muscle pain and cramps with Avonex

A board to discuss the Multiple Sclerosis modifying drug Avonex

Postby gwa » Tue Aug 21, 2007 7:28 am

NHE,

There was information on a Braintalk forum several years ago that discussed the importance of combining these two supplements, so I started taking them together at that point.

R-ALA is more potent and supposedly easier for the body to use than regular ALA. I normally use the R-ALA even though it is a lot more expensive than the other.

Here is one link below that will get you started looking up why both are needed. If you google alpha lipoic acid and acetyl-l-carnitine, there are lots of hits.

Also on page 2 of the link provided below, there are many research reports that you could follow up on.

gwa

http://www.lef.org/magazine/mag2003/sep ... pha_01.htm
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Postby AllyB » Tue Aug 21, 2007 12:21 pm

Hi NHE and Gwa (hope you don't mind if I write you both at once?)

I am using the pre-filled syringes, so will chat to neuro about switching over - thanks for the tip as I really want to persevere with this and am determined to get the side effects under control. I increased my ibuprofen intake this last weekend as per your suggestion, and it really helped with the muscle pain and fever/aches etc.
I also started using the basic supplements that you suggested (calcium, magnesium, and D3 - my chemist had to order the oil for me to get a high enough dose, and the fish oil), but I realise that it is a bit soon to expect results on the cramps just yet. The D3 is probably very important for me as although I live in a very hot country where it is sunny for about 300 of 365 days per year, I tend to avoid the sun because I am a red-head with very fair skin & I burn in 5 minutes or less...
I also have a long list of other recommended supplements that includes the acetyl-l-carnitine and R-ALA that you also mentioned and an appointment with a nutritionist next week (for diet), plus a referral to a health shop where most of the supplements can be found - not easy in my sunny spot of "backwoods" S.Africa, I can tell you!
Thanks guys - you have helped me get going with this and I am sure my Avonex woes will reduce too (they are already better). I am glad I asked for help, as getting it has actually forced me to act on it, if you know what I mean? You have been so kind, it is only decent for me to get off my fence and help myself in any way I can...So thanks again for sharing your experience.
Al
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Re: mucle pain can cramps with Avonex

Postby NHE » Wed Aug 22, 2007 3:26 am

Hi Gwa,
Thanks so much for posting the link to the lipoic acid/acetyl-l-carnitine article. Now it's time for me to dig out those references and read the full papers.
R-ALA is more potent and supposedly easier for the body to use than regular ALA. I normally use the R-ALA even though it is a lot more expensive than the other.

Yes, those are the reasons that persuaded me to switch over to R-lipoic acid almost 3½ years ago. Moreover, there were a couple of papers (*) that I read that stated that there was actually a physiological cost to consuming the S isomer in that it was not handled by the body in the same way as the R isomer. I'm curious how much you take per day and what brand you're using? I've only been able to find a few brands that specify R-lipoic as opposed to simply stating "ALA" and finding reliable independent verification of any particular supplement manufacturer's product has been difficult. For what it's worth, I've been using Source Naturals though I'm not happy with the brand overall. The other brand I'm somewhat familiar with is Hu-Max though they declined to send me a copy of their analysis report (though this really didn't seem to me to be that odd of a request since when I worked in a research laboratory as a graduate student companies would frequently send a certificate of analysis along with a product demonstrating the product's conformance to purity and quality standards).

* References

Molecular Aspects of Lipoic Acid in the Prevention of Diabetes Complications
Nutrition. 2001 Oct;17(10):888-95.

alpha-Lipoic Acid as a Biological Antioxidant
Free Radic Biol Med. 1995 Aug;19(2):227-50

Here are some interesting quotes that discuss the differences between the R and S isomers.

From the first paper:
The polyol pathway is known as the primary cause of cataractogenesis in diabetes. Lipoic acid can exert protective effects in different ways. The reduction of R-lipoic acid by lipoamide re-ductase depends on NADH. Accordingly, intramitochondrial reduction of R-lipoic acid can alleviate NADH surplus in diabetes. In a model of glucose-induced lens opacity in vitro, stereospecific protection by lipoic acid was observed. Although R-lipoic acid completely protected the lens, addition of racemic lipoic acid decreased damage only by about one-half, whereas S-lipoic acid potentiated deterioration of the lens.

Insulin resistance is typical for type II diabetes. Therapeutic intervention to enhance glucose uptake by skeletal muscle is potentially important for the prevention and treatment of non–insulin-dependent diabetes. As early as 1970, lipoic acid was shown to enhance glucose uptake into rat tissues. Subsequently, obese Zucker rats, an animal model of insulin resistance, were used to investigate the effects of acute and chronic intravenous treatments with R,S-lipoic acid on glucose transport in isolated skeletal muscle. Lipoic acid markedly increased net glucose uptake, which was associated with a significant enhancement of glycogen synthesis. This observation was supported by a separate experiment in vitro from the same group showing an increased glucose uptake into muscle from lean (insulin-sensitive) or obese (insulin-resistant) Zucker rats. In the same model, the effect of the individual enantiomers of lipoic acid on glucose disposal, hyperinsulinemia, and dyslipidemia was studied. Obese Zucker rats were treated acutely or chronically by intraperitoneal injection with R- or S-lipoic acid. Acute treatment with R-lipoic acid increased insulin-mediated glucose transport by 64%, whereas the S form showed no significant effect. Chronic R-lipoic acid administration reduced plasma insulin and free fatty acids, whereas S-lipoic acid increased insulin and had no effect on plasma free fatty acids. Further, R-lipoic acid improved insulin-stimulated glycogen synthesis and glucose oxidation. The level of glucose transporter-4 protein was not altered after chronic treatment with R-lipoic acid but was reduced by S-lipoic acid.

The effect of lipoic acid on glucose uptake into heart muscle also has been investigated. Glucose uptake into Langendorff hearts of insulin-resistant Zucker was measured with the [ 14 C] 3-O-methylglucose washout method. Glucose uptake rate increased 1.6-fold with R,S-lipoic acid, 1.8- fold with the R form, and was negatively influenced by the S-enantiomer (-50%).

In the working rat heart during reoxygenation, R-lipoic acid improved aortic flow, reaching 70% of normoxic conditions at nanomolar concentrations, whereas 1 µM of the S form was needed to achieve only 60%. In the same study, R-lipoic acid added to the perfusion medium increased mitochondrial ATP synthesis of the working rat heart, whereas ATP synthesis remained unaltered in response to S-lipoic acid.


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R-ALA

Postby gwa » Wed Aug 22, 2007 10:53 am

NHE,

Currently I am using the AST Sports Science brand of R-ALA and the IDS brand of Acetyl-L-Carnitine.

I take 200mg 2x a day of the R-ALA and 600mg 2x a day of the ALCAR.

I buy the supplements from netrition.com and have been using this company for over 10 years due to its customer service and large product line.

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Postby AllyB » Sun Oct 07, 2007 12:31 pm

Hey guys

Just wanted to give a quick update:

I have been supplementing for about 6 weeks now and have switched to the Avonex that you mix yourself, also taking ibuprofen as a single drug, as advised.

Although I am feeling well in general, I am sorry to say that I couldn't notice much improvement of my original problem, but I saw my neuro last week and discussed it with him.

He is not in general a very sympathetic guy, but I saw him on a Monday (the day after I inject), and he examined me and saw for himself the muscle contractions/cramps that I have been complaining of for 6 months! He says it is spasms/increased spasticity - something to do with hyper-reflexivity and spinal cord damage, and it seems to be worsened by the Avonex.
He prescribed baclophen, and I took it today after injecting, for the first time...I am only supposed to take it for 2 days a week, when I have this problem, and I have to titrate it, so I started on the lowest doseof 5mg.

I must say it has really helped with the muscle spasms, but every silver lining has a cloud, and now I find myself with the very WORST headache I have ever had in my life, the ibuprofen has not helped that, so now I need another pill :!: Feel like my brain is being sucked out of the base of my skull with a needle.. Can imagine that it feels similar to post-LP headaches (I did not get a headache with my LP, so I am just projecting here).
So sick of pills - does anyone else have any experience with baclophen? If so, how have you found it? This seems to be one thing trading off for another, a vicious cycle, a treadmill...Don't quite know what to do, so any other experience would be helpful.

Many thanks for taking the time to read this and apologies for continued whinning, seems to be I always have a problem and don't mean to complain so much.
Al
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great- thank!

Postby Chell » Sun Oct 14, 2007 10:49 pm

After reading this. everyone gave me some ideas to help with the aftermath of my shot..
I to am on avonex and also i know about the leg cramps. that is what i have to deal with after a couple of hr.'s and into the next day...
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Postby AllyB » Mon Oct 15, 2007 11:07 am

Hey Michelle

The ibuprofen really helps with the general ill-feeling (fever, chills, muscle pain etc), but the only thing that really sorted out my bad cramps (as I am sure you have read) was baclophen, as apparently the Avonex can exacerbate spasticity and spasms (which my neuro eventually figured out was my problem).
You need to ask your doc for a prescription, but I only need to take it for 2-3 days a week, and the headaches have settled! It does make you even more sleepy though...

Take care and I hope this helps.
Al
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Postby Chell » Mon Oct 15, 2007 9:19 pm

thank you! i will look into that, i have to go talk with my dr. some time this week.
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