aside as well? I am looking forward to a clarification.

    1. HEH: I’m doubtful Dr. Greger would be recommending those supplements if there was a danger. ALso, I tried to do a bit of research to see if I could find any place that says that the B12 supplements are made from algae. I wasn’t able to find that. (Doesn’t mean it’s not true. I just can’t get excited about the issue when I don’t even know if the supplements come from anywhere near algae. Since b12 comes from anaerobic bacteria, I’m not sure where the algae comes from…)

      I did send the question onto our medical moderators. Hopefully they will have an answer for us.

    2. There is a statement above (David F) indicating that Cyanocobalamin is derived from Cyanobacteria (blue green algae), but I could find nothing to support this. The ‘cyano’ prefix utlized with this particular type of B12 is presumably due to the use of potassium cyanide (in minute, non toxic amounts) in producing this particular cobalamin. I did find the following info which suggests that a genetically engineered bacteria (Propionibacterium freudenreichii) is used in producing commercial B12 : “Several probiotic bacterial species such as Lactic-acid bacetria (LAB)- Lactobacillus spp.(species), Propionibacterium spp. or Bifidobacterium spp. can produce B12 and other B-vitamins. Whole genome sequencing is used to identify particular bacterial strains or a community of different bacteria in the human body that produce B12. Two species that possess all the genes for B12 synthesis are Propionibacterium freudenreichii (A genetically-engineered strain of this bacteria is used to make B12 commercially) and Lactobacillus reuteri (naturally found in most human intestine).” https://www.quora.com/Exactly-what-kind-of-bacteria-produces-Vitamin-B12-and-under-what-kind-of-natural-habitat-and-climatic-conditions-does-it-thrive-in

  15. Hi all, I suspect that BMAA is but one cause of the triad of neurodegenerative diseases. For example, I still wonder if high cholesterol can lead to ND’s. My father died of ALS and while he was slim and didn’t consume seafood, he did consume a lot of coconut oil and had very high cholesterol. That said, good to avoid seafood, especially those listed in this article (basically bottom feeders but some articles mention fish at the top of the food chain as well – since they would bioaccumulate more toxins. https://www.sciencedaily.com/releases/2015/06/150601104444.htm

  16. Can we also talk about toxins in meat?
    Algae could be used as supplies in diet of cows and chicken, I see some of thus in literature about feeding animals for quickly growth and no one controls that too.

  17. Der Thea, thank you for your information .Some of us are fortunate to have discovered Dr Greger ett all before destoying our health with the western diet but some others have already destroy it and trying to put our “pieces together again”. Once again ,thank you very much .

  18. I take Algal DHA, so the mention of algae concerned me.
    Should I stop consuming Algal DHA?
    Is there some way of finding out whether there is any BMAA in Algal DHA supplements?
    How about B-12 derived from Algae?

  19. Found the answer about Algal DHA :
    =====================================
    Thea February 16th, 2017 at 3:25 pm

    Are You Concerned About Your Algae-based DHA/EPA Pills????

    Several people have expressed their concern about their supplements. Dr. Greger says that BMAA is made by blue-green algae and the EPA/DHA is from golden algae.

    So, NO WORRIES!
    =================================

    Thank you Thea! I should have read ALL the comments before I made my post about being concerned.

    1. Hi, Ken Hill. I am Christine, a NF volunteer moderator. It is possible that krill could be a source of BMAA, though probably less than fish that eat krill, and even less than fish that eat fish that eat krill, etc. Some toxins become concentrated in organisms that consume organisms that produce or contain the toxins, and this appears to be the case with BMAA. You might find this article to be of interest. http://www.pnas.org/content/107/20/9252 I hope that helps!

  20. There is a hypothesis on when the ALS affect cell dies it gives off glutamate. Neighboring weak or damaged cells take in some of the glutamate and they intern die and give off glutamate. Keeping the cells healthy and energy strong is so important. Some people can be exposed to the same disease but aren’t predisposed to contracting that disease. A little more research on genes and DNA will give us the answers. Does getting rid of the BMAA remove it from the cells or just the blood stream? I would suggest until there is a definitive reason and solution that one attacks this disease from every possible angle. Do it all but make sure that the treatment is being delivered right on top of the problem! My wife has Bulbar Palsy and we have tried allot of different things with sound theory not yet trials. All out of pocket. Didn’t a Doctor Lin and Win remove something from rats and the disease was gone. Unfortunately it only leads to more inquiry. Dumping ice on yourself will help keep you cool!

    1. Hi, Kris C Kersch. I am Christine, a NF volunteer moderator. This topic is of particular interest to me, because my late husband died of ALS. As it was explained to me by a top ALS researcher, genetics load the gun of various diseases, including ALS, and environmental and/or infectious exposures pull the trigger. This helps to explain why not everyone with particular risk factors for a disease actually develop the illness itself. I wish you and your wife all the best.

    1. Hi, Joe. I am Christine, a NF volunteer moderator. I do not know the exact mechanisms by which BMAA is eliminated from the body. Its presence in the liver suggests that it is processed there, and studies finding BMAA-producing cyanobacteria in the gut suggests fecal elimination. I don’t know that there is anything in particular that will help to eliminate BMAA from the body. It certainly could not hurt to stop taking in more BMAA. Sulforaphane found in cruciferous vegetables, especially broccoli sprouts, may stimulate the normal detoxification processes in the liver, and milk thistle seeds are reputed to support liver function. I hope that helps!

  21. I tried to post this earlier and it wouldn’t ‘take’. Here is a very goo overview article from 2012 regarding this topic. I think it’s worth reading.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295368/

    But here is one point I found in the body of the article:

    “In a 2005 article in Proceedings of the National Academy of Sciences, Cox and several colleagues reported testing 30 laboratory strains of cyanobacteria and finding that 95% of the genera tested produced BMAA.16 “We realized that once we published this result, it was going to shake a lot of trees,” says Cox. It could mean a paradigm shift for a field that has invested a lot of money studying the genetics of ALS rather than environmental triggers.”

  22. I have ALS. I was diagnosed in March of 2016. I struggle every waking moment. No family history of ALS. Time is ticking. However, I must say there was one point in my life, I took 4 (1400 mg) of fish oil capsules per day to lower my triglycerides. How much fish oil is equal to 3 mgs?

    1. Does anyone know if BMAA builds up in fish oil? I contacted Nordic Naturals but they have not replied yet…and it’s been 3 months. Considering sardines have a high concentration of BMAA and many manufactures concentrate their fish oils from sardines then it’s possible BMAA is passing through the manufactures filtrations and concentrating into their final fish oil products.

  23. Before my husband died he was always very dizzy for a few years. He never ate meat or chicken but had fish almost every day for decades. Do you think the dizziness could be the result of the BMAA in the fish? He did not have ALS, Parkinson’s or any named disease. Could there be a link?

  24. Unfortunately without a full workup there is no way to determine this. Dizziness can be caused by literally thousands of different conditions.

    Dr. Ben

  25. My sister died of ALS last year. She never, ever ate fish or seafood. She did not live near a lake or ocean. So there has to be other factors involved.
    Furthermore, if fish/seafood were suspect, then we would expect to see more ALS in populations with a high consumption of these foods, such as the Japanese, but this is not the case.
    I personally believe that some types of ALS are caused by a bacterial or viral infection that we have yet to discover.

  26. I agree, there are most certainly many factors involved. Almost all diseases are multi-factorial. There is growing evidence, however, supporting that BMAA plays a role in the onset of ALS. That doesn’t mean that ALS can only be caused by eating seafood. Interesting point about Japanese rates of ALS— maybe the traditional healthy Japanese diet and lifestyle has a protective effect.
    I’m sorry for your loss.

    Julia

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