Dietary Supplements to Repair the Myelin Sheath in MS

3 Supplements That May Help Restore Nerve Cell Function

Repairing Myelin in Multiple Sclerosis
Credit:PIXOLOGICSTUDIO/SCIENCE PHOTO LIBRARY/Getty Images

While current multiple sclerosis (MS) disease-modifying treatments focus on reducing inflammation in the brain and spinal cord, researchers are now investigating therapies that may help repair the very substance that is damaged and destroyed in MS—the myelin sheath.

By restoring the myelin sheath, there is hope that a person's neurological function can be restored. Even more surprising is the fact that these emerging myelin-restoring treatments are supplements you can find at your local grocery store or pharmacy. Three of these dietary supplements include:

  • Biotin
  • Vitamin D
  • Omega-3 fatty acids

That said, it's important to understand that the exploration of these supplements and their role in MS is still very early and wrought with skepticism.

Moreover, while supplements may be a sensible addition (not a substitute) to your current MS therapies, it's essential to only take them under the guidance of your doctor.

Being cautious about supplement use is important for many reasons, including the potential for toxicity or the fact that some supplements, like omega-3 fatty acids, may affect the effectiveness of MS drugs or other medications you are taking.

Biotin in Myelin Repair in MS

Biotin is a vitamin involved in both energy metabolism and the creation of fatty acids in the body. It's found in dietary supplements for hair, skin, and nail growth, as well as multivitamins and prenatal vitamins.

Since the myelin sheath is a fatty covering, researchers speculate that by giving people high doses of biotin (like 300mg per day), the myelin sheath could possibly be restored.

In addition to restoring myelin (a fatty covering), some scientists believe biotin may reduce the degeneration of axons by enhancing energy production. The degeneration of axons occurs predominantly in progressive types of MS and refers to the loss of nerve fibers and eventually nerve cell death.

The big picture here is that experts speculate that biotin may exert its therapeutic effect in two ways—a double bonus. Thus far, though, the scientific evidence supporting biotin's role in treating MS is scant and inconclusive.

Let's take a closer look at a few studies showcasing these mixed results.

Thumbs Up for Biotin

In a small study in Multiple Sclerosis and Related Disorders, 23 people with primary or secondary progressive MS were given high doses of biotin, and improvements were seen in a variety of symptoms, most notably vision acuity, spinal cord problems, and fatigue.

Mixed Results for Biotin

A large study in Multiple Sclerosis revealed that high-dose biotin improved MS-related disability in around 12 percent of participants with progressive MS. However, the fact that only 12 percent showed improvement suggests that potentially only a subset of people with MS may benefit from taking biotin.

In addition, it's worrisome that investigators in this study noted that those who took biotin had more new or enlarging brain lesions on their MRIs compared to those in the placebo group. The investigators questioned whether biotin was inducing an inflammatory response (this would not be good).

Thumbs Down for Biotin

A third study sheds further concern about biotin. In this study, there was no improvement in MS-related disability in people with progressive MS. In fact, about one-third of the participants had a worsening of their disease, most notably with more leg weakness, worse balance, and more falling.

Of course, the worsening of their disease could be unrelated to the biotin and due to the natural progression of MS. However, the investigators of the study pondered whether the high-dose biotin had something to do with it. Perhaps, the biotin shifted the body's metabolic demand away from protecting the brain and spinal cord, allowing the immune system to wreak havoc.

Role of Vitamin D in Myelin Repair

Vitamin D is found in supplements, as well as certain foods like salmon, cod liver oil, canned tuna, egg yolks, and fortified cereals, milk, and orange juice.

Based on multiple studies, we know that being vitamin D deficient increases a person's chance of developing MS. However, once a person has MS, it's not totally clear if or how vitamin D affects their disease activity (like whether being vitamin D deficient can increase a person's chance of having an MS relapse).

While research on vitamin D has focused mostly on how it causes or influences MS, an eye-opening study in The Journal of Cell Biology illuminates a potentially third role for vitamin D in MS—that vitamin D may be involved in myelin repair.

This study discovered that the vitamin D receptor pairs with a protein called the retinoid X receptor-gamma (RXR gamma receptor), which is a protein involved in regulating the maturation of cells that produce myelin (called oligodendrocyte).

The investigators found that when they added vitamin D to brain stem cells that contained the RXR gamma receptor, the number of oligodendrocytes expressing myelin basic protein (the main protein component of the myelin sheath) increased by 80 percent.

In other words, vitamin D stimulated the restoration of myelin—an amazing feat. Of course, this is one study, and many more studies need to be done to clarify this finding. All in all, though, this study highlights the multifunctional role vitamin D plays in your MS health.

Role of Omega-3 Fatty Acids in Myelin Repair

Omega-3 fatty acids are found in "good" fats which are called polyunsaturated fats. These good fats are present in foods like:

  • Fatty fish (for example, salmon, mackerel, herring, and sardines)
  • Chia seeds
  • Flaxseeds
  • Soybeans
  • Walnuts
  • Canola oil

Fish oil supplements also contain omega-3 fatty acids.

Scientific evidence supporting the benefit of consuming a diet rich in omega-3 fatty acids in treating MS is mixed. In other words, there is limited data showing that it reduces MS relapses or slows MS-related disability progression.

That said, it's interesting to note that recent animal studies have revealed that omega-3 fatty acids may promote remyelination. However, (and this is where some confusion lies), if omega-3 fatty acids help restore myelin, then improvements in disability in prior studies of patients with MS should have been seen. This inconsistency has left researchers scratching their heads.

All in all, it's likely that the role of omega-3 consumption in MS is complex, and its benefit may be derived from other related factors. Perhaps, obtaining omega-3 naturally as opposed to through supplement affects the results, or perhaps, some people do not absorb omega-3 as well as others.

Furthermore, omega-3 fatty acids can be broken down into two components, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It's possible that the ratio of how these components are consumed may affect study results.

The bottom line is that more investigation needs to be done to unveil the true benefits (if so) of omega-3 fatty acids in treating MS. This is especially true for people with progressive MS, as studies so far have been focused on people with relapsing-remitting MS.

A Word From Verywell

It's remarkable to think how far we have come in better understanding and treating MS. By investigating therapies that tackle MS from both ends (preventing myelin damage and then restoring myelin that has been already damaged), there is true hope for an end to this disease.

If you have MS (or a loved one does), remain resilient in your daily life—stay up-to-date on MS knowledge, continue your MS therapies, reach out to others for support, and most importantly enjoy life's precious moments.

Sources:

Birnbaum G, Stulc J. High dose biotin as treatment for progressive multiple sclerosis. Mult Scler Relat Disord. 2017 Nov;18:141-43.

de la Fuente AG et al. Vitamin D receptor-retinoid X receptor heterodimer signaling regulates oligodendrocyte progenitor cell differentiation. J Cell Biol. 2015 Dec 7;211(5):975-85.

Sedel F et al. High dose of biotin in chronic progressive multiple sclerosis: a pilot study. Mult Scler Relat Disord. 2015 Mar;4(2):159-69.

Torkildsen O et al. ω-3 fatty acid treatment in multiple sclerosis (OFAMS Study): a randomized, double-blind, placebo-controlled trial. Arch Neurol. 2012 Aug;69(8):1044-51.

Tourbah A et al. MD1003 (high-dose biotin) for the treatment of progressive multiple sclerosis: A randomised, double-blind, placebo-controlled study. Mult Scler. 2016 Nov;22(13):1719-31.