Vitamins and Other Supplements


Could replacing or augmenting the body’s supply of key vitamins, amino acids or other compounds help manage ITP? While ongoing research into this possibility shows that manipulating levels of these nutrients may lead to benefits for individuals with the rare bleeding disorder, the effects of individual dietary supplements and ingredients vary widely.

While dietary supplements may seem harmless, unlike drugs, these products aren’t evaluated or reviewed by the Food and Drug Administration (FDA) for safety and effectiveness, and even “natural” supplements can be risky. Instead, the manufacturers and distributors of dietary supplements and dietary ingredients have the responsibility to ensure their products are safe, are not adulterated or misbranded and meet all requirements of the FDA and other federal agencies. Due to the lack of regulations, the Federal Trade Commission strongly recommends that consumers consult with their healthcare provider before taking a new supplement, and avoid any supplement claiming it is a "cure."

In the U.S., dietary supplements include vitamins, herbs and other plant-derived products, minerals, amino acids, and parts or combinations of these products.5 Vitamins, a type of supplement, are organic (carbon-containing) compounds essential for growth and well-being. Minerals, such as calcium and potassium, are inorganic compounds needed for good health. The building blocks of proteins, including tryptophan, are classified as amino acids. In addition to the numerous supplements below, certain types of hormones, encapsulated foods and other natural products are also described.


What supplements may be effective for ITP?

Below is a sampling of vitamins and other supplements—along with associated research—that may have some potential to improve platelet count and/or symptoms of ITP. The effects of each supplement may vary according to an individual’s physical characteristics, as well as variations in manufacturing conditions, brands, vitamin types, dosages levels, and other factors. It is important to seek the advice of a medical care provider or professional trained in alternative medicine in before adding supplements to your daily regimen.


Vitamins

Folic acid (vitamin B9)

Folic acid is a water-soluble vitamin needed for numerous body functions including DNA repair and rapid cell division and growth, including blood cells. Folic acid deficiency may cause thrombocytopenia.4,11 In a study of 14 ITP patients given high doses of folic acid, 64 percent had a complete or partial response and the others showed some transient improvement.17 However, if someone has a low level of vitamin B12, high doses of folic acid may cause anemia and cognitive impairment.18


Vitamin C (L-ascorbic acid or L-ascorbate)

Vitamin C is an anti-inflammatory nutrient that is important for healing wounds, maintaining the integrity of capillaries, and absorbing iron from food. Since ITP is associated with inflammation6 and reducing bleeding symptoms is important, it is plausible that taking vitamin C could help people with the platelet disorder. Of all the vitamins and supplements, vitamin C has been the most studied in ITP. However, clinical results have been mixed, with very positive initial results2, but disappointing research results over time.8

In PDSA's Survey of Non-Traditional Treatments for ITP about 30 percent of those who tried vitamin C felt it helped their platelets and bleeding symptoms, with about 10 percent claiming there was a sustained effect.


Vitamin D

Vitamin D is a nutrient needed for healthy nerves, muscles, bones and immune system. According to a Japanese study, vitamin D plays a valuable role in the function of hematopoietic stem cells, cells in the bone marrow that give rise to red blood cells, white blood cells, and platelets.9 Since low levels of vitamin D have been associated with autoimmune diseases26 and vitamin D can alter regulatory T-cells (a type of white blood cell), some researchers speculate it could be used to treat autoimmune diseases.15 Note that ITP is a T-cell mediated disease.19


Vitamin K

Vitamin K is essential for your blood to clot and for healthy bones. However, its anti-inflammatory properties are less well known.1 In a large study, people with higher vitamin K levels had lower levels of 14 markers of inflammation, some of which are linked to chronic disease.20 Leafy greens such as kale, collards, and spinach, plus meat, eggs, and dairy products are all good sources of vitamin K.

In PDSA’s Survey of Non-Traditional Treatments for ITP, about 30 percent of the people who took vitamin K felt it helped their platelet count and bleeding symptoms.


Other Compounds

Chlorophyll/Algae/Seaweed

There are many plant-based, green supplements used for healing. Chlorella, a type of green algae has been well studied showing it is a chelator that binds to heavy metals, such as lead or mercury, and can help eliminate them from the body. Chorella can also “reduce high blood pressure, lower serum cholesterol levels, accelerate wound healing, and enhance immune functions."16 In general, seaweeds act as natural chelators of heavy metals. They improve metabolism, increase ATP (adenosine triphosphate, an enzyme needed for healthy cells) production, and help regulate body temperature, energy levels, and immune function.14

Chlorophyll is the green pigment found in almost all plants and algae, and in some bacteria. Nineteen percent of participants in PDSA’s Survey of Non-Traditional Treatments for ITP felt chlorophyll had a positive effect on their platelet count and 33 percent felt it helped their bleeding symptoms.


Colostrum

Colostrum is the first secretion of the mammary glands before milk is produced, which is commercially extracted from cows and sold as a supplement. In nature, its primary purpose is to activate a baby’s immune system. In clinical trials, colostrum changed the number of T-cells and consequently, the functioning of the immune system.7 Colostrum also contains immunoglobulins, or antibodies, with cows’ colostrum being particularly high in one form called IgG.21 Since ITP is a T-cell mediated disease and often treated with IgG it is possible that colostrum could affect the course of the disease.

In PDSA’s Survey of Non-Traditional Treatments for ITP, 19 percent of respondents felt that colostrum had a positive effect on their platelet count and 33 percent felt it helped their bleeding symptoms.


Melatonin

Melatonin, a hormone that regulates sleep/wake timing, is a strong antioxidant and is used as a supplement for many conditions. Researchers in Italy published three papers documenting the positive effects on a total of six ITP patients.23,24,25 Some adverse events have been documented for a small number of patients taking melatonin.12


Moducare Sterinol

Moducare Sterinol is a commercial compound comprised of various plant sterols, substances in plants that resemble cholesterol. There has been considerable research on the cholesterol-lowering effects of plant sterols in the diet and in supplement form. These plant sterols can also have an anti-inflammatory effect.13

In PDSA’s Survey of Non-Traditional Treatments for ITP, 46 percent of the people who used the product felt it helped their platelet count and bleeding symptoms while nearly 17 percent of those thought it had a sustained effect.


Noni (Morinda citrifolia L.) juice

Noni juice has been used as a folk remedy in Polynesia for more than 2000 years. There are more than 150 research articles testing this juice for a variety of conditions including wound healing, memory restoration and cancer. Research studies suggest that noni juice has significant antioxidant and anti-inflammatory properties.3


Risks

Supplements have biologic activity and, just as pharmaceuticals, may react differently in different people. It’s important to note that some supplements have been shown to activate the immune system—and because people with autoimmune diseases such as ITP have an overactive immune system, these supplements can possibly worsen the disease.10

Risks certain dietary supplements present include:

  • Noni juice, may cause liver toxicity, although that connection for noni is controversial.27,28
  • Supplements can interact with other medications. For example, people who are taking blood thinners are advised to avoid vitamin K. 
  • Some vitamins and supplements, such as vitamin E and omega-3 fatty acids (fish oil), can make it more difficult for platelets to clot.

Learn more about important outside influences  that can affect your blood platelet level.


Resources

1. FDA “FDA Basics: What is a dietary supplement?” https://www.fda.gov/aboutfda/transparency/basics/ucm195635.htm

2. Easton DJ et al. “Severe thrombocytopenia associated with acute folic acid deficiency and severe hemorrhage in two patients.” Can Med Assoc J. 1984 Feb 15;130(4):418-20, 422. http://www.ncbi.nlm.nih.gov/pubmed/6607097

3. Mant MJ et al. “Severe thrombocytopenia probably due to acute folic acid deficiency.” Crit Care Med. 1979 Jul;7(7):297-300. http://www.ncbi.nlm.nih.gov/pubmed/456004

4. Schulz E, et al. “Successful Treatment of Chronic Refractory Idiopathic Thrombocytopenic Purpura with High Dose Folic Acid. Phase II Trial. Preliminary Results.” Poster 1071, Blood, Volume 102, issue 11, November 16, 2003.

5. Selhub J,et al. “In vitamin B12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrations.” Proc Natl Acad Sci  2007 Dec 11;104(50):19995-20000. http://www.ncbi.nlm.nih.gov/pubmed/18056804

6. Imbach P. “Oxidative stress may cause ITP.” Blood. 2011 Apr 28;117(17):4405-6. http://www.ncbi.nlm.nih.gov/pubmed/21527538

7. Brox AG et l. “Treatment of idiopathic thrombocytopenic purpura with ascorbate.” Br J Haematol. 1988 Nov;70(3):341-4. http://www.ncbi.nlm.nih.gov/pubmed/3207627

8. Jubelirer SJ. “Pilot study of ascorbic acid for the treatment of refractory immune thrombocytopenic purpura.” Am J Hematol. 1993 May;43(1):44-6. http://www.ncbi.nlm.nih.gov/pubmed/8317460

9. Kawamori Y et al. “Role for vitamin D receptor in the neuronal control of the hematopoietic stem cell niche.” Blood. 2010 Dec 16;116(25):5528-35
http://www.ncbi.nlm.nih.gov/pubmed/20813899

10. Toubi E, Shoenfeld Y. “The role of vitamin D in regulating immune responses.” Isr Med Assoc J. 2010 Mar;12(3):174-5.. http://www.ncbi.nlm.nih.gov/pubmed/20684184

11. Szodoray P et al. “The complex role of vitamin D in autoimmune diseases.” Scand J Immunol. 2008 Sep;68(3):261-9.http://www.ncbi.nlm.nih.gov/pubmed/18510590

12. Prietl B, et al. “Vitamin D supplementation and regulatory T cells in apparently healthy subjects: vitamin D treatment for autoimmune diseases?” Isr Med Assoc J. 2010 Mar;12(3):136-9.http://www.ncbi.nlm.nih.gov/pubmed/20684175

13. Semple JW et al. “Recent progress in understanding the pathogenesis of immune thrombocytopenia.” Curr Opin Hematol. 2010 Nov;17(6):590-5. http://www.ncbi.nlm.nih.gov/pubmed/20739879

14. Aoganghua A et al. “Inhibitory effects of vitamin K derivatives on DNA polymerase and inflammatory activity.” Int J Mol Med. 2011 Dec;28(6):937-45. doi: 10.3892/ijmm.2011.773. http://www.ncbi.nlm.nih.gov/pubmed/21837358.

15. Shea MK et al. “Vitamin K and vitamin D status: associations with inflammatory markers in the Framingham Offspring Study.” Am J Epidemiol. 2008 Feb 1;167(3):313-20. http://www.ncbi.nlm.nih.gov/pubmed/18006902

16. Queiroz ML et al. “Chlorella vulgaris restores bone marrow cellularity and cytokine production in lead-exposed mice.” Food Chem Toxicol. 2011 Nov;49(11):2934-41. http://www.ncbi.nlm.nih.gov/pubmed/21820028

17. Posit Health News.  “AquaMUNE, a brown seaweed extract, improves metabolism, immune response, energy and chelates heavy metals.” 1998 Spring;(No 16):18. http://www.ncbi.nlm.nih.gov/pubmed/11365014

18. Jensen GS, et al. “A novel extract from bovine colostrum whey supports innate immune functions. II. Rapid changes in cellular immune function in humans.” Prev Med. 2012 Jan 17. http://www.ncbi.nlm.nih.gov/pubmed/22285946

19. Stelwagen K, et al.” Immune components of bovine colostrum and milk.” J Anim Sci. 2009 Apr;87(13 Suppl):3-9.  http://www.ncbi.nlm.nih.gov/pubmed/18952725

20. Todisco M.J. “Melatonin makes splenectomy unnecessary in two patients with idiopathic thrombocytopenic purpura refractory to corticosteroids. Pineal Res.” 2007 Sep;43(2):214. http://www.ncbi.nlm.nih.gov/pubmed/17645700

21. Todisco M, et al. “Severe bleeding symptoms in refractory idiopathic thrombocytopenic purpura: a case successfully treated with melatonin.” Am J Ther. 2003 Mar-Apr;10(2):135-6.http://www.ncbi.nlm.nih.gov/pubmed/12629593

22. Todisco M. et al. “Melatonin for refractory idiopathic thrombocytopenic purpura: a report of 3 cases.” Am J Ther. 2002 Nov-Dec;9(6):524-6. http://www.ncbi.nlm.nih.gov/pubmed/12424512

23. Morera AL et al. “[Safety in melatonin use].” Actas Esp Psiquiatr. 2001 Sep-Oct;29(5):334-7. http://www.ncbi.nlm.nih.gov/pubmed/11602091

24. Othman RA, Moghadasian MH. “Beyond cholesterol-lowering effects of plant sterols: clinical and experimental evidence of anti-inflammatory properties.” Nutr Rev. 2011 Jul;69(7):371-82.  http://www.ncbi.nlm.nih.gov/pubmed/21729090

25. Dussossoy E et al. “Characterization, anti-oxidative and anti-inflammatory effects of Costa Rican noni juice (Morinda citrifolia L.)” .J Ethnopharmacol. 2011 Jan 7;133(1):108-15. http://www.ncbi.nlm.nih.gov/pubmed/20858541

26. Lee AN, Werth VP. “Activation of autoimmunity following use of immunostimulatory herbal supplements.” Arch Dermatol. 2004 Jun;140(6):723-7. http://www.ncbi.nlm.nih.gov/pubmed/15210464

 

 

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