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8 CAM Cautions

By Gay Falkowski
Whether you are using complementary and alternative medicine as your prime multiple sclerosi treatment, or combining it with conventional medicine (the recommended approach), take heed: Just because a product is natural doesn’t mean it’s safe for your particular condition. Supplements may aggravate your symptoms and interact with prescription medications, including your MS disease-modifying therapy. That’s why it’s very important to talk to your physician before trying any type of CAM.
Dr. Allen C. Bowling, medical director of the Multiple Sclerosis Service and director of the Complementary and Alternative Medicine Service at the Colorado Neurological Institute has researched and written extensively about CAM and MS. You can learn more about the topic at his website. According to Dr. Bowling, here are eight CAM cautions if you have MS:
1) Antioxidant vitamins: These are among the dietary supplements that are most used by people with MS. However, as many antioxidants have been shown to stimulate the immune system, they pose a theoretical risk for people with MS. As the research does not provide clear answers at this time, those with MS should approach antioxidants cautiously. It may be reasonable to avoid these supplements altogether and rely on dietary intake of antioxidants. Vitamins A, C, and E are antioxidant vitamins, as is beta-carotene, a compound that is converted to vitamin A. If people choose to take antioxidant vitamin supplements, relatively low daily doses may be most appropriate: vitamin A, 5,000 IU or less; vitamin C, 90 to 120mg or less; vitamin E, 100 IU or less.
2) Melatonin: Melatonin is a hormone involved in regulating the normal 24-hour cycles of the body, known as circadian rhythms. Melatonin has many potential uses. Some researchers have found that melatonin may help with sleep problems and jet lag. Melatonin may activate the immune system by stimulating T cells. This poses a theoretical risk for people with MS and other autoimmune disorders. It may be reasonable for people with MS to avoid melatonin until further research is conducted. If people with MS choose to use melatonin, they should probably avoid high doses and long-term use.
3) Aromatherapy oils: Aromatherapy is generally well-tolerated. Application of oil to the skin may produce a rash. Clove or cinnamon oil should not be applied to the skin. The oils of basil, fennel, lemon grass, rosemary, and verbena may cause skin irritation. About five percent of people are allergic to fragrances. Because of toxicity concerns, oil should not be taken internally. Aromatherapy may cause miscarriage and should not be used by pregnant women. There are concerns that the odor of some oils may provoke headaches, asthma, and seizures.

4) Ashwagandha: Ayurveda is a healing system composed of many different practices. Generally, these practices have a low risk and moderate cost. Some practices, such as massage, meditation, and yoga, have low risk and have been suggested to have beneficial effects for MS-associated symptoms, including fatigue, spasticity, anxiety, depression, and pain. Other components of Ayurveda carry a much greater risk. The use of specific supplements has the potential to cause serious side effects, including worsening of MS. These supplements have not been fully studied in MS or any other medical condition. Ashwagandha, the herbal supplement sometimes recommended by Ayurvedic practitioners specifically for treating MS, could theoretically worsen the disease. It may also decrease the therapeutic effects of certain medications, increase the side effects of other medications, and increase MS fatigue.
5) Caffeine: Caffeine is known to alter the immune system, an issue of possible relevance to people with MS. People with MS may be especially prone to some caffeine side effects. MS may increase osteoporosis risk, and caffeine may increase this osteoporosis risk further. Caffeine also increases urination and may cause irritation of the urinary tract, thus possibly exacerbating MS-associated bladder problems. High doses of caffeine may produce insomnia, heart palpitations, anxiety, nausea, vomiting, increased blood pressure, muscle twitching, tremors, and increased cholesterol levels. Chronic use of high doses of caffeine can lead to tolerance, which causes the body to need larger doses in order to produce the same effect. When these high doses are stopped, withdrawal symptoms may be experienced, including irritability, dizziness, headache, and anxiety. Usually, the suggested maximum daily dose is between 250 to 300 mg. This is approximately four to five cups of tea or two to three cups of coffee.
6) Echinacea: Echinacea may stimulate the immune system. Specifically it may stimulate T cells and macrophages, cells that are already overactive in MS. This stimulation may act in opposition to many of the conventional medications for MS, which work to depress immune system activity. It is also possible that echinacea could worsen MS. Echinacea may cause liver damage. This effect may be amplified by some conventional MS medications, known to be associated with liver injury. With the limited information available at this time, the safest course of action for people with MS is to avoid echinacea.
7) St. John’s Wort: St. John’s wort should not be used for severe depression. It is generally well-tolerated, but may cause dizziness, sedation, upset stomach, confusion, and anxiety. In rare cases, this herb has produced photosensitivity, a hypersensitivity to sun exposure that affects the skin and nerves. This is more likely to occur in people with fair skin. St. John’s wort may cause mania or hypomania in people with depression or manic-depressive illness. Withdrawal side effects, such as dizziness, nausea, headaches, fatigue, insomnia, and confusion, may occur if use of St. John’s wort is abruptly discontinued. St. John’s wort may also interact with many medications. This herb acts on the liver, and may actually decrease the blood concentration of certain prescription drugs, including oral contraceptives and blood-thinning medication. Furthermore, several drugs used to treat MS-associated symptoms may be affected. St. John’s wort should not be taken while taking antidepressant medications.
8) Ginseng: Many different types of ginseng are commercially available. Among them, the most common and also the most studied type is Asian ginseng (Panax ginseng). Siberian ginseng (Eleutherococcus senticosus), also called eleuthero, is another relatively common form. Ginseng is an adaptogen, a compound claimed to increase both energy levels and resistance to stress. Because of its immune-stimulating properties, Asian ginseng poses a theoretical risk to people with MS. The effects of Asian ginseng on fatigue and stress are not clear at this time. Siberian ginseng is a completely different herb, but in studies it has produced similar results to Asian ginseng. It also appears to stimulate the immune system, and its effects on fatigue and stress are unclear. Both of these types of ginseng have been associated with adverse effects and drug interactions. The sedating effects sometimes associated with these herbs may exacerbate MS-associated fatigue or amplify the sedating effects of certain medications. It is also possible for Asian ginseng to interact with steroids. Neither Asian ginseng nor Siberian ginseng have any proven clinical benefits and may activate the immune system. It may be reasonable for people with MS to avoid consuming these herbs on a regular basis or in large doses.