Multiple Sclerosis
Multiple sclerosis (MS) is a slowly progressive, degenerative condition in which the myelin sheaths surrounding nerves in the brain and spinal cord are lost. Myelin sheaths are a type of connective tissue, composed of fats and proteins, that insulate nerve fibers. They protect nerves and are required for effective transmission of nerve impulses.
Indirect evidence suggests that MS may be an autoimmune disease, wherein the immune system attacks myelin in the central nervous system. MS is more common among people who live in temperate climates compared with those who live in tropical climates and receive greater exposure to the sun. Possible causes for MS may include genetic susceptibility, diet, environmental toxins, viral infections, and exposure to dogs, cats, or caged birds.1 Epstein-Barr virus has also been named as a risk factor,2 though the real cause or causes of MS are unknown.
Checklist for Multiple Sclerosis
| Rating | Nutritional Supplements | Herbs |
| | | Padma 28 |
| | Linoleic acid | Ginkgo biloba (injections) |
| Reliable and relatively consistent scientific data showing a substantial health benefit. | ||
What are the symptoms of multiple sclerosis?
MS is characterized by various neurological symptoms, with remissions and recurrent exacerbations. The most common symptoms are paresthesia (numbness and tingling) in the extremities, trunk, or on one side of the face. Muscle weakness, loss of coordination of a leg or hand, and visual disturbances (such as partial blindness in one eye, dim vision, or double vision) are common in MS. Limbs that fatigue easily, difficulty in walking, difficulty with bladder control, vertigo, and mood disturbances may appear years before MS is diagnosed. The course of the disease is highly varied and unpredictable. In most people, the disease remits for varying periods of time. However, symptoms usually recur, and the progression is often relentless.
Medical treatments for multiple sclerosis
Corticosteroids, such as prednisone (Deltasone®, Orasone®), are the most common prescription drugs used. Though they may shorten the duration of flare-ups, they have little or no effect on long-term disability. Interferon-beta (Avonex®, Betaseron®) may reduce the frequency of relapses and delay long-term disability. Intravenous gamma globulins (Gamimune N®, Sandoglobulin®) given monthly may also control relapses. A variety of immunosuppressive drugs are also used, such as methotrexate (Rheumatrex®), azathioprine (Imuran®), cyclophosphamide (Cytoxan®), and cladribine (Leustatin®). However, these drugs are reserved for more severe forms of MS, have limited potential benefits, and are highly toxic. A large variety of drugs, including antispasmodics, antidepressants, and pain relievers, are also used to manage the various symptoms of MS.
Dietary changes that may be helpful for multiple sclerosis
The amount and type of fat eaten may affect both the likelihood of healthy people getting the disease and the outcome of the disease for those already diagnosed with MS. For many years, the leading researcher linking dietary fat to MS risk and progression has been Dr. Roy Swank.
In one of Dr. Swank’s reports, a low-fat diet was recommended to 150 people with MS.3 Although hydrogenated oils, peanut butter, and animal fat (including fat from dairy) were dramatically reduced or eliminated, 5 grams per day of cod liver oil were added, and linoleic acid from vegetable oil was used. After 34 years, the mortality rate among people consuming an average of 17 grams of saturated fat per day was only 31%, compared with 79% among those who consumed a higher average of 25 grams of saturated fat per day. People who began to follow the low-fat diet early in the disease did better than those who changed their eating habits after the disease had progressed.
A survey of people in 36 different countries also suggests that the types of fat people eat may impact MS.4 In that report, people with MS who ate foods high in polyunsaturated and monounsaturated fatty acids were likely to live longer than those who ate more saturated fats. In another survey, researchers gathered information from nearly 400 people (half with MS) over three years.5 They found that people who ate more fish were less likely to develop MS, while those who ate pork, hot dogs, and other foods high in animal (saturated) fats were at greater risk. This same report found consumption of vegetable protein, fruit juice, and foods rich in vitamin C, thiamine, riboflavin, calcium, and potassium correlated with a decreased MS risk. Eating sweets was linked to an increased risk.
Despite research showing improvement with a low-fat diet in some people with MS, the link between foods containing animal fat and MS risk may not necessarily be due to the fat itself. Preliminary evidence from one report revealed an association between eating dairy foods (cows’milk, butter, and cream) and an increased prevalence of MS, yet no link was found between (high fat) cheese and MS in that same report.6
MS has been associated with a variety of dietary components apparently unrelated to fat intake,7 and the link between MS and diet remains poorly understood. Nonetheless, the most consistent links to date appear to involve certain foods containing animal fat. People with MS wishing to pursue a nutritional approach that incorporates an understanding of this research should consult with a doctor familiar with the “Swank diet.”
Some people with MS avoid gluten (a protein found in wheat, rye, and barley) in hopes of diminishing symptoms, because a preliminary study reported that consumption of grain (bread and pasta) was linked to development of MS.8 However, another trial found an association between eating cereals and breads and reduced MS risk.9 Other researchers have found gluten sensitivity to be no more common among people with MS than among healthy people.10 Thus, the idea that avoiding gluten will help MS remains speculative.
Lifestyle changes that may be helpful for multiple sclerosis
While some studies dispute it,11 12 there is preliminary evidence that exposure to organic solvents,13 insecticides,14 and X-rays15 may cause or aggravate MS. This may explain why clusters of multiple sclerosis cases occasionally occur in certain geographical areas or even in work sites.16
Swiss researchers found that nicotine temporarily impairs arm movement in people with MS.17 In one study, when people with MS smoked cigarettes, movement capacity was diminished for 10 minutes in 76% of them. Although this evidence is preliminary, there are many other adverse health effects of smoking. Smokers with MS should quit smoking.
While the outcome of some research disputes the connection between MS and mercury exposure,18 other investigations have reported an association between dental amalgams and this disease. One study found that mercury levels in the hair of people with MS are higher than in the hair of healthy people.19 This same report found that people with MS who had their amalgam fillings removed experienced one-third fewer relapses than people who kept their fillings. Another preliminary study found that people having a large number of fillings that had been in place for a long time appeared to be at increased risk for MS compared with those having fewer fillings.20 Preliminary evidence has also identified an association between tooth decay—as opposed to fillings—and MS.21 The importance of the reported links between mercury, tooth decay, and risk of MS has not been clearly established.
Nutritional supplements that may be helpful for multiple sclerosis
Although some doctors recommend fish oil capsules for people with MS, few investigations have explored the effects of this supplement. In one small trial, people with MS were given approximately 20 grams of fish oil in capsules per day.22 After one to four months, 42% of these people received slight but significant benefits, including reduced urinary incontinence and improved eyesight. However, a longer double-blind trial involving over 300 people with MS found that half this amount of fish oil given per day did not help.23 A preliminary, two-year intervention trial tested the effects of fish oil supplements (5 ml of fish oil per day, providing 400 mg of EPA and 500 mg of DHA) combined with other dietary supplements and dietary changes in people with newly diagnosed, relapsing-remitting MS.24 The other supplements included 3,333 IU of vitamin A per day, 400 IU of vitamin D per day, and approximately 5.5 IU of vitamin E per day. The dietary recommendations included reducing intake of sugar, coffee, tea, saturated fat from meat and dairy products, and alcohol, while increasing intake of fish, fruit, vegetables, and whole-grain bread. Sixty-nine percent of those following the regimen improved, 25% remained the same, and 6 % (one person) deteriorated. The many interventions used in this trial make it impossible to determine what was responsible for the positive outcomes. Given the lack of other effective treatments for MS, though, this approach is worth trying while awaiting further evidence.
In a small preliminary trial, people with MS were given 20 grams of cod liver oil, as well as approximately 680 mg of magnesium and 1,100 mg of calcium per day in the form of dolomite tablets.25 After one year, the average number of MS attacks decreased significantly for each person. Unlike fish oil capsules, the cod liver oil in this trial contained not only eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), but 5,000 IU of vitamin D. Therefore, it is not known whether the vitamin D or fatty acids were responsible for the cod liver oil’s effects. (One preliminary study found that giving vitamin D-like drugs to animals with MS was helpful.)26 It is also possible that the magnesium and/or calcium given to these people reduced MS attacks. Magnesium27 and calcium28 levels have been reported to be lower in the nerve tissue of people with MS compared with healthy people.
Animal studies have demonstrated that vitamin D can prevent an experimental form of multiple sclerosis. In humans, striking geographical differences in the prevalence of multiple sclerosis suggest that sun exposure (which promotes the synthesis of vitamin D) may protect against the development of the disease. While some scientists have theorized that vitamin D may help prevent MS, clinical trials are needed to validate that hypothesis.29
The omega-6 fatty acids, found in such oils as evening primrose oil (EPO) and sunflower seed oil, also may be beneficial. When people with MS were given 4 grams of EPO for three weeks, their hand grip improved.30 In a review of three double-blind trials, two of the trials reported that linoleic acid reduced the severity and length of relapses.31 When the data were re-examined, it was found that taking linoleic acid decreased disability due to MS in all three trials. According to these researchers, taking linoleic acid while following a diet low in animal fat and high in polyunsaturated fat may be even more beneficial. Amounts used in these trials were approximately 17 to 23 grams of linoleic acid per day, provided by 26 to 35 grams of sunflower seed oil.
Deficiency of thiamine (vitamin B1) may contribute to nerve damage.32 Many years ago, researchers found that injecting thiamine33 into the spinal cord or using intravenous thiamine combined with niacin34 in people with MS led to a reduction in symptoms. Using injectable vitamins requires medical supervision. No research has yet studied the effects of oral supplementation with B vitamins in people with MS.
Inosine is a precursor to uric acid, a compound that occurs naturally in the body. Uric acid is believed to block the effect of a toxic free-radical compound (peroxynitrite) that may play a role in the development of multiple sclerosis.35 In an attempt to raise uric acid levels, ten patients with MS were treated with inosine in amounts up to 3 grams per day for 46 weeks. Three of the ten treated patients showed some evidence of improved function and the others remained stable.36 Controlled studies are needed to confirm these preliminary results.
Are there any side effects or interactions with multiple sclerosis?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful for multiple sclerosis
A commercial herbal product called Padma 28® was given to 100 people with MS.37 After taking two pills three times per day, 44% of these people experienced increased muscle strength and general overall improvement. The composition of Padma 28® is based on a traditional Tibetan herbal formula.
Inflammation of nerve tissue is partly responsible for the breakdown of myelin in people with MS. When intravenous injections of a constituent of Ginkgo biloba, known as ginkgolide B, were given to people with MS for five days, 80% of them reportedly improved.38 This specialized treatment is experimental, and it is not known whether oral use of ginkgo extracts would have a similar effect.
Are there any side effects or interactions with multiple sclerosis?
Refer to the individual herb for information about any side effects or interactions.
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