What is this?
Dietary (nutritional, food) supplements are intended to supplement the diet and provide nutrients that may be missing or in short quantity. In the US, dietary supplements include vitamins, herbs and other plant-derived products, minerals, amino acids, and parts or combinations of these products (FDA 1994). Vitamins, a type of supplement, are organic (carbon-containing) compounds essential for growth and well-being. Minerals (example: calcium and potassium) are inorganic compounds needed for good health. Amino acids (example: tryptophan) are the building blocks of proteins. This page also includes hormones, encapsulated foods and other natural products used as dietary supplements today. Since there are a large number of supplements, we have listed herbs on a separate page.
How can this help?
Below is a sampling of vitamins and other supplements that have some potential to improve your platelet count and/or symptoms. Everyone is different, plus manufacturing conditions, brands, vitamin types, and dosages vary. It is important to seek the advice of a naturopathic doctor or other medical provider before taking any of these.
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 (Easton 1984, Mant 1979). In a study of 14 ITP patients given high doses of folic acid, 64% had a complete or partial response and the others showed some transient improvement (Schulz 2003). However, if someone has a low level of vitamin B12, high doses of folic acid may cause anemia and cognitive impairment (Selhub J, 2007).
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 inflammation (Imbach 2011) and reducing bleeding symptoms is important, it is plausible that taking vitamin C could help ITP patients. 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 results (Brox 1988), but disappointing research results over time (Jubelirer 1993).
In PDSA’s Survey of Non-Traditional Treatments for ITP about 30% of those who tried vitamin C felt it helped their platelets and bleeding symptoms with about 10% claiming there was a sustained effect.
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 (Kawamori 2010). Since low levels of vitamin D have been associated with autoimmune diseases (Toubi 2010) 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 (Prietl 2010). Note that ITP is a T-cell mediated disease (Semple 2010).
Vitamin K is essential for your blood to clot and for healthy bones. However its anti-inflammatory properties are less well known (Aoganghua 2011). 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 (Shea 2008). You can get vitamin K from leafy greens such as kale, collards, and spinach, plus meat, eggs, and dairy products.
In PDSA’s Survey of Non-Traditional Treatments for ITP about 30% of the people who took vitamin K felt it helped their platelet count and their bleeding symptoms.
There are many plant-based, green supplements used for healing. Chlorella, a type of green algae has been well-studied and it is clear that it 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” (Queiroz ML 2011). 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 (Posit 1998).
Chlorophyll is the green pigment found in almost all plants, algae and in some bacteria. In PDSA’s Survey of Non-Traditional Treatments for ITP 19% felt chlorophyll had a positive effect on their platelet count and 33% felt it helped their bleeding symptoms.
Colostrum is the first secretion of the mammary glands before milk is produced, 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 it changed the number of T-cells and consequently, the immune system (Jensen 2012). Colostrum also contains immunoglobulins, with cows’ colostrum being particularly high in IgG (Stelwagen 2009). 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% felt it had a positive effect on their platelet count and 33% felt it helped their bleeding symptoms.
Melatonin, a hormone that regulates sleep/wake timing, is also a strong antioxidant and used as a supplement for many conditions. Researchers in Italy published three papers documenting the positive effects on a total of six ITP patients (Todisco 2002, 2003, 2007). Some adverse events have been documented for a small number of patients taking melatonin (Morera 2001).
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 (Othman 2011).
In PDSA’s Survey of Non-Traditional Treatments for ITP 46% of the people who used the product felt it helped their platelet count and bleeding symptoms while nearly 17% of those thought it had a sustained effect.
Noni fruit (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 show Noni juice has significant anti-oxidant and anti-inflammatory properties (Dussossoy E 2011).
Supplements have biologic activity and, just as pharmaceuticals, may react differently in different people. Some supplements activate the immune system. Because people with autoimmune diseases such as ITP have an overactive immune system, these supplements can possibly worsen the disease (Lee 2004). Others, such as Noni juice, may cause liver toxicity, although that connection for Noni is controversial (Yu 2011, West 2007). 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. See the ‘warnings’ page for more information.
We have heard from many people who report success with various vitamins and supplements. Here is a sampling. You can find more accounts in the stories section of the web site and in the “A Different View” section of The Platelet News.
“About three months ago, my doctor told me to take even more vitamin D (now over 2,000 IUs per day) and wonder of wonders, my last platelet count was up to 94,000, despite my having a cold. It hasn’t been that high in at least five years! I’m thinking that the vitamin D supplementation is working for me (along with prayer, faith, whole foods, exercise, rest, etc. all of which you advocate!)” Jackie
“I don’t know if it was the Rocephin or the pomegranate extract I take each night or both or just coincidence, but this is the longest I’ve been without ITP for 20 years! The pomegranate extract, which I still take, tastes nasty, but I think it’s important to break the capsule with your teeth and absorb it under the tongue. I currently take 100 mg chewable vitamin C each night. This period of remission is really miraculous to me after 20 years of medical treatments, including splenectomy, which barely kept my platelet count out of the danger zone.” Cynthia
“Luckily, a business friend of mine said to try Noni Fruit. His father had a blood disorder and this seemed to work for him. My doctor said not to try it, as we would not know what was working. However, I tried Noni Fruit anyway (400 mg capsules, two times a day) and Selenium (200 mg capsules two times a day) for about a month. I then cut back to one capsule each a day. Now I have had normal platelets for over three years! I told another younger boy’s mother about this and now he has been fine too! I don’t know why it works. I really think it was the selenium (lack of minerals), but who cares. I still take both.” Lois
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.
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
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
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
FDA “Overview of Dietary Supplements What is a dietary supplement?” FDA Dietary Supplement Health and Education Act (DSHEA) of 1994, updated 2009 http://www.fda.gov/Food/DietarySupplements/ConsumerInformation/ucm110417.htm#what
Imbach P. “Oxidative stress may cause ITP.” Blood. 2011 Apr 28;117(17):4405-6. http://www.ncbi.nlm.nih.gov/pubmed/21527538
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
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
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
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
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
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
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
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
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
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
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.
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
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
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
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
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
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”
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
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
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
West BJ, “[Tahitian Noni juice is not hepatotoxic].”[Article in Spanish] Rev Esp Enferm Dig. 2007 Dec;99(12):737-8; author reply 738. http://www.ncbi.nlm.nih.gov/pubmed/18290705
Yu EL et al. “Acute hepatotoxicity after ingestion of Morinda citrifolia (Noni Berry) juice in a 14-year-old boy.” J Pediatr Gastroenterol Nutr. 2011 Feb;52(2):222-4. http://www.ncbi.nlm.nih.gov/pubmed/21119544
PDSA thanks Dr. Veronica Hayduk for reviewing this page