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).