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Myasthenia Gravis

Nutritional Support

Many traditional therapies are somewhat successful in managing myasthenia gravis, but often at a price. Side effects of prescription drugs, especially glucocorticoids, can be serious and even life threatening. Complementary nutrients may offer ways to address myasthenia gravis and attack it from several angles while limiting adverse effects. The following nutrients have been shown to suppress the overactive immune response or enhance the action of acetylcholine:

Vitamin K. Vitamin K may have a regulatory effect on myasthenia gravis. This fat-soluble vitamin has been shown to decrease levels of the pro-inflammatory cytokine interleukin-6 (Reddi 1995), which is involved in myasthenia gravis pathogenesis and correlates with acetylcholine receptor antibody production (Mocchegiani 2000).

Dehydroepiandrosterone. Dehydroepiandrosterone (DHEA) is a hormone produced by the adrenal glands that can be converted into estrogen and testosterone. One study sought to detect a possible effect of DHEA in the pathogenesis of experimental myasthenia gravis. DHEA administered to rats resulted in a decrease in antibodies against acetylcholine receptors and an inhibition of the antibody-secreting cells. The authors concluded that these results encourage future study of DHEA treatment in human myasthenia gravis (Duan 2003).

Huperzine A. Huperzine A is an active component of Chinese club moss (Huperzia serrata). Huperzine A is a reversible, highly effective, and highly selective inhibitor of the acetylcholinesterase enzyme (Wang 2006). Several experiments have demonstrated that huperzine A can intensify muscular contractions (Lin 1997). Research on 128 cases of myasthenia gravis indicated that 99 percent of the clinical symptoms were controlled or improved after treatment with huperzine A (Cheng 1986).

Creatine. Many studies have investigated creatine supplementation to enhance muscle power and strength, both in normal participants and patients with various neuromuscular diseases. A case study was performed to determine the effects of creatine supplementation in a myasthenia gravis patient taking glucocorticoids. After creatine supplementation (5 g daily) and training, the patient demonstrated increases in body weight, lean muscle mass, and muscle strength. The authors concluded that resistance exercise plus creatine supplementation may promote gains in strength and lean muscle mass in myasthenia gravis patients (Stout 2001).

Choline and lecithin. Choline is critical to normal membrane structure and function. Lecithin, (phosphatidylcholine) abundant in nerve cell membranes, is required for nerve growth and function. Lecithin is a safer means of dietary choline supplementation than is choline itself. Additionally, it is fully compatible with pharmaceuticals and other nutrients. Bioavailability of lecithin is high; about 90 percent is absorbed over 24 hours. Also, lecithin is an excellent emulsifier that enhances the bioavailability of co-administered nutrients.

Choline is a precursor of acetylcholine biosynthesis. Consumption of supplemental choline has been shown to increase acetylcholine release and enhance cholinergic function (Wurtman 1978). A subsequent trial of oral choline ameliorated symptoms in patients with tardive dyskinesia, a disease associated cholinergic dysfunction. The authors suggested a role for dietary precursors in treating diseases associated with neurotransmitter abnormality (Wurtman 1978). Another study of choline supplementation in five patients with tardive dyskinesia produced similar results. Both choline and lecithin increased blood choline levels and improved abnormal movements in all patients. Lecithin had fewer adverse effects than choline (Gelenberg 1979). Choline and lecithin supplementation may be an effective means of increasing the levels of acetylcholine in myasthenia gravis patients; thus relieving symptoms or preventing myasthenic episodes.

Considering all the options. Besides the supplements mentioned above, there are many nutrients with a profound impact on muscle function or that can moderate the production of inflammatory cytokines, which have been implicated in myasthenia gravis. Although these supplements have not yet been studied in the context of myasthenia gravis, there may nevertheless be justification to experiment with them and see if beneficial results are obtained, provided there is no contraindication. As always, a supplement regimen should be monitored by a qualified physician familiar with your particular condition. Supplements that might help with muscle function or reduce inflammation include branch chain amino acids, coenzyme Q10, fish oil, NADH, vitamin E, and minerals such as calcium and potassium. The B vitamin complex is also highly involved in cellular function as well as acetylcholine production and may help boost acetylcholine levels.

Many people report that dietary modification helped their myasthenia gravis. While these claims are not supported in peer-reviewed studies, some patients with myasthenia gravis advocate a raw food or gluten-free diet. As long as adequate nutrition is maintained (a multivitamin is probably a good idea), these diets can be attempted under the supervision of a qualified physician.