Multiple sclerosis (MS) is a disease of the central nervous system. In MS the body’s immune system attacks myelin, which coats nerve cells. Symptoms of MS include muscle weakness (often in the hands and legs), tingling and burning sensations, numbness, chronic pain, coordination and balance problems, fatigue, vision problems, and difficulty with bladder control. People with MS also may feel depressed and have trouble thinking clearly.

MS is the most common disabling neurological disease affecting young adults. It generally strikes people ages 20 to 40 and more commonly affects women. It affects some 400,000 Americans, and about 2.5 million people worldwide. The most common form of the disease is called relapsing-remitting MS, in which symptoms come and go.

Although MS has no cure, some conventional treatments can improve symptoms, reduce the number and severity of relapses, and delay the disease’s progression. Many people with MS try some form of complementary health approach, often special diets (such as the Swank diet, which is low in saturated fats and high in polyunsaturated fatty acids, such as fish oils) and dietary supplements.

Bottom Line

Some complementary health practices, like yoga, may help ease some symptoms of MS. There’s no evidence that any dietary supplement is effective for MS.

• Psychological and Physical Approaches
  • Practicing yoga may help with fatigue and mood, but not with mobility or thinking ability.
  • A few studies have investigated the potential of acupuncture for MS symptoms, and those that have noted benefit have been criticized for having less rigorous methods.
  • Reflexology (applying pressure to the soles of the feet) may reduce a burning or prickling sensation associated with MS; however, larger studies are needed to provide a reliable conclusion.
• Dietary Supplements
  • Fish oil supplements have not been shown to be helpful for MS.
  • Ginkgo has not been shown to enhance the ability to think clearly and logically in people with MS.
  • Results of a large, 5-year study suggest that low blood levels of vitamin D may be a risk factor for long-term disease activity and progression. However, more studies need to be done to determine if taking vitamin D supplements is beneficial.
• Other Complementary Health Approaches
  • Research involving pulsed magnetic therapy (devices that use an electrical current to generate a magnetic field) has shown mixed results for MS-related fatigue.
  • Bee sting, or bee venom, therapy (which involves placing live bees on certain parts of the body and allowing them to sting) seems to have no effect on either MS symptoms or disease progression.
  • Chemicals in marijuana known as THC/cannabinoids may relieve spasticity and/or pain in people with MS. While no marijuana-derived medications are approved by the U.S. Food and Drug Administration to treat MS in the United States, Canada and some European countries have approved Sativex, a plant-derived cannabinoid prescription drug mouth spray containing THC delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), for MS-related muscle control. It’s unknown if smoking marijuana helps with MS. Researchers have not conducted enough large-scale clinical trials that show that the benefits of the marijuana plant (as opposed to its cannabinoid ingredients) outweigh its risks in patients it’s meant to treat.

Safety

• Reflexology and yoga are generally considered safe.
• Acupuncture is considered to be safe when performed by a trained practitioner.
• Bee venom therapy may carry the risk of anaphylaxis, a potentially life-threatening allergic reaction.
• Cannabinoid medications, which should only be taken when prescribed and monitored by a physician, are generally well tolerated. They may cause dizziness, anxiety, and short-term and long-term problems with memory and concentration. A small number of people may experience nausea/vomiting, constipation, and dry or sore mouth.
• Marijuana can be addictive.
• People who smoke marijuana frequently can have the same breathing problems faced by tobacco smokers (daily cough and phlegm, more frequent lung illness, and a higher risk of lung infections); it also can affect the heart.
• If you’re considering a dietary supplement, remember that “natural” does not mean “safe.” Some dietary supplements may have side effects, and some may interact with drugs and other supplements. Taking too much of some supplements, such as vitamin D, can be harmful—and even life threatening.

Multiple sclerosis (MS) disrupts communication between the brain and other parts of the body. In the worst cases, it can bring partial or complete paralysis. Researchers don’t yet know what causes this disease or how to cure it, but they’ve been making progress on both fronts.

Symptoms of MS arise most often between the ages of 20 and 40. It often begins with blurred or double vision, color distortion, or even blindness in one eye. It can cause muscle weakness, vision loss, numbness or tingling, and difficulty with coordination and balance. MS can bring many other symptoms as well.

In some people, doctors may not be able to readily identify the cause of these symptoms. Patients may endure years of uncertainty and multiple diagnoses while baffling symptoms come and go. The vast majority of patients are mildly affected, but in the worst cases, MS can leave a person unable to write, speak or walk.

MS is a disease in which the body’s immune system inappropriately attacks the brain and spinal cord. Specifically, the immune system targets the fatty insulating material around nerves called myelin. When myelin is damaged, the messages that nerve cells send and receive can be interrupted.

Researchers estimate that 250,000 to 350,000 people in the United States have been diagnosed with MS. Scientists don’t yet understand what triggers the immune system to attack myelin in these people. But researchers do know that whites are more than twice as likely as others to develop MS, and women almost twice as likely as men.

Geography seems to play a role in MS. The disease is much more prevalent in temperate climates than in tropical regions. Your risk for MS seems to depend on where you live before the age of 15. Some studies have found that a person who moves before the age of 15 tends to adopt the risk of the new area. People moving after age 15 seem to maintain the risk level of the area where they grew up. Some researchers believe that vitamin D, which the body makes when sunlight strikes the skin, may lower the risk of MS and help explain these findings, but studies haven’t yet confirmed this link.

Some microbes, such as the Epstein-Barr virus, have been suspected of causing MS. But researchers haven’t been able to prove for certain that any microbes raise your chances of getting MS. Cigarette smoking, however, does appear to raise your risk.

Genes clearly affect how likely you are to develop MS. Having a sibling with MS raises your risk of getting MS to about 4% to 5%; having an identical twin raises your risk to about 25% to 30%. These facts suggest a strong genetic component to MS. However, although some studies have linked specific genes to MS, most of the results haven’t been definitive. Researchers are now working on more detailed studies.

There’s no cure yet for MS, but various therapies can treat it. Researchers are continuing to develop new and better therapies for MS, with several now in the pipeline.

Signs and Symptoms of MS

• Muscle weakness
• Blurred or distorted vision
• Numbness or tingling
• Coordination problems
• Speech disturbances
• Vertigo or dizziness
• Trouble concentrating
• Fatigue
• Tremor

Orally administered cannabinoids (cannabis extract, synthetic tetrahydrocannabinol [THC]), mucosally delivered cannabinoids (cannabis THC and cannabidiol [CBD] extract oral spray, nabiximols (brand name Sativex), and smoked cannabis have all been studied for therapeutic effects in MS. Based on available evidence, cannabinoids may relieve spasticity and/or pain in people with MS; however, no marijuana-derived medications are approved by the U.S. Food and Drug Administration to treat MS. Sativex has received regulatory approval in more than 25 countries outside the United States for the treatment of spasticity (muscle stiffness/spasm) due to MS. There are insufficient data to determine if using marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered. Sativex is licensed in the United Kingdom for use as an add-on treatment for MS-related spasticity when people have shown inadequate response to other symptomatic treatments or found their side effects intolerable.

There is insufficient data to determine if smoking marijuana ameliorates symptoms of MS. Additionally, the psychoactive properties and other potential adverse effects need to be considered.

What Does the Research Show?

• A  2022 Cochrane review of 25 randomized controlled trials involving a total of 3763 participants found that compared with placebo, nabiximols probably reduces the severity of spasticity in the short term in people with MS. The reviewers were less certain about the effect on chronic neurological pain and health-related quality of life. A 2018 systematic review and meta-analysis of 17 trials involving a total of 3,161 participants found limited efficacy of cannabinoids such as THC, CBD, THC:CBD formulations, pharmaceutical cannabinoids (dronabinol and nabilone), smoked cannabis, and oral cannabinoid extracts for the treatment of spasticity, pain, and bladder dysfunction in patients with MS. Another 2018 systematic review of 11 reviews providing data from 32 studies (including 10 moderate-to-high quality randomized controlled trials) found sufficient evidence that cannabinoids may be effective for symptoms of pain and/or spasticity in MS. A 2015 systematic review and meta-analysis of 79 trials (involving 6,462 participants) found moderate-quality evidence to support the use of cannabinoids for the treatment of chronic pain and spasticity in people with MS.
• Oral cannabinoids. The 2014 evidence-based guidelines issued by the American Academy of Neurology concluded that oral cannabis extract is established as effective for reducing patient-reported spasticity symptoms and pain. This subjective benefit is possibly maintained for 1 year. The guidelines also concluded that THC is probably effective for reducing patient-reported symptoms of spasticity and pain. This subjective benefit is possibly maintained for 1 year. However, the guidelines state that oral cannabis extract and THC are probably ineffective for reducing both objective spasticity measures and MS-related tremor symptoms. Oral cannabis extract and THC are possibly effective for reducing symptoms and objective measures of spasticity over 1 year.
• Oromucosal cannabinoid spray. The 2014 American Academy of Neurology evidence-based guidelines concluded that Sativex oromucosal cannabinoid spray is probably effective for improving subjective spasticity symptoms and is probably ineffective for reducing objective spasticity measures over 6 weeks or bladder incontinence episodes over 10 weeks. Further, the guidelines state that Sativex oromucosal spray is possibly ineffective for reducing MS-related tremor over 15 weeks. In addition, a 2010-reported meta-analysis from 666 MS patients who had spasticity that was not well controlled using existing treatments were given either nabiximols (363) or placebo (303). Results showed nabiximols effects are typically seen within 3 weeks. Furthermore, about one-third of the MS patients given nabiximols had a 30 percent improvement from baseline. The authors noted the treatment appeared reasonably safe.
• Smoked cannabis. Based on two small studies, the 2014 evidence-based guidelines issued by the American Academy of Neurology concluded that data are inadequate to determine the safety or efficacy of smoked cannabis used for spasticity/pain, balance/posture, and cognition.

Safety

• In the studies that were the basis for the 2014 American Academy of Neurology guidelines, cannabinoids were generally well tolerated, although some serious adverse effects were reported. Mild or moderate side effects including dizziness, somnolence, drowsiness, lightheadedness, memory disturbance, and difficulty concentrating were more common in participants receiving cannabinoids vs placebo. Less common effects included increased appetite, nausea, vomiting, constipation, dry/sore mouth, myalgia, seizures, and others. The guidelines noted that because cannabinoids have known psychoactive properties, their potential for psychopathologic and neurocognitive adverse effects is a concern, especially in a patient population that may be vulnerable due to underlying disorders.
• The guidelines recommend that clinicians counsel patients about the potential for psychopathologic/cognitive and other adverse events associated with cannabinoids. Sativex oromucosal cannabinoid spray is not approved by the U.S. Food and Drug Administration and is unavailable in the United States. Further, the guidelines suggest caution should be exercised with regard to extrapolation of results of trials of standardized oral cannabis extract (which are unavailable commercially) to other nonstandardized, nonregulated cannabis extracts (which may be commercially available in states with medical marijuana laws).
• Although people sometimes think that CBD products are completely safe, they may not be. Unlike Epidiolex (the purified CBD product sold as an FDA-approved prescription drug), over-the-counter CBD products may contain more or less CBD than stated on their labels, and because of inadequate quality control, they may also contain contaminants, such as THC. 

According to 2014 clinical practice guidelines issued by the American Academy of Neurology, there is strong evidence that Ginkgo biloba is ineffective for improving cognitive function in people with MS. The guidelines also state that there is weak evidence that Ginkgo biloba is possibly effective for reducing fatigue.

What Does the Research Show?

• The 2014 evidence-based guidelines from the American Academy of Neurology concluded that Ginkgo biloba is ineffective for improving cognitive function in people with MS, but that it is possibly effective over 4 weeks for reducing fatigue in MS. These conclusions are based on four small studies.
• A 2012 randomized controlled trial involving 120 participants with MS with some cognitive impairment found that Ginkgo biloba twice a day for 12 weeks did not improve cognitive performance.
• A 2011 Cochrane review of four randomized controlled trials evaluated pharmacologic treatments, including Ginkgo biloba, for memory disorder in MS. The reviewers concluded that based on available evidence, there is no convincing evidence to support the use of Ginkgo biloba as an effective treatment for memory disorder in MS patients.

Safety

• Side effects of ginkgo may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions. More severe allergic reactions have occasionally been reported.
• There are some data from animal models to suggest that ginkgo can have an effect on the pharmacokinetics of several drugs; however, current available clinical evidence suggests that low doses do not pose a risk for clinically relevant herb-drug interactions.
• Fresh ginkgo seeds contain large amounts of ginkgotoxin, which can cause serious adverse reactions, including seizures and death. Roasted seeds can also be toxic. Products made from standardized ginkgo leaf extracts contain little ginkgotoxin and appear to be safe when used orally and appropriately.
• National Toxicology Program (NTP) studies showed that rats and mice developed tumors after being given a specific ginkgo extract for up to 2 years. Further studies are needed to find out what substances in ginkgo caused the tumors and whether taking ginkgo as a dietary supplement affects the risk of cancer in people.

There is insufficient data to assess any real beneficial effects of omega-3 fatty acid supplementation on MS. 2014 evidence-based guidelines from the American Academy of Neurology concluded that a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or MRI lesions, or for improving fatigue or quality of life.

What Does the Research Show?

• The 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on three reviewed studies, a low-fat diet with fish oil supplementation is probably ineffective for reducing MS-related relapse, disability, or MRI lesions, or for improving fatigue or quality of life.
• A 2020 Cochrane review of 30 trials examining dietary interventions, including polyunsaturated fatty acids (PUFAs) and dietary plans with recommendations for specific whole foods, macronutrients, and natural health products, concluded that PUFA administration may not differ when compared to alternatives with regards to relapse rate, disability worsening, or overall clinical status in people with MS; however, evidence is uncertain.

Safety

• Omega-3 fatty acid supplements usually do not have negative side effects. When side effects do occur, they typically consist of minor gastrointestinal symptoms.

To date, results of studies have been conflicting as to whether vitamin D may provide a therapeutic benefit for people with MS. A 2018 Cochrane review found very low-quality evidence suggesting no benefit of vitamin D for patient-improving outcomes among people with MS. However, findings from a 2018 meta-analysis suggest that vitamin D supplementation may have a therapeutic role in the treatment of MS. Further high-quality studies are needed before definitive conclusions can be drawn.

What Does the Research Show?

• A 2018 Cochrane review of 12 randomized controlled trials involving a total of 933 participants with MS found very low-quality evidence suggesting no benefit of vitamin D for patient-important outcomes. The reviewers concluded that vitamins D appears to have no effect on recurrence of relapse, worsening of disability, and MRI lesions. Effects on health-related quality of life and fatigue were unclear.
• A 2018 meta-analysis of 12 studies involving a total of 950 participants found that vitamin D may be useful in the treatment of MS; however, the findings were not sufficient to recommend vitamin D supplementation at present.
• Results of a large, 5-year randomized trial in 468 participants with MS suggest that low blood levels of vitamin D may be a risk factor for long-term disease activity and progression. However, more studies need to be conducted to determine if vitamin D supplementation affects disease course and progression.

Safety

• Limited intervention studies in MS suggest that vitamin D supplements are generally well tolerated in MS.
• High doses may cause fatigue, abdominal cramps, nausea, vomiting, renal damage, and other adverse effects.

Based on a few small studies, bee venom therapy seems to have no effect on either MS symptoms or disease progression. There are serious side effects associated with bee venom, including risk of anaphylactic reactions and death, which could limit any efficacy of bee venom therapy for the treatment of MS.

What Does the Research Show?

• Based on a review of one small study, the 2014 evidence-based guidelines from the American Academy of Neurology concluded that bee sting therapy is possibly ineffective for reducing MS-related relapses, disability, fatigue, total MRI lesion burden, new gadolinium-enhancing lesion volume, or health-related quality of life.

Safety

• There are serious side effects associated with bee venom, which could limit any efficacy of bee venom therapy in the treatment of MS.

There is some limited evidence suggesting beneficial short-term effects of yoga on fatigue and mood in people with MS, but scientific studies overall had a high risk of bias and definitive conclusions could not be drawn.

What Does the Research Show?

• A  2020 systematic review and meta-analysis of 10 randomized controlled trials involving 693 patients evaluated the effect of yoga intervention on the quality of life and fatigue in patients with MS. The meta-analysis found that the effect of yoga intervention on fatigue in patients with MS was significantly better compared to the typical MS care group, but did not show significant difference compared to the exercise group.
• The 2014 evidence-based guidelines from the American Academy of Neurology concluded that the data are inadequate to assess the effect of yoga on disability, spasticity, fatigue, cognition, mood, balance, or walking speed in people with MS.

Safety

• In the studies included in a 2014 systematic review and meta-analysis, yoga was not associated with serious adverse events.
• People with certain medical conditions, including MS, should modify or avoid some yoga poses.

There is insufficient evidence to support the use of reflexology for most symptoms of MS, including pain, health-related quality of life, disability, spasticity, fatigue, depression, and others. However, 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks.

What Does the Research Show?

• The 2014 evidence-based guidelines from the American Academy of Neurology concluded that, based on four studies, reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks. However, the guidelines state that data are inadequate to support or refute the use of reflexology for pain, health-related quality of life, disability, spasticity, fatigue, cognition, bowel or bladder function, depression, anxiety, or insomnia in MS.
• A 2011 update of a systematic review evaluating the evidence of 23 randomized controlled trials of reflexology in patients with any type of health condition found that 8 studies suggested that reflexology is effective for several conditions, including MS. However, the reviewers concluded that the best clinical evidence does not demonstrate convincingly that reflexology is an effective treatment for any condition.

Safety

Reflexology is generally considered safe for most people; however, vigorous pressure applied to the feet may cause discomfort for some people.

There is some limited, low-level evidence that suggests that magnet therapy may have modest beneficial effects on spasticity outcomes in people with MS, but the studies have been of low methodological quality. There are also some data from two studies, suggesting that magnet therapy may be useful in reducing fatigue in people with relapsing-remitting MS.

What Does the Research Show?

• A small 2016 study (63 participants) on electromagnetic therapy for multiple sclerosis–related paresthesia pain found that 60 days of twice weekly pulsed electro-magnetic field (PEMF) therapy for 20 minutes per session was effective in reducing pain in people with multiple sclerosis. A smaller reduction in pain was also found after 30 days of PEMF treatment. No recent research is available on static magnet therapy for paresthesia pain from multiple sclerosis.
• The 2014 evidence-based guidelines from the American Academy of Neurology concluded that magnet therapy is probably effective for reducing fatigue in relapsing-remitting MS, and probably ineffective for reducing depression in relapsing-remitting MS over 15 weeks. There is insufficient evidence to support the use of magnet therapy for reducing MS-related disability, bladder control problems, or spasticity, or on improving cognition, mobility, sensation, or vision.
• A 2013 Cochrane review of 9 randomized controlled trials involving a total of 301 participants concluded that there is “low level” evidence for non-pharmacological interventions, including magnetic stimulation for beneficial effects on spasticity outcomes in people with MS. The studies included in the review were of low methodological quality and had high risk of bias.

Safety

• Magnets may interfere with the functioning of some medical devices (e.g., pacemaker, insulin pump) and may not be safe for some people. Otherwise, magnets are generally considered safe when applied to the skin.
• Reports of side effects or complications have been rare.

Although hyperbaric oxygen therapy is often heavily marketed to people with MS, there are no consistent data that support the use of hyperbaric oxygen therapy for the treatment of MS.

What Does the Research Show?

• A  2010 meta-analysis of 12 randomized studies concluded that hyperbaric oxygen therapy does not produce any clinically significant benefits in MS.
• A  2004 Cochrane review had similar findings. The review of nine studies of hyperbaric oxygen therapy for the treatment of multiple sclerosis found no consistent evidence to confirm a beneficial effect. The reviewers also noted that based on available evidence, routine use is not justified.

Safety
When safety guidelines are strictly adhered to, hyperbaric oxygen therapy appears to be generally safe. The predominant complication is pressure equalization problems within the middle ear. Serious complications are rare.

Multiple sclerosis (MS) is a disease of the central nervous system. In MS, the body’s immune system attacks myelin, which coats nerve cells. Symptoms of MS include muscle weakness (often in the hands and legs), tingling and burning sensations, numbness, chronic pain, coordination and balance problems, fatigue, vision problems, and difficulty with bladder control.

Although MS has no cure, some conventional treatments can improve symptoms, reduce the number and severity of relapses, and delay the disease’s progression. Many people with MS try some form of complementary health approach, often special diets and dietary supplements. Here are 7 things to know about complementary health approaches for MS.

1. Practicing yoga may help with fatigue and mood, but there’s no evidence that yoga can help with mobility or thinking ability.

2. Reflexology (applying pressure to the soles of the feet) may reduce a burning or prickling sensation sometimes associated with MS, but larger studies are needed to provide a reliable conclusion.

3. Studies of magnetic therapy, which involves devices that use an electrical current to generate a magnetic field, have shown mixed results for MS-related fatigue.

4. Chemicals in marijuana known as THC/cannabinoids may relieve spasticity and/or pain in people with MS. While no marijuana-derived medications are approved by the U.S. Food and Drug Administration to treat MS in the United States, Canada and some European countries have approved Sativex®, a mouth spray with THC/cannabinoids for muscle control related to MS.

5. Dietary supplements such as fish oil and ginkgo biloba have not been shown to be helpful for MS.

6. One large, 5-year study suggests that low blood levels of vitamin D may be a risk factor for long-term disease activity and progression. However, more studies need to be done to determine if vitamin D supplementation is beneficial.

7. Take charge of your health—talk with your health care providers about any complementary health approaches you use. Together, you can make shared, well-informed decisions.