Thursday, 16 October 2014

Riboflavin is no good another nutriceutical bites the dust?

Naghashpour M, Majdinasab N, Shakerinejad G, Kouchak M, Haghighizadeh MH, Jarvandi F, Hajinajaf S. Riboflavin Supplementation to Patients with Multiple Sclerosis does not Improve Disability Status nor is Riboflavin Supplementation Correlated to Homocysteine. Int J Vitam Nutr Res. 2013 Oct 1;83(5):281-290

Background: Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Riboflavin is involved in myelin formation in nerve cells. Riboflavin is a precursor of flavin adenine D-nucleotide (FAD), which is a coenzyme of methylene tetrahydrofolate reductase (MTHFR), which is an important enzyme for remethylation of homocysteine. Riboflavin supplementation has been shown to affect the serum levels of homocysteine in healthy volunteers. The aim of the present study was to test the effect of riboflavin supplementation on the status and disability of patients with MS and whether this effect could be mediated by serum homocysteine levels. 

Materials and Methods: This was a randomized, double-blind, controlled trial in which 29 MS patients with a mean age of 33 were tested with riboflavin, and the placebo group, with a mean age of 31, received either riboflavin supplementation (10 mg) or the placebo daily for six months. Disability, measured by the Expanded Disability Status Scale (EDSS) scores, erythrocyte glutathione reductase activity coefficient (EGRAC), and serum homocysteine levels were measured before and after the study. 
Results: The mean ± SD of EDSS score was significantly decreased in both groups over the six months of the study (2.3 ± 0.7 vs. 1.6 ± 0.6 for the riboflavin group and 2.8 ± 1.1 vs. 2.3 ± 1.3 for the placebo groups. No significant differences were observed between the two groups in terms of EGRAC, riboflavin deficiency levels by EGRAC category, and serum homocysteine levels before and after the study. Conclusion: Riboflavin supplementation (10 mg/day) to patients with MS does not improve disability status. It appears that this effect is not related to serum homocysteine levels.

So a trial of riboflavin (Vitamin B2) fails to find any difference. Do we conclude it is of no use...maybe..but again we question if this trial was big enough to tell us anything...I suspect not. So just as we have positive studies showing effect or trends of this or that nutriceutical, by chance we will have negative data also.  

I wish people would do studies big enough to tell us one way of another


  1. By selection we will have fewer studies showing negative result and more studies showing positive result going into publishing. Tricky.
    My neurologist yesterday recommended multi-vit B supplementation. As long as it is something totally harmless (like water-soluble vitamins) I am all for it.

  2. They should have tested for B 12 - that's related to homocysteine and the nerves.

    B12 shots are given for autoimmune gastritis on a regular basis.

  3. "The comparison across both groups yielded a non-significant change (P = 0.001 and 0.02, respectively). "

    If p values don't tell you anything there is something wrong.

  4. Having done quite a lot of investigation I think there is a lot more to the involvement of all of the B Group Vitamins in MS, especially B12, although we should keep in mind that the B Vits work as a group, not just individually.

    We need to remember that RDAs and Reference Ranges that are used all around the world vary and many of them are rather old and are based on population surveys to arrive at levels which are really only those at which disease states are not blatantly evident. A clear example is that B12 deficiency can exist and be causing neurological damage even without any anaemic markers being detectable in blood tests – fortunately this is now more widely recognised, but there are still many “authorities” who still promulgate that B12 deficiency doesn’t “exist” until the anaemic markers can be found.

    While anyone who wants to can find a multitude of scientific journal articles to support their own viewpoints, especially if they are doing a “review” of previously published literature, I did find the following article struck a chord with me, and it sent me off to get some tests done. And, Yes, some deficiencies were found and are now being addressed. Should my B vitamins have been checked (which they weren’t – and nothing else was tested either) as part of the diagnostic work-up which concluded I had MS – no-one can tell me (perhaps you good guys at Barts can tell me….)

    And, again, the study on Vit B1 in only very small number of patients and cited on this website does offer some food for thought (unfortunately, I’m not a subscriber to PubMed and can only access the Abstract)

    Given the proliferation of diets of various types which claim to help with MS (some well researched and some not), and which have countless numbers of articles published both for and against and on which these diets are based, as well as plenty of followers who swear by them, I am left with just plain and simple confusion. I also wonder whether some who swear by the diets are getting benefits of just generally healthier eating compared to what they ate before starting on one of the “MS Diets”. Or do we MSers just have greater needs for some nutrients/vitamins anyway – maybe a contributing factor to why we ended up with MS or as a result of our MS, or ?????????? Aaaarrrghhhh……….

    (Note – no definitive answers required – I’m just posing some currently unanswerable questions)

    1. Complicated, init;). I agree very much with what you are saying. I have my B vitamins measured every 4 months and they are all are 'normal' and some higher than 'normal', though not excessively so. Interestingly, I've done this since diagnosis 15 years ago, rarely get fatigue (only very occasionally on relapse). I wonder if my B levels have anything to do with this? I think it is a combination of a healthy veggie diet (so not easy to have good levels of B12),exercise and supplements but equally could just be I'm just 'blessed' -so far -with extremely mild MS.

  5. Maybe we should take a look at Vitamin B3. A couple of days ago you posted this:

    NAD+ supply is maintained through Vitamin B3 (Niacin) intake.


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