Multiple Sclerosis

Why it works: Omega-3s are precursors to specialized pro-resolving mediators (resolvins, protectins, maresins) that can dampen neuroinflammation and promote resolution of inflammatory responses...

Instructions: There is no established, evidence-based omega-3 “treatment protocol” for MS. Major guidelines do not recommend omega-3s as a disease-modifying therapy. If you still want to use ome...

Warnings: Not a substitute for DMTs. Do not replace prescribed MS therapies with omega-3 supplements. AAN and...

Studies: Randomized controlled trials (RCTs) & guidelinesOFAMS RC...

Why it works: Immunomodulation. Active vitamin D (1,25-dihydroxyvitamin D) binds the vitamin D receptor (VDR) on immune cells and tends to:. • tilt T cells away from pro-inflammatory Th1/Th17 ph...

Instructions: Measure a baseline 25(OH)D level.. • 25(OH)D is the correct test (not 1,25-dihydroxyvitamin D). Many MS clinics monitor to keep levels in an “adequate” range. Cleveland Clinic. Tar...

Warnings: Vitamin D toxicity (hypervitaminosis D) leads to hypercalcemia and hypercalciuria, which can cause k...

Studies: Key trials/reviewsD-Lay MS (JAMA, 2025) – Monotherapy in CIS...

Why it works: Endocannabinoid system (ECS) targeting. Cannabinoids act at CB1 receptors in the CNS (modulating excitatory neurotransmitters and muscle tone) and CB2 receptors on immune cells (an...

Instructions: Who to consider. Adults with moderate–severe spasticity not controlled by first-line therapies; therapy should be started and supervised by a clinician experienced in MS spasticity...

Warnings: Common early side effects: dizziness and fatigue during titration; usually settle in a few days or w...

Studies: Randomized trials (examples):CAMS/Lancet 2003 (667 participa...

Why it works: Improves core MS symptoms and function. Well-designed trials and guidelines show that structured aerobic and resistance training can reduce fatigue, improve walking/mobility, balan...

Instructions: Aerobic training. • Frequency: 2–3 days/week to start; progress toward 150 minutes/week moderate activity (can be accumulated in short bouts). ResearchGate. • Intensity: Moderate (...

Warnings: Heat sensitivity (Uhthoff’s phenomenon): Heat can temporarily worsen neurologic symptoms. Use coolin...

Studies: Network/meta-analyses of RCTs2024 network meta-analysis: exe...

Why it works: They target balance, mobility, and quality of life (QOL). A systematic review of Tai Chi in MS found improvements in functional balance and QOL, with some studies also reporting be...

Instructions: Below is a safe, MS-informed starting template. Adjust up/down with your clinician or a neuro-PT/yoga therapist.. 1) Frequency & dosage (aligning to NMSS guidance by EDSS). EDSS ~0...

Warnings: Heat sensitivity / Uhthoff’s phenomenon: Heat can temporarily worsen MS symptoms. Exercise (includin...

Studies: Randomized & controlled trials / reviews (MS-specific):Y...

Why it works: Targets stress, mood, and coping, which are major drivers of MS symptom burden (fatigue, pain, sleep, anxiety/depression) and quality of life. Mindfulness programs consistently red...

Instructions: Mindfulness-based programs (MBSR / MBCT). Format (typical MBCT/MBSR):. • 8 weekly group sessions (~2–2.5 hours) plus a silent practice day; daily home practice (~30–45 minutes). Co...

Warnings: Not a replacement for disease-modifying therapies or relapse care. Use mindfulness/CBT alongside neu...

Studies: Mindfulness (MBIs)Systematic reviews / meta-analyses:Mindful...

Why it works: Anti-inflammatory & neuroprotective pattern. The Mediterranean diet (MedDiet) is rich in vegetables, fruit, legumes, whole grains, nuts, fish, and extra-virgin olive oil (EVOO), wh...

Instructions: Daily / weekly targets (typical ranges):. • Vegetables & fruit: make them the base of each meal (aim ≥5 servings veg + fruit/day). OLDWAYS - Cultural Food Traditions. • Whole grain...

Warnings: Do not replace prescribed DMTs. All major guidelines emphasize continuing evidence-based MS medicati...

Studies: Systematic reviews & meta-analyses (latest first):2025 M...

Why it works: Anti-inflammatory / antioxidant actions. Standardized extracts (e.g., EGb 761) reduce pro-inflammatory cytokines in preclinical work and have antioxidant effects in neural tissue....

Instructions: Extract & dose: Studies generally used a standardized leaf extract (EGb 761) at 120 mg twice daily (total 240 mg/day). Duration was typically 4–12 weeks. Europe PMC. Role: Use only...

Warnings: Bleeding risk. Ginkgo can increase bleeding, especially with warfarin, DOACs, antiplatelets (e.g., a...

Studies: Cognition: A Class I randomized, placebo-controlled Neurolog...

Why it works: Anti-inflammatory & neuroprotective actions (preclinical): Ginsenosides (e.g., Rb1, Rd, Re) reduce inflammatory signaling, protect the blood–brain barrier, and lessen demyelination...

Instructions: There is no established, MS-specific dosing for ginseng. If you and your clinician decide to try it for fatigue, the only dosing guidance comes from small trials and regulatory mon...

Warnings: Possible immune stimulation: Asian ginseng can modulate immune function; some MS resources caution a...

Studies: Mixed and low-certainty evidence, focused on fatigue:Positiv...

Why it works: Leukotriene pathway / 5-lipoxygenase (5-LOX) inhibition. The main boswellic acid, AKBA, is an allosteric inhibitor of 5-LOX, a key enzyme in leukotriene synthesis. 5-LOX and its pr...

Instructions: RRMS disease-activity study (SABA trial; standardized frankincense extract “Boswelan/SFE”).. • Design: phase IIa, open-label, baseline-to-treatment. Dosing: individualized dose-fin...

Warnings: Not a substitute for MS DMTs. Major guidelines (AAN; reaffirmed 2024) discuss FDA-approved DMTs; Bos...

Studies: Disease activity (MRI lesions; RRMS):SABA phase IIa (open-la...

Why it works: Anti-inflammatory immune effects (preclinical): In the EAE animal model of MS and human T-cell studies, EGCG dampens pro-inflammatory Th1/Th17 responses and NF-κB activity, and can...

Instructions: Doses used in MS trials:. • RRMS add-on: up to 800 mg EGCG/day (divided), 18 months. No efficacy; generally well tolerated. MDC Berlin. • Progressive MS: up to 1,200 mg EGCG/day (d...

Warnings: Liver toxicity (most important):. • Case series and mechanistic research show green tea extract–rela...

Studies: Relapsing-remitting MS (RRMS), add-on to glatiramer acetate:...

Why it works: EPO supplies GLA (omega-6), which the body can convert to dihomo-γ-linolenic acid (DGLA) and then to prostaglandin E1 and other eicosanoids that may have anti-inflammatory effects....

Instructions: Formulation & quality: Choose a product with independent quality testing (e.g., USP/NSF/ConsumerLab) because supplements aren’t pre-approved by the FDA for content or purity. NCCIH...

Warnings: Bleeding risk: Avoid if you have a bleeding disorder; stop at least 2 weeks before surgery. EPO may...

Studies: 2018 double-blind RCT (n=52): 3 months of EPO vs placebo in...