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

Journal: Multiple sclerosis and related disorders 2020;37():101486

PMID: 31707234

Full Text on Elsevier Science View on PubMed

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.

Address: 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: [email protected].; Deakin University, IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Geelong, Australia.; Murdoch Children's Research Institute, Royal Children's Hospital, Australia; Department of Paediatrics, University of Melbourne, Parkville, Melbourne, Australia.; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.; 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.; School of Medicine, Griffith University, Gold Coast, Queensland Australia.; School of Medicine and Public Health, University Newcastle, Australia; Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, Australia.; 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.; 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.

DOI: 10.1016/j.msard.2019.101486

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MeSH Terms: Dietary Supplements, Humans, Multiple Sclerosis, Outcome Assessment, Health Care