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
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
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
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
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
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?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
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?
Refer to the individual herb for information about any side effects or interactions.
References
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purposes only. It is based on scientific studies (human, animal, or in vitro),
clinical experience, or traditional usage as cited in each article. The results reported may
not necessarily occur in all individuals. For many of the conditions discussed, treatment with
prescription or over-the-counter medication is also available. Consult your doctor,
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before making any changes in prescribed medications. Information expires March 2005.
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