Biotin is considered a form of vitamin B, and is a component of enzymes in the body that help break down certain substances. It also activates certain enzymes that help the body produce myelin – the substance wrapped around many nerves in the central nervous system. Biotin, also known as vitamin H, is usually obtained from food.
Because of the role in myelin production, high-dose Biotin (MD1003) was thought to be a promising treatment for progressive MS and early clinical trials had positive results. However, the largest clinical trial of MD1003
involving people with primary and secondary progressive MS who did not have recent relapses failed to reverse disability or improve walking speed in those who took MD1003 versus placebo. The study authors reported treatment with MD1003 led to inaccurate laboratory tests for other health conditions and that commercially available high-dose biotin should not be used to treat progressive MS.
: In November 2017, the US Food and Drug Administration (FDA) issued a Safety Communication
to let the public and healthcare providers know that biotin can significantly interfere with certain lab tests, causing falsely high or falsely low test results that may go undetected. They issued a second Safety Communication
in November 2019 to remind the public and healthcare providers about biotin interference with lab tests. Work with your healthcare provider and laboratory to help prevent adverse events. If you suspect or experience a problem with a laboratory test while taking biotin, the FDA encourages you to report the problem through the MedWatch Voluntary Reporting Form
Fat is an essential nutrient for the body. While some fats are deemed “bad,” others, such as polyunsaturated fats, actually help lower cholesterol and the risk of heart disease. These polyunsaturated fats — and the omega-3 fatty acids they contain — have been the focus of MS studies with some evidence pointing to benefits for relapsing-remitting MS.
Two placebo-controlled clinical trials studied supplementation with omega-3 fatty acids. A large, two-year study followed 312 people with MS. The group taking daily 10 grams of fish oil (which contains omega-3 fatty acids) had less disability progression and fewer relapses than those taking the “dummy pill.” The difference was not “statistically significant,” but there was a trend favoring the fish oil group.
Getting a dose
- Omega-3 fatty acids are found in certain fatty fish, such as salmon, mackerel, herring and sardines, and in fish oil products.
- Smaller amounts are found in a few other sources, such as canola oil, flaxseed, and walnuts.
- Fish oil supplements, in pill or liquid form, are the richest sources of omega-3 fatty acids. A daily intake of up to 3 grams is usually considered safe.
- The safety and effectiveness of omega-3 supplementation in combination with Copaxone®, Avonex®, Betaseron®, or Rebif® have received only limited study. It is possible, though unlikely based on current evidence, that omega-3 fatty acid supplements could decrease their effectiveness. Omega-3 fatty acids have not been studied with Novantrone® or Tysabri®.
- Drug interactions may occur with anticoagulant medications such as warfarin (Coumadin®), enoxaparin (Lovenox®), heparin, aspirin, and other drugs with aspirin-like effects such as clopidine (Ticlid®) and clopidogrel (Plavix®).
- Omega-3 fatty acids may also decrease the effectiveness of insulin, oral diabetes medicine, and high blood pressure medications.
To take or not to take?
Reasonable doses of fish oil supplements are generally safe as long as there are no medical issues restricting its use (see cautions above). While there is a scientific rationale for taking omega-3 fatty acids and some hints of effectiveness, omega-3 fatty acids should never be used instead of the conventional MS medications or treatments. If one is considering taking omega-3 fatty acids, this decision should be discussed with a health professional.