According to the U.S. Food and Drug Administration (FDA), the number of supplements has increased nearly 20 times since 1994, and business is booming. According to market reports, the US supplement industry is expected to exceed $68 billion in 2023. This growth is even more remarkable considering that the FDA does not have the authority to regulate or approve these products for safety or effectiveness under the Dietary Supplement Health and Education Act.
Everyone seems to be taking vitamins and supplements, including people with neurological disorders.we asked brain and life Please let our editorial board members know whether your patients use these products and, if so, why.
“Some of my patients believe that supplements are ‘natural,'” says Barbara Gieser, MD, FAAN, a neurologist at the Pacific Neuroscience Institute in Santa Monica, California. ) says. “They told me they think supplements are safer than drugs, even though they haven’t been tested for safety and effectiveness like pharmaceuticals.”
There’s a green ring around the supplement, agrees Joli Fleischer, MD, FAAN, associate professor of neuroscience at Rush University in Chicago. “Many of my patients believe that supplements are ‘green’ or ‘natural’ and therefore will not harm them.” It points out that it is derived from natural sources and is recognized to have therapeutic benefits. Unlike supplements, medicines are tested, proven and regulated so people can take the right amount, she added. “And we can advise patients about what to expect and about side effects. You can’t do that with supplements, because manufacturers don’t know what they claim is in the bottle. There’s no need to prove what’s actually in the bottle or that the claims are true.”
Teshamei Monteith, MD, FAAN, associate professor of neurology at the University of Miami Miller School of Medicine, says migraine patients often seek alternatives to medications. “They’re worried about adverse events, they don’t want strong drugs, they don’t want to feel like they’re ‘addicted to drugs.'”
Neurologists are concerned that few supplements have been tested with the same rigor expected of pharmaceuticals. That is, a large, multicenter, randomized, placebo-controlled trial that proves that a particular vitamin or supplement has a particular effect.
The latest research on the effects of vitamin D on multiple sclerosis (MS) lancet MS specialist Dr. Giesser said vitamin D as an add-on therapy has not been shown to reduce relapses in 2023. “No data exist for supplements with disease-modifying effects on MS,” she added. Dr. Giesser recommends that patients get as much vitamins and minerals from food as possible and only consider supplements if they are clearly deficient.
Dr. Fleischer, who specializes in Parkinson’s disease and other movement disorders, advises his patients to rely on food for vitamins and minerals. He also stays up to date on the latest research, especially regarding B vitamins and Parkinson’s disease. Three of his studies over the past three years have found an association between vitamin B12 supplementation and modest improvement in symptoms in patients with untreated early Parkinson’s disease. Dr. Fleischer says the evidence isn’t convincing enough. And, she notes, high doses of B6 can cause neuropathy (weakness, numbness, and pain in the hands and feet).
For migraine patients who may benefit from taking vitamins and supplements as adjunctive therapy, Dr. Monteith is guided by research that proves their effectiveness and safety. She also takes cost into account. “There is evidence that magnesium and riboflavin tend to be the most affordable for migraine prevention,” she says. Other supplements for migraine prevention include melatonin, CoQ10, ginger, and lavender. Another option is butterbur. There’s a good level of evidence for this, says Dr. Monteith. “It’s important to choose a brand that takes extra safety precautions to remove pyrrolizidine alkaloids, which can harm the liver.” Are you suffering from debilitating or disabling migraine attacks? For people, Dr. Monteith does not recommend vitamins or supplements. Instead, she frequently recommends calcitonin gene-related peptide (CGRP) inhibitors, medications that target migraine mechanisms. “CGRP inhibitors are often better tolerated than other oral medications,” she says.
These neurologists say people will continue to take vitamins and supplements no matter what their doctors tell them. With that in mind, they ask patients to tell their doctors everything they’re taking, as some supplements can interfere with the action of medications. For example, St. John’s wort can interact negatively with antidepressants, says Dr. Giesser. They also suggest that patients allocate their resources to more valuable products and pursuits. “Spend that money on better tennis shoes, physical therapy, and exercise,” Dr. Fleischer says.
