On MSM and DMSO from the Arthritis Foundation

[Guest guest]

From the Arthritis Foundation, Judith Horstman writes on MSM and DMSO in

Arthritis Today (1999):

MSM - DMSO

MSM is being touted as a magic bullet for treating arthritis pain - just

as its mother compound, DMSO, was in the 1960s. What's the true story

behind these compounds? Can they help - or hurt?

After Coburn won an for Best Supporting Actor this year, he

credited the supplement MSM for helping him overcome the pain and

disability of rheumatoid arthritis. MSM, he said in many interviews,

made it possible for him to work.

MSM (which stands for methylsulfonylmethane), was already selling

briskly, and with added publicity from Coburn, sales have boomed.

Hundreds of vendors market it for a range of ailments including pain

and/or inflammation from rheumatoid arthritis (RA), osteoarthritis (OA),

fibromyalgia and gout; and to correct constipation, relieve allergies,

control stomach acidity and - believe it or not - stop snoring.

However, there's not much on which to base these claims: There are

numerous testimonials, but little hard scientific data on MSM's safety

or benefits. " How can we say if it's safe or not - much less, if it

works? " asks Pisetsky, MD, chief of rheumatology at Duke

University Medical Center and an arthritis researcher. " We just don't

know enough about it. "

Stanley , MD, the doctor who developed MSM, acknowledges that the

" arthritis cure " claims are over-hyped. While Dr. stands by the

many benefits of MSM, he is quick to point out that it's not a " cure. "

" I don't know of a single disease that MSM cures. We are not curing

arthritis - I want that understood, " says Dr. . He says MSM's major

benefit for those with OA and RA is pain relief: It hasn't been shown to

repair or preserve cartilage or to modify or stop progression or joint

destruction caused by autoimmune types of arthritis, and its effects

last only as long as the supplement is taken.

Some rheumatologists are suspicious of MSM because of its relationship

to DMSO - a substance that has stirred controversy since the 1960s. MSM

is a sulfur compound plentiful in fresh fruits and vegetables, milk,

fish and grains, but quickly destroyed when foods are processed. Vendors

say MSM boosts sulfur levels; they also say it is a " natural " product,

but the supplement being sold is actually a chemical compound made from

DMSO.

What's the real story on MSM? We had to look at the history of DMSO to

find some answers.

The Mother Compound

DMSO (which stands for dimethyl sulfoxide) is a versatile compound with

many uses and a checkered past.

It is both a prescription drug and an industrial solvent. It's formed as

a byproduct of wood pulp processing; its use is determined by the

quality: You will find industrial-grade DMSO in paint thinner and

antifreeze, and medical-grade DMSO in many medical laboratories. Its

industrial usefulness comes from its remarkable solvent qualities, and

much of its medical value from its ability to transport other substances

through cell membranes. It is also reported to have anti-inflammatory

and antioxidant properties.

Medical-grade DMSO is safe, and is widely used in medical processes.

DMSO is the chemical used to protect human tissue (such as bone marrow,

stem cells and embryos) when frozen for storage. It's also an

FDA-approved prescription drug (called Rimso) given by catheter for

interstitial cystitis, a painful bladder condition.

Dr. says thousands of scientific papers have been published about

DMSO's chemistry, including test tube, animal and human studies. Some

have shown DMSO can relieve muscle and joint pain; reduce inflammation;

soften collagen to relieve scleroderma symptoms; help heal skin ulcers

caused by diabetes and scleroderma; and relieve blood vessel

constrictions common to Raynaud's phenomenon. Other research has

suggested it may help prevent brain damage after stroke or head

injuries. And it appears to have few side effects, even at very high

dosages.

DMSO is approved for use in many other countries for arthritis and

related conditions. In fact, a new drug, combining DMSO with the

nonsteroidal anti-inflammatory drug (NSAID) diclofenac is being

considered by the FDA for approval as a prescription topical NSAID (see

" A Stronger Topical NSAID " ).

So why the controversy?

DMSO: Why the Controversy?

The controversial history of DMSO begins with Dr. , a

Harvard-trained surgeon with an endowed chair at Oregon Health Sciences

University (OHSU), where he has a special clinic for the use of DMSO.

In the early 1960s, Dr. headed the organ transplant program at

OHSU and was looking for a substance to preserve organs being stored for

transplant when he stumbled across DMSO. Further research uncovered DMSO

's medical uses, and it was soon being hailed as a wonder drug.

But in the mid-'60s, DMSO fell out of favor with the FDA during its

testing phase when an animal study, using high doses, showed changes in

the lens of the eye. (There have, however, been no reports of problems

with eyes of participants in human studies.)

DMSO's ability as a solvent to transport molecules across cell membranes

was also a potential problem. It meant that when used topically DMSO

could carry anything - including toxins - straight through the skin and

directly into the body.

DMSO also has a harmless but unpleasant side effect: Taken internally or

even used externally, it causes a bad taste in the mouth and makes those

who use it smell like garlic or oysters.

And so medical-grade DMSO faded from the consumer marketplace. Its

reputation was further sullied as reports of bad reactions from

arthritis patients who had used industrial-grade products bought at

roadside stands or gas stations came to light.

Nonetheless, DMSO was approved in 1978 as the prescription drug Rimso

for interstitial cystitis. Because medical-grade DMSO is an approved

prescription drug (although only for one use), it can't legally be sold

over the counter or as a dietary supplement. Therefore, most of the DMSO

people have been trying for the past 30 years has been the same quality

used in industrial solvents - in other words, unfit for human use - and

doctors have been rightly suspicious of these products.

Enter MSM

Meanwhile, as Dr. and other researchers at OHSU continued to study

DMSO, they found that 15 percent of DMSO was broken down into another

sulfur compound in the human body. The compound, which they called MSM,

had many of the helpful qualities of DMSO, with some distinct

advantages: It lacked the distinctive oyster-garlic smell; it didn't

have the sullied history of DMSO; and it could be sold directly to

consumers as a dietary supplement.

But it also lacked research: Unlike DMSO, which has many published

studies and evidence of safety, there was little scientific evidence for

or against MSM. Animal studies found MSM eased RA-like symptoms in mice,

and it prolonged life for mice with a condition similar to lupus

nephritis.

But even now, there are no scientifically accepted human studies, and

what works in animals doesn't always work in humans. Dr. and

others have conducted human studies that they say show MSM relieves the

pain of OA and other conditions. However, these studies are not

published in peer-reviewed medical journals, and there is a potential

conflict of interest: Dr. also serves as medical director for a

company that produces and sells MSM.

Dr. contends MSM does not need research because the DMSO studies

can be applied to this breakdown product. He also says MSM is safe,

citing animal toxicology studies from manufacturers.

What Rheumatologists Say

The rheumatologists we interviewed consider MSM an unproven remedy. So

far, MSM shows most promise as a pain reliever. As for DMSO,

rheumatologists don't know much about the scientific evidence and were

skeptical, and patients said they don't like the oyster-garlic smell.

A handful of rheumatologists are cautiously recommending MSM.

Nyman, MD, a rheumatologist and internal medicine specialist in Tarzana,

Calif., recommends MSM for OA and for pain, but not as a substitute for

prescription arthritis drugs. " My patients with aggressive RA need

aggressive treatment with proven disease-modifying drugs, " he says. " I

use MSM in conjunction with those drugs. " (Dr. Nyman has no financial

involvement in MSM.)

But some physicians are concerned that MSM may interfere with other

drugs and cause complications. " MSM is a real mystery, " says Ronenn

Roubenoff, MD, a rheumatologist and nutritional expert at Tufts

University/ New England Medical School. Sulfur compounds, like those in

MSM, are " very active in the body and can have powerful effects, " he

says. " We really don't know what the effects will be over time, " he

says.

" MSM is worth clinical trials, " says Dr. Roubenoff. " We need to keep

an open mind, and not just reject things out of hand. But we also

shouldn't give up the scientific method just because there is a lot of

hype about a product. It needs to be tested. "

Bottom line: MSM may be safe, but there is no convincing scientific

evidence it helps arthritis. And DMSO may help with a number of

arthritis-related conditions, but it is not safe for consumers to use

products available on the open market.

Good Advice: MSM and DMSO

DMSO and MSM are both taken several ways: orally; applied externally as

lotions or gels; given intravenously and injected.

a.. If you decide to experiment with these substances, be sure to tell

your doctor and ask your doctor to monitor you for any adverse effects

with regular blood, kidney and liver function tests.

b.. Don't stop taking disease-modifying medication if you have RA or

another autoimmune disease.

c.. Consult your doctor if you are taking heparin or other

blood-thinners, including herbs and aspirin, because both substances may

have some blood thinning effects.

Good Advice: MSM

a.. Buy MSM only from an established company that you can be sure will

stand by its products - and be wary of companies making " miracle " and

other hyped claims.

b.. Start with a low dosage of 500 milligrams (mg) or less twice a day

and gradually increase the amount until you notice some effect. Most

sources suggest 1,000 mg (1 gram) twice a day. MSM is most often taken

in capsules or dissolved in a liquid.

c.. Be patient. But if you don't see any difference after two months,

you may never - and it may not be worth continuing to expose yourself to

unknown risks.

d.. Tell your doctor if you get diarrhea, stomach upsets or mild

cramps; these side effects are common, especially at higher doses.

Lowering the dose may stop these symptoms.

Good Advice: DMSO

a.. Don't buy DMSO on your own: Ask your doctor to find a

medical-grade source. Almost all DMSO available to the public is

industrial grade - including most veterinary DMSO and products sold in

health food stores and on the Internet - and may not be safe for medical

use.

b.. Do not try DMSO without a doctor's help. It's a powerful

transdermal agent, which means it can carry anything that touches it

through your skin and into your body.

c.. If you have a reaction, stop using the product and see your

doctor. Some people may have an allergic reaction, skin irritation or

itching from DMSO applied externally.

d.. Be aware DMSO has been known to cause bad breath or a bad taste in

the mouth (like garlic or oysters) among those who use it, whether it's

taken orally or applied to the skin.

Judith Horstman, author of The Arthritis Foundation's Guide to

Alternative Therapies (Arthritis Foundation, 1999), is a contributing

editor to Arthritis Today. She writes regularly about alternative and

complementary therapies.

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