CAM2

Vitamins
There are theoretical reasons why antioxidant vitamins, which include vitamins A, C, and E, may
be beneficial for MS. Antioxidant vitamins decrease the levels of free radicals, which, according
to some evidence, may be a factor in the myelin and nerve damage that occurs in MS. On the
other hand, antioxidants stimulate the immune system and this could be harmful for MS. MS
can increase the risk for developing osteoporosis, and vitamin D and calcium may be beneficial
in this regard. There is no clear indication for the use of vitamin B12 therapy in MS, except for
the rare patient who also has documented vitamin B12 deficiency.
High doses of some vitamins and minerals may produce toxic effects. Doses of vitamins and
minerals to avoid include:
Vitamin A (or beta-carotene): greater than 10,000 IU daily may produce liver injury and
other toxic effects.
Vitamin B6 (pyridoxine): greater than 50 milligrams daily may produce nerve injury.
Vitamin C: greater than 1,000 milligrams daily may produce diarrhea and kidney stones.
Vitamin D: greater than 1,000 IU daily may produce liver injury.
Selenium: greater than 200 micrograms daily may produce multiple toxic effects.
In addition, vitamin A and beta-carotene should probably be avoided in smokers, and warfarin
(Coumadin®) should not be taken with coenzyme Q10, vitamin E, vitamin K, and possibly vitamin
C.
Other Supplements
Zinc is sometimes used to prevent or limit the severity of the common cold. Often for unclear
reasons, some CAM books recommend zinc supplements specifically for MS. In people with MS,
it may be best to avoid or limit zinc supplements since zinc may stimulate specific cells in the
immune system. Similarly, melatonin and DHEA, two hormones that are available as supplements,
may activate the immune system.
Traditional Chinese Medicine
Traditional Chinese medicine includes acupuncture and herbal therapy. Acupuncture is increasingly
recognized for its effectiveness in some types of pain and nausea, but studies in MS have
been limited and contradictory. Chinese herbal medicine should be used cautiously and with a
clear understanding of the effects of the herbs. Asian ginseng and astragalus, which are common
components of Chinese herbal preparations, may stimulate the immune system. Another form of
Chinese medicine, Chinese proprietary medicine, should probably be avoided since there are no
well-established benefits in MS and some ingredients may be toxic.
Other Possibly Beneficial Therapies
Limited studies indicate that several CAM therapies may be beneficial for people with MS. Cooling
therapy, which involves the use of cooling suits, may improve some MS symptoms. Mindbody
approaches, such as meditation, guided imagery, and yoga, may relieve anxiety and pain.
Yoga may also be helpful for spasticity. T’ai chi, which is a Chinese exercise regimen that
involves slow body movements and specific breathing techniques, may improve walking ability
and decrease spasticity. Massage may be beneficial for anxiety, depression, pain, and spasticity.
Horseback riding, known as hippotherapy, may provide multiple therapeutic effects. Rigorous
clinical studies are needed to further evaluate the effectiveness of these therapies.

Miscellaneous Therapies Lacking Proven Benefit
Bee venom therapy is currently being studied in humans, but preliminary results from animal
studies at Allegheny University indicate that it has no effect and may be harmful. Therapies in
which there is no strong evidence for a beneficial effect in MS include calcium EAP, chelation
therapy, craniosacral therapy, enemas, hyperbaric oxygen, and dental mercury amalgam removal.
PRINCIPLES OF CAM USE
Several guidelines should be followed when patients are considering CAM use:
Consider conventional medicine first.
Evaluate and directly address the reasons for wanting to use CAM.
If CAM is chosen, direct the patient to keep the physician informed; monitor the response
to the therapy; and discontinue therapy when appropriate.
Stress caution to the patient.
THE PLACEBO EFFECT
In trials of immunomodulating agents, the “placebo effect” has been quite high, with a transient
30–40% reduction in relapses. In some trials, placebos have actually produced greater improvement
than “active” medications. Some studies have even suggested that placebos produce bene-
ficial effects on specific cells in the immune system.
The placebo effect demonstrates the powerful influence that the mind may have over the body
(or brain). This mind-body effect may be under-utilized in conventional medicine and may be an
important component of some forms of CAM.
A WELLNESS APPROACH
CAM and the influence of the mind over the body are two areas that may be incorporated into a
more inclusive “wellness approach” that optimizes functioning in the different components of the
MS patient’s life: health, physical fitness, psychological well-being, social connectedness, nutrition,
sexuality, spirituality, and bowel and bladder function. These components are interwoven;
in a state of wellness, there is a sense of wholeness and balance among them. A chronic disease
such as MS may disrupt this wholeness and balance. Integration of neurologic care with a wellness
focus requires a multidisciplinary approach, including medical, psychological, nursing,
dietetic, and rehabilitation services.

C.A.M.