The use of vitamins, minerals, and other supplements is both popular and controversial. Surveys of people with MS indicate that the use of supplements is one of the most common forms of CAM. Much of their popularity probably is due to their accessibility. Supplements are easily purchased from grocery stores, health food stores, and drug stores, and using supplements does not require seeing a practitioner.
The potential benefits of supplements are frequently exaggerated by vendors and other proponents of supplements, and the possible uses of supplements in MS are sometimes based on incorrect information about the disease process. In conventional medicine, supplements have been viewed typically with skepticism. Supplements are now undergoing more serious investigation, and supplements are now recommended for preventing or treating a limited number of conditions on the basis of recent research studies.
Background Information
Vitamins are chemicals that are used for many of the body’s fundamental chemical processes. In spite of the fact that they are present in only very small quantities, vitamins are absolutely necessary for normal body function. Thirteen vitamins are “essential,” which means that the body does not have the biochemical machinery to synthesize them and that they must therefore be consumed in the diet. Most vitamins come from animal or plant foods. The 13 essential vitamins are the eight B vitamins and vitamins A, C, D, E, and K. Most vitamins are water-soluble. The four fat-soluble vitamins are A, D, E, and K.
Minerals are also important for maintaining the body’s fundamental chemical processes. Minerals originate in soil and water and are incorporated into plants and animals. The minerals that are needed in large quantities, known as “major minerals,” include calcium, chloride, magnesium, phosphorus, potassium, sodium, and sulfur. Those required in small quantities, the “trace elements,” include chromium, fluoride, iron, selenium, and zinc. A total of 18 trace elements are considered essential.
In addition to vitamins and minerals, there are other types of supplements. Herbs are an especially popular supplement. Other categories of supplements include hormones, antioxidants, amino acids, and enzymes.
How Much Is Needed?
Much of the controversy in the supplement field centers around how much of a particular vitamin or mineral should be consumed daily. The Food and Nutrition Board of the National Academy of Sciences determines the Recommended Daily Allowances (RDAs), Adequate Intakes (AIs), or other similar values for vitamins and minerals.
Are Adequate Amounts of Vitamins and Minerals Available in Food?
For a healthy adult, a well-balanced diet should be adequate because it contains enough vitamins and minerals to meet the RDA. It is not clear that supplements are necessary in this situation. However, supplementation may play an important role in other circumstances. For example, if the diet is not well balanced or is low in quantity, the RDA may not be met and supplementation is important. Also, people with certain conditions may benefit from vitamin or mineral doses that are higher than the RDA and may not consume these doses in spite of a well-balanced diet. Examples of this situation are folic acid supplements for pregnant women and vitamin D and vitamin B12 supplements for the elderly.
Vitamins and Minerals Interact with Each Other
There are several other significant features of vitamin and mineral supplements. First, there are complex interactions between vitamins and minerals. As a result, high doses of a single vitamin or mineral may be harmful or ineffective. For example, excessive vitamin C intake may affect the body’s ability to absorb copper, and high doses of vitamin B1 may produce deficiencies of vitamins B2 and B6. Also, calcium cannot be utilized for bone health without adequate levels of vitamin D.
Supplements and MS
Supplements are one of the most popular forms of CAM used by people with MS. In addition to vitamins and minerals, a whole range of other specially formulated supplements is sometimes recommended for MS.
Several errors are frequently made in recommending supplements for use in MS. First, recommendations are sometimes haphazard and random; little or no justification is given for a long (and expensive!) list of supplements. When a justification is given, it is sometimes stated that MS is an immune disease and that immune-stimulating supplements are therefore needed. In fact, MS is an immune disease, but it is characterized by too much, not too little, immune activity. As a result, immune-stimulating supplements may actually be harmful for MS. Similarly, supplements that may affect the immune system are sometimes recommended for MS along with cancer and AIDS. Once again, all three diseases do involve the immune system, but people with cancer and AIDS may benefit from stimulation of the immune system, whereas people with MS may benefit from its suppression.
It is sometimes mistakenly assumed that if a deficiency of a vitamin or mineral impairs the function of the immune system or nervous system, an excess of that same vitamin or mineral will be beneficial to the immune system or nervous system and thus will be therapeutic for MS. In other words, it is assumed that if a little is good, a lot is better. In fact, there are probably very limited uses of high doses of vitamins and minerals.
A good example of this dosing issue that is relevant to the nervous system is that of vitamin B6 (pyridoxine). A deficiency of vitamin B6 impairs nervous system function. However, an excess of vitamin B6 injures the nervous system and may actually produce symptoms similar to those of MS. Thus, for vitamin B6 and the nervous system, a normal level is desirable, and either a deficiency or an excess may be harmful.
In the case of immune system function, seemingly paradoxical situations may arise with regard to supplement doses. For example, vitamin B7 (biotin) is important for maintaining a healthy immune system; a deficiency of vitamin B7 appears to be beneficial for animals with EAE, an experimental form of MS. On the other hand, supplementation with either selenium or zinc, two minerals involved in immune system function, may worsen EAE. On the basis of this limited scientific information, it could be argued that a state of deficiency of immune-relevant vitamins and minerals may be beneficial for MS, and a state of excess of these nutrients may be harmful. Because of limited information, it is not known if this argument is true. It is conceivable that it is true. Because MS is characterized by excessive immune system activity, deficiencies may be beneficial because they decrease immune system activity, and high levels may be harmful because they increase immune activity. This argument is not provided as a recommendation for people with MS to induce a deficiency state! Rather, it is provided to illustrate the complexities of vitamin and mineral dosing for specific diseases such as MS.
Vitamin and mineral supplements are clearly necessary for people with MS who have an inadequate diet. This may occur for a variety of reasons and may be particularly prevalent in those who are more severely impaired. With a poor diet, supplementation is essential to ensure an adequate intake of essential nutrients.
The most conservative approach to supplement use in MS is to avoid all supplements (except in people who clearly are nutritionally deficient). The rationale behind this view is that the effectiveness and safety of supplements has not been fully investigated in MS and therefore that supplements should not be used because they may be of no benefit and may actually be harmful.