Complementary and Alternative Medicine Use in MS

By Allen C. Bowling, MD, PhD of the
Rocky Mountain MS Center
And author of Alternative Medicine and MS, Demos Pub, 2001

~ Reprinted with the Permission of ~
Allen C. Bowling, MD, PhD
8/2002

Complementary and alternative medicine (CAM) is popular, especially among people with chronic diseases such as multiple sclerosis (MS). Unfortunately, in the area of CAM, patients and health care professionals often do not communicate clearly and, for patients as well as health care professionals, objective and accurate information is difficult to locate on specific diseases. To attempt to overcome some of these deficiencies and provide a reliable guide for people with MS, we created the Complementary and Alternative Medicine Program at the Rocky Mountain MS Center (http://www.ms-cam.org).Through this program, we have developed patient-friendly CAM information resources, surveyed CAM use in people with MS, and reviewed currently available MS-relevant CAM information.

What is Alternative Medicine?

There are many different terms and definitions that are used in this area. In addition to "alternative medicine", other frequently used terms include unconventional medicine, complementary medicine, and integrative medicine. Once definition that is sometimes used is that unconventional medicine refers to medical practices that are not generally taught in medical schools or are not generally available in hospitals. The term "alternative medicine" refers to therapies that are used instead of conventional medicine, while "complementary medicine" refers to practices that are used in addition to conventional medicine. A broad term that encompasses both of these approaches is "complementary and alternative medicine" or CAM.

Use of Alternative Medicine

CAM is used widely by the general population and also by people with MS. One large, well-known survey of adults in the United States showed that approximately one-third used CAM. Through surveys at our center and other MS programs, it appears that one-half to two-thirds of people with MS use some form of CAM. This indicates that CAM use among people with MS is higher than that of the general population. In the general population and in people with MS, the vast majority appear to use unconventional medicine in combination with conventional medicine. In other words, most people use unconventional therapies in a complementary manner.

Principals of CAM Use

There are several steps that should be followed when considering CAM use:

Consider conventional medicine options first
Evaluate and address reasons for wanting to use CAM
Obtain accurate, unbiased information about effectiveness, safety, cost, and effort involved
If CAM is chosen, then discuss with physician, monitor response, and discontinue when appropriate
Use caution!

Popular Literature on CAM Therapy in MS

To understand more clearly the type of information that is available, we went to several local bookstores and reviewed the recommendations for MS therapy in 50 CAM books. MS was discussed in 33 of these books. On average, 5 or 6 different therapies were recommended. In 20% of the books, 10 or more therapies were recommended. It is interesting to note that no two books had the same recommendations, several books confused MS with 'muscular dystrophy", and it was very rare for a book to specifically discourage any therapy.

Medical Literature on CAM in MS

As for most diseases, there is limited objective information on the use of CAM therapies in MS. It is important to state clearly that high quality clinical trials have demonstrated that glatiramer acetate (Copaxone), interferons (Avonex, Rebif, Betaseron), and mitoxantrone (Novantrone) are effective therapies for MS and that no comparable trials have been conducted for any CAM therapy in MS. However, at the same time, it is important to acknowledge that conventional MS therapies are not 100% effective and that, as a result, some people with MS are interested in supplementing conventional therapy with unconventional therapy that might provide some additional benefit.

Herbal Medicine. Herbal therapy is one of the most accessible forms of CAM. Whenever herbs are consumed, it must be kept in mind that they are not currently under strict FDA regulation and, consequently, the composition of preparations is extremely variable and the exact identities and effects of all the chemicals in the herbs are not known. Herbal preparations that may be effective include cranberry tablets for the prevention of urinary tract infections, psyllium for constipation (FDA approved), valerian for insomnia, and kava-kava for anxiety. St. John's wort may have an antidepressant effect in people with mild-moderate depression, but it may interact with several prescription medications.

Certain herbs should be used with caution due to the possibility that they might worsen disease or interact with medications. People with MS should use care with herbs with possible immune-stimulating activity, including alfalfa, astragalus, cat's claw, Echinacea, garlic, and ginseng (Asian and Siberian). Patients who have fatigue or take potentially sedating medications, such as Baclofen, Zanaflex, and Valium, should be careful about using sedating herbs, which include chamomile, ginseng (Asian and Siberian), goldenseal, kava-kava, nettle, passionflower, sage, St. John's wort and valerian. When steroids are used, steroid side effects may potentially be worsened by some herbs, including aloe, Asian ginseng, bayberry, and licorice. Herbs sometimes recommended for MS that could produce severe side effects include borage seed oil, chaparral, comfrey, lobelia, and yohimbe.

It is important to keep in mind several important precautions when considering herbal therapy:

Herbs are often used as drugs
Herbs contain many different compounds, some of which may be toxic or interact with other drugs
Herbs may contain compounds that have not yet been identified or characterized
The quality and composition of herbal preparations are variable
Herbs should only be used for a short time for benign, self-limited conditions
Herb use should be avoided in women who are pregnant or breastfeeding, people with multiple medical problems or taking multiple medications, and children
Use caution and discuss with your physician before starting

Vitamins, Minerals and Other Supplements. Among vitamins, there are theoretical reasons why antioxidants, such as vitamin E, might be helpful. Antioxidant vitamins decrease the levels of free radicals, which are very toxic chemicals in the body. There is some evidence that free radicals are involved in the myelin and nerve damage that occurs in MS. On the other hand, antioxidants stimulate the immune system and this could be harmful. Further research is being conducted to clarify these issues.

Some people with MS are at increased risk for developing osteoporosis, and osteoporosis may be underdiagnosed in people with MS. For osteoporosis, vitamin D and calcium are beneficial. There is no clear use for vitamin B12 therapy in most people with MS; the exception to this is the rare person who has MS and also has vitamin B12 deficiency demonstrated by blood testing.

High doses of some vitamins and minerals may produce toxic effects. Doses to avoid include: greater than 10,000 IU/day of vitamin A or beta-carotene, which may produce birth defects and liver injury; greater than 50 mg/day of vitamin B6 (pyridoxine), which may produce nerve injury; greater than 1,000 mg/day of vitamin C, which may produce diarrhea and kidney stones; greater than 2,000 IU/day of vitamin D, which may impair bone metabolism and produce liver injury; greater than 35mg/day of niacin, which may produce nausea, diarrhea, and liver injury; greater than 200 microgram/day of selenium, which may produce multiple toxic effects. In addition, vitamin A and beta-carotene should be avoided in smokers, and Coumadin (warfarin) should not be taken with coenzyme Q10, vitamin E, vitamin K, and possibly vitamin C.

Zinc is sometimes used to prevent or limit the severity of the common cold. For unclear reasons, some CAM books recommend zinc supplements specifically for MS. In people with MS, however, zinc poses a theoretical risk since it may stimulate specific cells in the immune system. Similar risks for the immune system activation are possible with melatonin, a hormone used for insomnia, and DHEA, a hormone with many purported beneficial effects.

Traditional Chinese Medicine. Traditional Chinese medicine includes acupuncture and herbal therapy. Acupuncture is increasingly recognized for its effectiveness in some types of pain and nausea, but studies in MS have been very limited and contradictory. Further studies are needed in the area of acupuncture and MS. Chinese herbal medicine should be taken cautiously and with a clear understanding of the effects of the herbs .Asian ginseng and astragalus, common components of Chinese herbal preparations, may stimulate the immune system. In general, Chinese proprietary (patent) medicine, a form of Chinese herbal medicine, should probably be avoided since there are no demonstrated benefits in MS and some ingredients may be toxic.

Other Possibly Beneficial Therapies. Cooling of the body may improve multiple symptoms in MS. A variety of relaxation methods, including meditation and biofeedback, may be helpful, especially for those prone to stress or anxiety. Horseback riding (hippotherapy), tai chi, massage, and yoga may also be beneficial to some people with MS.

Miscellaneous Therapies. Bee venom therapy is currently being investigated. Preliminary results from animal studies at Allegheny University indicate that it has no effect or may be harmful. Clinical studies in people are being conducted. Therapies in which there is not strong evidence for a beneficial effect in MS include calcium EAP, chelation therapy, craniosacral therapy, enemas, hyperbaric oxygen, and mercury amalgam removal.

Placebo Effects

The placebo effect is a beneficial response that occurs in a person who is given an inactive medication, such as a sugar pill. This effect is frequently observed and may be quite powerful. In trials of new MS medications, placebos are always given and the placebo effect is notoriously high. People with MS who are given placebos may have a 30-40% reduction in their relapses and a 30% or greater slowing of disease progression. In some trials, the placebo has actually produced greater improvement than the "active" medication. Also, some studies have shown that the placebo may produce beneficial effects on specific cells in the immune system.

There are implications of this placebo effect in people with MS. First, the placebo effect shows the importance of doing formal clinical studies in which a large group of people is studied and some members of the group receive inactive medication. This applies to studies of conventional as well as unconventional therapies. One cannot rely on reports of the beneficial effects of an unconventional or conventional therapy that are based solely on studies with a small number of people (anecdotes or testimonials) or without a placebo-treated group. Another important point about the placebo effect is that it demonstrated the powerful influence of the mind over the body (or brain).

A Wellness Approach

The influence of the mind over the body and CAM are two areas that, along with many other important areas, can all be incorporated into a more inclusive "wellness approach" to MS. While there are a variety of approaches to wellness, an approach of value in MS is one that uses many different methods to optimize functioning in the different components of one's life. Health is one of these components; other important components include physical fitness, psychological well-being, social connectedness, nutrition, sexuality, spirituality, and bowel and bladder function. These components are interwoven and, in a state of wellness, there is a sense of wholeness and balance. Neurological care can improve the health component, while a wellness approach may produce benefits in the other areas. Assessing these other areas and providing therapy requires a multidisciplinary approach, including medical, psychological, nursing, dietetic, and rehabilitation services.

Craze or Cure?

Is CAM use in MS a craze or a cure? The answer is "neither". Each specific therapy needs to be evaluated with respect to MS. Some therapies may be beneficial, others are ineffective or unsafe, and a large number have yet to be studied carefully in people with MS. This large variability in the possible effectiveness of different therapies is the cause for much of the confusion and controversy in CAM. Improving the way in which CAM is used involves increasing communication between patients and health care professionals, providing accurate information to people with MS, and conducting reliable studies to determine which therapies might be effective.

About the Author:

Dr. Allen C. Bowling is the Associate Medical Director at the Rocky Mountain MS Center. He is also the director of a wellness program based at the center and is a Clinical Assistant Professor of Neurology at the University of Colorado Health Sciences Center. Dr. Bowling received his undergraduate, M.D., and Ph.D. (pharmacology) degrees at Yale University. He completed a residency in the neurology department at the University of California, San Francisco and was a Fellow in the Neurology Service at Massachusetts General Hospital and Harvard Medical School. Dr. Bowling has published numerous articles in clinical and basic science journals.

Dr. Bowling has presented information and original research on CAM and MS at national and international medical conferences. His work on herb and vitamin use in MS was awarded the Labe Scheinberg award at the annual meeting of the Consortium of MS Centers in May 1999. The information that he has developed on CAM and MS is available in a book, Alternative Medicine and MS: a Practical Guide, published through Demos Medical Publishers.

Glossary of Possibly Harmful Supplements

Alfalfa: immune-stimulating
Aloe: may interact with steroids
Asian ginseng: immune-stimulating, possibly fatigue-producing, may interact with steroids
Astragalus: immune-stimulating
Bayberry: may interact with steroids
Beta-carotene: immune-stimulating, greater than 10,000 IU/day may produce toxic effects, avoid in smokers
Borage seed oil: possible liver toxicity
Cat's claw: immune-stimulating
Chamomile: possibly fatigue-producing
Chaparral: possible liver toxicity
Coenzyme Q10:immune-stimulating, may interact with warfarin(Coumadin)
Comfrey: possible liver toxicity
DHEA: possible immune-stimulating
Echinacea: immune-stimulating
Garlic: immune-stimulating
Goldenseal: possibly immune-stimulating, possibly fatigue-producing
Grapeseed extract: possibly immune-stimulating
Kava-kava: possibly fatigue-producing
Licorice: may interact with steroids
Lobelia: multiple possible toxic effects
Melatonin: possibly immune-stimulating
Niacin: greater than 35 milligrams/day may produce toxic effects
Nettle: possibly fatigue-producing
Oligomeric proanthocyanidins: possibly immune-stimulating
Passionflower: possibly fatigue-producing
Pycnogenol: possibly immune-stimulating
Sage: possibly fatigue-producing
St. John's wort: possibly fatigue-producing
Selenium: possibly immune-stimulating, greater than 200 micrograms/day may produce multiple toxic effects
Siberian ginseng: immune-stimulating, possibly fatigue-producing
Valerian: possibly fatigue-producing
Vitamin A: immune-stimulating, greater than 10,000 IU/day may produce toxic effects, avoid in smokers
Vitamin B6:greater than 50 milligrams/day may produce toxic effects
Vitamin C: immune-stimulating, greater than 1,000 milligrams/day may produce toxic effects, may interact with warfarin (Coumadin)
Vitamin D: greater than 2,000 IU/day may be harmful
Vitamin E: immune-stimulating, may interact with warfarin (Coumadin)
Vitamin K: may interact with warfarin (Coumadin)
Zinc: possibly immune-stimulating, may cause copper deficiency

References

MS Relevant CAM Information

http://www.ms-cam.org - interactive CAM website of Rocky Mountain MS Center

Alternative Medicine and Multiple Sclerosis, Allen C. Bowling, Demos Medical Publishing, 2001

General CAM Information

The Alternative Medicine Handbook, Barrie Cassileth, Norton, 1998

Complementary/Alternative Medicine: An Evidence-Based Approach, John W. Spencer and Joseph J. Jacobs, Mosby, 1999 (Technical)

Living with Multiple Sclerosis: A Wellness Approach, G.H. Kraft and M. Catanzaro, Demos Medical Publishing, 2000

Natural Medicines Comprehensive Database, J. M. Jellin, F. Batz, K. Hitchens, Therapeutic Research Faculty, 2000 (Technical) (http://www.NaturalDatabase.com)

Tyler's Herbs of Choice, James E. Robbers and Varro E. Tyler, Haworth Herbal Press, 1999

Tyler's Honest Herbal, Steven E. Foster and Varro E. Tyler, Haworth Herbal Press, 1999

~ Reprinted with the Permission of ~
Allen C. Bowling, MD, PhD, of the Rocky Mountain MS Center
And author of Alternative Medicine and MS, Demos Medical Publishing, 2001

Was this information helpful? Then please consider making a donation. We are a small, independent nonprofit agency and are dependent on donations from our supporters. Thank you from all the staff at the MSA.




	Complementary and Alternative Medicine Use in MS By Allen C. Bowling, MD, PhD of the Rocky Mountain MS Center And author of Alternative Medicine and MS, Demos Pub, 2001 ~ Reprinted with the Permission of ~ Allen C. Bowling, MD, PhD 8/2002 Complementary and alternative medicine (CAM) is popular, especially among people with chronic diseases such as multiple sclerosis (MS). Unfortunately, in the area of CAM, patients and health care professionals often do not communicate clearly and, for patients as well as health care professionals, objective and accurate information is difficult to locate on specific diseases. To attempt to overcome some of these deficiencies and provide a reliable guide for people with MS, we created the Complementary and Alternative Medicine Program at the Rocky Mountain MS Center (http://www.ms-cam.org).Through this program, we have developed patient-friendly CAM information resources, surveyed CAM use in people with MS, and reviewed currently available MS-relevant CAM information. What is Alternative Medicine? There are many different terms and definitions that are used in this area. In addition to "alternative medicine", other frequently used terms include unconventional medicine, complementary medicine, and integrative medicine. Once definition that is sometimes used is that unconventional medicine refers to medical practices that are not generally taught in medical schools or are not generally available in hospitals. The term "alternative medicine" refers to therapies that are used instead of conventional medicine, while "complementary medicine" refers to practices that are used in addition to conventional medicine. A broad term that encompasses both of these approaches is "complementary and alternative medicine" or CAM. Use of Alternative Medicine CAM is used widely by the general population and also by people with MS. One large, well-known survey of adults in the United States showed that approximately one-third used CAM. Through surveys at our center and other MS programs, it appears that one-half to two-thirds of people with MS use some form of CAM. This indicates that CAM use among people with MS is higher than that of the general population. In the general population and in people with MS, the vast majority appear to use unconventional medicine in combination with conventional medicine. In other words, most people use unconventional therapies in a complementary manner. Principals of CAM Use There are several steps that should be followed when considering CAM use: Consider conventional medicine options first Evaluate and address reasons for wanting to use CAM Obtain accurate, unbiased information about effectiveness, safety, cost, and effort involved If CAM is chosen, then discuss with physician, monitor response, and discontinue when appropriate Use caution! Popular Literature on CAM Therapy in MS To understand more clearly the type of information that is available, we went to several local bookstores and reviewed the recommendations for MS therapy in 50 CAM books. MS was discussed in 33 of these books. On average, 5 or 6 different therapies were recommended. In 20% of the books, 10 or more therapies were recommended. It is interesting to note that no two books had the same recommendations, several books confused MS with 'muscular dystrophy", and it was very rare for a book to specifically discourage any therapy. Medical Literature on CAM in MS As for most diseases, there is limited objective information on the use of CAM therapies in MS. It is important to state clearly that high quality clinical trials have demonstrated that glatiramer acetate (Copaxone), interferons (Avonex, Rebif, Betaseron), and mitoxantrone (Novantrone) are effective therapies for MS and that no comparable trials have been conducted for any CAM therapy in MS. However, at the same time, it is important to acknowledge that conventional MS therapies are not 100% effective and that, as a result, some people with MS are interested in supplementing conventional therapy with unconventional therapy that might provide some additional benefit. Herbal Medicine. Herbal therapy is one of the most accessible forms of CAM. Whenever herbs are consumed, it must be kept in mind that they are not currently under strict FDA regulation and, consequently, the composition of preparations is extremely variable and the exact identities and effects of all the chemicals in the herbs are not known. Herbal preparations that may be effective include cranberry tablets for the prevention of urinary tract infections, psyllium for constipation (FDA approved), valerian for insomnia, and kava-kava for anxiety. St. John's wort may have an antidepressant effect in people with mild-moderate depression, but it may interact with several prescription medications. Certain herbs should be used with caution due to the possibility that they might worsen disease or interact with medications. People with MS should use care with herbs with possible immune-stimulating activity, including alfalfa, astragalus, cat's claw, Echinacea, garlic, and ginseng (Asian and Siberian). Patients who have fatigue or take potentially sedating medications, such as Baclofen, Zanaflex, and Valium, should be careful about using sedating herbs, which include chamomile, ginseng (Asian and Siberian), goldenseal, kava-kava, nettle, passionflower, sage, St. John's wort and valerian. When steroids are used, steroid side effects may potentially be worsened by some herbs, including aloe, Asian ginseng, bayberry, and licorice. Herbs sometimes recommended for MS that could produce severe side effects include borage seed oil, chaparral, comfrey, lobelia, and yohimbe. It is important to keep in mind several important precautions when considering herbal therapy: Herbs are often used as drugs Herbs contain many different compounds, some of which may be toxic or interact with other drugs Herbs may contain compounds that have not yet been identified or characterized The quality and composition of herbal preparations are variable Herbs should only be used for a short time for benign, self-limited conditions Herb use should be avoided in women who are pregnant or breastfeeding, people with multiple medical problems or taking multiple medications, and children Use caution and discuss with your physician before starting Vitamins, Minerals and Other Supplements. Among vitamins, there are theoretical reasons why antioxidants, such as vitamin E, might be helpful. Antioxidant vitamins decrease the levels of free radicals, which are very toxic chemicals in the body. There is some evidence that free radicals are involved in the myelin and nerve damage that occurs in MS. On the other hand, antioxidants stimulate the immune system and this could be harmful. Further research is being conducted to clarify these issues. Some people with MS are at increased risk for developing osteoporosis, and osteoporosis may be underdiagnosed in people with MS. For osteoporosis, vitamin D and calcium are beneficial. There is no clear use for vitamin B12 therapy in most people with MS; the exception to this is the rare person who has MS and also has vitamin B12 deficiency demonstrated by blood testing. High doses of some vitamins and minerals may produce toxic effects. Doses to avoid include: greater than 10,000 IU/day of vitamin A or beta-carotene, which may produce birth defects and liver injury; greater than 50 mg/day of vitamin B6 (pyridoxine), which may produce nerve injury; greater than 1,000 mg/day of vitamin C, which may produce diarrhea and kidney stones; greater than 2,000 IU/day of vitamin D, which may impair bone metabolism and produce liver injury; greater than 35mg/day of niacin, which may produce nausea, diarrhea, and liver injury; greater than 200 microgram/day of selenium, which may produce multiple toxic effects. In addition, vitamin A and beta-carotene should be avoided in smokers, and Coumadin (warfarin) should not be taken with coenzyme Q10, vitamin E, vitamin K, and possibly vitamin C. Zinc is sometimes used to prevent or limit the severity of the common cold. For unclear reasons, some CAM books recommend zinc supplements specifically for MS. In people with MS, however, zinc poses a theoretical risk since it may stimulate specific cells in the immune system. Similar risks for the immune system activation are possible with melatonin, a hormone used for insomnia, and DHEA, a hormone with many purported beneficial effects. Traditional Chinese Medicine. Traditional Chinese medicine includes acupuncture and herbal therapy. Acupuncture is increasingly recognized for its effectiveness in some types of pain and nausea, but studies in MS have been very limited and contradictory. Further studies are needed in the area of acupuncture and MS. Chinese herbal medicine should be taken cautiously and with a clear understanding of the effects of the herbs .Asian ginseng and astragalus, common components of Chinese herbal preparations, may stimulate the immune system. In general, Chinese proprietary (patent) medicine, a form of Chinese herbal medicine, should probably be avoided since there are no demonstrated benefits in MS and some ingredients may be toxic. Other Possibly Beneficial Therapies. Cooling of the body may improve multiple symptoms in MS. A variety of relaxation methods, including meditation and biofeedback, may be helpful, especially for those prone to stress or anxiety. Horseback riding (hippotherapy), tai chi, massage, and yoga may also be beneficial to some people with MS. Miscellaneous Therapies. Bee venom therapy is currently being investigated. Preliminary results from animal studies at Allegheny University indicate that it has no effect or may be harmful. Clinical studies in people are being conducted. Therapies in which there is not strong evidence for a beneficial effect in MS include calcium EAP, chelation therapy, craniosacral therapy, enemas, hyperbaric oxygen, and mercury amalgam removal. Placebo Effects The placebo effect is a beneficial response that occurs in a person who is given an inactive medication, such as a sugar pill. This effect is frequently observed and may be quite powerful. In trials of new MS medications, placebos are always given and the placebo effect is notoriously high. People with MS who are given placebos may have a 30-40% reduction in their relapses and a 30% or greater slowing of disease progression. In some trials, the placebo has actually produced greater improvement than the "active" medication. Also, some studies have shown that the placebo may produce beneficial effects on specific cells in the immune system. There are implications of this placebo effect in people with MS. First, the placebo effect shows the importance of doing formal clinical studies in which a large group of people is studied and some members of the group receive inactive medication. This applies to studies of conventional as well as unconventional therapies. One cannot rely on reports of the beneficial effects of an unconventional or conventional therapy that are based solely on studies with a small number of people (anecdotes or testimonials) or without a placebo-treated group. Another important point about the placebo effect is that it demonstrated the powerful influence of the mind over the body (or brain). A Wellness Approach The influence of the mind over the body and CAM are two areas that, along with many other important areas, can all be incorporated into a more inclusive "wellness approach" to MS. While there are a variety of approaches to wellness, an approach of value in MS is one that uses many different methods to optimize functioning in the different components of one's life. Health is one of these components; other important components include physical fitness, psychological well-being, social connectedness, nutrition, sexuality, spirituality, and bowel and bladder function. These components are interwoven and, in a state of wellness, there is a sense of wholeness and balance. Neurological care can improve the health component, while a wellness approach may produce benefits in the other areas. Assessing these other areas and providing therapy requires a multidisciplinary approach, including medical, psychological, nursing, dietetic, and rehabilitation services. Craze or Cure? Is CAM use in MS a craze or a cure? The answer is "neither". Each specific therapy needs to be evaluated with respect to MS. Some therapies may be beneficial, others are ineffective or unsafe, and a large number have yet to be studied carefully in people with MS. This large variability in the possible effectiveness of different therapies is the cause for much of the confusion and controversy in CAM. Improving the way in which CAM is used involves increasing communication between patients and health care professionals, providing accurate information to people with MS, and conducting reliable studies to determine which therapies might be effective. About the Author: Dr. Allen C. Bowling is the Associate Medical Director at the Rocky Mountain MS Center. He is also the director of a wellness program based at the center and is a Clinical Assistant Professor of Neurology at the University of Colorado Health Sciences Center. Dr. Bowling received his undergraduate, M.D., and Ph.D. (pharmacology) degrees at Yale University. He completed a residency in the neurology department at the University of California, San Francisco and was a Fellow in the Neurology Service at Massachusetts General Hospital and Harvard Medical School. Dr. Bowling has published numerous articles in clinical and basic science journals. Dr. Bowling has presented information and original research on CAM and MS at national and international medical conferences. His work on herb and vitamin use in MS was awarded the Labe Scheinberg award at the annual meeting of the Consortium of MS Centers in May 1999. The information that he has developed on CAM and MS is available in a book, Alternative Medicine and MS: a Practical Guide, published through Demos Medical Publishers. Glossary of Possibly Harmful Supplements Alfalfa: immune-stimulating Aloe: may interact with steroids Asian ginseng: immune-stimulating, possibly fatigue-producing, may interact with steroids Astragalus: immune-stimulating Bayberry: may interact with steroids Beta-carotene: immune-stimulating, greater than 10,000 IU/day may produce toxic effects, avoid in smokers Borage seed oil: possible liver toxicity Cat's claw: immune-stimulating Chamomile: possibly fatigue-producing Chaparral: possible liver toxicity Coenzyme Q10:immune-stimulating, may interact with warfarin(Coumadin) Comfrey: possible liver toxicity DHEA: possible immune-stimulating Echinacea: immune-stimulating Garlic: immune-stimulating Goldenseal: possibly immune-stimulating, possibly fatigue-producing Grapeseed extract: possibly immune-stimulating Kava-kava: possibly fatigue-producing Licorice: may interact with steroids Lobelia: multiple possible toxic effects Melatonin: possibly immune-stimulating Niacin: greater than 35 milligrams/day may produce toxic effects Nettle: possibly fatigue-producing Oligomeric proanthocyanidins: possibly immune-stimulating Passionflower: possibly fatigue-producing Pycnogenol: possibly immune-stimulating Sage: possibly fatigue-producing St. John's wort: possibly fatigue-producing Selenium: possibly immune-stimulating, greater than 200 micrograms/day may produce multiple toxic effects Siberian ginseng: immune-stimulating, possibly fatigue-producing Valerian: possibly fatigue-producing Vitamin A: immune-stimulating, greater than 10,000 IU/day may produce toxic effects, avoid in smokers Vitamin B6:greater than 50 milligrams/day may produce toxic effects Vitamin C: immune-stimulating, greater than 1,000 milligrams/day may produce toxic effects, may interact with warfarin (Coumadin) Vitamin D: greater than 2,000 IU/day may be harmful Vitamin E: immune-stimulating, may interact with warfarin (Coumadin) Vitamin K: may interact with warfarin (Coumadin) Zinc: possibly immune-stimulating, may cause copper deficiency References MS Relevant CAM Information http://www.ms-cam.org - interactive CAM website of Rocky Mountain MS Center Alternative Medicine and Multiple Sclerosis, Allen C. Bowling, Demos Medical Publishing, 2001 General CAM Information The Alternative Medicine Handbook, Barrie Cassileth, Norton, 1998 Complementary/Alternative Medicine: An Evidence-Based Approach, John W. Spencer and Joseph J. Jacobs, Mosby, 1999 (Technical) Living with Multiple Sclerosis: A Wellness Approach, G.H. Kraft and M. Catanzaro, Demos Medical Publishing, 2000 Natural Medicines Comprehensive Database, J. M. Jellin, F. Batz, K. Hitchens, Therapeutic Research Faculty, 2000 (Technical) (http://www.NaturalDatabase.com) Tyler's Herbs of Choice, James E. Robbers and Varro E. Tyler, Haworth Herbal Press, 1999 Tyler's Honest Herbal, Steven E. Foster and Varro E. Tyler, Haworth Herbal Press, 1999 ~ Reprinted with the Permission of ~ Allen C. Bowling, MD, PhD, of the Rocky Mountain MS Center And author of Alternative Medicine and MS, Demos Medical Publishing, 2001 Was this information helpful? Then please consider making a donation. We are a small, independent nonprofit agency and are dependent on donations from our supporters. Thank you from all the staff at the MSA.
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