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Vitamins, Minerals, andHerbs in MS: An Introduction

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The National Multiple Sclerosis Societyis dedicated to ending the devastating

effects of multiple sclerosis.

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700 Broadway, Suite 810Denver, CO 80203Tel: (303) 813-1052Fax: (303) 813-1513National Web site:

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The National Multiple Sclerosis Society isproud to be a source of information aboutmultiple sclerosis. Our comments arebased on professional advice, publishedexperience, and expert opinion, but do notrepresent individual therapeutic recom-mendations or prescription. For specificinformation and advice, consult your per-sonal physician.

The Society publishes many other pamphletsand articles about various aspects of MS. Toask for these, or for other information, call theNational MS Society at 1-800-FIGHT-MS(1-800-344-4867).

All our publications are on our Web site, alongwith handouts called "Basic Facts" on varioustopics. For a list, click the bar on our homepage called “Library”. If you have no access tothe Internet, just call your chapter and ask fora copy of the latest Publications List.

Some of our popular pamphlets include:

� Putting the Brakes on MS� Clear Thinking About Alternative

Therapies� Taming Stress in Multiple Sclerosis� Managing MS Through Rehabilitation

We welcome your comments by mail or [email protected].

Allen Bowling, MD, PhD, is the Director ofthe Complementary and Alternative MedicineProgram at the Rocky Mountain MS Center,and Clinical Assistant Professor of Neurologyat the University of Colorado Health SciencesCenter.

Thomas Stewart, JD, PA-C, is a certifiedphysician assistant and is the AssociateDirector of the Complementary andAlternative Medicine Program at the RockyMountain MS Center.

Photograph by Bill Stanton.

This publication is supported by contribu-tions to the National Multiple SclerosisSociety from its members and friends.

Reviewed by members of the ClientEducation Committee of the NationalMultiple Sclerosis Society’s Medical AdvisoryBoard.

© 2006 National Multiple Sclerosis Society

Vitamins, Minerals,and Herbs in MSAn Introduction

by Allen Bowling, MD, PhDand Thomas Stewart, JD, PA-C

2 Vitamins, Minerals, and Herbs in MS: An Introduction 3

TABLE OF CONTENTS

Introduction..................................................4

General Information for EvaluatingSupplements..................................................6

Specific Information about SelectVitamins, Minerals, and Herbs.................9

Vitamins......................................................9Vitamin D .............................................10The Antioxidant Vitamins...................12Specific Issues Regarding

the Antioxidant Vitamins.................14Vitamin B12 .........................................16

Minerals ....................................................17Selenium...............................................18Calcium.................................................19Zinc .......................................................20

Herbs .........................................................20Ginkgo Biloba.......................................21Echinacea .............................................23St. John’s Wort.....................................24Valerian ................................................25Asian Ginseng ......................................26Cranberry .............................................27

Conclusion ...................................................28

References ...................................................30

Despite these medications, MS remains achronic disease that is sometimes relativelybenign, but sometimes frighteningly unpredict-able. For this and other reasons, many peoplewith MS use some forms of CAM therapy.Most, but not all of them, use CAM therapiesin addition to, rather than instead of, medicaltreatments. That means that CAM therapiesare usually used in a complementary, ratherthan an alternative, manner. Taking dietarysupplements is one of the most popular CAMtreatments.

Most treatments, including the ones listed inthis booklet, have risks associated with them.This booklet will identify some of the risksassociated with selected vitamins, minerals,and herbal supplements in MS. However,because of a lack of well-conducted scientificstudies and the enormous variation in individ-ual clinical situations, not all risks can beidentified. Readers should always discusstheir personal situation with their physicianbefore using any CAM therapy.

Beginning on page 6, we provide some basicinformation that relates to supplements gener-ally, and, beginning on page 9, we offer moredetailed information relating to some of the mostcommonly used vitamins, herbs, and minerals.

INTRODUCTION

This booklet focuses on the use of popularvitamins, minerals, and herbs by people withmultiple sclerosis (MS). The use of these sup-plements is one form of complementary andalternative medicine, which we’ll call CAM.

CAM is difficult to define, in part becauseits contours continually shift. One definitiondescribes CAM as therapies that are notcommonly taught at U.S. medical schools norcommonly available at U.S. hospitals. Almostby definition, then, this booklet explorescontroversial and incompletely studiedtreatments.

Accordingly, this booklet is not intended tobe a primary source for understanding thestandard, evidence-based, treatment of multi-ple sclerosis. Rather, it is intended for thosewho already use, or at least understand, thebenefits of mainstream medical interventions.Over the last decade, medications have beendeveloped that modify or slow down MS. Themajority of people with MS should be usingone of these medications under the supervi-sion of a physician with expertise in treatingMS.


The details of the immune system are verycomplex, but in general it may be best toassume that in MS, immune stimulation maybe dangerous and immune down-regulationmay be beneficial. Accordingly, supplementsthat are supposed to “boost” or “improve”immune function may be the worst choicefor people with MS.

Unfortunately, the immune effects of manysupplements are poorly understood. Oftenthe use of supplements requires users tomake reasonable inferences based on limitedevidence. However, inferences may seem rea-sonable and still be mistaken.

Often what is used to support the use ofsupplements is simply a story, sometimescalled “anecdotal evidence”. This is the leastreliable of all the various kinds of evidence.Particularly in MS, where symptoms come andgo unpredictably, improvement in symptomsmay appear to be related to the use of supple-ments, when it is not.

The best evidence is generally obtained fromcarefully controlled trials among a large groupof people with MS. Another source of evidenceis animal studies. These studies can be help-ful, but may also be misleading. Evidence can

For additional information on supplementsand other forms of CAM, see the section onreferences beginning on page 30. The informa-tion presented here was developed through theComplementary and Alternative MedicineProgram of the Rocky Mountain MS Center, inEnglewood, Colorado.

GENERAL INFORMATIONFOR EVALUATING

SUPPLEMENTS

To weigh the pros and cons of dietary supple-ments fairly requires a basic understandingof the role of the immune system in MS.Thoughtful supplementation also requires anunderstanding of evidence about safety andeffectiveness, dosing issues, and the law relat-ing to supplements.

In MS, the immune system actively damagesmyelin, the protective covering of nerves inthe brain and spinal cord—the central nervoussystem. Most treatments for MS involve theattempt to down-regulate the immune system.All supplements should be considered in light oftheir potential effects on the immune system.


SPECIFIC INFORMATIONABOUT SELECT VITAMINS,

MINERALS, AND HERBSThe number of available vitamins, minerals,and herbs is too great to catalogue here. Thisbooklet reviews only a few vitamins, minerals,and herbs that are most popular with peoplewith MS.

Vitamins

Vitamins are chemicals without caloric con-tent that are necessary for health. With theexception of vitamin D, we must obtain themfrom dietary sources.

The Food and Nutrition Board of the NationalAcademy of Sciences has established a recom-mended daily allowance (RDA) or adequateintake (AI) for vitamins. In general, the RDAused in this text refers to the guidelinesestablished for those who are 19-50 years old,without considering other factors, such asbreast-feeding and pregnancy. The RDA orAI represents the minimum amount for eachvitamin that we should obtain from our dieton a daily basis. On that point, there is littledisagreement.

also be obtained from experiments done in lab-oratories. Again, these studies are helpful, butcan’t be considered definitive in any way.

Dose is always a critical factor in any medica-tion, and more is not always better. Supple-ments may have different effects dependingon the size of the dose that is taken. While asmall amount of certain supplements may beuseful, larger amounts may be dangerous.Proper dose should always be consideredbefore beginning supplementation. Andtherein lies a current difficulty.

The Dietary Supplement Health and EducationAct of 1994 (DSHEA) has important implica-tions for users of supplements. Unlike someother countries, the U.S. federal governmentdoes not regulate supplements as it doesdrugs. Under DSHEA, sellers of supplementsare not required to meet rigorous quality stan-dards or to prove the effectiveness of theirproducts. This means it is not easy to be cer-tain of the amount of active ingredient inmany herbal supplements. Users of any sup-plements should exercise caution regardingmarketing information from the seller.


geographic location, skin pigmentation, andseason. Some researchers have studied popu-lations and suggested that there is a correla-tion between low vitamin D levels and MS.

Scientific studies indicate that vitamin Dalters immune function in a way that maybe desirable in MS. In addition, a handful ofstudies using an animal model of MS providefurther support for the idea that vitamin Dplays a protective role in MS.

One recent, large-scale study involving nursessuggested that those who had highter vitaminD intakes, in the form of multivitamin supple-ments, may have had a reduced risk of devel-oping MS. However, this study did not deter-mine whether vitamin D can have a positiveimpact on the course or severity of MS in peo-ple who already have the disease. Furtherresearch is necessary to clarify these findings.

A much better understood role for vitamin Damong people with MS relates to its part inmaintaining bone density. There is increasingawareness that low bone density (osteoporosis)may be under-diagnosed in many people,including those with MS. Importantly, manypeople with MS have risk factors for develop-ing osteoporosis:

On the other hand, the question of whetherlarger doses of vitamins are beneficial is con-troversial. Vitamins do not function in isola-tion from one another, but rather work incareful balance. Accordingly, a high concen-tration of one vitamin might cause a relativedeficiency of another.

Dietary sources of vitamins, such as fruits andvegetables, appear to be preferable to vitaminsupplements. Perhaps this is because fruitsand vegetables contain vitamins in useful pro-portions, as well as fiber, minerals, and otherunidentified chemicals found in plants thattogether play a role in good nutrition and dis-ease prevention.

Vitamins that are of particular relevance topeople with MS are vitamin D, the antioxidantvitamins, and vitamin B12. A description ofeach follows.

Vitamin DVitamin D is a hormone, orchemical messenger, in the body.Dietary sources of vitamin Dinclude fish and fortified foods,such as dairy products and breakfast cereals.Vitamin D is produced in the skin in responseto sunlight, but this production is limited by


in the disease process in MS. A few studiesusing an animal model of MS suggest thatantioxidants may even be therapeutic. But thevalue of these animal studies is limited. Thereare no well-documented published studies ofpeople with MS that show a clinical benefitrelated to antioxidant supplements.

The safety of taking antioxidants for peoplewith MS has not been established either. Onesmall, five-week study indicates that antioxi-dants are safe for people with MS, but thestudy is too small and short to be conclusive.

There is an important theoretical risk to consid-er. Antioxidant vitamins stimulate the immunesystem in laboratory experiments and in somegroups of people. In MS, where an overactiveimmune system appears to be part of the dis-ease process, stimulation may be dangerous.

In summary, there is limited evidence suggest-ing that antioxidants may be beneficial, andthere is also some evidence suggesting poten-tial harm.

The most reasonable course may be for peopleto obtain antioxidants by eating 2-4 servingsof fruits and 3-4 servings of vegetables everyday. If antioxidant supplements are used, itmay be best to use them in moderation.

� female gender� decreased physical activity� decreased exposure to sunlight� frequent treatment with steroids

People with MS who have these risk factorsmay wish to consider having bone densitytests and taking supplements of vitamin Dand calcium (see page 19). Recommendedintake of vitamin D is 200 to 600 IU daily.Doses greater than 2,000 IU daily may causetoxic effects, and should not be used unlessprescribed by a physician.

The Antioxidant VitaminsA free radical, also called anoxidant, is a molecule that con-tains an unpaired electron. Theunpaired electron is highlyunstable and generally allows the molecule toreact with other nearby substances. The anti-oxidant vitamins include vitamin A (or its saferform, beta-carotene), vitamin C, and vitaminE. As the name implies, antioxidants tend todecrease the damage caused by oxidants orfree radicals. Antioxidant vitamins are gener-ally available in fruits and vegetables.

Preliminary evidence suggests that the dam-age caused by free radicals may be involved


grams for men and 75 milligrams for womenunder normal circumstances. The RDA forsmokers is an additional 35 milligrams.

For a variety of reasons, people with MStend to be at an increased risk for urinarytract infections. Some people supplementwith vitamin C to reduce that risk. Thetheory in support of that practice is thatvitamin C supplementation can acidify theurine, thereby creating a challenge toinfection-causing bacteria. However, theweight of evidence suggests that vitamin Cdoes not acidify urine. There is more evi-dence to support the use of cranberry (seebelow) to prevent urinary tract infectionsthan there is for vitamin C.

Whether a higher intake of vitamin C isbeneficial is controversial. The proper doseof vitamin C (and all other vitamins) forpeople with MS is unresolved. Some author-ities believe that daily doses greater than1,000 milligrams may cause diarrhea orkidney damage.

� Vitamin E and Polyunsaturated FattyAcids (PUFAs)—Vitamin E preventsoxidative damage to cell membranes or lin-ings and can be obtained from vegetable

Specific Issues Regarding theAntioxidant Vitamins

� Vitamin A and Pregnancy—Vitamin A isnecessary for vision and promotes normalgrowth and differentiation of cells in thebody. Vitamin A is fat soluble, and is foundin liver, eggs, and cod liver oil.

Fat soluble vitamins are stored in the bodyand high levels may accumulate over time.The RDA for women and men is 2,300 and3,000 IU per day, respectively. In general,people should avoid doses in excess of10,000 IU per day. Some studies have con-cluded that vitamin A in amounts greaterthan 10,000 IU may produce birth defects.Pregnant women taking cod liver oil (whichcontains vitamin A) must use caution toensure that they are not consuming exces-sive amounts. In general, pregnant womenshould obtain vitamin A in the form of beta-carotene found in fruits and vegetables.

� Vitamin C and Urinary Tract Infec-tions—Vitamin C, also known as ascorbicacid, plays a role in building and maintain-ing body tissues. Vitamin C is readily avail-able in foods such as citrus fruits and toma-toes. The RDA for this vitamin is 90 milli-


vitamin B12 is 2.4 micrograms/day for bothmen and women. Also known as cobalamin,vitamin B12 is required for the production ofred blood cells and for proper function of thenervous system. In fact, a severe vitamin B12deficiency produces neurological symptomssimilar to those seen in people with MS.

A variety of observations have suggested thatthere may be a relationship between B12 lev-els and MS. For example, people with MS havelow levels of vitamin B12 in their blood morefrequently than the general population. Somehave unusually large red blood cells. This cansometimes be caused by low vitamin B12.

For all people with MS to supplement withvitamin B12 on the basis of these associationswould be a mistake. However, B12 deficiencycan be evaluated through a blood test. Peoplewith low levels should consider vitamin B12supplementation. For other people with MS,there is no evidence that vitamin B12 eitherimproves neurological symptoms or favorablyalters the course of the disease.

Minerals

Minerals are elements widely distributed innature that perform diverse and critical roles

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oils, fruits, vegetables, nuts, and meat. TheRDA for vitamin E is 22.5 IU for both menand women.

The body’s requirements for vitamin Eincrease as the intake of polyunsaturatedfats (PUFAs) in the diet increases. This isrelevant to MS because some peopleincrease their consumption of PUFAs in thehope that PUFAs are beneficial in MS.

In general, the additional amount of vita-min E needed in diets that are high inPUFAs is quite low: approximately 0.6 to0.9 additional IU of vitamin E is needed foreach additional gram of PUFA. This meansthat a person consuming 25-30 grams ofPUFAs daily needs 15-27 IU of vitamin Edaily.

Daily vitamin E doses greater than 1000 IUshould be avoided. Consuming substantiallylower doses of vitamin E (in the range of100 IU or less) may be preferable in light ofthe unresolved questions about the immuneeffects of vitamin E in people with MS.

Vitamin B12 Vitamin B12 is found in eggs, meat, poultry,shellfish, and dairy products. The RDA for

16 Vitamins, Minerals, and Herbs in MS: An Introduction

Se


Ca

in human health and disease. The potentialroles of selenium, calcium, and zinc are con-sidered here.

SeleniumSelenium is a mineral that hasantioxidant effects. For a briefreview of the relevance of antioxi-

dants in MS, see the section on antioxidantvitamins on page 12. As with the other antiox-idants, it is difficult to determine the exacteffect that selenium has on people with MS.Good sources of selenium include seafood,legumes, whole grains, low-fat meats, anddairy products.

Some studies indicate that selenium levelsmay be lower in people with MS than in thegeneral population. Partly based on thatobservation, some have speculated thatincreased amounts of selenium might havebeneficial effects in people with MS.

However, in a study using laboratory animals,selenium supplementation worsened an MS-like disease. In one five-week human study,selenium supplementation seemed to be safe.However, that study was too short andinvolved too few people to reliably assuresafety. Furthermore, selenium may increase

the immune response, which may be undesir-able in people who have MS.

For adults over the age of 19 the RDA ofselenium is 55 micrograms. Until more infor-mation is available, it may be best for peoplewith MS to obtain selenium from foods or touse selenium supplements only in moderation.Toxic effects may occur with daily dosesgreater than 200 micrograms.

CalciumImportant in the formation of teethand bone and in the regulation ofmany body processes, calcium is the

most abundant mineral in the human body.Good food sources for calcium include dairyproducts, eggs, and green leafy vegetables.

An old hypothesis about the cause of MSconnected it to calcium intake. Based on thestudies of populations, the incidence of MSappeared linked to high intake of milk duringchildhood followed by a large or sudden reduc-tion in milk drinking during adolescence. Verylittle evidence supports this hypothesis.

On the other hand, calcium is a criticallyimportant supplement for those who are atrisk for very thin bones, or osteoporosis. As

body and can sometimes produce changes inbody processes. The changes produced by bothherbs and drugs may be beneficial, but theymay also be harmful.

To minimize the risk of harmful side effects,herbs should only be used with caution. Herbusers should be aware of proper dosing, poten-tial side effects, and potential drug-herb andherb-herb interactions. It is important to rec-ognize that there are many unknown aspectsto herbs. Specifically, herbs contain many dif-ferent chemicals. Their effects on the body, ondifferent diseases (such as MS), and on drugshave not been fully determined. In addition,the quality and composition of herbal prepara-tions currently marketed in the United Statesare extremely variable.

The six herbs described below are amongthose commonly considered to have potentialrelevance to people with MS.

Ginkgo BilobaGinkgo comes from one of theoldest tree species and has beenused in China for medicinal pur-poses for thousands of years.There is some limited evidence to supportginkgo’s ability to improve cognitive function


Zn

indicated in the section on vitamin D on page11, many people with MS have risk factors forosteoporosis.

People between the ages of 19 and 50 shouldconsume 1,000 mg of calcium in the diet. Dailydoses greater than 2,500 milligrams should beavoided.

ZincZinc is a mineral that plays a rolein many different processes in thebody. The results of limited studies

of MS and zinc are unclear. Some studies indi-cate that zinc levels are low in people withMS. Other studies indicate that zinc levels arehigh in MS, that zinc may activate theimmune system, and that zinc supplementa-tion may worsen an animal model of MS.

The RDA for zinc is 11 mg for men and 8 mg forwomen. Given the uncertainties about zinc andMS, it would seem preferable for people withMS to avoid doses of zinc in excess of the RDA.

Herbs

The word herb generally refers to a plant, orpart of a plant, used for medicinal purposes.Herbs, like drugs, interact with the cells of the

who plan elective surgery. In all cases, regularginkgo use should be reported to all health-care providers.

EchinaceaEchinacea, an extremely popularherb, is a flowering plant nativeto North America and a memberof the daisy (Asteraceae) family.Of the three species available, the best studiedis echinacea purpurea.

Echinacea is generally used to treat the com-mon cold. Some studies suggest that it may behelpful for decreasing the duration and symp-toms of the common cold. But many studies ofechinacea have been criticized by scientists forbeing poorly designed and performed. Nodefinitive conclusion can be drawn regardingthe efficacy of echinacea to treat colds.

Because viral respiratory infections may belinked to exacerbations or acute attacks of MS,treating colds with echinacea is an appealingstrategy. The problem is that echinacea maystimulate the immune system. This is a theo-retical risk for people with MS because theirimmune systems are already inappropriatelystimulated. No study has been done to investi-gate this theoretical risk in people with MS.

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among older people with mild to moderatedementia. There is no evidence that itimproves memory or concentration in healthyadults or people with MS.

Ginkgo is an antioxidant (the function of anti-oxidants is discussed above). It also inhibits asubstance known as platelet activating factor(PAF). By inhibiting PAF, ginkgo can cause adecrease in the activity of certain immunecells. These activities provide theoretical sup-port for the use of ginkgo to treat MS.

Ginkgo has been studied in both the animalmodel of MS and in people with MS. In theanimal model, ginkgo decreased diseaseactivity. Two studies have been done in peo-ple. One suggested a benefit, but the largerof the two trials suggested no benefit. Inthat study, ginkgo was used to treat exacer-bations, or attacks, of MS. The study did notconsider whether ginkgo might have a role inpreventing attacks or in improving MS-relatedcognitive dysfunction.

Few serious side effects with ginkgo supple-mentation are known. Ginkgo may inhibitblood clotting and therefore should be avoidedby people with bleeding disorders, those whotake blood-thinning medications, and those


sion. Medications taken by people with MSthat could possibly be affected by St. John’swort include amitriptyline (Elavil), nortrip-tyline (Pamelor), carbamazepine (Tegretol),phenobarbital, phenytoin (Dilantin) and pri-midone (Mysoline).

There is a relatively high incidence of depres-sion among people with MS. It is important torecognize that depression should not be self-diagnosed or self-treated. If you think that youmay be a candidate for treatment with St.John’s wort, you should first seek a profession-al evaluation. St. John’s wort is not suitablefor anyone with severe depression.

ValerianThe unpleasant-smelling root of a flowercalled valerian is sometimes used as a sleepaid. (It is also sometimes used in root beer!)People with MS may have difficulty sleeping,and difficulties with sleep may contribute toMS-related fatigue. Thus, a sleep aid may bevery useful to some people with MS.

A few well-designed trials not involving peoplewith MS show that valerian can decrease theamount of time required to fall asleep withoutresidual feelings in the morning. Valerian isusually well tolerated. However, its immuneeffects have not been studied.

25

St. John’s WortSt. John’s wort is a yellow flower that grows inmany parts of the world. It is generally usedas an antidepressant. Many studies indicatethat St. John’s wort indeed has antidepressanteffects. However, the claim was not supportedby data from the first large-scale multicenterclinical trial of St. John’s wort versus an inertplacebo or Zoloft. This trial, conducted by theNational Institute of Mental Health, NationalCenter for Complementary and AlternativeMedicine, and the federal Office of DietarySupplements, was completed in 2002. It con-cluded that St. John’s wort is not effectivein treating major depression of moderateseverity. The NIMH and cosponsors are nowplanning to study the herb in people with milddepression.

St. John’s wort is generally well tolerated andno reported study has identified effects on theimmune system that could be concerning topeople with MS.

Interaction with other medications is oneimportant risk of using this herb. St. John’swort appears to alter the body’s metabolism ofcertain drugs, which may include birth controlpills and drugs commonly used to treat heartdisease, seizures, certain cancers, and depres-


short, there is too little evidence to concludewhether ginseng is safe for people with MS ornot, and nothing to indicate that it improvesenergy or strength.

CranberryCranberry is grown in bogs in North Americafor juice, jelly, and seasonal decorations. Manypeople use the ripe fruit from this plant to pre-vent or treat urinary tract infections.

Evidence suggests that cranberries preventbacteria from sticking to the cells that line theurinary tract. This unique action of cranberryis attributed to two compounds, fructose (atype of sugar), and another chemical known asproanthrocyanidin. Recently published pre-liminary evidence suggests that cranberrymay also kill bacteria directly.

Cranberry has very few side effects. Therefore,using cranberry tablets or juice to preventurinary tract infections is probably reasonable.Increased fluid intake and improved hygienemay also be helpful preventive measures.

Cranberries should never be used to treatexisting urinary tract infections. Urinarytract infections can have serious consequencesfor people with MS. Urinary tract infections

27

People with fatigue should consider the possi-bility that their fatigue may worsen when theytake valerian as it may have a lingering sedat-ing effect. Also, valerian may increase thesedating effects of prescription medicationssuch as diazepam (Valium), baclofen(Lioresal), and tizanidine (Zanaflex).

Asian GinsengAsian ginseng, also known asPanax ginseng, has been used forcenturies by the Chinese for itssupposed ability to enhance phys-ical performance and resistance to stress andaging. The evidence in support of these vagueclaims is not very strong. One clinical studysupported the use of ginseng to enhance quali-ty of life, and another study showed animprovement in the speed of mathematicalcomputations among college students. Butother studies have failed to find benefits.

An herb that increases energy and strengthwould be of great use to people with MS whosometimes suffer from debilitating fatigue.Although some evidence suggests ginsengmight be safe in people with MS, other experi-ments raise the possibility that ginseng maystimulate the immune system in ways thatmay be detrimental to people with MS. In


ments we described. Just as importantly,we hope that it provides a framework forthoughtful consideration of other CAM treat-ments not discussed here.

29

require immediate antibiotic treatment froma physician to get them under control quickly.

CONCLUSION

People with MS and other chronic diseasesoften consider using complementary and alter-native medicine (CAM). Doing all that one canto live well with MS is reasonable, but the useof CAM implies that people accept importantresponsibilities as well.

Nowhere in this booklet do we recommend anyparticular treatment. Rather, the pros andcons for each are described as well as spaceand available data permit. As with most CAMtreatments, the evidence regarding dietarysupplements is inconclusive. The lack ofbetter evidence is frustrating. Nevertheless,an inquiry into CAM can also be rewarding.It may help restore a sense of control andhope to people who are struggling with anunpredictable disease. Hope and a good quali-ty of life are tightly linked, and both should becultivated.

We hope this booklet provides enough use-ful and specific information to allow moreinformed decision-making about the supple-


Other non-technical books with objective gen-eral information on dietary supplements andCAM are:

� Dillard J., Ziporyn T. AlternativeMedicine for Dummies. Foster City, CA:IDG Books Worldwide, Inc., 1998.

� Steven Foster and Varro E. Tyler, PhD,Tyler's Honest Herbal: A Sensible Guideto the Use of Herbs and Related Remedies.Binghamton, NY: Haworth Press. Web site:www.haworthpressinc.com. Tel: 800-HAWORTH (1-800-429-6784).

Note: The above-mentioned books may beavailable for loan at your local chapter of theNational MS Society, or at your public library.

Technical References

Detailed technical references include:

� 2006 Physicians' Desk Reference forNonprescription Drugs, DietarySupplements and Herbs, ThomsonHealthcare, NJ. Web site: www.pdrbookstore.com; Tel: 800-232-7379. ISBN: 1-55363-530-5.

31

REFERENCES

Web sites

� The National MS Society offers localreferrals, education programs, counseling,self-help groups, and other booklets andbrochures on MS. Log on to nationalmssociety.org.

� Regularly updated information focused onCAM and MS is available on an interactiveWeb site at www.ms-cam.org. This site ismanaged by the Rocky Mountain MSCenter.

Non-technical books

There are many non-technical books on CAM.One book that specifically deals with CAMand MS is:

� Bowling A.C. Alternative Medicine andMultiple Sclerosis. New York: DemosMedical Publishing, 2001. Web site:www.demosmedpub.com. Tel: 800-532-8663.


Sources of information onhealth fraud

� National Council Against Health Fraud,119 Foster Street, Peabody, MA 01960.Tel: 978-532-9383. Web site: ncahf.org.

� Quackwatch. Web site:www.quackwatch.com.

Federal government sources

� Federal Trade Commission, ConsumerResponse Center, 600 PennsylvaniaAvenue, NW, Washington, DC 20580.Tel: 877-FTC-HELP (877-382-4357). Website: www.ftc.gov. Investigates falseadvertising.

� Food and Drug Administration, 5600Fishers Lane, Rockville, MD 20857. Tel:888-463-6332. Web site: www.fda.gov. In1988, the FDA established the NationalHealth Fraud Unit to fight medical fraud.This unit helps coordinate federal, state,and local regulatory actions against fraudu-lent products and practices.

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� Physicians' Desk Reference for HerbalMedicines, Second Edition, ThomsonHealthcare, NJ. Web site: www.pdrbookstore.com; Tel: 800-232-7379.

� Bowling, A., Stewart, T. Current comple-mentary and alternative therapies formultiple sclerosis. Current TreatmentOptions in Neurology, 5:55-68, 2003.

� Ernst, E., Pittler, M.H., Stevinson, C.,White, A. The Desktop Guide toComplementary and AlternativeMedicine: An Evidence-BasedApproach. London: Mosby, 2001.

� Fetrow, C., Avila, J. The Professional'sHandbook of Complementary andAlternative Medicines. Springhouse, PA:Springhouse Corp., 2003.

� Fragakis, A.S. The Health Professional'sGuide to Popular Dietary Supplements.Chicago, IL: The American DieteticAssociation, 2003.

� Jellin J.M., Batz F., Hitchens K., et al.Natural Medicines ComprehensiveDatabase. Stockton, CA: TherapeuticResearch Faculty, 2006.


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� National Center for Complementary andAlternative Medicine Clearinghouse, P.O.Box 7923, Gaithersburg, MD 20898-7923.Tel: 888-644-6226. TTY: 866-464-3615. Website: nccam.nih.gov. E-mail:[email protected].

� U.S. Postal Inspection Service. Web site:www.usps.gov/postalinspectors.Monitors products purchased by mail.



Sources of additional informationand other services

1-800-FIGHT-MS (1-800-344-4867) can beused to reach the National MS Society chapternearest you. Your chapter offers local refer-rals, education programs, counseling, self-helpgroups, and booklets and brochures on manyaspects of living with MS.

If you join the Society, you will receive ournational magazine, InsideMS, a quarterlypacked with news and features of interest toanyone affected by MS, and MS Connection,a newsletter from the Society office closestto you, which covers nearby events andresources.

For the best MS information online, consultthe National MS Society Web site. You canfind information on diagnosis, treatments,medications, clinical trials, research news,issues in coping and management, MS publi-cations, news on advocacy, events and servicesoffered by your chapter, MS clinics, and howyou can join the Society. Log on to:nationalmssociety.org.

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