MSM 1500 mg [Discontinued] by Good 'N Natural

POSSIBLY EFFECTIVE

• Osteoarthritis. Most clinical research shows that MSM is modestly beneficial when used alone or in combination with other ingredients. Details: Clinical research shows that taking MSM 1.5-6 grams orally in two to three divided doses daily, either alone or in combination with glucosamine, can modestly improve joint function and some symptoms of osteoarthritis such as pain and swelling (12469,14335,17127,19312). However, MSM does not seem to reduce stiffness or total symptom score (14335). Also, some patients may not consider the modest benefit to be clinically significant (17127). Some clinical research has evaluated MSM in combination with other ingredients. One clinical study in adults with knee osteoarthritis shows that taking MSM 500 mg, glucosamine sulfate 1500 mg, and chondroitin sulfate 1200 mg daily for 12 weeks is associated with greater reductions in pain and osteoarthritis scores when compared with glucosamine sulfate and chondroitin sulfate alone (96447). Clinical studies using combination products containing MSM 5 grams daily and boswellic acid 7.2 mg daily with or without vitamin C (Lignisul, Triterpenol; Artosulfur C, Laborest Italia S.p.A), orally for 60 days show reductions in anti-inflammatory drug use, but conflicting results for pain reduction (19313,96446). Also, one small study suggests that taking a combination of MSM with collagen type II, cetyl myristoleate, lipase, vitamin C, turmeric, and bromelain (AR7 Joint Complex, Robinson Pharma) orally for 12 weeks improves scores for joint pain and tenderness, but does not improve X-rays of affected joints (19314).

POSSIBLY INEFFECTIVE

• Chronic venous insufficiency (CVI). Clinical research suggests that topical MSM is not beneficial in CVI. Details: Clinical research shows that topical application of MSM plus EDTA can reduce the circumference of the calf, ankle, and foot in patients with CVI. However, application of MSM alone appears to increase swelling in these patients (19315).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if oral MSM improves the appearance of aging skin to a clinically meaningful extent. Details: Preliminary clinical research shows that taking MSM (OptiMSM, Bergstrom Nutrition) 3 grams daily for 16 weeks improves facial wrinkles associated with aging by a moderate amount when compared with placebo. When compared with baseline, taking MSM 1 gram daily for 16 weeks is as effective as taking 3 grams for reducing fine lines and wrinkles and improving smoothness, radiance, firmness, and elasticity (102000).
• Allergic rhinitis (hay fever). It is unclear if oral MSM is beneficial in patients with allergic rhinitis. Details: Preliminary clinical research shows that taking MSM (OptiMSM 650 mg) 2600 mg orally for 30 days might relieve some symptoms of seasonal allergic rhinitis when compared with baseline (8574). However, this study lacked blinding and a control group, and also did not provide information on severity of symptoms (12000).
• Alzheimer disease. Although there is interest in using oral MSM for Alzheimer disease, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Androgenic alopecia. Although there is interest in using oral and topical MSM for androgenic alopecia, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Aromatase inhibitor-induced arthralgia. Oral MSM has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with estrogen receptor positive (ER+) breast cancer and aromatase inhibitor-induced arthralgia shows that taking a specific combination product (Opera, GAMFARMA s.r.l) containing MSM 200 mg, boswellia 40 mg, alpha-lipoic acid 240 mg, and bromelain 20 mg once daily for 6 months reduces arthralgia intensity when compared to baseline, with around 22% of patients having complete symptom resolution at the end of the study (109570). The validity of these findings is limited by a lack of control group.
• Asthma. Although there is interest in using oral MSM for asthma, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Athletic performance. It is unclear if topical MSM is beneficial for improving athletic performance. Details: A small clinical study in healthy, physically active adults shows that applying a specific cream containing magnesium and MSM (MagPro, Custom Prescription Shoppe) prior to stretching and pedaling on a stationary bicycle does not appear to improve flexibility or endurance when compared with a placebo cream (19317).
• Chemotherapy-induced peripheral neuropathy. Oral MSM has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with chemotherapy-induced peripheral neuropathy shows that taking a specific product (OPERA, GAMFARMA s.r.l.) containing MSM 200 mg, alpha-lipoic acid 240 mg, boswellia 40 mg, and bromelain 20 mg daily for 12 weeks reduces overall pain when compared with baseline (96449). The validity of these findings is limited by the lack of a placebo group. Additionally, it is not clear if benefit is associated with MSM, other ingredients, or the combination.
• Chronic fatigue syndrome (CFS). Although there is interest in using oral MSM for CFS, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Chronic obstructive pulmonary disease (COPD). Although there is interest in using oral MSM for COPD, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Constipation. Although there is interest in using oral MSM for constipation, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Diabetes. Although there is interest in using oral MSM for diabetes, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Dyslipidemia. It is unclear if oral MSM is beneficial for dyslipidemia. Details: A very small clinical study in adults with overweight or obesity shows that taking a specific MSM product (OptiMSM, Bergstrom Nutrition) 3 grams daily for 16 weeks modestly increases high-density lipoprotein (HDL) cholesterol when compared with baseline, but not when compared with placebo. Taking MSM also did not improve total cholesterol, low-density lipoprotein (LDL) cholesterol, very-low-density lipoprotein (VLDL) cholesterol, or triglycerides (110572). However, this study may have been underpowered to detect differences between groups.
• Dyspepsia. Although there is interest in using oral MSM for dyspepsia, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Exercise-induced muscle damage. It is unclear if oral MSM is beneficial for preventing exercise-induced muscle damage. Details: Clinical research shows that taking MSM 50 mg/kg in 200 mL water orally daily beginning 10 days prior to a 14-km run can attenuate the increase in creatine kinase (CK) and bilirubin levels caused by exercise-induced muscle damage (19320). However, other clinical research shows that taking MSM (OptiMSM, Bergstrom Nutrition) 3 grams daily beginning 3 weeks prior to a 13.1-mile run and continuing for 2 days after does not reduce muscle or joint pain or alter serum markers of oxidative stress or muscle damage when compared with placebo (96448).
• Hangover. Although there is interest in using oral MSM for hangover, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Hemorrhoids. Topical MSM has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study shows that applying a specific gel containing MSM in combination with hyaluronic acid and tea tree oil (Proctoial, BSD Pharma) for 14 days improves symptoms of hemorrhoids, including pain during defecation, visible bleeding, and inflammation/irritation, when compared with placebo (19318). It is not clear if these effects are due to MSM, the other ingredients, or the combination.
• Insect bite. Although there is interest in using oral MSM for preventing insect bites, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Interstitial cystitis. Although there is interest in using oral MSM for interstitial cystitis, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Knee pain. It is unclear if oral MSM is beneficial for knee pain. Details: A moderate-sized clinical study in healthy adults with mild knee pain shows that taking MSM (OptiMSM, Bergstrom Nutrition) 1000 mg twice daily for 12 weeks modestly improves morning pain and pain while standing but does not benefit nocturnal or movement-associated pain, stiffness, or activities of daily living when compared with placebo (114751).
• Muscle cramps. Although there is interest in using oral MSM for muscle cramps, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Obesity. It is unclear if oral MSM is beneficial for obesity. Details: A very small clinical study in adults with overweight or obesity shows that taking a specific MSM product (OptiMSM, Bergstrom Nutrition) 3 grams daily for 16 weeks does not improve body weight, body mass index, waist circumference, or body composition when compared with placebo. (110572). However, this study may have been underpowered to detect differences between groups.
• Osteoporosis. Although there is interest in using oral MSM for osteoporosis, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Periodontitis. Although there is interest in using topical MSM for periodontitis, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Pneumonia. Although there is interest in using oral MSM for pneumonia, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Postoperative pain. Oral MSM has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients who have undergone arthroscopic rotator cuff repair shows that taking a specific combination product (Tenosan, Agave s.r.l.) containing MSM 550 mg, arginine alpha-ketoglutarate 500 mg, collagen peptides 300 mg, apple and grape polyphenols 125 mg, bromelain 40 mg, and vitamin C 60 mg for 3 months can reduce postoperative pain and slightly improve repair integrity (19322). However, improvement in overall functional outcomes was not observed.
• Rheumatoid arthritis (RA). Although there is interest in using oral and topical MSM for RA, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Rosacea. Oral MSM has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with rosacea shows that topical application of a cream containing silymarin and MSM twice daily for one month improves skin redness, papules, itching, hydration, and skin color when compared to baseline (19319). The validity of these findings is limited by the lack of a comparator group.
• Scleroderma. Although there is interest in using oral and topical MSM for scleroderma, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Stretch marks (striae distensae). Although there is interest in using topical MSM for stretch marks, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Systemic lupus erythematosus (SLE). Although there is interest in using oral MSM for SLE, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Temporomandibular disorders (TMD). Although there is interest in using oral MSM for TMD, there is insufficient reliable information about the clinical effects of MSM for this condition.
• Tendinopathy. Oral MSM has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with Achilles tendinopathy shows that taking two sachets orally daily of a specific combination product (Tenosan, Agave s.r.l.) each containing MSM 550 mg, arginine alpha-ketoglutarate 500 mg, collagen peptides 300 mg, apple and grape polyphenols (Vinitrox) 125 mg, bromelain 50 mg, and vitamin C 60 mg for 60 days might improve the outcomes of extracorporeal shock wave therapy (ESWT) (19321). However, it is unclear if any benefit is due to MSM, other ingredients, or the combination.
• Wound healing. Although there is interest in using topical MSM for wound healing, there is insufficient reliable information about the clinical effects of MSM for this condition. More evidence is needed to rate MSM for these uses.

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POSSIBLY EFFECTIVE

• Dandruff. Sulfur is an FDA-permitted ingredient of over-the-counter (OTC) topical products to treat dandruff (88107). However, efficacy data from clinical trials is limited. In a study of 48 adults using shampoos containing sulfur 2%, salicylic acid 2%, or both ingredients twice weekly for 5 weeks, reductions in scaling and the number of desquamating cells per square centimeter were greater with any of the active treatments compared with the shampoo base alone. However, the combination of both ingredients produced significantly greater and earlier reductions than either active ingredient alone (88108).
• Scabies. Applying topical preparations of 5% to 20% precipitated sulfur in petrolatum appears to be effective for the treatment of scabies in some patients. Response occurs in 24% to 97% of patients, but is unpleasant due to the smell. Sulfur preparations are applied overnight (10-12 hours) for between 3 and 6 nights, with reduced efficacy when used for only 24 hours (27846,27847,88124,98205,98207). Concentrations should be limited to between 2% and 6% for infants, children, adolescents, and pregnant women (27846,27847,98207). Sulfur ointments have also been compared with other treatments for scabies. Clinical research and a meta-analysis of the available research show that topical sulfur is less effective and has a higher risk of adverse effects when compared with topical permethrin or topical or oral ivermectin (98205,100735). Sulfur ointment also seems to be more expensive when compared with topical permethrin or oral ivermectin (98207). Preliminary clinical trials and a meta-analysis have reported similar efficacy rates for topical sulfur and lindane, and for topical sulfur and benzyl benzoate (27848,100735).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Acne. Sulfur in concentrations of 3% to 10% is an FDA-permitted ingredient in over-the-counter (OTC) topical products to treat acne (88107,88123). However, efficacy data is mainly anecdotal (88122). Creams and ointments containing 1% to 10% sulfur have been used to treat acne for many decades, but sulfur is now generally found in combination with benzoyl peroxide, salicylic acid, or sodium sulfacetamide (88120,88121).
• Allergic rhinitis (hay fever). A preliminary clinical study suggests that using a homeopathic nasal spray containing sulfur, luffa, Galphimia glauca, and histamine for 42 days has similar efficacy to cromolyn sodium nasal spray for relief of symptoms of allergic rhinitis (60080).
• Chronic obstructive pulmonary disease (COPD). Preliminary clinical research shows that inhalation of aerosolized sulfurous water (Acqua Breta, Terme di Riolo) 5 mL once daily for 12 days does not improve lung function when compared with baseline in patients with COPD (98206).
• Common cold. A preliminary clinical study suggests that taking a homeopathic product containing sulfur and German ipecac (Engystol, Heel GmbH) orally for up to 2 weeks during a cold provides similar symptomatic relief to conventional over-the-counter remedies such as antihistamines, antitussives, and NSAIDs (27849).
• Hyperlipidemia. A preliminary clinical study suggests that drinking 50 mL of water from a sulfurous spring three times daily for 4 weeks reduces total cholesterol, low-density lipoprotein (LDL) cholesterol, and triglyceride levels, and decreases platelet aggregability. However, the study has methodological problems, including the lack of a control group, and does not address the effects of sulfur alone (91101).
• Rosacea. Preliminary clinical research shows that applying sulfur 10% in an emollient base (Diprobase, Merck Sharp and Dohme) once daily for 4 weeks is as effective as oral tetracycline (300 mg twice daily for 1 week, then 150 mg twice daily for 3 weeks) for reducing rosacea papules and pustules (88113). Using a combination of sulfur 5% and sodium sulfacetamide 10% in a topical emollient foam (Clarifoam EF, Onset Dermatologics) twice daily also seems to reduce the severity of rosacea (88111,88112). Other clinical research shows that using this same product for 8 weeks reduces inflammatory lesions by an additional 42% and erythema by an additional 52% when compared with placebo (88112). In another study, using foam containing sulfur 5% and sodium sulfacetamide 10% for 8 weeks reduced papules, pustules, and overall severity of rosacea more than topical metronidazole 0.75% gel (88112). More evidence is needed to rate sulfur for these uses.

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POSSIBLY SAFE ...when used orally and appropriately, short term. MSM in doses of 1.5-6 grams daily or 50 mg/kg daily has been used safely in studies lasting up to 6 months (8574,12469,14335,17127,19312,96446,96448,102555). One specific product (OptiMSM, Bergstrom Nutrition) is Generally Recognized As Safe (GRAS) by the United States Food and Drug Administration (FDA) (102555). ...when used topically. Topical cream containing MSM and silymarin, as well as topical gel containing MSM, hyaluronic acid, and tea tree oil, have been used with apparent safety for up to 20 days (19318,19319).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

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POSSIBLY SAFE ...when used topically and appropriately, short-term. Topical products containing sulfur in concentrations up to 10% have been used safely in clinical research for up to 8 weeks (27846,27847,88107,88112,88123,88124,98205,98207,100735). There is insufficient reliable information available about the safety of using sulfur orally.

CHILDREN: POSSIBLY SAFE
when used topically and appropriately, short-term. Topical products containing sulfur in concentrations up to 6% have been used safely when applied nightly in children and adolescents for up to 6 nights (27846,27847). In infants, topical products containing sulfur in concentrations up to 2% have been safely applied for 3 hours daily for up to 6 days (27847).

PREGNANCY AND LACTATION: POSSIBLY SAFE
when applied topically and appropriately, short-term. Topical products containing sulfur in concentrations up to 6% have been safely applied nightly for up to 6 nights (27846,27847). There is insufficient reliable information available about the safety of sulfur when used orally; avoid using.

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(Read more about METHYLSULFONYLMETHANE (MSM))

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General ...Orally, MSM is generally well tolerated.
Most Common Adverse Effects:
Orally: Bloating, diarrhea, gastrointestinal discomfort, nausea.

Dermatologic ...In rare cases, MSM has caused pruritus when taken orally (8574).

Gastrointestinal ...Orally, MSM may cause mild gastrointestinal discomfort, nausea, bloating, and diarrhea (8574,12469).

Immunologic ...Orally, MSM may increase allergy symptoms (8574).

Neurologic/CNS ...Orally, MSM may cause headache, fatigue, insomnia, and difficulty concentrating (8574,14335).

Ocular/Otic ...In a case report, a 35-year-old female presented with bilateral acute angle closure glaucoma, which resolved 4 days after discontinuing a multi-ingredient product. Although the product contained over 35 vitamins, minerals, and other ingredients, only MSM contained sulfur, which the authors suggest acted like a sulfa-drug to cause acute angle closure glaucoma (90613).

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General ...Topically, sulfur is generally well tolerated when used in concentrations of up to 10%. Adverse effects include skin dryness, irritation, and pruritus (27846,88112,88120,88121,88126). Orally, sulfur has been reported to cause diarrhea and metabolic acidosis (27845).

Dermatologic ...Topically, application of sulfur preparations can cause dryness, leading to local irritation and pruritus in up to 28% of patients (27846,88112,88120,88121,88126).

Gastrointestinal ...Orally, sulfur is converted to sulfide in the gastrointestinal tract, causing intestinal irritation which can lead to diarrhea (27845).

Renal ...There is one case report of metabolic acidosis occurring in a 57-year-old woman who had consumed approximately 250 grams of flowers of sulfur, a form of sulfur prepared by sublimation, over a 6-day period (27845). Underlying conditions, including diabetes and renal failure, may have contributed to the acidosis. Sulfur is converted to sulfide by colonic bacteria and then to sulfate in various tissues, generating hydrogen ions which can lead to acidosis when clearance mechanisms are overwhelmed (27845).

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