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Vitamins & MS

We have known for centuries that a diet rich in micronutrients, specifi cally vitamins, minerals and antioxidants is helpful in preventing a range of diseases. What is uncertain is whether larger doses of vitamins obtained by extracting those nutrients, concentrating them, and taking them in supplement form has any increased benefits.

Vitamins do not function in isolation from one another, but rather work in careful balance. As such, a high concentration of one vitamin might cause a relative defi ciency of another.
Vitamin D, the antioxidant vitamins, vitamin B6, and vitamin B12 are of particular interest in relation to multiple sclerosis.

Free radicals & Antioxidants

A free radical, also called an oxidant, is a molecule that contains an unpaired electron. The unpaired electron is highly unstable and generally allows the molecule to react with other nearby substances causing cell damage. This oxidation plays a role in many diseases, including cardiovascular diseases and cancer, as well as in the aging process.

Certain vitamins can limit the damage to cells caused by oxidants or free radicals. These vitamins, which include vitamin A, vitamin C and vitamin E, are known as antioxidants. Because of these potential benefits, the antioxidant vitamins and elements have been the most studied group of vitamins.

There has been some limited research which suggests that oxidant activity in the central nervous system may be linked to the damage that occurs in MS. However, no large-scale, rigorous clinical trials have been conducted to definitively determine the safety or effectiveness of antioxidants in MS, and the signifi cance of oxidants is still unclear.

Further research is needed to determine the safety and potential benefi ts of antioxidant therapy for MS. Antioxidant therapy might also carry a risk for people with MS, as some antioxidants have a stimulating effect on the immune system, which in theory could worsen the effects of MS.

As the research does not provide clear answers at this time, those with MS should approach antioxidants cautiously. It may be reasonable to avoid supplements altogether and rely on dietary intake of antioxidants. A diet rich in vegetables, fruit, nuts, seeds and grains ensures a potent dietary mixture of vitamins, minerals and antioxidants. It also ensures that these substances are in their natural state, balanced with other food factors essential for their optimal function. If antioxidant supplements are used, it may be best to use them in moderation.

Vitamin B12

Also known as cobalamin, vitamin B12 is an important nutrient found primarily in meat, especially liver, eggs and dairy products. No plant foods can be relied on as a defi nite source of vitamin B12.

As a result of this B12 deficiency is well known to occur in vegans.

Vitamin B12 is necessary for the production of red blood cells and for the maintenance of a healthy nervous system and plays a key role in the metabolism of fatty acids essential for the maintenance of myelin.

Prolonged B12 defi ciency can lead to nerve degeneration and irreversible neurological damage. It can take many years for deficiency disease to develop after changing to diets low in B12, although B12 deficiency is surprisingly common. One Australian study showed that about 23% of people aged over 50 had low vitamin B12 levels.

MS and vitamin B12 defi ciency are pretty similar diseases in terms of their inflammatory and neurodegenerative processes. It is actually hard to tell the difference between them sometimes, due to similarities in clinical features and MRI findings. In addition, decreased levels of vitamin B12 are fairly common in MS patients. Researchers have raised the possibility of B12 causing MS, and suggested close monitoring of vitamin B12 levels in people with MS, as well as B12 supplementation.

The B group vitamins in general are extremely important for normal brain function. They are quite cheap and readilyabsorbed. The B group also includes folate. Folate deficiency has most recently been shown to be involved in causing Alzheimer’s Disease. Folate is intimately related to normal nerve cell development, as shown by the reduced incidence of spina bifida in babies born to mothers taking folate supplementsƒ.

Glucosamine

Glucosamine is an extract from the shells of shellfish and is sold in capsule form from most health food shops. Recently it has been shown in experimental animals to produce a shift in the balance of the Th1/Th2 immune response towards a suppressive Th2 response, and to significantly suppress the animal form of MS, EAE, in the laboratory. The authors suggested a potential use for glucosamine either alone or in combination with diseasemodifying drugs to enhance their benefit and reduce their doses in MS and possibly other autoimmune disorders.

Alpha-lipoic acid

Alpha-lipoic acid is present in mitochondria, which produce energy within cells. It is anantioxidant, and as such it acts to reduce damage done by free radicals. It has been shown to have favourable immune effects in the laboratory, to suppress and treat the animal model of MS, EAE, and to stabilise the blood-brain barrier in an animal model. It has been further studied in humans.ˆ In a 14 day placebo-controlled study, the investigators found that LA inhibited enzymes responsible for helping T cells get access to the CNS. They postulated that it may therefore prove useful in treating MS. They found that oral LA was generally well tolerated by patients. LA may ultimately be a useful treatment for MS.

References

(1). Flood VM, Smith WT, Webb KL, et al. Prevalence of low serum folate and vitamin B12 in an older Australian population. Aust N Z J Public Health 2006; 30:38 - 41

(2). Miller A, Korem M, Almog R, et al. Vitamin B12, demyelination, remyelination and repair in multiple sclerosis. J Neurol Sci 2005

(3). Pitkin RM. Folate and neural tube defects. Am J Clin Nutr 2007; 85:285S - 288S

(4). Zhang GX, Yu S, Gran B, et al. Glucosamine abrogates the acute phase of experimental autoimmune encephalomyelitis by induction of th2 response. J Immunol 2005

(5). Marracci GH, McKeon GP, Marquardt WE, et al. alpha lipoic acid inhibits human T-cell migration: Implications for multiple sclerosis. J Neurosci Res 2004

(6). Morini M, Roccatagliata L, Dell’Eva R, et al. Alpha-lipoic acid is effective in prevention and treatment of experimental autoimmune encephalomyelitis. J Neuroimmunol 2004; 148:146 - 153

(7). Schreibelt G, Musters RJ, Reijerkerk A, et al. Lipoic Acid affects cellular migration into the central nervous system and stabilizes blood-brain barrier integrity. J Immunol 2006; 177:2630-2637

(8). Yadav V, Marracci G, Lovera J, et al. Lipoic acid in multiple sclerosis: a pilot study. Mult Scler 2005; 11:159-165