Julie Rowin MD
Alternative and Complementary Medicine for Autoimmune Myasthenia Gravis
What is alternative and complementary medicine versus integrative medicine?
Alternative medicine- any of a number of medical modalities that are used for healing that are not typically accepted by the mainstream medical profession as a primary treatment. These include but are not limited to herbalism, Ayurveda, acupuncture and traditional Chinese medicine.
Complementary medicine- any alternative medicine that is used in concert with mainstream medical treatment, typically to improve the outcome or reduce side-effects. Frequently, nutrition and lifestyle changes are used as complementary medicine.
Integrative Medicine- Medicine where the practicioner practices both mainstream medicine and alternative medicine.
Most people with myasthenia gravis require conventional medical management to control the disease. This means that medications like pyridostigmine, prednisone, immunosuppressive agents or infusions are the mainstay of treatment. However, complementary medicine approaches including the utilization of nutrition, stress management, lifestyle changes and exercise play a vital role in the recovery process and are integral to getting your life back, as well as avoiding many of the medication related side-effects.
Poor food choices, environmental toxins, chronic infections and stress may all contribute to perpetuating your autoimmune disease. Therefore, adapting appropriate lifestyle and dietary changes are important ways to take charge of your health. Here are some examples:
Improve your nutrition
Your diet has an important impact on your immune health. The standard American diet (SAD) which is high in processed foods and sugar promotes inflammation and impairs immune function. Remember food is information for your cells.
Avoid processed foods, instead eat whole foods and read ingredient labels in order to remove preservatives, additives, added sugar and artificial sweeteners from the diet.
Consider working with a professional on an elimination diet. This is a whole food, predominantly plant-based, organic diet void of common food sensitivities. The elimination diet removes wheat, dairy, sugar and genetically modified foods from the diet. Read more about the elimination diet here. This isn't a forever diet. It is a plan to help you assess your food sensitivities, reduce body inflammation and improve the health of your gut and immune system.
If you have swallowing or chewing difficulties work with a speech pathologist and nutritionist to make sure that you are getting the proper nutrition.
Address your nutrient gaps
Medications like prednisone can lead to poor absorption of Vitamin D, calcium and other nutrients. Acid reducing medications can lead to poor absorption of vitamin B12. It is common for Americans to have nutrient deficiencies in these and other vitamins that are vital to proper immune function, such as omega-3s. Here are ways to address your nutrient gaps:
Increase your vitamin D level:
Get out into the sun for 15-20 min of sun exposure daily
Eat eggs from pasture-raised chickens
Eat mushrooms exposed to sunshine to increase vitamin D content.
Improve your omega-3 level:
Eat wild-caught fatty-fish (salmon, herring, mackerel, sardines) at least 3-5 times per week to increase your omega-3s and learn about eating fish safely.
Increase your phytonutrient intake (anti-oxidants):
Eat the rainbow’ which includes 8-12 servings of colorful fruits and vegetables every day. See eat the rainbow recipes and smoothie recipes. Choose organic produce whenever possible.
See how to optimize your immune health naturally.
Support your body’s detoxification and elimination pathways
We are what we eat, drink, breathe, touch and can’t eliminate. If you aren’t eliminating toxins properly, they may accumulate in the body and impair immune function. Here are some lifestyle choices to help you minimize your toxic body burden:
Drink filtered water (half your body weight in ounces/day)
Sweat daily through exercise or sauna, if possible
Avoid artificial fragrances in household and personal care products (see homemade household cleaner). Don’t burn scented candles.
Eat organic produce whenever possible, or at least avoid the dirty dozen. See the Clean 15/Dirty Dozen list from the environmental working group.
Avoid microwaving or heating food in plastic.
Eat more fiber rich foods such as flax seed, chia seed, psyllium husk and stay regular with 1-3 bowel movements per day
Eat sulfur containing foods like brassica vegetables (including broccoli, cauliflower, Brussel sprouts), eggs and leafy greens daily.
Get outside and breathe fresh air! Inside air is often not the best quality. Keep your living area well ventilated and consider a good quality HEPA filter for your bedroom. Read: How is Your Indoor Air Quality?
Understand the gut and immune health connection
Add a variety of prebiotic and probiotic foods to your diet daily in order to colonize your gut with beneficial bacteria. The beneficial bacteria help to digest food, synthesize vitamins, decrease inflammation in the body, protect gut health and act as a barrier to help our bodies filter and appropriately absorb nutrients from what we eat. There is direct communication between your gut bacteria and your immune system, so you want to have healthy beneficial bacteria colonizing your gut. Read: Should I take a probiotic?.
Talk to your practitioner about vitamins and herbs for nutritional support and immune balance
No supplement or vitamin can replace a nutritious diet, stress reduction and exercise. However, chronic illness and use of medications can deplete the body of what it needs to heal and supplementation can be important to replace depleted nutrients and fill nutrient gaps.
Vitamin D- Vitamin D is crucial to immune health and in my experience, most adults who do not supplement have sub-optimal levels of vitamin D. Supplement with 800-2,000IU daily of Vitamin D3 and have your vitamin D level checked to ensure that it is in the optimal range.
Omega-3 Fish oil- If you are not eating fatty fish at least 3-5 times per week, take a clean fish oil or vegan algae omega supplement. Nordic Naturals or Carlson Labs are good brands. If you are on a blood thinning medication, talk to your doctor first.
Multi-vitamin containing activated B vitamins- If you are on medications that can contribute to nutrient depletion or reduced absorption of vitamins such as prednisone or an acid reducing medication, consider taking a daily multivitamin containing the 'activated' forms of the B-vitamins so that they are more readily available to be utilized by the body.
Selenium is an essential trace element which is often found to be low in patients with autoimmune disease and may contribute to the inflammation. A sufficient level of selenium is important to the management of autoimmune conditions.(1) To ensure adequate selenium levels eat one Brazil nut daily or take a selenium supplement or a multi-vitamin containing selenium and have your level checked if you have myasthenia gravis or another autoimmune disease. This is of particular importance in autoimmune thyroid disease. Caution: It is possible to take too much selenium which can be toxic, so stick within the recommended daily allowance of around 55 mcg. daily.
Vegan protein powder- Chronic illness and being sedentary contribute to muscle loss. Many adults consume too little protein to build muscle. The protein in powdered supplements, when added to the diet, give the added protein you need to maintain and build muscle (along with a progressive exercise regimen). Read the labels and avoid protein powders with fillers and high sodium levels. Although there many benefits to consuming whey protein, there is some evidence for it contributing to autoimmune disease, so it probably best to stick with a vegan protein powder like rice or hemp protein in a brand such as Nutribiotic.
Curcumin is an extract of turmeric root, and is a potent anti-inflammatory agent with many immune health promoting benefits. (see: Turmeric Spiced Herbal Tea Recipe). It has been shown to be beneficial in experimental mouse models of MG.(2) It is well-tolerated, but may have anti-platelet effects, so talk to your doctor before starting this supplement especially if you are on a blood thinning medication.
Ashwagandha has many potential beneficial health effects. It has anti-inflammatory and anti-stress properties among others. There are no human studies of Ashwagandha and myasthenia gravis, but animal studies support its use to counteract the side-effects of immunosuppressant drugs and prednisone.(3) It is effective at lowering blood glucose and cortisol levels and improves anxiety with long-term use. *
What you need to know about magnesium Intravenous (IV) magnesium is contraindicated in active myasthenia because it can lead to a myasthenia gravis exacerbation. Some individuals with myasthenia find that even small dosages of oral or topical magnesium make them feel weaker or give them diarrhea, a common side-effect of magnesium supplementation. However, chronic use of corticosteroids like prednisone, can increase the body's loss of magnesium leading to poor sleep, anxiety, constipation and bone loss. And, magnesium is important for nerve and muscle function and energy production. Therefore, eat magnesium rich foods daily including greens, nuts and seeds. Some individuals with controlled myasthenia can tolerate taking oral (300-400mg per day) or topical magnesium to help with these symptoms. Talk to your neurologist before taking any supplements with magnesium.
There is a clear association between chronic stress and autoimmune disease. There are many ways to reduce the effects of stress on the body. Start with a daily mindfulness practice of your choosing. This can be breathing exercises, prayer, chanting, meditation, journaling, yoga, tai chi or getting out into nature. There are many options. The point is to stick to a daily practice. This will improve immune function and reduce anxiety, fatigue and depression. Having a daily practice will also lower stress hormone levels, heart rate and blood pressure.
Acupuncture and Chinese Herbal Medicine
Acupuncture and Traditional Chinese Medicine have been utilized for myasthenia gravis for many years. Clinical trials suggest that acupuncture and Chinese herbal medicine may be beneficial for myasthenia gravis when given along with medical management.(4,5) There is on-going research into the benefits of Chinese herbal medicine in myasthenia gravis.(6)*
Increase physical activity gradually and consistently
Exercise with MG is very challenging. However, if your MG is stable, you must start to slowly and gradually increase the amount of physical activity. Here is a helpful video on MG and exercise. Exercise is anti-inflammatory for the body and being sedentary is pro-inflammatory. Exercise improves your gut health, increases your energy and improves your sleep. It will help you to maintain more muscle bulk which is important for strength, function, immune health and brain health.
Get adequate rest
Get your 7-9 hours of nightly sleep. There are associations between chronic lack of sleep and subsequent development of autoimmune disease. Since we know MG can be associated with sleep disordered breathing, such as sleep apnea, consider speaking to your doctor about being evaluated for your quality of sleep.
In summary, the use of complementary medicine strategies including nutrition, lifestyle changes, stress-reduction, appropriate physical activity and rest can assist your recovery from myasthenia, improve your quality of life and help to minimize medication side-effects.
*Talk to your neurologist before taking any herbs as there may be interactions with your pharmaceutical medications.
Sahebar M, et al. Selenium and autoimmune diseases: a review article. Curr Rheumatol Rev. 2019;15(2):123-134.
Wang S, Li H, Zhang M, et al. Curcumin ameliorates experimental autoimmune myasthenia gravis by diverse immune cells. Neurosci Lett. 2016;626:25-34.
Mandlik Ingawale DS, Namdeo AG. Pharmacological evaluation of Ashwagandha highlighting its healthcare claims, safety, and toxicity aspects. J Diet Suppl. 2020:1-44.
Zhang X, et al. The effectiveness and safety of acupuncture for the treatment of myasthenia gravis: a systemic review and meta-analysis of randomized controlled trials. Ann Palliat Med. 2019;8(5):576-585.
Chen S, Xu MB, Zhou XL, Rong PQ, Jin TY, Zheng GQ. Chinese Herbal Medicine for Myasthenia Gravis: A Systematic Review and Meta-Analysis. Front Pharmacol. 2018;9:969.
Weng S, Fan Z, Qiu G, et al. Therapeutic efficacy and immunoregulatory effect of Qiangji Jianli Capsule for patients with myasthenia gravis: Study protocol for a series of randomized, controlled N-of-1 trials. Medicine (Baltimore). 2020;99(51):e23679