Imagine battling the unyielding march of progressive multiple sclerosis, where every step feels like a battle against your own body – could an everyday supplement like lipoic acid hold the key to relief? A groundbreaking study offers some hope, but with results that are far from clear-cut, leaving us all wondering about the future of treatment options. And this is the part most people miss: while it showed promise in one area, it fell short in others, sparking debates that could reshape how we approach this devastating disease.
By Erik Robinson (https://news.ohsu.edu/authors/author/erikrobinson) December 15, 2025 Portland, Oregon
Rebecca Spain, M.D., M.S.P.H., spearheads a fresh randomized controlled clinical trial exploring the potential of the widely available supplement lipoic acid for managing progressive multiple sclerosis. (OHSU/Christine Torres Hicks)
Exciting news emerges from Oregon Health & Science University and the Portland VA Health Care System: the over-the-counter supplement lipoic acid might offer a modest advantage in curbing the decline of gray matter in the brains of individuals grappling with progressive forms of multiple sclerosis. Yet, this same rigorous experiment revealed no enhancement in the main clinical metric they tracked – namely, how fast people could walk. These insights are detailed in a publication released today (https://www.neurology.org/doi/10.1212/WNL.0000000000214454) within the pages of Neurology, the esteemed journal of the American Academy of Neurology.
The investigation drew in 54 volunteers living with primary progressive or secondary progressive multiple sclerosis. Those in the active treatment arm ingested a substantial 1,200-milligram daily dose of lipoic acid for a full two years. Their progress was contrasted against 61 others who received a placebo. The key measure of success was walking speed, with additional factors like brain shrinkage assessed via magnetic resonance imaging (MRI), various other health markers, and overall safety also under scrutiny.
Rebecca Spain, M.D., M.S.P.H. (OHSU)
'It didn't deliver the clinical improvements we were rooting for in progressive multiple sclerosis,' shared leading researcher Rebecca Spain, M.D., M.S.P.H., an associate professor of neurology at the OHSU School of Medicine, co-director of the VA MS Center of Excellence West, and a physician at the Portland VA. 'That said, the evidence of reduced brain atrophy on MRI scans hints that we might be heading in the right direction – particularly if we can devise smarter methods to harness the protective powers of antioxidants such as lipoic acid.'
To help beginners grasp this, multiple sclerosis (MS) is a condition that attacks myelin, the insulating layer enveloping nerve fibers in the central nervous system. When myelin and those nerves sustain damage in MS, it disrupts the electrical signals our bodies rely on for essential functions like vision, muscle movement, sensory perception, and even cognition. Globally, around 2.8 million people (https://www.nationalmssociety.org/about-the-society/who-we-are/research-we-fund/ms-prevalence) have received this diagnosis, making it a widespread concern.
Scientists theorize that lipoic acid could wield anti-inflammatory and antioxidant properties to shield compromised myelin and the nerves beneath, provided sufficient levels reach the bloodstream and cross into the brain. But here's where it gets controversial: lipoic acid is lipophobic, meaning it struggles to penetrate the blood-brain barrier effectively, limiting its access to the central nervous system. This raises eyebrows about whether supplements can truly compete with more targeted drugs – a point that might divide opinions on relying on over-the-counter options versus prescription treatments.
This research builds on earlier stages, beginning with experiments on mice, dose calibration efforts, and encouraging outcomes from a 2017 pilot study. Participants in this trial endured a potent dosage of lipoic acid, which unfortunately brought some unwelcome side effects. For instance, the OHSU team briefly halted the study after two individuals developed a kidney issue linked to interactions with certain drugs, including lipoic acid itself. And this is the part most people miss: balancing potential benefits against such risks could make or break the supplement's viability, prompting questions about whether the pros outweigh the cons for those desperate for new therapies.
Despite the hurdles, optimism persists among the experts. The findings are now fueling a more expansive initiative (https://ms-octopus.mrcctu.ucl.ac.uk/) in the United Kingdom, dubbed the Optimal Clinical Trials Platform for Multiple Sclerosis, or Octopus. This innovative multi-arm, multi-stage trial will pit lipoic acid and metformin – another candidate for tackling progressive MS – against a placebo in a significantly larger pool of participants.
Spain, who provides guidance to this international effort, emphasized how it will merge OHSU's data with broader collections. 'By teaming up with the Octopus trial, we'll gain deeper insights into whether lipoic acid deserves a place in the treatment arsenal for progressive MS,' she noted. 'I'm staying cautiously enthusiastic about the possibilities ahead.'
Funding for this endeavor came from the Department of Veterans Affairs (grant RX002682-01), the National Multiple Sclerosis Society (grant R-1705-27628), and the Multiple Sclerosis Society of Canada (supplement to R1705-27628). Additionally, support was provided by the National Center for Advancing Translational Sciences at the National Institutes of Health via grant UL1TR002369.
But here's where it gets controversial: with lipoic acid showing mixed results – hinting at brain protection without easing mobility – does this justify the push for more studies, or should we question if chasing supplements distracts from proven medications? What say you – do you think over-the-counter remedies like this could revolutionize MS care, or are they just a risky gamble? Share your thoughts in the comments below; I'd love to hear agreements, disagreements, or personal stories that might shed light on this ongoing debate!
