Note: The U.S. Food and Drug Administration (FDA) does not approve supplements for safety or effectiveness. Talk to a healthcare professional about whether a supplement is the right fit for your individual health, and about any potential drug interactions or safety concerns.
More and more people with multiple sclerosis (MS) are looking for complementary and integrative approaches to incorporate into their treatment plan. But it’s important to use caution, because some supplements that appear to be helpful have actually been shown to be harmful.
“Talking to your doctor is certainly the first step before trying any supplements,” says Ellen M. Mowry, MD, a professor of neurology and the director of the MS Experimental Therapeutics Program at Johns Hopkins Medicine in Baltimore. “I think sometimes people get frustrated that doctors aren't more ‘positive’ about supplements, but as a neurologist, I expect to see the same high-quality data for a supplement as I would expect for any medication I prescribe before recommending it.”
The U.S. Food and Drug Administration (FDA) doesn’t require that kind of data for supplements to be sold, which means that something may be advertised as helping with MS but have little to no evidence to back it up.
And while the American Academy of Neurology (AAN) published its first-ever guidelines on complementary therapies, including supplementation, for MS in 2014, they haven’t been updated since then.
So what does the evidence say about which supplements may be worth exploring and which ones you should avoid? Here are some dos and don’ts for people with MS.
Supplements to Discuss With Your Doctor if You Have MS
Do Consider Vitamin D, Which May Help Manage Fatigue
There is some evidence that maintaining the recommended level of vitamin D may lower the risk of MS, especially in women. Other studies also suggest that people with MS could benefit from taking vitamin D, particularly if they’re deficient.
“Vitamin D supplementation has emerged as a promising and widely recommended option for managing fatigue in MS patients. Recent studies indicate that correcting vitamin D deficiency can lead to small yet significant improvements in fatigue levels,” says Achillefs Ntranos, MD, a neurologist specializing in MS and the founder of Achilles Neurology Clinic in Los Angeles.
“Beyond fatigue, vitamin D offers broader benefits in MS, potentially reducing inflammation and enhancing overall disease management,” Dr. Ntranos says. “Given its safety, affordability, and multiple health advantages, maintaining optimal vitamin D levels is a practical and beneficial approach for anyone dealing with MS-related fatigue.”
In the past, providers often recommended supplements for people whose blood levels weren’t at the high end of the normal range, says Vijayshree Yadav, MD, a professor of neurology and the director of the Multiple Sclerosis Center at Oregon Health and Science University in Portland.
“That has changed,” Dr. Yadav says. “Although there is still evidence that vitamin D is important, high levels may not be as important as we once thought. We are no longer recommending that people with MS should be in the higher range of normal. We are recommending that they be in the mid to lower range of normal, and that is a big difference.”
The recommended daily allowance (RDA) for vitamin D is 600 international units (IU) for people ages 1 to 70 and 800 IU for people over 70.
But Yadav warns that too much of it can be a problem, and may lead to vitamin D toxicity as well as kidney damage. Toxicity is most likely to occur at doses of 10,000 IU daily or higher.
It’s best to take any vitamin D supplement under the supervision of a medical professional who can monitor your blood levels, Yadav says.
Do Ask Your Doctor About Coenzyme Q10, Which May Reduce Inflammation
Coenzyme Q10 is an antioxidant that is naturally produced in the body, where your cells use it to grow and make energy.
A review of six studies found taking 500 milligrams (mg) per day of CoQ10 for two to three months may reduce oxidative stress and inflammation, both of which are associated with demyelination. Demyelination is the process that damages the myelin sheath, or the protective cover surrounding nerve fibers, and leads to symptoms in MS. The review also found that CoQ10 may alleviate depression and fatigue.
In another study using mice, researchers also found that CoQ10 helped with oxidative stress and inflammation. They concluded that the supplement had potential to enhance remyelination (the natural repair mechanism of demyelination) in people with MS, but that further study in humans is needed.
“In my practice, I do sometimes recommend CoQ10 for patients struggling with fatigue. It’s not a guaranteed fix for everyone, but given its safety profile and the positive research, it’s a reasonable supplemental therapy to try for symptom management,” Ntranos says. “As always, I advise discussing it with a doctor first, but overall CoQ10 may be a helpful addition for energy and mood in MS.”
Do Consider Omega-3s to Possibly Manage Disease Progression
Omega-3s are a type of healthy fat found in foods such as fatty fish, flaxseeds, and soybeans. They’re well-known for their cardiovascular benefits, but some research suggests they may also help people with MS.
“In a [systematic review] of multiple studies, researchers looked at how omega-3s affected markers of inflammation, relapse rates, and disease progression in people with MS,” says Terry Wahls, MD, an internist and a clinical professor of medicine at University of Iowa Health Care in Iowa City, whose research focuses on diet and lifestyle’s effect on MS and other chronic illnesses.
“They saw that taking an omega-3 supplement, in the form of fish oil, was beneficial for all three of these measures,” Dr. Wahls continues.
Most studies involve using one to 4 grams (g) of omega-3s daily, Wahls says. In her clinical practice, she generally suggests 1 to 2 g a day, which can be obtained through a supplement or food.
Docosahexaenoic acid (DHA) — one of three main types of omega-3s along with eicosapentaenoic acid (EHA) and alpha-linolenic acid (ALA) — is especially important for supporting brain development.
Seafood, including wild-caught salmon, halibut, and herring, are good sources of DHA, Wahls says. The body can convert some ALA — found in plant foods, such as flaxseeds — into DHA, but only in very small amounts. So, if you’re vegan or vegetarian, Wahls says a supplement may be useful, though be sure to speak with your doctor before starting any supplement.
Do Talk to Your Doctor About Alpha-Lipoic Acid Supplements, Which May Help Protect the Brain
Alpha-lipoic acid is an antioxidant that is both made by the body and naturally present in some foods, particularly organ meats.
Alpha-lipoic acid supplements are available in both oral and IV forms, and they may be of interest to people with MS.
“There is increasing evidence to support the use of alpha-lipoic acid for MS,” says Mill Etienne, MPH, MD, the vice chancellor and an associate professor of neurology and medicine at New York Medical College in New York City. “Alpha-lipoic acid can reduce inflammation and protect the brain and spinal cord, the two areas that are impacted by MS.”
Dr. Etienne explains that alpha-lipoic acid appears to neutralize free radicals, preventing them from damaging cells in the neurological system.
A recent systematic review and meta-analysis of five studies involving 179 patients found taking 1,200 mg of alpha-lipoic acid daily notably reduced MS symptoms, though researchers noted more long-term clinical trials are needed.
Before taking alpha-lipoic acid, it’s important to talk with your provider about the potential risks involved, as well as the possibility of drug interactions, Etienne says. People taking synthetic thyroid hormones, for instance, may need to avoid this supplement as it could decrease the hormone’s efficacy.
Do Consider Adding More Probiotics to Your Diet to Potentially Ease MS Symptoms
Probiotics feed the beneficial bacteria in your gut microbiome — the collection of trillions of microorganisms that influence your digestive, immune system, nervous system, and endocrine system.
A small, placebo-controlled clinical trial of 40 MS patients suggests these nutrients may improve MS symptoms, including fatigue and pain, as well as quality of life.
Prior research suggests people with MS tend to have disbalanced microbiomes, with more inflammation-promoting bacteria that may exacerbate autoimmunity, says Mary Ann Picone, MD, a neurologist and the medical director at Holy Name Medical Center in Teaneck, New Jersey.
Probiotics may help restore balance and decrease inflammation and oxidative stress, Dr. Picone explains, though more robust research is needed.
Foods — including kimchi, kombucha, yogurt, and kefir — are the best sources of probiotics, Picone says.
“Unfortunately, it is often the case that although we know what we should be eating, we don't always eat the right foods, so supplementing with a probiotic [may] help,” she adds, but as always, speak with your doctor first.
Supplements to Avoid if You Have MS — and Why
Don’t Assume Ginkgo Biloba Can Improve Cognitive Function
Ginkgo biloba is an extract produced from the leaves of the ginkgo tree. It’s purported to improve brain function and memory, although clinical trials have not consistently shown these benefits.
To date, scientific evidence supporting its effectiveness in treating memory loss associated with MS is limited, with multiple studies producing mixed results.
Additionally, though it’s generally considered safe for most healthy people, ginkgo may increase bleeding and interfere with certain medications, including those used to treat depression, anxiety, and seizures.
“Ginkgo biloba is often touted as a beneficial supplement to help with cognition. But study results have been mixed, so it’s not recommended,” says Picone.
“Exercise and maintaining a well-balanced, more plant-based diet with minimal ultra-processed foods and additives can be more beneficial,” she adds.
Don’t Use Ashwagandha as It May Stimulate the Immune System
Ashwagandha has been used in traditional medicine for thousands of years.
Research shows that the herb may be effective for insomnia and stress, and may be safe when taken for a short period of time, up to three months, in healthy populations.
But it’s best to avoid it if you have MS, Ntranos warns. “It can stimulate the immune system — and in an autoimmune disease like MS, that’s a real concern,” he explains.
In fact, a recent review noted that ashwagandha’s immune-boosting effect could theoretically worsen conditions such as MS by revving up the very immune cells attacking the nerves, Ntranos adds.
“We don’t have good evidence that ashwagandha helps MS symptoms at all, and given the risk that it might aggravate the disease or interfere with MS medications, it’s not worth it,” Ntranos explains.
Ashwagandha may also interfere with certain medications, including immunosuppressants and anticonvulsants. Pregnant or breastfeeding women should also avoid ashwagandha.
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Do Discuss Your Diet With Your Doctor
There is a lot of interest and research on diet and how it may impact MS, says Yadav. A meta-analysis of 12 trials found that diet, particularly paleo and Mediterranean diets, could be helpful for improving quality of life and fatigue in people with MS.
The studies included in this review were small and of short duration, so more research is needed, the authors concluded.
Other research has indicated that diet may be a valuable tool for managing MS symptoms and complications. “There’s growing evidence that what you eat can affect how you feel with MS,” Ntranos says.
Mediterranean, paleo, and similar eating plans emphasize fruits, vegetables, nuts, seeds, whole grains, olive oil, and fish. “These foods are known to reduce inflammation and oxidative stress, which play significant roles in MS progression,” he explains.
Additionally, plant-forward diets are rich in fiber, vitamins, and antioxidants and lower in ultra-processed foods, which tend to increase inflammation, he continues. There’s also evidence that a healthy diet may positively influence the gut microbiome, potentially helping to curb autoimmune activity, Ntranos says.
“I always tell patients that while diet isn’t a cure for MS, it’s a powerful tool: eating a well-balanced Mediterranean-like diet can make a real difference in day-to-day symptoms and health. Plus, it’s great for your heart and weight, so it’s a win-win,” Ntranos notes.
“More rigorous studies are underway, but it’s very plausible that these diets help people with MS feel better, and I commonly recommend leaning toward a Mediterranean or similar whole-food diet," he adds.
Do Talk to Your Doctor Before Trying Any Complementary and Integrative Therapies for Multiple Sclerosis
It’s important to remember that no two cases of MS are exactly the same. “We should be looking at each individual’s MS and their overall health to determine the best complementary therapies to achieve optimal health,” says Yadav.
In addition to any complementary and integrative therapies, Yadav recommends adopting habits like regular physical activity (provided it’s approved by your doctor) and managing any other health conditions.
“People with MS who are in generally good health tend to do better, and there are many ways to get to that goal,” she says.
The Takeaway
Complementary and integrative approaches, including supplementation, are no substitute for firstline MS treatments, but research suggests certain vitamins and supplements may reduce symptoms.
Potentially beneficial supplements include vitamin D, which may help manage fatigue; omega-3s, which may help with disease progression; alpha-lipoic acid, which may reduce inflammation; and probiotics, which may improve several MS symptoms.
Other supplements, such as ashwagandha, may cause dangerous side effects for people with MS. Still others, like ginkgo biloba, may not have any benefits for people with MS at all.
Always talk to your doctor before trying any supplements, especially if you are taking medications or have a chronic health condition like MS.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
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Jason Chua, MD, PhD, is an assistant professor in the Department of Neurology and Division of Movement Disorders at Johns Hopkins School of Medicine. He received his training at the University of Michigan, where he obtained medical and graduate degrees, then completed a residency in neurology and a combined clinical/research fellowship in movement disorders and neurodegeneration.
Dr. Chua’s primary research interests are in neurodegenerative disease, with a special focus on the cellular housekeeping pathway of autophagy and its impact on disease development in diseases such as Parkinson disease. His work has been supported by multiple research training and career development grants from the National Institute of Neurological Disorders and Stroke and the American Academy of Neurology. He is the primary or coauthor of 14 peer-reviewed scientific publications and two peer-reviewed online learning modules from the American Academy of Neurology. He is also a contributing author to The Little Black Book of Neurology by Osama Zaldat, MD and Alan Lerner, MD, and has peer reviewed for the scientific journals Autophagy, eLife, and Neurobiology of Disease.
Brian P. Dunleavy is a writer and editor with more than 25 years of experience covering issues related to health and medicine for both consumer and professional audiences. As a journalist, his work has focused on new research in the treatment of infectious diseases, neurological disorders (including multiple sclerosis and Alzheimer's disease), and pain management. His work has appeared in ADDitude, Consumer Reports, Health, Pain Medicine News, and Clinical Oncology News.
Dunleavy is the former editor of the infectious disease special edition at ContagionLive.com. He is also an experienced sports reporter who has covered the NFL, MLB, NBA, NHL, and professional soccer for a number of publications. He is based in New York City.
Becky Upham has worked throughout the health and wellness world for over 25 years. She's been a race director, a team recruiter for the Leukemia and Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.
Upham majored in English at the University of North Carolina and has a master's in English writing from Hollins University.
Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.
Kate Daniel is a journalist specializing in health and wellness. Previously, she was a reporter for Whidbey News Group in Washington, where she earned four regional awards for her work. Daniel has written for various outlets, including HealthDay, Nice News, and Giddy.
