Vitamins & Supplements: An interview with Dr. Brenda Banwell

Following last week’s webcast, Living Well with MS: Lifestyle, Diet and Complementary Therapies, we sat down with Dr. Brenda Banwell, MD, to get answers to your questions about vitamins and supplements that are potentially helpful and harmful for people with MS.

In addition to Vitamin D, what other vitamins or supplements do you recommend taking on a daily basis to help MS?

There really isn’t anything else that’s even close to vitamin D in terms of research support for its use in MS. However, I do a blood test of the serum levels of vitamin B12 to make sure my patients aren’t deficient. Vitamin B12 deficiency has a negative impact on myelin, which is important for neurological function and is a particular target in MS. In fact, B12 deficiency can actually look like MS in some patients, and having low B12 if you have MS can further compromise the brain and spine. That said, healthy people who are eating a regular diet are rarely deficient in B12, and if you have normal levels, taking additional B12 has no proven value. People who are on some extreme diets or don’t eat red meat are more likely to have low levels and should be treated if that’s the case.

There’s really no evidence of a specific role for any particular B-complex vitamin in MS. There’s an ongoing debate about the benefits of omega-3 and other fatty acids. I caution parents of kids I look after about not giving too high a dose of fish oils or other oils – when you put too much oil into your gut you actually absorb other nutrients less well. This can put you at risk of diarrhea and other nutritional problems. I strongly discourage a, “A little bit is good, a lot must be great” philosophy. Very few things in nature are meant to be consumed in excessive amounts. If we step back and think more from a nature perspective, almost every species has what we call, “satiety safety.” In other words, they stop when they’re full – and I think that’s a message that we as humans should not override.

What supplements should people with MS avoid?

There are a lot claims made on alternative remedies that may or may not be biologically accurate. To be fair, there are a lot of medications that are approved for which we don’t fully understand their mechanism either. I recommend avoiding nutritional supplements or holistic remedies that claim to boost the activity of your immune system – these are commonly suggested for people who get a lot of coughs, colds, fevers or illnesses. Theoretically, boosting your immune system would not be something you’d want to do if you have MS. MS is a disorder that is characterized by an exaggerated immune response directed at the brain, spine or optic nerves – and there is a dysregulation or failure to turn down the immune response when it starts attacking your own body. So, to give someone something that boosts the ability of turned on immune cells to act even more would go against what we want to do in MS.

When you seek out advice from alternative care providers, I suggest that you ask the provider what the substance they’re recommending is supposed to do. Ask them why they think that would be effective in MS. Then, ask what they know about MS and its characterizations. If that dialogue leads to the choice of a supplement that he or she believes would help with immune control or with improvement in myelin or nerve regeneration, then I would advocate that you bring that information and the supplement to your primary healthcare provider so that he or she can analyze the substance and whether or not it would have any potential interaction with other medication you may be on.

Do you have any other advice for people who are considering complementary or alternative therapies for MS?

There are so many opportunities on the internet to support, give insight and share ideas – that’s one of the strengths of the internet. The problem is that there’s no filter. So, I think an open, honest and trusting dialogue between people with MS, their well-meaning families and friends and all of their healthcare providers is essential to ensure we’re all on the same page and working together. Where we’re seeing alternate treatments cause harm, is when one healthcare provider doesn’t know what the other is doing.

There seems to be a perception from many people with MS that their healthcare providers aren’t open to complementary and alternative medicine, but I think that’s changing. When we’re able to have an open and honest dialogue, I’ve been able to work with families to agree upon what is reasonable and what is potentially dangerous – and ultimately find a course of treatment we’re all happy with.

Please tune in to the MS Connection blog next week as we chat with Drs. Allen Bowling, Timothy Coetzee and Albert Lo about the roles of diet, exercise and other holistic approaches to living well with MS.
Tags Healthy Living, Research, Treatment      10

Brenda Banwell, MD

Division Chief, Neurology, Professor of Pediatrics (Neurology), Children's Hospital of Philadelphia, University of Pennsylvania