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Supplements

Ideally we would obtain all our nutritional needs from a well balanced diet rich in nutrients.

Sometimes people are unable to obtain everything they need from their diet. This might be because they find it difficult to maintain and manage a healthy well balanced diet, they may have digestive issues which can make adequate absorption of nutrients difficult, they may have a chronic health condition which warrants higher nutritional content in their diet.

Supplements are generally synthetically manufactured in factories. Where possible it's preferable to select a supplement which is made from foods rather than synthetically produced, however these food-based supplements can be difficult to source - with the exception of fish and flaxseed oils. Supplements can also contain other additives, so it's worth purchasing a good quality supplement from a reliable source.

If you do choose to supplement, you should speak with a dietitian, nutritionist or GP first.

Following are some of the key supplements people with multiple sclerosis might consider.

Vitamin D

Multiple sclerosis occurs much more frequently in areas of the world where people have less sunlight and as a result less vitamin D. The best way to obtain Vitamin D is via sunlight, however modern living can make this difficult and supplementation may be useful.

Low vitamin D levels are associated with more rapid disease progression and more relapses in people with multiple sclerosis.[i]
Vitamin D has many effects on the body, and is essential for calcium absorption for bone health, immune function, and brain function.
Vitamin D deficiency is linked with osteoporosis, depression, high blood pressure, cardiovascular disease and autoimmune diseases like multiple sclerosis[ii], rheumatoid arthritis, diabetes and certain cancers.
Regular safe sun exposure is how our bodies produce Vitamin D. People with multiple sclerosis should aim for fifteen minutes of sun on as much of their body as possible three to five times per week.[iii] However, it is important not to get too red or burnt as this raises the risk of skin cancer.
Lack of sun exposure resulting in Vitamin D deficiency is implicated in multiple sclerosis[iv] [v].
Vitamin D also appears to be lower when a person with multiple sclerosis is experiencing a relapse.[vi] [vii] [viii]
Low dose supplementation can reduce the risk of developing multiple sclerosis.
You can test your Vitamin D level by a simple blood test.
Food sources of vitamin D include cod liver oil, oily fish, such as kippers, mackerel, salmon, tuna, sardines and fish liver oil; eggs are also rich in vitamin D. However, only a small amount can be obtained from the diet – most is generated by exposure to sunlight.
Vitamin D is not needed in the diet everyday because the body stores any vitamin D that is not needed immediately for future use.

Fish oils / essential fatty acids

Fish oil supplements are high in Omega 3 essential fatty acids. They have an anti inflammatory effect and are needed for the nervous system and for the production of myelin. Supplementing with fish oils has a number of general health benefits, plus some specific benefits for people with multiple sclerosis.

Some studies have shown Omega 3s help to improve quality of life, slow disease progression[ix] and reduce relapses in people with multiple sclerosis.^{^[x]}
Fish oils have lots of benefits for your heart health, blood pressure and cholesterol levels^{.[xi] [xii] [xiii] [xiv]}
Studies have shown consuming fish rich in omega 3s decreases the risk in developing breast, prostate and colon cancers.^{^[xv]}
If you choose to supplement with fish oils choose a good quality product where the heavy metals which can contaminate fish oil supplements have been screened out carefully and that the processes used to produce the oil protect it from rancidity.

Flaxseed / linseed oil

Flaxseed oil (linseed oil) is another rich source of Omega 3 oils.

A study has shown that supplementing with both fish oil and flaxseed has the most beneficial effect for people with multiple sclerosis[xvi].

B Group Vitamins and Vitamin B₁₂

The B group vitamins are required for good energy production and a healthy myelin sheath and nervous system.

B vitamins are water soluble, they are not stored in the body and are generally considered safe to supplement.
B vitamins appear to work synergistically together and are best taken as a group.
Vitamin B₁₂ is vital for the metabolism of fatty acids and the maintenance of myelin.
B₁₂ is found primarily in meat, poultry, fish dairy and fortified cereals. B12 will most likely be deficient in people who have a vegetarian diet.
Vitamin B₁₂ is often found to be low in MS suffers.[xvii] [xviii]

Vitamin C

Vitamin C is considered a safe supplement to take as it is water soluble.

Vitamin C is a major antioxidant.
Vitamin C is needed for a healthy immune system, tissue repair, wound healing and production of neurotransmitters such as serotonin.
Vitamin C increases iron absorption.
Vitamin C is found in fruit and vegetables. High levels of vitamin C is found in green chilies, raspberries, guavas, bell peppers, broccoli, dark leafy greens and kiwi fruit.

Iron

It is possible to become iron deficient if you are restricting or avoiding meat, especially if you are a pre-menopausal female. Iron deficiency anaemia is experienced by over 14% of pre-menopausal women.

Iron has many functions in our body, however the best known function of iron is its role in the production of the haemoglobin molecule, which carries oxygen in the blood. Oxygen is essential for most functions in the body, so iron is vital for ensuring adequate oxygen supply.
Iron levels are measured by a simple blood test.
Some people have a condition called "haemachromatosis", which causes iron overload, and the symptoms are very similar to iron deficiency.
Always check your blood iron levels before supplementing.
Good food sources of iron include oysters, beef, chicken, tuna, pumpkin seeds, prunes, apricots and molasses.
Many people find that iron tablets cause constipation and sometimes nausea. This is typically associated with the ferrous sulfate form. More digestible forms of iron supplements tend to be in the ferrous gluconate or iron fumarate form.

Caution regarding Vit A, E and Beta Carotene

Antioxidant supplements containing beta-carotene, Vitamin A and Vitamin E are cautioned against on the basis of a number of large reliable studies which indicate taking synthetic supplements of beta carotene, Vitamin A and Vitamin E can shorten your life not lengthen it.[xix] [xx] [xxi]

You can safely obtain these vitamins from food:

Vitamin A: liver, fish, cod liver oil, sweet potato, pumpkin, leafy green vegetables (e.g. spinach) and egg yolks.
Beta Carotene (a precursor to Vitamin A): Brightly coloured fruit and vegetables such as pumpkin, oranges, carrots, sweet potato
Vitamin E: Sunflower seeds, almond, spinach, avocado and asparagus.

Additionally blueberries, broccoli and green tea are full of antioxidants.

[i] Ascherio A, Munger KL, White R, Köchert K, Simon KC, Polman CH, Freedman MS, Hartung HP,Miller DH, Montalbán X, Edan G, Barkhof F, Pleimes D, Radü EW, Sandbrink R, Kappos L¹¹,Pohl C. Vitamin D as an early predictor of multiple sclerosis activity and progression .JAMA Neurol. 2014 Mar;71(3):306-14. doi: 10.1001/jamaneurol.2013.5993.

[ii] Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA. 2006;296:2832–2838.

[iii] Professor G. Jelinek, Overcoming Multiple Sclerosis, p127

[iv] Ponsonby AL, McMichael A, van der Mei I. Ultraviolet radiation and auto-immune disease: insights from epidemiological research. Toxicology 2002;181-2:71-8

[v] Esparaza ML , Sasaki S, Kesteloot H. Nutrition, latitude, and multiple sclerosis mortality: an ecologic study. Am J Epidemiol 1995; 142:733-7

[vi] Oilu-Hanninen M, Airas L, Mononen I et al. 25-hydroxyvitamin D levels in serum at the onset of multiple sclerosis. Mult Scler 2005;11:266-71

[vii] Smolders J, et al. Association of vitamin D metabolite levels with relapse rate and
disability in multiple sclerosis. Multiple Sclerosis 2008;14:1220-1224.

[viii] James E, Dobson R, Kuhle J, Baker D, Giovannoni G, Ramagopalan SV. The effect of vitamin D-related interventions on multiple sclerosis relapses: a meta-analysis. Mult Scler. 2013 May 22. PMID: 23698130.

[ix] Tettey P, Simpson S Jr, Taylor B, Blizzard L, Ponsonby AL, Dwyer T, Kostner K, van der Mei I An adverse lipid profile is associated with disability and progression in disability, in people with MS. Mult Scler. 2014 Nov;20(13):1737-44. doi: 10.1177/1352458514533162. Epub 2014 May 14.

[x] Jelinek GA, Hadgkiss EJ, Weiland TJ, Pereira NG, Mark CH, van der Meer DM. Association of fish consumption and omega 3 supplementation with quality of life, disability and disease activity in an international cohort of people with multiple sclerosis. Int J Neurosci, 2013 Nov; 123(11):792-800

[xi] Kristof Vanschoonbeek et al Fish oil consumption and reduction of arterial disease Nutr. 133:657-660, March 2003

[xii] Jeppesen J et al. Triglyceride concentration and ischemic heart disease: an eight year follow up in the Copenhagen Male Study. Circulation 97.11 (1998):1029-36

[xiii] Sudheera S et al. Prevention of Cardiac Arrhythmia by Dietary (n-3) Polyunsaturated Fatty Acids and Their Mechanism of Action

[xiv] Geleijnse JM et al. Blood pressure response to fish oil supplementation: meta regression analysis of randomised trials. J Hypertension 20.8 (2002): 1493 - 99

[xv] S.C.Larsson, M. Kumlin, M. Ingelman-sundberg, A. Wolk. Dietary long chain
n-3 fatty acids for the prevention of cancer: a review of potential mechanisms. Am. J.
Clin. Nutr. 2004; 79: 935-945

[xvi] Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. The association of diet with quality of life, disability, and relapse rate in an international sample of people with multiple sclerosis. Nutr Neurosci. 2015 Apr;18(3):125-36. doi: 10.1179/1476830514Y.0000000117. Epub 2014 Mar 17.

[xvii] Ariel Miller, Maya Korem, Ronit Almog, Yanina Galboiz, Vitamin B12, demyelination, remyelination and repair in multiple sclerosis, Journal of the Neurological Sciences 233 (2005) 93 – 97

[xviii] Mastronardi FG, Min W, Wang H, Winer S, Dosch M, Boggs JM, et al. Attenuation of experimental autoimmune encephalomyelitis and nonimmune demyelination by IFN-beta plus vitamin B12: treatment to modify notch-1/sonic hedgehog balance. J Immunol 2004; 172:6418–26.

[xix] Bjelakovic G, Nikolova D, Gluud LL, et al. Mortality in randomised trials of antioxidant supplements for primary and secondary prevention: systemic review and meta analysis. JAMA 2007; 297:842-57

[xx] Omenn, G.S. et al. Effects of a combination of beta carotene and Vitamin A on lung cancer and cardio vascular disease. New England Journal of Medicine. 334 (18):pp1145-1149; May2, 1996

[xxi] Shekelle, R.B. et al. Dietary vitamin A and the risk of cancer in the Western Electric study. The Lancet 2 (8257):pp 1186 – 1190, Nov 28, 1981

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