The effect of emerging nutraceutical interventions for clinical and biological outcomes in multiple sclerosis: A systematic review

Wolfgang Marx; Meghan Hockey; Amelia J McGuinness; Melissa Lane; John Christodoulou; Ingrid van der Mei; Michael Berk; Olivia M Dean; Bruce Taylor; Simon Broadley; Jeannette Lechner-Scott; Felice N Jacka; Robyn M Lucas; Anne-Louise Ponsonby; RELIEF Trial team

doi:10.1016/j.msard.2019.101486

The effect of emerging nutraceutical interventions for clinical and biological outcomes in multiple sclerosis: A systematic review

Mult Scler Relat Disord. 2020 Jan:37:101486. doi: 10.1016/j.msard.2019.101486. Epub 2019 Nov 2.

Authors

Affiliations

¹ Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Australia. Electronic address: wolf.marx@deakin.edu.au.
² Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.
³ Murdoch Children's Research Institute, Royal Children's Hospital, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Australia.
⁴ Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
⁵ Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Australia; University of Melbourne, Department of Psychiatry, Level 1 North, Main Block, Royal Melbourne Hospital, Parkville, Australia.
⁶ School of Medicine, Griffith University, Gold Coast, Queensland Australia.
⁷ School of Medicine and Public Health, University Newcastle, Australia; Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia.
⁸ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia; Centre for Ophthalmology and Visual Sciences, University of Western Australia, Perth, Australia.
⁹ Murdoch Children's Research Institute, Royal Children's Hospital, Australia; National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia.

PMID: 31707234
DOI: 10.1016/j.msard.2019.101486

Abstract

Background: Due to the considerable burden of multiple sclerosis (MS)-related symptoms and the need to identify effective interventions to prevent disease progression, various nutraceutical interventions have been trialed as adjunctive treatments. The aim of this review was to investigate the efficacy and safety of nutraceutical interventions for clinical and biological outcomes in people with MS.

Methods: In accordance with PRISMA reporting guidelines, a systematic literature search was conducted using three electronic literature databases. Risk of bias was assessed using the Jadad scale.

Results: Thirty-seven randomized controlled trials, investigating fourteen nutraceuticals, were included in the review. Trials that investigated alpha lipoic acid (n = 4/6), ginkgo biloba (n = 3/5), vitamin A (n = 2/2), biotin (n = 1/2), carnitine (n = 1/2), green tea (n = 1/2), coenzyme Q10 (n = 1/1), probiotics (n = 1/1), curcumin (n = 1/1), Andrographis paniculata (n = 1/1), ginseng (n = 1/1), and lemon verbena (n = 1/1) were reported to improve biological (e.g. MRI brain volume change, antioxidant capacity) and/or clinical (e.g. fatigue, depression, Expanded Disability Status Scale) outcomes in multiple sclerosis compared to control. However, most trials were relatively small (average study sample size across included studies, n = 55) and there were few replicate studies per nutraceutical to validate the reported results. Furthermore, some nutraceuticals (e.g. green tea and inosine) should be used with caution due to reported adverse events. Risk of bias across most studies was low, with 31 studies receiving a score between 4 and 5 (out of 5) on the Jadad Scale.

Conclusion: The existing literature provides preliminary support for the use of a number of nutraceutical interventions in MS. However, sufficiently powered long-term trials are required to expand the currently limited literature and to investigate unexplored nutraceuticals that may target relevant pathways involved in MS such as the gut microbiome and mitochondrial dysfunction. Prospero ID: CRD42018111736.

Keywords: Dietary supplement; Multiple sclerosis; Nutraceutical; Vitamin.

Publication types

Systematic Review

MeSH terms

Dietary Supplements*
Humans
Multiple Sclerosis / diet therapy*
Outcome Assessment, Health Care*