Sulfur
   

Sulfur
Overview
Uses
Dietary Sources
Available Forms
How to Take It
Precautions
Possible Interactions
Supporting Research

Overview

Sulfur is a naturally occurring mineral that is found primarily near hot springs and volcanic craters. Sulfur has a distinct "rotten egg" smell which is caused by sulfur dioxide gas escaping into the air. It is available in two supplement forms -- dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM) -- and both forms have been touted widely as effective treatments for pain.

Sulfur is part of the chemical structure of three different amino acids (the building blocks that make up protein) -- namely, cystine, cysteine, and methionine. Sulfur works with vitamins B1 (thiamine), B5 (pantothenic acid), and H (biotin) to promote metabolism and communication between nerve cells. Sulfur is found abundantly in keratin, a protein that strengthens hair, nails, and skin. Occasionally referred to as "nature's beauty mineral," sulfur plays a role in the production of collagen, a protein that helps keep skin elastic and healthy.

Sulfur-containing mud baths (often called balneotherapy) help in the treatment of skin disorders and arthritis. Balneotherapy is one of the oldest forms of therapy for pain relief for people with arthritis. The term "balneo" comes from the Latin word for bath (balneum) and refers to bathing in thermal or mineral waters. Some people also claim that these baths are useful for allergies and respiratory disorders. However, there is no scientific evidence for these traditional uses. In fact, many (but not all) studies suggest that there may actually be a connection between sulfur gases in the environment and the rise in allergy and respiratory related illnesses, particularly asthma, throughout industrialized countries. The sulfur gases responsible for pollution in the environment come primarily from coal-fired power stations.


Uses

Skin Disorders
Sulfur baths, and other forms of sulfur applied directly to the skin, seem to benefit psoriasis, eczema, dandruff, folliculitis (infected hair follicles), warts, and pityriasis versicolor (a chronic skin disorder characterized by patches of skin that differ in color from the usual skin tone).

Arthritis
Well-designed studies, primarily conducted in Israel, suggest that balneotherapy (including sulfur baths with or without mud packs and/or soaks in the Dead Sea) can help treat several different kinds of arthritis including osteoarthritis, rheumatoid arthritis, and psoriatic arthritis.

Positive effects experienced by those receiving sulfur baths and other spa therapies include improved strength, decreased morning stiffness, better walking ability, and decreased inflammation, swelling, and pain in joints, particularly the neck and back.

Mud packs and Dead Sea salts dissolved in a regular bath tub were also found to improve symptoms of arthritis, but not as effectively as the Dead Sea itself. Several studies have also suggested that DMSO applied topically to affected areas may reduce pain and swelling in those who suffer from rheumatoid arthritis and osteoarthritis, but not all studies on this topic agree and more research is needed.

Pain and Injury
Use of topical DMSO for people who have bursitis, tendonitis, or a joint sprain has led to improvement in symptoms, including decreased pain and improved range of motion, in up to 72% of participants in a series of studies. For the most part, however, none of these studies has been considered scientifically rigorous. Plus, there are additional studies on this subject that have not shown improvement in injury related symptoms from DMSO compared to placebo. Therefore, most experts feel that more research is needed before conclusions can be drawn about the value of DMSO for pain or injuries.

Interstitial Cystitis
Although research is somewhat limited, DMSO is approved by the FDA to treat interstitial cystitis (bladder inflammation causing frequent and nighttime urination as well as pain), as it may relieve pain and other symptoms associated with this inflammatory condition. When used to treat interstitial cystitis, a physician inserts a liquid solution of DMSO directly into the bladder. General anesthesia may be required in some cases because the process can be painful and may cause bladder spasms.

Other
DMSO is also under investigation for the treatment of scleroderma (a connective-tissue disease that causes a progressive build up of tough scar-like tissue in the skin and internal organs), amyloidosis (a group of diseases in which amyloid -- a protein-like substance -- builds up in the organs and tissues), Sjogren's syndrome (a connective tissue disorder that generally includes arthritis, dry eyes, and dry mouth), and spinal cord injuries. However, the results thus far are not very promising and the tests being conducted are often evaluating DMSO as a prescription drug, not as a dietary supplement.


Dietary Sources

The elemental mineral form of sulfur is found in rocks near hot springs and volcanoes. The form the body ingests is found in protein-rich foods such as eggs, meat, poultry, fish, and legumes. Other good sources include garlic, onions, brussels sprouts, asparagus, kale, and wheat germ.


Available Forms

Sulfur supplements are available in two main forms -- dimethyl sulfoxide (DMSO) and methylsulfonylmethane (MSM). Each of these substances, first DMSO in the 1960s and 1970s and more recently MSM, has been touted to treat many conditions, particularly those related to pain. The only use for which DMSO is approved by the FDA is interstitial cystitis (inflammation of the bladder), which is injected under medical supervision.

DMSO, first made in 1866, is prepared from byproducts of paper manufacturing and used as an industrial solvent. MSM is derived from DMSO.

Although sulfur is available as a dietary supplement in tablets and capsules, supplemental sulfur is generally not necessary because appropriate amounts are obtained from a well-balanced diet that includes the recommended daily allowance of protein. People who follow a vegan diet, however, are at risk for sulfur deficiency.

Ointments, creams, lotions, and dusting powders containing sulfur are available to provide relief from skin rashes. Natural sulfur baths (the kind usually found at hot springs) may help ease pain associated with arthritis.


How to Take It

Pediatric

There are no known scientific reports on the pediatric use of sulfur. Therefore, use as a supplement is not currently recommended for children.

Adult

There is no Recommended Dietary Allowance (RDA) for sulfur because appropriate amounts of this mineral are obtained from a well-balanced diet that includes the recommended daily allowance of protein.

  • Arthritis: oral doses of 500 to 1,000 mg MSM per day may decrease symptoms; or, topical doses of 60% to 90% DMSO applied 1 to 3 times per day
  • Amyloidosis: oral doses of 7 to 15 g DMSO per day; or, topical doses of 50% to100% DMSO applied 2 times per week.

Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Sulfur, by itself, is not toxic to the body. However, some people are highly allergic to relatives of sulfur such as sulfites and sulfa drugs. Sulfites are used as food preservatives (such as in beer and wine) and can trigger asthma, hives, and other allergic reactions. Sulfites may also cause stomach pain, nausea, diarrhea, and even seizures in certain individuals. Sulfa drugs can cause skin rashes, high fever, headache, fatigue, and gastric problems.

Side effects from DMSO and MSM also include nausea, headache, and rash.

Those with known allergies to sulfa-containing medications and/or sulfites should avoid sulfur supplements as a precautionary measure.

Sulfur should not be used during pregnancy.


Possible Interactions

There are no reports in the scientific literature to suggest that sulfur interacts with any conventional medications.


Supporting Research

Ayres JG. Trends in air quality in the UK. Allergy. 1997;52(38 Suppl):7-13.

Barnes PJ. Air pollution and asthma. Postgrad Med J. 1994;70(823(:319-325.

Barnes PJ. Air pollution and asthma: molecular mechanisms. Mol Med Today. 1995;1(3):149-155.

Carpio-Obeso MP, Shorr M, Valdez-Salas B. Desert ecosystems: similarities, characteristics, and health beneftis. Rev Environment Health. 1999;14(4):257-267.

Childs SJ. Dimethyl sulfone (DMSO2) in the treatment of interstitial cystitis. Urol Clin North Am. 1994;21(1):85-88.

Devalia JL, Rusznak C, Wang J, Khair OA, Abdelaziz MM, Calderon MA, Davies RJ. Air pollutants and respiratory hypersensitivity. Toxicol Lett. 1996;86(2-3):169-176.

D'Amato G, Liccardi G, D'Amato M. Environmental risk factors (outdoor air pollution and climatic changes) and increased trend of respiratory allergy. J Investig Allergol Clin Immunol. 2000;10(3):123-128.

Elkayam O, Ophir J, Brener S, Paran D, Wigler I, Efron D, Even-Paz Z, Politi Y, Yaron M. Immediate and delayed effects of treatment at the Dead Sea in patients with psoriatic arthritis. Rheumatol Int. 2000;19(3):77-82.

Food and Drug Administration (FDA). Dimethyl sulfoxide (DMSO): New drug without an approved new drug application or investigational new drug application (NDA/IND). 1992. Accessed at: http://www.fda.gov/ora/fiars/ora_import_ia6206.html on February 8, 2002.

Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996.

Lester MR. Sulfite sensitivity: significance in human health. J Am Coll Nutr. 1995;14(3):229-232.

Pain. MSM: does it work? Harv Health Lett. 2000;25(10):7.

Ring J, Eberlein-Koenig B, Behrendt H. Environmental pollution and allergy. Ann Allergy Asthma Immunol. 2001;87(6 Suppl 3):2-6.

Rosenstein ED. Topical agents in the treatment of rheumatic disorders. rheum Dis Clin N Am. 1999;25(4):899-918.

Rusznak C, Devalia JL, Davies RJ. The impact of pollution on allergic disease. Allergy. 1994;49(18 Suppl):21-27.

Schmidt A. Malassezia fufur: a fungus belonging to the physiological skin flora and its relevance in skin disorders. Cutis. 1997;59(1):21-24.

Schwela D. Exposure to environmental chemicals relevant for respiratory hypersensitivity: global aspects. Toxicol Lett. 1996;86(2-3):131-142.

Sukenik S. Balneotherapy for rheumatic diseases at the Dead sea area. Isr J Med Sci. 1996;32Suppl:S16-19.

Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman S, Horowitz J. Sulphur bath and mud pack treatment for rheumatoid arthritis at the Dead Sea area. Ann Rheum Dis. 1990;49(2):99-102.

Sukenik S, Flusser D, Codish S, Abu-Shakra M. Balneotherapy at the Dead Sea area for knee osteoarthritis. Isr Med Assoc J. 1999;1(2):83-85.

Sukenik S, Giryes H, Halevy, et al. Treatment of psoriatic arthritis at the Dead Sea. J Rheumatol. 1994;21:1305-1309.

Sukenik S, Neumann L, Flusser D, Kleiner-Baumgarten A, Buskila D. Balneotherapy for rheumatoid arthritis at the Dead Sea. Isr J Med Sci. 1995;31(4):210-214.

Trice JM, Pinals RS. Dimethyl sulfoxide: a review of its use in the rheumatic disorders. [Review]. Semin Arthritis Rheum. 1985;15(1):45-60.

Verhagen AP, de Vet HC, de BIE RA, Kessels AG, Boers M, Knipschild PG. Balneotherapy for rheumatoid arthritis and osteoarthritis (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.

von Mutius E. The environmental predictors of allergic disease. J Allergy Clin Immunol. 2000;105(1 Pt 1):9-19.

Yang WH, Purchase EC. Adverse reactions to sulfites. CMAJ. 1985;133(9):865-867,880.


Review Date: April 2002
Reviewed By: Participants in the review process include: Ruth DeBusk, RD, PhD, Editor, Nutrition in Complementary Care, Tallahassee, FL; Jacqueline A. Hart, MD, Department of Internal Medicine, Newton-Wellesley Hospital, Harvard University and Senior Medical Editor Integrative Medicine, Boston, MA; Gary Kracoff, RPh (Pediatric Dosing section February 2001), Johnson Drugs, Natick, Ma; Steven Ottariono, RPh (Pediatric Dosing section February 2001), Veteran's Administrative Hospital, Londonderry, NH. All interaction sections have also been reviewed by a team of experts including Joseph Lamb, MD (July 2000), The Integrative Medicine Works, Alexandria, VA;Enrico Liva, ND, RPh (August 2000), Vital Nutrients, Middletown, CT; Brian T Sanderoff, PD, BS in Pharmacy (March 2000), Clinical Assistant Professor, University of Maryland School of Pharmacy; President, Your Prescription for Health, Owings Mills, MD; Ira Zunin, MD, MPH, MBA (July 2000), President and Chairman, Hawaii State Consortium for Integrative Medicine, Honolulu, HI.

Copyright © 2004 A.D.A.M., Inc

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