Several herbal supplements have been considered as symptomatic and disease-modifying treatments for MS. These include valerian, St. John’s Wort, ginkgo biloba, Echinacea, and kava kava.
The herbal supplement valerian is made from the roots of a perennial flowering plant and has been used for medicinal purposes for more than 1,000 years. Valerian is used for the symptomatic treatment of insomnia, a common symptom in people with MS. The herb has been evaluated for treatment of sleep problems in several studies of varying quality. Results from these studies suggest that valerian is effective in treating insomnia. Claims that it is effective in psychiatric conditions, including depression and anxiety, and in spasticity have not been substantiated. Valerian is generally safe and well tolerated, although it does cause sedation.
St. John’s Wort
St. John’s Wort refers to any one of a number of species of plants in the genus Hypericum. It is a perennial herb originating in Europe that can now be found throughout the world. An extract of the herb is prepared using the leaves and flowers of the plant. Use of St. John’s Wort for medicinal purposes, specifically treatment of depression, spans more than 2,000 years. St. John’s Wort has been shown to be effective in mild-to-moderate depression, which is a common problem in people with MS. There is no evidence of the effectiveness of St. John’s Wort in severe depression. The herb is well tolerated. However, it is associated with fatigue and photosensitivity. Because it is metabolized in the liver by CYP 450 enzymes, St. John’s Wort can interact with many medications, resulting in changes in levels of these drugs, including anticonvulsants, warfarin, antidepressants, and oral contraceptives. If you are thinking of trying St. John’s Wort, you should talk to your doctor before taking it.
Ginkgo biloba, an extract made from the leaves of the tree Ginkgo biloba, may have symptomatic and disease-modifying effects in people with MS. Results from animal studies (using animal models of MS) have shown that ginkgo decreases the severity of MS. However, in studies conducted in people with MS, ginkgo was not effective as a treatment for relapses. In small studies conducted in people with MS, ginkgo was effective as a symptomatic treatment for fatigue and cognitive impairment. Ginkgo is generally well tolerated, but does have anticoagulant effects and may increase the likelihood of seizure in some people. The most common side effects include nausea, dizziness, rash, headache, vomiting, diarrhea, and flatulence.
Immune-stimulating herbal supplements
A variety of herbs, including Echinacea, alfalfa, Asian ginseng, ashwagandha, garlic, astragalus, cat’s claw, maitake mushroom, mistletoe, shiitake mushroom, Siberian ginseng, and stinging nettle, have been shown to have immune-stimulating properties, including the ability to activate T-cells and macrophages. However, there have been no rigorous studies of these substances in people with MS. It is important to note that supplements that boost or stimulate immune response may pose a risk for a person with MS.
Echinacea belongs to the daisy family and is native to North America. It has been studied as a treatment for the common cold. However, the quality of existing studies has been called into question and definitive conclusions about effectiveness cannot be made based on their results. Although Echinacea may be useful in treating respiratory infections, which may occur during relapses, potential activation of the immune system with Echinacea should be a concern for anyone with MS who is thinking of taking the herb. Additionally, Echinacea may increase the risk of liver damage when taken with medications including methotrexate and interferon beta treatments.
Kava kava is an herbal treatment derived from the root of the kava plant and is used to treat anxiety, which is a common symptom in people with MS. Kava kava works in a similar manner to benzodiazepines, which are indicated for the treatment of anxiety, by targeting a receptor in the brain called the gamma-aminobutyric acid (GABA) receptor. When this receptor is stimulated, it produces a sedative effect. A number of studies have shown kava kava to be effective in treating mild anxiety. However, kava kava has been associated with liver toxicity that can result in liver damage or death. This safety issue has resulted in kava kava being banned in Canada and Europe.
Asian ginseng (also called Panax ginseng) is a century-old performance enhancing substance and, as such, would be potentially valuable for people with MS who are affected by fatigue and weakness. However, evidence to support use of ginseng is not strong. There is some evidence that supports the use of ginseng to improve quality of life and speed of performance in an academic setting (in mathematical computation). However, these results have not been confirmed by repeated studies. While some results suggest that ginseng may be safe and provide benefits for people with MS, other studies suggest that the herb may stimulate the immune system and, therefore, may have detrimental effects in MS. At present, there is too little known about the effects of ginseng in MS to recommend its use.
Cranberries which are grown in bogs in North America and harvested for use as a juice, jelly, and for seasonal decorative purposes, are used (in tablet form or as a juice) in MS to prevent urinary tract infection (UTI). Components of cranberry are thought to inhibit adhesion of bacteria to cells in the urinary tract. Results from several studies suggest that cranberry may be effective in preventing UTIs. However, there is no evidence that the supplement is effective in treating existing infections. Cranberry is well tolerated, although it may increase the anticoagulant effect of warfarin and, with long-term use, may increase risk of kidney stones.