Vitamin D plays an important regulatory role in the immune system. Our bodies produce vitamin D in the skin through exposure to sunlight, and some foods are fortified with vitamin D (MedlinePlus 2014; Hewison 2012; O'Donnell 2008). However, it is difficult to obtain optimal blood vitamin D levels through these sources alone because people tend to spend less time outdoors than in the past (MedlinePlus 2014). A pilot study in 2012 showed that supplementation with vitamin D has beneficial effects on autoimmune response and may alleviate fatigue associated with myasthenia gravis. The researchers demonstrated that 16 patients with myasthenia gravis had 26% lower baseline serum levels of vitamin D than 50 healthy patients (20 ng/mL vs. 27 ng/mL). Thirteen myasthenia gravis patients treated with vitamin D (800 IU/day) had 22% higher serum vitamin D levels and a 38% improvement in muscle fatigue. Researchers suggest that serum vitamin D levels should be monitored in patients with myasthenia gravis and supplementation should be considered if levels are found to be inadequate (Askmark 2012).
Extracts of astragalus have been used for centuries as an herbal remedy for cardiovascular disorders, hepatitis, kidney disease, and skin problems. Astragalus is composed of saponins, polysaccharides, and flavonoids. The most prevalent saponin with medicinal activity identified in astragalus is astragaloside IV. Numerous experimental studies have demonstrated that astragaloside IV improves cardiac function, promotes blood vessel growth, inhibits fibrosis in different organs, and regulates immune function (Ren 2013). In a 2009 study comparing the effects of astragalus and the steroid prednisone on immune response in 60 myasthenia gravis patients, astragalus was as effective as prednisone for reducing symptoms of myasthenia gravis. Also, astragalus was more effective than prednisone for reducing ratios of CD4+/CD8+ T cells (Niu 2009).
Creatine is an organic acid produced by the body that is also present in food — primarily meat. Creatine supplementation helps increase lean body mass, muscle strength, and energy; it also improves active performance in healthy individuals and patients with neuromuscular diseases such as muscular dystrophy (Kley 2013; Stout 2001). An analysis of 6 randomized, controlled trials in muscle diseases reported that patients who supplemented with creatine had a significant improvement in muscle strength versus placebo-treated patients, with a mean difference of 8.5%. Patients from 4 trials receiving creatine also reported an overall improvement in well-being (Kley 2013). Creatine supplementation has also been reported to help patients with myasthenia gravis. A 26-year old man with myasthenia gravis who self-administered 5 g of creatine daily for 15 weeks combined with resistance exercise training, along with prednisone and azathioprine, had significant improvements in muscle strength, body weight, and fat free mass (Stout 2001).
Other Natural Agents with Potential Benefit in Myasthenia Gravis
Several natural interventions have been studied in the context of diseases that may share some underlying pathological features with myasthenia gravis such as inflammation, autoimmunity, and perturbed acetylcholine signaling. However, these agents have not been investigated in clinical trials involving myasthenia gravis patients as of the time of this writing. More research is required to elucidate the potential benefits of these agents for those with myasthenia gravis.