A question I frequently receive is: “Are there supplements I can take to manage my MS?” MS impacts the day-to-day lives of those living with the disease, so it’s no surprise that many individuals explore complementary and alternative medications (CAMs) to take control of their MS. CAMs are approaches that come from a variety of traditions and practices, including exercise, natural health products, supplements and vitamins. In addition to helping in the management of MS, CAMs are used by Canadians to enhance their overall wellness.
There are a variety of small studies that have looked at the role of CAMs in MS, however their effects are unclear. One area that is growing in interest are the role of supplements as potential treatments. In this post, I will touch on three supplements that have recently gained some traction among the MS research community – vitamin D, biotin, and lipoic acid.
Vitamin D has been a hot topic in MS research. Referred to as the “sunshine vitamin”, vitamin D is produced by our skin through sun exposure, but can also come from other sources like supplements and diet (eggs, fish and fortified dairy products). Vitamin D works to help absorb nutrients, particularly calcium, and more recently vitamin D has been investigated for other proposed health benefits.
So, how did vitamin D get linked to MS? Well, we know that MS is more common in countries farther away from the equator, therefore, researchers have become interested in the role that sunlight, and hence vitamin D, could play in MS.
We are still learning about the association between vitamin D and MS, with research groups worldwide assessing the role of vitamin D in the onset, progression, and treatment of MS.
What research tells us thus far?
In recent years, some observational studies of individuals with MS have identified a link between vitamin D deficiency and increased risk of developing MS. One large study of 200,000 women who took part in the Nurse’s Health Study found that intake of 400 International Units (IU- describes the potency or biological activity of a product) daily of vitamin D was associated with a 40% lower risk of MS. Another prospective study found that higher levels of vitamin D in the blood (also known as your vitamin D status) during late adolescence or early adulthood were associated with a lower risk of developing MS later in life.
While there appears to be an association between vitamin D status and risk of MS, it is less clear whether vitamin D supplementation can improve disease outcomes in people living with MS. Clinical trials comparing vitamin D treatment versus placebo, or high-dose vitamin D treatment versus low-dose vitamin D treatment, found no significant effects in terms of improved MS outcomes. Other studies, however, demonstrated modest benefits of vitamin D treatment in on various disease outcomes such as lesion sizes, immune activity etc.
One major study that is currently ongoing is led by Dr. Ellen Mowry at Johns Hopkins University. This phase III clinical trial is anticipated to enroll 172 individuals with relapsing-remitting MS, and will examine if a high-dose vitamin D intervention will alter the number of relapses compared to low-dose vitamin D. Another phase III clinical trial, anticipated to enroll 316 participants and led by Dr. Eric Thouvenot at the Centre Hospitalier Universitaire de Nimes, is examining if administration of vitamin D compared to placebo will reduce the conversion to MS after individuals have experienced their first symptoms relating to MS.
In addition to these ongoing major trails, there are a handful of studies that have been conducted with mixed results. The SOLAR trial, which involved 260 people with relapsing-remitting MS, tested the effects of vitamin D supplementation as an add-on treatment with interferon beta-1a (Rebif) on MS outcomes, versus placebo. The data so far shows no significant effect of vitamin D supplementation on relapses, disease activity and disability, although the individuals in the vitamin D group did have fewer number of lesions as seen on MRI compared to placebo. Another small study involving 40 people with relapsing MS found that taking 10,400 international units (IU) of vitamin D every day for six months reduced the number of certain immune cells that are known to cause damage in MS.
For more studies on vitamin D and MS, check out our vitamin D hot topics page.
Biotin, also known as vitamin B7 or vitamin H, is essential for breaking down proteins, carbohydrates and fats into forms that the body can use. Biotin, which can be obtained from foods such as eggs, almonds, nuts and legumes, is important for the maintenance of healthy skin, hair, eyes, liver, and nervous system functioning. Additionally, biotin deficiency is common in pregnant women, and thus women who are expecting are advised to take biotin or a multi-vitamin containing biotin.
Biotin has become of interest to the MS community due to its advancement up the clinical trial ladder where it is now being examined in phase III clinical trials by French pharmaceutical company MedDay. Interestingly, they are looking at a new pharmaceutical formulation of biotin which is 10,000-fold higher in dose than what is available over the counter. The compound is called MD1003.
What research tells us thus far?
The first of two clinical trials sponsored by MedDay is MS-SPI. This randomized, double-blind, placebo-controlled phase III trial involved 154 participants with primary and secondary progressive MS who received either MD1003 or placebo over two years. Researchers found that treatment with MD1003 resulted in a significant improvement in disability compared to placebo treatment.
The second phase III clinical trial, SPI2, is underway to test MD1003 treatment compared with placebo. Currently, recruitment is ongoing in multiple countries, including Canada, with the estimated enrollment of 600 participants with primary and secondary progressive MS. The U.S. Food and Drug Administration (FDA) wanted a study in the U.S. population which prompted the launch of the SPI2 trial. This global study will confirm the findings of the MS-SPI trial but will also include additional measures on the safety and efficacy of MD1003.
Although considered a vitamin in low doses, more information is needed on the long-term efficacy safety of taking ultra-high doses of biotin for a prolonged period of time.
Lipoic acid is an over-the-counter supplement known to have antioxidant properties. Antioxidants block the action of “free radicals”, which are by-products of the body that cause tissue injury in MS. In addition to supplements, lipoic acid can also be found in foods such as spinach, broccoli and potatoes.
Controlled trials are currently ongoing to test the potential of several antioxidants in MS, including lipoic acid.
What research tells us thus far?
While research on the role of lipoic acid as a treatment for MS is in the early stages, there are a few small clinical trials, mainly in phase I and II, that are testing the safety and efficacy of lipoic acid in people with MS.
A single-site, phase I clinical trial led by Dr. Daniel Carr at the Portland VA Medical Center and Oregon Health & Science University enrolled 69 SPMS patients, RRMS patients or healthy individuals to observe how lipoic acid (1200 mg) is broken down in the body.
Following this study was a single-site, double-blind phase II clinical trial led by Dr. Rebecca Spain and her colleagues at the Oregon Health and Science University, which involved 51 individuals who received either oral lipoic acid (1200 mg) or placebo daily for two years. The results showed that participants who received lipoic acid had a 68% decrease in the rate of brain volume loss compared to individuals on placebo.
Another phase II clinical trial led by Daniel Carr was completed this year and aimed to determine if the combination of lipoic acid and omega-3 fatty acids improve cognition in RRMS or SPMS compared to placebo treatment. Thus far, the results did not show changes in cognition after 12 weeks of treatment.
While research is pointing to promising outcomes among people with MS who take supplements as treatments, it’s important to note that such studies are small and serve as critical starting points for larger research studies. Clinical trials such as those described above are important avenues to better understand the benefits and safety of supplements in MS, especially those which are administered at very high doses. It is important to discuss your treatment options with your health care team, as this decision is based on a number of factors.
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