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What supplements help ALS?

No supplement has been shown to slow ALS (amyotrophic lateral sclerosis). Creatine made no difference to survival or decline in 3 trials with 386 people (grade A), and vitamin E and CoQ10 trials were also negative. Ultra-high-dose methylcobalamin, a vitamin B12, slowed decline over 16 weeks in 130 people with early ALS, but as a shot into the muscle twice a week, so B12 pills remain untested. Use supplements only alongside care from an ALS clinic.

Last reviewed

How we grade evidenceEditorial policy

What the studies found

  • Grade A. Creatine made no clear difference. A Cochrane review pooled 3 placebo-controlled trials with 386 people taking 5 to 10 g a day: survival and how fast everyday function declined were no different, and breathing measures trended slightly worse. (Pastula 2012)
  • Grade B. Vitamin E and CoQ10 trials were negative. Vitamin E taken as 500 mg twice daily for a year (289 people), or 5,000 mg daily over 18 months (160 people), left survival unchanged. CoQ10 at 2,700 mg daily over 9 months (185 people) showed too little promise for a bigger trial. (Desnuelle 2001; Graf 2005; Kaufmann 2009)
  • Grade B. Very high-dose methylcobalamin helped only as an injection. In 130 people within a year of first symptoms, 50 mg injected into muscle twice weekly for 16 weeks meant 1.97 fewer points lost on the functional scale than placebo. An earlier injected trial in 373 people found no overall benefit. Neither tested tablets. (Oki 2022; Kaji 2019)
  • Grade C. Extra calories were well tolerated but have not lengthened survival. In 201 people, 405 extra fat calories a day made no overall difference to survival. In 20 people fed by stomach tube, a high-carbohydrate, high-calorie formula caused fewer serious side effects than a standard one. (Ludolph 2020; Wills 2014)

Who should be careful

  • The adult upper limit for vitamin E from supplements is 1,000 mg a day (1,500 IU natural or 1,100 IU synthetic), per the NIH ODS vitamin E fact sheet. Vitamin E can add to bleeding risk with warfarin or other blood thinners.
  • Don't stop or change riluzole, edaravone or any prescribed medicine on your own; tell the ALS team about every supplement.
  • Contact the ALS team promptly for shortness of breath, morning headaches, trouble lying flat, coughing or choking at meals, or weight loss. These can mean breathing or swallowing muscles are weakening.
  • If you are pregnant, breastfeeding or under 18, ask a clinician first.

Try first

  • Care from a specialist ALS clinic. The prescription drugs riluzole and edaravone can delay progression by 2 to 4 months at most; care from multidisciplinary teams is linked with 4 to 7 months longer survival. (Ravits 2026)
  • Breathing support when breathing weakens. Non-invasive ventilation (a mask machine, often at night) improved quality of life, and in people with good swallowing it added a median of 205 days. (Bourke 2006)
  • Ask the team dietitian to track weight, since weight loss signals a worse outlook. (Ludolph 2020)

Sources

  1. Pastula DM, et al. Creatine for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev. 2012. PubMed 23235621 · doi:10.1002/14651858.CD005225.pub3
  2. Desnuelle C, et al. A double-blind, placebo-controlled randomized clinical trial of alpha-tocopherol (vitamin E) in the treatment of amyotrophic lateral sclerosis. ALS riluzole-tocopherol Study Group. Amyotroph Lateral Scler Other Motor Neuron Disord. 2001. PubMed 11465936 · doi:10.1080/146608201300079364
  3. Graf M, et al. High dose vitamin E therapy in amyotrophic lateral sclerosis as add-on therapy to riluzole: results of a placebo-controlled double-blind study. J Neural Transm (Vienna). 2005. PubMed 15517433 · doi:10.1007/s00702-004-0220-1
  4. Kaufmann P, et al. Phase II trial of CoQ10 for ALS finds insufficient evidence to justify phase III. Ann Neurol. 2009. PubMed 19743457 · doi:10.1002/ana.21743
  5. Oki R, et al. Efficacy and Safety of Ultrahigh-Dose Methylcobalamin in Early-Stage Amyotrophic Lateral Sclerosis: A Randomized Clinical Trial. JAMA Neurol. 2022. PubMed 35532908 · doi:10.1001/jamaneurol.2022.0901
  6. Kaji R, et al. Ultra-high-dose methylcobalamin in amyotrophic lateral sclerosis: a long-term phase II/III randomised controlled study. J Neurol Neurosurg Psychiatry. 2019. PubMed 30636701 · doi:10.1136/jnnp-2018-319294
  7. Ludolph AC, et al. Effect of High-Caloric Nutrition on Survival in Amyotrophic Lateral Sclerosis. Ann Neurol. 2020. PubMed 31849093 · doi:10.1002/ana.25661
  8. Wills AM, et al. Hypercaloric enteral nutrition in patients with amyotrophic lateral sclerosis: a randomised, double-blind, placebo-controlled phase 2 trial. Lancet. 2014. PubMed 24582471 · doi:10.1016/S0140-6736(14)60222-1
  9. Ravits J, et al. Amyotrophic Lateral Sclerosis: A Review. JAMA. 2026. PubMed 42113599 · doi:10.1001/jama.2026.6385
  10. Bourke SC, et al. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol. 2006. PubMed 16426990 · doi:10.1016/S1474-4422(05)70326-4