Which supplements are actually beneficial for people with MS?

Many people affected by multiple sclerosis (MS) look to dietary supplements as a way of supporting their health alongside other approaches. While supplements aren’t a cure for MS, certain vitamins and nutrients may help manage symptoms, support the immune system or promote overall wellbeing. Below we explore some of the most commonly discussed supplements in the MS community, along with what the research currently says.

Vitamin D

Vitamin D plays a vital role in bone and muscle health and helps regulate the immune system. In MS, low vitamin D levels have been associated with an increased risk of developing the condition and a higher rate of disease activity.

A large longitudinal study published in JAMA Neurology in 2014 found that low vitamin D levels in people with relapsing-remitting MS (RRMS) were associated with a higher relapse rate and greater lesion activity on MRI. Another study published in Neurology in 2012 suggested that higher vitamin D levels were linked to a reduced risk of new lesions and relapses.

Because our bodies struggle to produce enough vitamin D in the UK during the colder months, supplementation is often recommended – particularly from October to March. You can also get vitamin D from foods like oily fish, eggs and fortified cereals.

Lipoic acid

Lipoic acid is a powerful antioxidant that helps reduce oxidative stress, which is linked to inflammation, nerve damage and MS progression.

A 2021 systematic review published in the journal Antioxidants analysed 32 studies and found that lipoic acid supplementation prevented the worsening of EDSS (Expanded Disability Status Scale) scores in people with MS and reduced disability scores in mice models. A major clinical trial, the LAPMS (Lipoic Acid for Progressive Multiple Sclerosis) study, involving 115 participants, is ongoing in North America. It is exploring whether 1200mg of lipoic acid taken daily over two years can help reduce brain injury and maintain mobility in people with progressive MS. The estimated completion date is June 2024.

Lipoic acid can also be found naturally in spinach, broccoli, potatoes and tomatoes.

Vitamin B12

Vitamin B12 supports nerve health and the production of red blood cells. It also helps maintain the myelin sheath, which protects nerve fibres – a key concern in MS.

A small study published in the Iranian Journal of Neurology in 2016 looked at the effects of B12 and folic acid supplements in people with RRMS. The study found those who took the supplements experienced moderate improvements in physical and mental aspects of quality of life, compared to those given a placebo. Although these results were promising, researchers agreed that larger and more robust studies are needed to fully understand B12’s role in MS.

Vitamin B12 is naturally found in animal-based foods such as meat, fish, eggs and dairy, and supplementation is particularly important for people following a vegan diet.

Omega 3 fatty acids

Omega 3 fatty acids – particularly EPA and DHA – are known for their anti-inflammatory and neuroprotective effects.

A 2022 meta-analysis published in Nutrients reviewed over 5,000 studies and concluded that omega 3 supplementation was associated with reduced levels of inflammatory markers, a lower relapse rate and improvements in quality of life in people with MS. However, despite this evidence, current NICE guidelines recommend that omega 3 (and omega 6) should not be offered as a treatment for MS due to insufficient proof of effectiveness in reducing relapse frequency or progression.

Omega 3 is found in oily fish, flaxseeds, chia seeds, walnuts and fortified foods. Plant-based omega 3 (ALA) can be converted into EPA and DHA in the body, but only in small amounts.

Evening primrose oil (EPO)

Evening primrose oil contains gamma-linolenic acid (GLA), an omega 6 fatty acid believed to have anti-inflammatory effects.

A 2020 double-blind randomised trial published in Complementary Therapies in Clinical Practice studied 52 people with MS, comparing those taking EPO with those on a placebo. After three months, the EPO group showed improvements in cognitive function, vitality and life satisfaction, along with reduced fatigue and pain. However, there was no significant impact on overall quality of life or disease progression.

While the evidence is still early-stage, some people report benefits from using EPO alongside other approaches.

Nicotinamide adenine dinucleotide (NAD⁺)

NAD⁺ is a coenzyme form of vitamin B3 that plays a crucial role in energy production and cellular repair. It has recently attracted attention for its potential to protect nerve cells.

A 2014 study published in Trends in Immunology suggested that NAD⁺ could help modulate the immune response in autoimmune conditions, including MS. A more recent 2021 study published in Biomedicines tested NAD⁺ supplementation in mice modelling MS. The treatment appeared to reduce neurological damage and delay the onset of MS-like symptoms. These results are encouraging, but clinical studies in humans are still needed.

NAD⁺ and its precursor, nicotinamide riboside (a form of vitamin B3), are available as dietary supplements.

Coenzyme Q10 (CoQ10)

CoQ10 is an antioxidant that helps generate energy in cells and is involved in reducing oxidative stress.

A 2016 double-blind placebo-controlled trial published in Nutritional Neuroscience explored the effects of 500mg of CoQ10 daily in 48 people with MS over 12 weeks. The study showed significant improvements in fatigue and depression compared to the placebo group. Another study in 2021, conducted on mice with MS-like symptoms, found that CoQ10 supplementation reduced inflammation and oxidative stress and showed potential for enhancing remyelination.

CoQ10 levels naturally decline with age, so supplementation may be beneficial, especially for those looking to manage fatigue or support cellular health.

If you’re thinking about adding supplements to your routine, speak to your GP, neurologist or MS nurse first. They can help you make safe, informed choices based on your individual needs and current medications.

You can also explore MS-UK’s free Choices booklets and resources on our website to learn more about these topics in your own time.