Supplement Dos and Don’ts for Multiple Sclerosis

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On July 18, 2025

Do Consider Vitamin D, Which May Help Manage Fatigue

There is some evidence that maintaining the recommended level of vitamin D may lower the risk of MS, especially in women.

Other studies also suggest that people with MS could benefit from taking vitamin D, particularly if they’re deficient.

“Vitamin D supplementation has emerged as a promising and widely recommended option for managing fatigue in MS patients. Recent studies indicate that correcting vitamin D deficiency can lead to small yet significant improvements in fatigue levels,” says Achillefs Ntranos, MD, a neurologist specializing in MS and the founder of Achilles Neurology Clinic in Los Angeles.

“Beyond fatigue, vitamin D offers broader benefits in MS, potentially reducing inflammation and enhancing overall disease management,” Dr. Ntranos says.

“Given its safety, affordability, and multiple health advantages, maintaining optimal vitamin D levels is a practical and beneficial approach for anyone dealing with MS-related fatigue.”

In the past, providers often recommended supplements for people whose blood levels weren’t at the high end of the normal range, says Vijayshree Yadav, MD, a professor of neurology and the director of the Multiple Sclerosis Center at Oregon Health and Science University in Portland.

“That has changed,” Dr. Yadav says. “Although there is still evidence that vitamin D is important, high levels may not be as important as we once thought. We are no longer recommending that people with MS should be in the higher range of normal. We are recommending that they be in the mid to lower range of normal, and that is a big difference.”

The recommended daily allowance (RDA) for vitamin D is 600 international units (IU) for people ages 1 to 70 and 800 IU for people over 70.

But Yadav warns that too much of it can be a problem, and may lead to vitamin D toxicity as well as kidney damage. Toxicity is most likely to occur at doses of 10,000 IU daily or higher.

It’s best to take any vitamin D supplement under the supervision of a medical professional who can monitor your blood levels, Yadav says.

Do Ask Your Doctor About Coenzyme Q10, Which May Reduce Inflammation

Coenzyme Q10 is an antioxidant that is naturally produced in the body, where your cells use it to grow and make energy.

A review of six studies found taking 500 milligrams (mg) per day of CoQ10 for two to three months may reduce oxidative stress and inflammation, both of which are associated with demyelination. Demyelination is the process that damages the myelin sheath, or the protective cover surrounding nerve fibers, and leads to symptoms in MS. The review also found that CoQ10 may alleviate depression and fatigue.

In another study using mice, researchers also found that CoQ10 helped with oxidative stress and inflammation.

They concluded that the supplement had potential to enhance remyelination (the natural repair mechanism of demyelination) in people with MS, but that further study in humans is needed.

“In my practice, I do sometimes recommend CoQ10 for patients struggling with fatigue. It’s not a guaranteed fix for everyone, but given its safety profile and the positive research, it’s a reasonable supplemental therapy to try for symptom management,” Ntranos says. “As always, I advise discussing it with a doctor first, but overall CoQ10 may be a helpful addition for energy and mood in MS.”

Do Consider Omega-3s to Possibly Manage Disease Progression

Omega-3s are a type of healthy fat found in foods such as fatty fish, flaxseeds, and soybeans.

They’re well-known for their cardiovascular benefits, but some research suggests they may also help people with MS.

“In a [systematic review] of multiple studies, researchers looked at how omega-3s affected markers of inflammation, relapse rates, and disease progression in people with MS,” says Terry Wahls, MD, an internist and a clinical professor of medicine at University of Iowa Health Care in Iowa City, whose research focuses on diet and lifestyle’s effect on MS and other chronic illnesses.

“They saw that taking an omega-3 supplement, in the form of fish oil, was beneficial for all three of these measures,” Dr. Wahls continues.

Most studies involve using one to 4 grams (g) of omega-3s daily, Wahls says. In her clinical practice, she generally suggests 1 to 2 g a day, which can be obtained through a supplement or food.

Docosahexaenoic acid (DHA) — one of three main types of omega-3s along with eicosapentaenoic acid (EHA) and alpha-linolenic acid (ALA) — is especially important for supporting brain development.

Seafood, including wild-caught salmon, halibut, and herring, are good sources of DHA, Wahls says.

The body can convert some ALA — found in plant foods, such as flaxseeds — into DHA, but only in very small amounts.

So, if you’re vegan or vegetarian, Wahls says a supplement may be useful, though be sure to speak with your doctor before starting any supplement.

Do Talk to Your Doctor About Alpha-Lipoic Acid Supplements, Which May Help Protect the Brain

Alpha-lipoic acid is an antioxidant that is both made by the body and naturally present in some foods, particularly organ meats.

Alpha-lipoic acid supplements are available in both oral and IV forms, and they may be of interest to people with MS.

“There is increasing evidence to support the use of alpha-lipoic acid for MS,” says Mill Etienne, MPH, MD, the vice chancellor and an associate professor of neurology and medicine at New York Medical College in New York City. “Alpha-lipoic acid can reduce inflammation and protect the brain and spinal cord, the two areas that are impacted by MS.”

Dr. Etienne explains that alpha-lipoic acid appears to neutralize free radicals, preventing them from damaging cells in the neurological system.

A recent systematic review and meta-analysis of five studies involving 179 patients found taking 1,200 mg of alpha-lipoic acid daily notably reduced MS symptoms, though researchers noted more long-term clinical trials are needed.

Before taking alpha-lipoic acid, it’s important to talk with your provider about the potential risks involved, as well as the possibility of drug interactions, Etienne says. People taking synthetic thyroid hormones, for instance, may need to avoid this supplement as it could decrease the hormone’s efficacy.

Do Consider Adding More Probiotics to Your Diet to Potentially Ease MS Symptoms

Probiotics feed the beneficial bacteria in your gut microbiome — the collection of trillions of microorganisms that influence your digestive, immune system, nervous system, and endocrine system.

A small, placebo-controlled clinical trial of 40 MS patients suggests these nutrients may improve MS symptoms, including fatigue and pain, as well as quality of life.

Prior research suggests people with MS tend to have disbalanced microbiomes, with more inflammation-promoting bacteria that may exacerbate autoimmunity, says Mary Ann Picone, MD, a neurologist and the medical director at Holy Name Medical Center in Teaneck, New Jersey.

Probiotics may help restore balance and decrease inflammation and oxidative stress, Dr. Picone explains, though more robust research is needed.

Foods — including kimchi, kombucha, yogurt, and kefir — are the best sources of probiotics, Picone says.

“Unfortunately, it is often the case that although we know what we should be eating, we don’t always eat the right foods, so supplementing with a probiotic [may] help,” she adds, but as always, speak with your doctor first.