Supplements and MS

Supplements are one of the most popular forms of CAM used by people with MS. The largest and most detailed survey of dietary supplement use among people with MS was conducted at the Rocky Mountain Multiple Sclerosis Center. Of the respondents to this survey, more than 90 percent had used dietary supplements since being diagnosed with MS, and more than 80 percent were using some type of dietary supplement at the time of the survey. The full results of the survey are available at www.ms-cam.org, the CAM website of the Rocky Mountain Multiple Sclerosis Center.

Several errors are frequently made in recommending supplements for use in MS. First, recommendations are sometimes haphazard and random; little or no justification is given for a long (and expensive!) list of supplements. When a justification is given, it is sometimes stated that MS is an immune disease and that immune-stimulating supplements are therefore needed. In fact, MS is an immune disease, but it is characterized by too much, not too little, immune activity. As a result, immune-stimulating supplements actually may be harmful for MS. Similarly, supplements that may affect the immune system are sometimes recommended for MS as well as cancer and AIDS. Once again, all three diseases do involve the immune system, but people with cancer and AIDS may benefit from stimulation of the immune system, whereas people with MS may benefit from its suppression.

It is sometimes mistakenly assumed that if a deficiency of a vitamin or mineral impairs the function of the immune system or nervous system, an excess of that same vitamin or mineral will be beneficial to the immune system or nervous system and thus will be therapeutic for MS. In other words, it is assumed that if a little is good, a lot is better. In fact, high doses of vitamins and minerals probably have very limited uses.

A good example of this dosing issue as it relates to the nervous system is that of vitamin B6 (pyridoxine). A deficiency of vitamin B6 impairs nervous-system function. However, an excess of vitamin B6 also injures the nervous system and may actually produce symptoms similar to those of MS. Thus, for vitamin B6 and the nervous system, a normal level is desirable, and either a deficiency or an excess may be harmful.

In the case of immune-system function, seemingly paradoxical situations may arise with regard to supplement doses. For example, vitamin B7 (biotin) is important for maintaining a healthy immune system; however, a deficiency of vitamin B7 appears to be beneficial for animals with EAE, an experimental form of MS. On the other hand, supplementation with either selenium or zinc, two minerals also involved in immune-system function, may worsen EAE. On the basis of this limited scientific information, it could be argued that a state of deficiency of immune-relevant vitamins and minerals may be beneficial for MS, and a state of excess of these nutrients may be harmful. In fact, in one study, malnutrition was found to be a highly effective therapy for the animal model of MS. This information is not provided as a recommendation for people with MS to malnourish themselves or induce deficiency states for particular nutrients! Rather, it is provided to illustrate the complexities of vitamin and mineral dosing for specific diseases such as MS.

Vitamin and mineral supplements are clearly necessary for people with MS who have an inadequate diet. This may occur for a variety of reasons, and may be particularly prevalent in those with more severe disability. With a poor diet, supplementation is essential to ensure an adequate intake of essential nutrients.

The most conservative approach to supplement use in MS is to avoid all supplements (except in people who clearly are nutritionally deficient). The rationale behind this view is that the effectiveness and safety of supplements has not been fully investigated in MS. Thus, according to this view, supplements should not be used, because they may be of no benefit and may actually be harmful.

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