Methylcobalamin is a form of vitamin B12 necessary for nervous system maintenance (Tanaka 2013). In a study on 60 subjects with Bell’s palsy of greater than 2-weeks duration, researchers divided subjects into 3 treatment groups of 20 subjects each: 500 mcg intramuscular injections of methylcobalamin 3 times weekly for 8 weeks; 60 mg daily of prednisolone tapered over 3 weeks; and methylcobalamin plus prednisolone. After one week of treatment, the methylcobalamin only and the methylcobalamin plus prednisolone groups had improved significantly, but participants receiving only the steroid showed just slight improvement. It took, on average, about 2 weeks for participants in the methylcobalamin and the methylcobalamin plus prednisolone groups to achieve complete recovery, whereas an average of 9 weeks passed before those in the steroid-only group were fully recovered. The scientists who conducted the study noted “In this study, the efficacy of methylcobalamin in patients with Bell’s palsy was confirmed. Methylcobalamin-treated patients recovered much faster than those treated with steroid alone. Recovery was seen as early as the first week of treatment” (Jalaludin 1995). Because methylcobalamin is generally considered safe and is relatively inexpensive, it represents an intriguing natural option for treating Bell’s palsy (Sickels 2008).
Acetyl-L-carnitine is a compound found throughout both the central and peripheral nervous systems and plays a role in a number of processes, including the processing of fatty acids. Therapeutically, it can help damaged neurons regenerate and reduce neuronal damage after injury (Flatters 2006). Studies have found that acetyl-L-carnitine is effective for treating various forms of neuropathy, including diabetic and drug-induced neuropathies (Flatters 2006; Sima 2005). A randomized, placebo-controlled study on 43 subjects with idiopathic facial palsy found that one month of daily administration of 3 g of oral acetyl-L-carnitine along with daily administration of 50 mg of methylprednisolone for 14 days sped functional recovery of the facial nerve compared to methylprednisolone plus placebo. After 10 days of treatment a measure of paralysis was reduced by half in the supplement group, whereas in the placebo group it remained the same during this period (Mezzina 1992).
Given the relatively benign nature of Bell’s palsy, and its typically limited disease course and good recovery prognosis in most cases, few human clinical trials have examined integrative treatment options. Nevertheless, owing to the inflammation and nerve involvement intrinsic to the pathogenesis of Bell’s palsy, several natural agents that promote neuronal health and quell inflammation may confer benefits. The following integrative therapies may be able to target some of the pathologic mechanisms underlying Bell’s palsy.
Omega-3 fatty acids. Omega-3 fatty acids are metabolized in the body into compounds that reduce inflammation (Calder 2006; Calder 2008; Simopoulos 2002). One omega-3 fatty acid, called docosahexaenoic acid (DHA), is able to inhibit signaling of a pro-inflammatory molecule called NF-ĸB and also reduces levels of other chemicals that trigger inflammation, such as tumor necrosis factor-alpha (TNF-α) and interleukin-6 (Lu 2010; Singer 2008). Eicosapentaenoic acid (EPA), another omega-3 fatty acid, has similar effects (Lu 2010). These fatty acids can also lead to the creation of different chemicals that can protect nerves from damage (Bazan 2007). As a result, a diet high in omega-3 fatty acids and low in omega-6 fatty acids may be able to help reduce inflammation (Calder 2006; Calder 2008; Simopoulos 2002), although this has not been specifically tested for Bell’s palsy. Fish oil is a good source of omega-3 fatty acids (Simopoulos 2002).
Curcumin. Curcumin is a yellow compound found in turmeric that has potent anti-inflammatory properties. It has been shown to help protect against nerve damage caused by diabetes and alcohol (Kandhare 2012; Kulkarni 2010), possibly by protecting neurons from damage caused by inflammation (Kulkarni 2010). Specifically, curcumin is able to reduce inflammation by increasing the activity of proteins that inhibit the activity of NF-ĸB, a major trigger for inflammation. Consequently, it is able to suppress the levels of many molecules that play a role in inflammation, including TNF-α, prostaglandins, and COX-2. By reducing inflammation, curcumin has been shown to protect neurons in the brain from damage from inadequate blood flow in a rat model of stroke (Liu 2013). Curcumin is also able to protect neuronal cells in culture from inflammation and toxicity produced by beta-amyloid protein, which is implicated in Alzheimer’s disease. Beneficial effects of curcumin were also observed in animal models of Alzheimer’s disease (Potter 2013). In addition, curcumin may activate genes that protect neurons from oxidative damage (Scapagnini 2006) and has been found to protect cultured neurons from oxidative damage (Huang 2011). Although the benefits of curcumin have not been tested specifically for Bell’s palsy, its benefits in other neurological conditions suggest that it could be helpful in treating the disease.
The Chronic Inflammation protocol provides a review of several additional interventions that may help reduce inflammation.
Niacin. Niacin (vitamin B3) is a vitamin that can cause blood vessels to dilate, which is why it causes flushing in many people. This increased blood flow may help speed the healing of the facial nerve. Some evidence suggests that niacin, administered orally or via intramuscular injection, may be useful in treating Bell’s palsy, although data are limited. In a series of 74 cases treated with 100-250 mg of niacin, all but one case resulted in good facial nerve response within 2 to 4 weeks (eg, an observer would be unable to point out which side of the face was paralyzed). In 39 of the 74 cases, treatment began within 2 days of the onset of paralysis and these individuals had complete recovery within 14 days (Kime 1958).
Integrative Interventions with Antiviral Properties
Given the suspected role of herpes virus reactivation in some cases of Bell’s palsy (Kennedy 2010), natural agents shown to combat viral infection may be of some benefit for those affected by Bell’s palsy, although clinical trials have yet to evaluate this hypothesis.
Licorice is a member of the Glycyrrhiza species, which has been used traditionally to combat viral infections. It contains a compound called glycyrrhizin that has been shown in several studies to exert antiviral activity against a number of viruses, including herpes virus (Fiore 2008; Pompei 1979). In fact, the broad antiviral activity of licorice has given rise to interest in its clinical application as a broad-spectrum antiviral (Pu 2013). Animal studies show that licorice compounds mitigate the impact of HSV-1 infection and reduce HSV-1 viral replication (Sekizawa 2001).
Zinc may be able to combat Bell’s palsy on a number of fronts. Zinc inhibits the replication of the herpes virus and has been used in multiple trials to reduce the duration of herpes outbreaks (Gaby 2006). Zinc is also important for nerve function, as zinc deficiency can impair the ability of nerves to transmit signals (O’Dell 1990; NINDS 2012).
Lysine is an amino acid sometimes used to treat recurrent herpes simplex infections (Flodin 1997). It has not been formally evaluated in the context of Bell’s palsy, but studies have found it to be useful in combatting herpes virus-related illnesses. A double-blind, placebo-controlled study that included participants with oral-facial or genital herpes found that consumption of one gram of L-lysine three times daily for 6 months reduced the frequency, duration, and severity of herpes outbreaks (Griffith 1987). Other studies have also found that lysine supplementation can reduce the frequency of cold sores that occur during HSV-1 infection (Ozden 2011). Overall, lysine appears to be able to reduce the intensity and frequency of HSV flare-ups when used regularly (EBSCO CAM Review Board 2011).
The reishi mushroom, also known as Ganoderma lucidum, is a fungus that has been used medicinally for centuries in China, Japan, and Korea. Some of the components of reishi appear to have antiviral properties (Paterson 2006). Researchers have identified two different compounds in the reishi mushroom, known as GLPG (Ganoderma lucidum proteoglycan) and APBP (acidic protein bound polysaccharide), which showed strong antiviral activities against both HSV-1 and HSV-2 in vitro (Liu 2004; Li 2005; Kim 2000).
Preparations of the reishi mushroom have also shown promising results in human trials. Reishi was very effective in reducing pain caused by herpes and shingles infections that did not respond to standard treatment. Also, an herbal mixture containing reishi reduced shingles pain. In addition, another reishi-containing herbal mixture shortened the duration of symptoms in patients with oral and genital herpes infections (Hijikata 1998; Hijikata 2005; Hijikata 2007).
Much of reishi’s benefit may be due to its ability to combat immunosenescence – the normal decline of the immune system that accompanies aging. Reishi mushrooms attack and reverse immunosenescence through the combined effects of three compounds: first, a group of long-chain carbohydrates called polysaccharides; second, a unique protein named LZ-8; and third, a small group of steroid-like molecules called triterpenes (Bao 2001; Xu 2011; Yeh 2010).
Together, these three reishi components achieve the dual goals of promoting healthy immune responses against viral, bacterial, or fungal infections, while suppressing excessive or chronic inflammation that threatens long-term health.
Among its broad-spectrum immune-boosting effects are the following:
On the other side of the immunosenescence coin, reishi's various components work to suppress inflammatory cytokines produced during chronic inflammation, as seen for example in rheumatoid arthritis, while maintaining normal acute inflammatory responses (Ji 2011; Kohda 1985; Ho 2007; Ko 2008; Xi Bao 2006). Under conditions of chronic inflammation, reishi reduces inflammatory promoters (Dudhgaonkar 2009).
Lemon balm (Melissa officinalis) is a form of mint used traditionally to treat numerous ailments, including herpes outbreaks (Yarnell 2009). Several laboratory experiments have shown lemon balm extracts possess a variety of antiviral activities against both HSV-1 and HSV-2 (Mazzanti 2008; Astani 2012; Schnitzler 2008; Geuenich 2008; Nolkemper 2006; Allahverdiyev 2004; Dimitrova 1993). Clinical trials have evaluated the efficacy of topical lemon balm preparations and shown positive results. In one trial, a lemon balm ointment improved symptoms of oral herpes compared to placebo when applied 4 times daily for 5 days; the lemon balm treatment also prevented the spread of the outbreak, and the authors suggested that lemon balm may increase the time between outbreaks (Koytchev 1999). Two additional trials involving 115 and 116 patients also found that local therapy with lemon balm extract effectively eases oral herpes symptoms (Wolbling 1994).
Propolis is a resin-like substance obtained from beehives and has a long history of medicinal use (Natural Medicines Comprehensive Database 2012). It contains a mixture of several compounds, including flavonoids and polyphenols, many of which have anti-HSV-1 activity (Schnitzler 2010). The variety of effects that it has on the immune system, together with its anti-inflammatory properties, may allow it to help the body more effectively fight infections (Storcin 2007).
In one study, a constituent of propolis was found to significantly inhibit the synthesis of HSV in cell cultures (Amoros 1994). Another study showed that a propolis extract has potent antiviral activity against HSV-2 in cell cultures (Nolkemper 2010). Notably, an ointment containing flavonoids from propolis was more effective in aiding the healing of genital herpes lesions and reducing local symptoms than the antiviral medication acyclovir (Vynograd 2000). Propolis, as a 3% ointment, was also shown to reduce the duration of cold sores caused by oral herpes and decreased pain associated with the lesions (Ehrlic 2011).
A number of other integrative interventions shown to possess antiviral properties are presented in the Herpes and Shingles protocol.