Expert Voices: Complementary and alternative medicine for multiple sclerosis

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In this installment of our “Expert Voices” series, Multiple Sclerosis News Today asked Allen C. Bowling, MD, PhD, to answer some of your questions related to complementary and alternative medicine (CAM) for people with multiple sclerosis (MS).

Bowling is an internationally recognized neurologist and integrative medicine pioneer with more than three decades of clinical and research experience. He has devoted his career to developing and providing rigorous, comprehensive, and compassionate care to those with MS. Bowling is director of the NeuroHealth Institute. He also is a clinical professor of neurology at the University of Colorado.

Bowling lectures extensively and is actively engaged in the ongoing clinical care of people with MS. He incorporates the approaches outlined in writing and speaking in his clinical practice, Neurology Care, in Englewood, Colorado.

He is a summa cum laude graduate of Yale, where he also obtained his MD and PhD degrees. He completed his neurology residency training at the University of California, San Francisco, and his fellowship training at Massachusetts General Hospital-Harvard Medical School.

What misunderstandings about complementary and alternative medicine would you like to dispel in regards to MS?

Allen C. Bowling, MD, PhD, is a neurologist specializing in integrative medicine for MS. (Photo courtesy of Allen C. Bowling)

I think a major misunderstanding is with the term itself, “complementary and alternative medicine.” This misunderstanding is of concern, especially for those with MS, because CAM is actually somewhat limiting in the therapies that it offers. Technically, CAM refers to therapies that are “unconventional.” For those who want to consider all available therapies, which is the majority of those with MS, a much broader and more helpful term is “integrative medicine.” This refers to an approach that combines conventional medicine, unconventional medicine (or CAM), and lifestyle medicine, which includes lifestyle practices such as diet and physical activity.

It’s important to recognize that with integrative medicine in MS, including CAM, there is a lot of misinformation, some of which is marketing for sales purposes. This is confusing, unfair, and potentially dangerous to those with MS. Some of these approaches are low risk and potentially beneficial, but others are dangerous and/or ineffective. It’s essential for people with MS who have an interest in this area to distinguish between potentially helpful and harmful approaches by first obtaining objective, evidence-based information.

In addition, people with MS need to recognize that integrative medicine has a few important distinctions from conventional medicine. First, integrative medicine, like conventional medicine, aims to treat disease. But it is also very much directed at maintaining health and preventing disease. Also, integrative medicine should be pursued with clinicians who have expertise in this area and are able to provide a relationship that is supportive of this approach.

Generally, what’s your thought process for deciding what treatment might be best for a patient to try? 

When applying integrative medicine to MS, I think of seven “steps” that all people with MS should pursue:

  1. conventional, FDA-approved medications
  2. symptom management, which should include the use of conventional medication but also lifestyle and unconventional medication
  3. exercise
  4. diet, including food, dietary supplements, and weight management
  5. emotional health
  6. decreasing tobacco and alcohol use
  7. maintaining the health of the rest of the body

Practical, evidence-based information about all of the above approaches may be found on my website and in a book that I’ve written, “Optimal Health with Multiple Sclerosis: A Guide to Integrating Lifestyle, Alternative, and Conventional Medicine.”

Are there CAM trends you’d like to warn against?

As I’ve mentioned, I think misinformation is rampant in the CAM field, and this is dangerous because some CAM approaches are excessively costly, dangerous, and/or ineffective. People with MS need to talk with their healthcare providers and do their own “homework” to obtain objective safety and effectiveness information about complementary and alternative medicine.

One area in which there is a lot of MS misinformation is dietary supplements. Supplements are often marketed specifically to people with MS even though many may do more harm than good. There are actually more than 200 supplements that should be avoided or used with caution by people with MS.

An area of frequent confusion is with products that activate the immune system. These are often marketed to those with MS because MS is an immune condition. MS is, in fact, an immune condition, but it is characterized by excessive immune system activity. As a result, supplements that activate the immune system could actually be harmful because they could worsen MS or inhibit the therapeutic effects of MS medications. Examples of immune-stimulating supplements include many herbs, such as the popular Ayurvedic herb Ashwagandha, and antioxidant vitamins.

Are there generally helpful and safe forms of complementary and alternative medicine you tend to recommend to MS patients?

I work with my patients to rigorously follow the seven steps that I’ve outlined above. Importantly, no one does these steps perfectly, and the best ways to pursue each step may change over time, so it’s always a “work in progress.”

Do you have any thoughts about medical marijuana’s use in MS treatment?

Medical marijuana has been of much interest to me for more than three decades. There is quite good evidence that it relieves MS-associated pain and spasticity. As with most medications, however, it has potential adverse effects and drug interactions, some of which are significant in MS. It is a disservice to people with MS that medical marijuana programs in the U.S. do not readily provide objective, MS-relevant information about the effectiveness, safety, and drug interactions of marijuana. I have compiled this information, and it is available on my website through this link.

How about acupuncture?

Acupuncture is one component of a comprehensive treatment approach known as traditional Chinese medicine. For people with MS, I think of acupuncture as a low-risk, potentially beneficial therapy. It is widely known that it may relieve pain. Other MS symptoms that could possibly be eased with acupuncture include bladder difficulties, anxiety, fatigue, and insomnia.

Are any important nutrients or vitamins often overlooked for people with MS?

I think the most important vitamin to be aware of with MS is vitamin D. In some studies, low levels or low intake of vitamin D have been associated with increased risk for MS attacks and disability.

The other vitamin that is important to be mindful of is vitamin B12. People with MS may be at risk for low vitamin B12 levels, and low vitamin B12 levels may produce many of the same neurological symptoms that are caused by MS. Levels of vitamin D and vitamin B12 are measured with routine blood testing — if levels are low, then supplements may be needed.

Expert Voices is a monthly series involving a Q&A with an expert in the MS space about a specific topic. These topics and questions are curated from a survey in which we ask readers what they want to learn more about from experts. 

Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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