Multiple sclerosis alternative therapies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D., Julinka Auta Fernandes
Overview
Complementary and alternative approaches used by people with multiple sclerosis include special diets and supplements, mind-body practices, herbal products, manual therapies, cannabis products, hyperbaric oxygen, magnetic-field devices, and biologically based practices. These approaches are generally used in an attempt to reduce symptoms such as fatigue, pain, spasticity, stress, or paresthesia, or to improve general wellbeing and quality of life.
Evidence varies substantially between approaches. Some may provide limited relief of particular symptoms, whereas others have not demonstrated benefit or carry important risks. None of the approaches discussed in this microchapter has been established as a cure or as a treatment that reliably prevents MS relapses or disability progression.[1][2][3]
The American Academy of Neurology (AAN) guideline on complementary and alternative medicine in MS was published in 2014 and reaffirmed in February 2023. Its evidence levels describe the studies reviewed for that guideline and should be interpreted alongside current European guidance and more recent evidence.[4]
Patients should inform their MS care team about any special diet, supplement, herbal product, cannabis product, or complementary intervention they use. Product composition and quality may vary, adverse effects may occur, and interactions with medicines may be unknown.[1]
Alternative Therapies
Dietary and nutritional approaches
Specific dietary regimens
Dietary regimens used by people with MS commonly alter food selection, meal timing, carbohydrate or fat intake, or the use of nutritional supplements. Examples include intermittent fasting, ketogenic diets, the Swank diet, and the Wahls diet. These diets are generally promoted with the aim of reducing inflammation, improving energy, or influencing the course of MS.
The 2026 Deutsche Gesellschaft für Neurologie (DGN; German Neurological Society) living guideline concluded that studies of these specific dietary regimens were not of sufficient quality to establish a definite beneficial effect on MS.[3]
A balanced diet remains appropriate for general health. The DGN guideline strongly recommends a nutritionally balanced eating pattern consistent with current cardiovascular-prevention guidance. Referral for dietary counseling may be helpful when a person needs support with nutrition, weight management, or cardiovascular risk.[3]
National Institute for Health and Care Excellence (NICE) states that there is no evidence that a specific diet improves MS-related fatigue, although following a healthy diet benefits general health.[2]
Omega fatty acids and fish oil
omega-3 and omega-6 fatty acid supplements, including fish-oil products, have been used with the proposed aim of reducing inflammation and improving neurological function.
NICE recommends not offering omega-3 or omega-6 fatty-acid compounds as treatments for MS because there is no evidence that they affect relapse frequency or disease progression.[2]
The AAN guideline concluded that combining a low-fat diet with fish-oil supplementation is probably ineffective for reducing relapses, disability, or MRI lesions and for improving fatigue or quality of life.[1]
Vitamin D
Vitamin D supplements are used because low vitamin D levels are associated with an increased risk of developing MS and may be associated with disease activity. However, an association does not establish that supplementation treats established MS.
NICE recommends that vitamin D not be offered solely for the purpose of treating MS.[2]
The 2026 DGN living guideline recommends checking vitamin D status and correcting a documented deficiency. Supplementation into the high-normal serum range of 50–125 nmol/L may be considered when the baseline level is normal, but patients should be informed that a beneficial effect on MS has not been proven.[3]
According to the DGN guideline, long-term supplemental intake should not exceed 4,000 IU (100 micrograms) daily. Ultra-high-dose regimens, including regimens resembling the so-called Coimbra protocol, should not be used because of the risks of hypercalcemia, kidney stones, kidney damage, and other toxic effects.[3]
Other supplements and herbal preparations
Antioxidants, multivitamin combinations, probiotics, herbal mixtures, and supplements marketed for nerve repair, energy metabolism, or immune regulation are also used by some people with MS.
Current guidelines do not establish these products as effective treatments for MS. Documented nutritional deficiencies should be corrected, but taking doses above nutritional requirements has not been shown to provide additional MS-specific benefit. Supplements may have variable composition, cause toxicity, or interact with other medicines.[1][3]
Mind-body and movement approaches
Yoga and Pilates
Yoga combines physical postures, stretching, controlled breathing, relaxation, and sometimes meditation. Programs can be adapted for people with impaired mobility, balance problems, or fatigue. Pilates uses controlled movements that emphasize posture, flexibility, breathing, and core strength.
NICE advises that aerobic, resistance, and balance exercises—including yoga and Pilates—may help reduce MS-related fatigue.[2]
Current evidence suggests that yoga may provide short-term improvement in fatigue or mood for some people with MS, but studies have generally been small and at risk of bias. Yoga has not been shown to prevent relapses or alter long-term MS progression.[4]
Mindfulness, meditation, and stress management
Mindfulness and meditation practices generally involve focused attention, breathing exercises, relaxation, and nonjudgmental awareness of thoughts or physical sensations. They are used to improve coping, reduce perceived stress, and support emotional wellbeing.
NICE includes mindfulness and other wellbeing approaches among the options that may be discussed when helping a person self-manage MS-related fatigue.[2]
The DGN living guideline notes that individualized stress-management programs may include meditation-based practices, yoga, autogenic training, and other psychological or body-oriented approaches. Evidence primarily concerns psychological symptoms. Benefit for anxiety is not well established, and it remains uncertain whether stress-management practices influence inflammatory activity or long-term disease progression.[3]
Non-standardized cannabis and marijuana products
Cannabis may be smoked, vaporized, eaten, or taken as oils or extracts. People with MS may use cannabis products in an attempt to reduce spasticity, pain, sleep disturbance, or other symptoms. Non-standardized products can differ substantially in their tetrahydrocannabinol (THC), cannabidiol (CBD), and contaminant content.
The AAN found insufficient evidence to support or refute smoked marijuana for MS-related spasticity, pain, balance or posture, and cognition. Findings from studies of standardized cannabinoid preparations cannot be assumed to apply to smoked cannabis, dispensary products, or extracts with uncertain composition and dose.[1]
Cannabis-related adverse effects may include dizziness, sedation, impaired attention or memory, altered mood, psychiatric symptoms, and impaired ability to drive or operate machinery. The probability and severity of these effects may increase with higher THC exposure.[1][4]
Hyperbaric oxygen therapy
Hyperbaric oxygen therapy involves breathing oxygen inside a pressurized chamber. It has been promoted for MS on the theory that increasing oxygen delivery might improve damaged nervous-system tissue or reduce symptoms.
Controlled studies have not produced consistent evidence that hyperbaric oxygen improves MS. NICE specifically recommends that it not be offered for MS-related fatigue.[2][4]
Hyperbaric oxygen has not been shown to reduce relapses, prevent disability progression, or modify the underlying course of MS.
Herbal, manual, and device-based approaches
The AAN reviewed several additional complementary approaches. The evidence relates to individual symptoms and does not demonstrate an effect on the underlying course of MS.[1]
| Approach | Description and intended use | Guideline evidence |
|---|---|---|
| Ginkgo biloba | An extract derived from leaves of the Ginkgo biloba tree. It is used in an attempt to improve cognition or reduce fatigue. | The AAN found it established as ineffective for improving cognitive function (Level A) but possibly effective for reducing fatigue (Level C). Evidence for fatigue is limited, and product quality, bleeding risk, adverse effects, and medication interactions should be considered. |
| Reflexology | A manual practice involving pressure applied to selected areas of the feet or hands. It is used for relaxation and relief of sensory discomfort. | Reflexology is possibly effective for reducing paresthesia (Level C). Evidence is limited to symptomatic relief and does not demonstrate an effect on relapses or disability. |
| Therapeutic magnetic-field devices | Wearable pads, mats, or other devices that expose the body to static or pulsed magnetic fields. They are promoted mainly for fatigue, pain, or spasticity and are unrelated to diagnostic magnetic resonance imaging. | The AAN classified magnetic therapy as probably effective for reducing fatigue and probably ineffective for reducing depression (Level B). More recent reviews describe the supporting studies as limited and generally of low methodological quality.[4] |
| massage therapy | Manual manipulation of muscles and other soft tissues, generally used for relaxation, discomfort, muscle tension, or wellbeing. | Evidence is insufficient to establish massage as an MS-specific treatment. Limited research suggests possible short-term improvement in quality of life, but effects on relapses or disability have not been demonstrated.[4] |
| Acupuncture | Insertion of fine needles at selected body sites, sometimes with electrical or manual stimulation. It is used for symptoms such as pain, fatigue, or spasticity. | Available evidence is insufficient to support a routine MS-specific recommendation. Safety depends on sterile technique and a properly trained practitioner. |
| Bee-sting or bee-venom therapy | Deliberate exposure to bee stings or bee venom, promoted on the theory that venom may alter inflammation or immune activity. | The AAN found bee-venom therapy possibly ineffective for relapses, disability, fatigue, MRI lesion burden, and health-related quality of life (Level C). It can cause severe anaphylaxis and death. |
Selecting a complementary approach
Before beginning a complementary or alternative approach, the patient and clinician should identify the symptom or goal being targeted and discuss:
- The quality and strength of the supporting evidence
- Whether the expected benefit is symptom relief or general wellbeing
- Possible adverse effects and interactions
- The qualifications and regulation of the practitioner
- Product composition, dose, purity, and cost
- How benefit and harm will be assessed
- When the intervention should be stopped
Continued use should depend on a meaningful patient-centered benefit without unacceptable adverse effects or unnecessary financial burden. Lack of evidence of harm should not be interpreted as proof that an intervention is safe.[1]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Yadav V, Bever C Jr, Bowen J, et al. (March 25, 2014). "Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology". Neurology. 82 (12): 1083–1092. doi:10.1212/WNL.0000000000000250. PMC 3962995. PMID 24663230.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 National Institute for Health and Care Excellence (June 22, 2022). "Multiple sclerosis in adults: management". NICE guideline NG220. National Institute for Health and Care Excellence. Retrieved August 31, 2026.
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Deutsche Gesellschaft für Neurologie (April 27, 2026). "Diagnose und Therapie der Multiplen Sklerose, Neuromyelitis-optica-Spektrum-Erkrankungen und MOG-IgG-assoziierten Erkrankungen: S2k-Living Guideline, Version 9.0". AWMF Registry Number 030-050 (in German). Deutsche Gesellschaft für Neurologie. Retrieved August 31, 2026.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 National Center for Complementary and Integrative Health (March 2025). "Multiple Sclerosis and Complementary Health Approaches". National Institutes of Health. Retrieved August 31, 2026.