Vitamin D has long been recognized to reduce risk of MS and probably to modify the course. New studies point to the importance of melatonin as well. It seems to modulate the effects of vitamin D. It would fit the recognized latitude effects of sunshine on MS susceptibility, often attributed to vitamin D, but melatonin levels also vary by latitude. It has antioxidant, anti-inflammatory, and immune regulation effects. It also helps mitochondrial function. Melatonin production is dependent on the availability of serotonin, and decreased melatonin is seen in MS, bipolar disorder, depression, and some forms of cancer. Some disease-modifying drugs used in MS increase melatonin levels, which fall when the treatments are stopped. The best dose for MS patients is not known. Studies are ongoing. Three milligrams at bedtime is commonly used to help sleep. New research shows that folate supplementation is also important. One milligram should be used. This is available by prescription only. Increased homocysteine levels occur in MS. They also increase the risk of cardiovascular disorders, often seen in MS patients, and high-dose folic acid may negate these unwanted effects.

Jack Florin, MD

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