In new guidelines released today, the American Academy of Neurology (AAN) said that while oral forms of medical marijuana have proven effective for treating some symptoms of multiple sclerosis (MS), other complementary and alternative medicine (CAM) treatments have not.
The guidelines, which were published in the journal Neurology, suggest that smoking marijuana has little effect on symptoms MS, though the oral pill and spray forms have been shown to reduce spasticity and frequent urination in those with MS.
Other CAM therapies included in the guidelines were gingko biloba, bee sting therapy, magnetic therapy, reflexology, and omega-3 fatty acid supplementation.
"Using different CAM therapies is common in 33 to 80 percent of people with MS, particularly those who are female, have higher education levels, and report poorer health," said guideline lead author Vijayshree Yadav, MD of Oregon Health & Science University in Portland in a press release. "People with MS should let their doctors know what types of these therapies they are taking, or thinking about taking."
Good News, Bad News
While CAM therapies were not generally found to be effective, according to the AAN guidelines, the writers did make some concessions.
They said that gingko biloba and magnetic therapy may both reduce the tiredness associated with MS, while “reflexology might possibly help ease symptoms such tingling, numbness, and other unusual skin sensations.”
The guidelines found that “bee sting therapy, a low-fat diet with fish oil, and a therapy called the Cari Loder regimen all do not appear to help MS symptoms such as disability, depression, and tiredness. They also warn that bee stings "can cause a life-threatening allergic reaction and dangerous infections.”
Approved Treatment Options
In contrast to CAM therapies, there are currently 10 disease modifying therapies (DMTs) for MS approved by the Food and Drug Administration (FDA). All of the drugs underwent at least three phases of clinical trials in which they were extensively tested in humans.
These therapies, however, are all proprietary compounds patented by pharmaceutical companies with the resources to conduct large-scale studies of their safety and effectiveness. Clinical studies of CAM therapies are not normally backed by these companies because there is little financial incentive to study them, so there isn’t much conclusive evidence about how well they work.
CAM therapies, such as reflexology or omega-3 fatty acid supplements, typically rely on academic researchers for validation, supported by grants from MS advocacy groups like the National Multiple Sclerosis Society and the Myelin Repair Foundation.
Some academic researchers have pushed forward with small studies. Dr. Terry Wahls, a clinical professor of medicine at the University of Iowa used crowdfunding to support her currently enrolling study of the Wahls Paleo Diet and progressive MS. According to the listing on ClinicalTrials.gov, “The study diet is… structured to be low in carbohydrate and high in fat but still ensure consumption of the specific micronutrients important to optimal brain function. This diet is designed to induce a low level nutritional ketosis.”
This study, whether or not the diet is proven effective, will contribute much needed data to the CAM debate.
Using CAMs—and DMTs—With Caution
There is little research on the safety and efficacy of CAM therapies and whether or not they interact with other medications, so it is important to speak with your doctor before trying them. Even those shown to be effective, such as medical marijuana, can cause side effects.
“Examples are seizures, dizziness, thinking and memory problems, as well as psychological problems such as depression,” caution the guideline authors, “This can be a concern given that some people with MS are at an increased risk for depression or suicide.”
None of the approved DMTs are without risk, however, and it’s important to understand their safety profiles as well.
An approved drug or CAM that works for one person might not work for another. Ask your doctor and weigh the risks and benefits of all the available DMTs and CAMS before you begin any treatment, whether they are complementary or not.