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Do dietary supplements help or hurt MS therapy?

Tribune Media Services

DEAR MAYO CLINIC: Our 26-year-old daughter is described as having an "aggressive" form of MS. She is now taking Novantrone, a chemotherapy drug and immune suppressor, after having an allergic reaction to Tysabri. If the chemotherapy is administered to stop the immune system from attacking itself, what happens if she takes supplements for well-being (fish oil, lecithin, vitamins E and B, etc.)? Is this counter-productive?

It’s a good question. Due to the limitations of conventional medicine in treating multiple sclerosis (MS), an inflammatory disease that affects the central nervous system, many MS patients are turning to complementary and alternative medicine, which includes the use of a variety of dietary supplements to treat the disease or its symptoms. Unfortunately, many of these supplements have not been proven to offer any benefits.

When MS is active, the body’s immune system attacks the myelin sheath, a fatty substance that covers and insulates nerve fibers in the brain and spinal cord. Doctors refer to the areas of injury and scarring on the myelin sheath as lesions. Eventually, damage to the sheath and nerves can slow or block the nerve signals that control muscle coordination, strength, sensation and vision.

The severity of MS varies considerably from one person to another. Active MS means a person is having frequent attacks and new or enhanced lesions can be seen on MRI. Treatment with interferon beta or glatiramer acetate is then used to reduce the number of attacks and new lesions and, in the long term, reduce disability. Sometimes, these treatments aren’t effective enough, and stronger drugs like Tysabri or Novantrone are needed. The medication your daughter is taking, Novantrone, works to suppress the immune system, thus reducing the activity of the disease.

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There is some evidence, though it is not definitive, that a diet enriched with polyunsaturated fatty acids — which includes omega-6 and omega-3 — might be helpful in treating MS. There are many unknowns, however, including how the fatty acids work, their safety and their effectiveness when used with conventional treatment for MS.

Regardless what diet is followed, a well-balanced intake of nutrients is important. Though many MS patients now take antioxidants (for example, vitamins A, C, E, selenium and CoQ10) because it has been proposed that free radicals play a role in MS, supporting information is limited. Eating more fruits and vegetables would be reasonable and, if supplements are taken, then modest doses of Vitamin A, C and E might be appropriate. Patients also need to be wary of supplements touted to be immune-stimulating, as these may potentially worsen MS or antagonize conventional therapies, especially if used in large amounts.

MS patients at risk for osteoporosis or osteopenia should consider taking vitamin D and calcium. Some small studies have suggested that vitamin D may prevent or delay MS onset and may have some beneficial disease-modifying effects, however current evidence is inadequate to allow specific recommendations. I recommend that before any patients decide to take vitamin D, they consult their physician, as high doses may cause unwanted side effects such as fatigue, cramps and high blood pressure.

In conclusion, your daughter should be cautious when deciding which supplements to take. Quite a bit of the information on the Internet promotes supplements for people with MS. There’s little data to support these claims, and she should be careful not to spend a lot of money on false promises.

If your daughter would like to take supplements, a daily multi-vitamin containing vitamin D would be reasonable. I suggest she talk with her doctor to confirm that the supplements she’s taking are right for her. She should keep in mind, too, the benefits of a healthy lifestyle overall, which includes a well-balanced diet, regular exercise (if possible), low stress and trying to maintain a positive attitude. For example, an exercise program, developed with input from her physician, may improve strength, muscle tone, balance and coordination. Getting enough rest can combat fatigue, a common MS symptom. More information is available online on the National MS Society’s Web site (www.nationalmssociety.org). — Sean Pittock, M.D., Neurology, Mayo Clinic, Rochester.

E-mail a question to medicaledge@mayo.edu or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207.

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