What are natural treatments for multiple sclerosis (MS)?

Introduction

Multiple
sclerosis (MS) is a disease affecting the fatty sheath that
covers nerve fibers in the brain and spinal cord. This sheath, made of a substance
called myelin, normally insulates the nerve fibers, allowing nerve impulses to
move swiftly and efficiently between brain, spinal cord, and body. In MS, patchy
areas of this insulating material are destroyed and replaced by scar tissue, which
results in the slowing or blocking of nerve signals.

People with MS may experience symptoms such as blurred vision, muscle weakness and
spasticity, difficulty walking, poor coordination, bladder problems, numbness, and
fatigue. In its most common form, the disease begins between the ages of twenty
and forty with an initial attack of symptoms followed by partial or complete
remission. Further attacks usually follow and can eventually lead to progressive
disability. Another form of the disease progresses more quickly.

Although the exact cause of MS is not known, scientists generally assume that MS
is an autoimmune
disease in which the immune system attacks the body’s own
myelin cells. Scientists theorize that something, perhaps a toxin or virus,
triggers this autoimmune response in susceptible people. It appears that not all
people are equally susceptible. Gene studies suggest that genetics plays a role in
who gets the disease, but other factors too seem to be important. For example, MS
tends to be more common the farther one travels from the equator. The disease is
also more prevalent in societies with greater dietary intake of meat and animal
fat, lower intake of unsaturated fats compared to saturated fats, and lower intake
of fish. Not everyone agrees that all of these factors actually contribute to the
disease. Some factors may simply be statistically associated with the actual
cause.

There is no cure for MS, but several newer drugs, including two forms of the
substance interferon (Avonex and Betaseron) and an unrelated drug,
glatiramer acetate (Copaxone), appear able to reduce the frequency of relapses in
people with certain forms of MS and slow the rate of progression of the disease.
Other medications reduce the severity of acute attacks or treat specific symptoms
such as muscle spasticity.

Proposed Natural Treatments

While there are no well-documented natural treatments for multiple sclerosis, there are a few options that may provide some help. There is some evidence that changing the type and amount of fat in the diet might alter the course of MS. Based on observations from population studies linking diets lower in fat or saturated fat to lower rates of MS, physician R. L. Swank developed a special low-fat diet for MS in which unsaturated fats replace most saturated fat. This approach, called the Swank diet, has been used by many people with MS. When he analyzed the long-term effects of the diet on his patients, Swank found that those adhering closely to the diet for twenty to thirty-four years developed significantly less disability than those who ate more saturated fat. Because these were not controlled trials, they do not actually prove that the Swank diet works. Nonetheless, the possible connection between MS and fatty acids continues to arouse interest, and a variety of essential fatty acids have been proposed as possible treatments for MS. Although a link between fat intake and MS is intriguing, research has not provided clear-cut evidence that any of these treatments help.

Linoleic acid. One of the omega-6 essential fatty acids, linoleic acid, is found in high concentration in sunflower and safflower oil and in lower concentrations in most other vegetable oils. Several researchers have investigated whether linoleic acid in the form of sunflower seed oil can help MS, but the results of their research were equivocal.

Three groups of investigators performed double-blind studies, using olive oil as a placebo, to see if linoleic acid supplements could affect the symptoms or course of MS. Two of these studies (one involving 75 people, the other 116) found that those taking linoleic acid had shorter and less-severe attacks of MS compared to those taking placebo. However, in the two years of the trials, the frequency of attacks and overall levels of disability were not significantly affected. The third study of seventy-six people found that linoleic acid had no effects on either MS attacks or degrees of disability in 2.5 years, compared to olive oil.

Another researcher suggests that these studies may have been too short and that it may take far longer than two years for linoleic acid to exert its effects on myelin. Olive oil also contains important fatty acids; others have wondered if the olive oil could have been an effective treatment on its own, thereby obscuring the benefits of linoleic acid. Finally, another researcher who carefully examined the study reports found that linoleic acid might have been effective in those persons with less severe MS symptoms.

Although interesting, this type of after-the-fact analysis must be interpreted with caution. More studies are needed to confirm whether linoleic acid, taken early in the course of MS or at other times, has the power to prevent, delay, or improve disability. In the three double-blind studies, participants received 17 to 20 grams (g) of linoleic acid per day, the equivalent of one ounce of sunflower seed oil.

Other essential fatty acids. There has been much excitement about
other essential fatty acids as treatments for MS, including those found in
fish
oil (omega-3) and evening primrose oil (omega-6). However,
evidence does not support this concept.

Blood tests among people with MS have found lower levels of omega-3 fatty acids in
their body fluids and tissues compared to those without MS. This hints, but does
not prove, that taking extra omega-3 fatty acids might help. Only double-blind,
placebo-controlled studies can show that treatments actually
work.

The only meaningful double-blind study of fish oil for MS failed to find evidence of benefit. In this two-year study of 292 people with MS, comparing fish oil’s omega-3 fatty acids with an olive oil placebo, no significant differences were seen between the two groups. Another study did find possible benefit with fish oil compared to olive oil in the relapsing-remitting form of MS. When fish oil was used in combination with a low-fat diet, participants showed benefits on some measures. However, the study was small, and the results were far from definitive. Similarly, while some researchers have suggested that gamma-linolenic acid might be beneficial in MS, what little evidence there is remains more negative than positive.

Threonine. Early evidence suggests that threonine, a naturally occurring amino acid, might be able to decrease the muscle spasticity that often occurs with MS. Two small double-blind studies found a modest but statistically significant improvement in muscle spasticity among people who took threonine compared to those who took placebo. In one study of twenty-six people with MS, the improvement was so slight after eight weeks of treatment that it was detectable by doctors but not by the participants themselves. In the other study, both researchers and a few of the thirty-three participants noticed improvement after two weeks of treatment, with some persons reporting fewer spasms and milder pain. This shorter trial that showed more improvement also used lower doses: 6 g daily of L-threonine, as opposed to 7.5 g daily of threonine. No significant side effects were noted in either study.

Vitamin B
12
. Because several studies have found MS to be occasionally
associated with vitamin B12
deficiency, and lack of
B12 can cause neurological problems on its own, some doctors
recommend that people with MS be screened for this condition. One preliminary
study suggested that massive doses of B12 could improve certain test
results (“evoked potentials”) but not disability in people with chronic
progressive MS. A double-blind study of fifty people with MS found that high doses
of injected hydroxocobalamin, a form of B12, did not affect the course
of disease or number of relapses.

Vitamin D. The human body normally obtains vitamin D in
one of two ways: through diet or through exposure to the sun. More than one group
of researchers has noted that populations in areas with less sunshine tend to have
a higher incidence of MS, unless the residents of these areas commonly eat more
fish that is rich in vitamin D. This has led to a theory that vitamin D might
confer some protection against MS. No human studies have adequately tested this
hypothesis, although one poorly designed study did investigate a combination of
calcium, magnesium, and vitamin D given in the form of cod liver oil; the study
found some benefit.

Phenylalanine and TENS. Phenylalanine is an essential amino acid,
meaning that it is essential for life and that the human body cannot manufacture
it from other chemicals. Humans normally obtain all the phenylalanine needed for
nutritional purposes from high-protein foods. Supplemental phenylalanine
has been studied for MS only in combination with another treatment called
transcutaneous nerve stimulation (TENS), a portable electrical device used to
decrease pain and muscle spasticity.

Two small double-blind trials compared phenylalanine to placebo among a total of sixteen people with MS being treated with TENS. In both studies, those treated with phenylalanine and TENS experienced less muscle spasticity, fewer bladder symptoms, and less depression after four weeks of treatment than those treated with TENS and placebo. These findings are somewhat difficult to interpret, but they tend to suggest that phenylalanine may be helpful in MS.

Other treatments. A special form of magnet therapy called PEMF (pulsed electromagnetic field therapy) has shown some promise for MS. In a two-month, double-blind, placebo-controlled study, thirty people with multiple sclerosis applied a real or a fake PEMF device to one of three acupuncture points on the shoulder, back, or hip. The study found statistically significant improvements in the treatment group, most notably in bladder control, hand function, and muscle spasticity.

One small double-blind trial suggests that neural therapy, a treatment related to
acupuncture, might be helpful for MS. In addition, weak evidence hints that
reflexology might be helpful.

The use of bee stings or injected bee venom for MS has generated a great
deal of interest over the years, despite a lack of reliable research supporting
its use. The one meaningful study, reported in 2005, failed to find any benefit.
Other treatments suggested for MS include adenosine monophosphate, biotin,
glycine, proteolytic enzymes, selenium, and vitamins B1, C, and E, but
little evidence supports these recommendations.

Although the herb ginkgo is sometimes suggested as a treatment for MS, there
is no meaningful evidence that it works. One study reported as showing benefit was
actually too small to provide meaningful results. Another double-blind study
examined ginkgolide B, a chemical in ginkgo, for treating MS attacks, but it found
no evidence of benefit.

Johnson, S. K., et al. “The Effect of Ginkgo biloba on Functional Measures in Multiple Sclerosis.” Explore (New York) 2 (2006): 19-24.

Lambert, C. P., et al. “Influence of Creatine Monohydrate Ingestion on Muscle Metabolites and Intense Exercise Capacity in Individuals with Multiple Sclerosis.” Archives of Physical Medicine and Rehabilitation 84 (2003): 1206-1210.

Siev-Ner, I., et al. “Reflexology Treatment Relieves Symptoms of Multiple Sclerosis.” Multiple Sclerosis 9 (2003): 356-361.

Weinstock-Guttman, B., et al. “Low Fat Dietary Intervention with Omega-3 Fatty Acid Supplementation in Multiple Sclerosis Patients.” Prostaglandins, Leukotrienes, and Essential Fatty Acids 73 (2005): 397-404.

Wesselius, T., et al. “A Randomized Crossover Study of Bee Sting Therapy for Multiple Sclerosis.” Neurology 65 (2005): 1764-1768.