Since November 2016 (the date the review was originally published) we found 2 validated ALS reversals associated with L-serine (both were also taking many other supplements). Associations like these do not prove that L-serine works for ALS. There are multiple possible explanations for ALS reversals. Nonetheless, these are enough to change our TOE Cases grade from D to B. We found no other new data to warrant TOE grade changes. We remain interested in the results of the ongoing L-serine clinical trial (https://clinicaltrials.gov/ct2/show/NCT03580616?term=l-serine&cond=ALS&draw=2&rank=2)
Key Information
L-serine is a reasonably inexpensive, widely available nutritional supplement that has a plausible mech-anism by which it could help a subset of patients who might have ALS from BMAA-toxicity. A small Phase I trial showed that L-serine up to 15 g twice daily is relatively well tolerated. A larger follow up trial is planned and will shed further light on its safety and utility as an ALS therapeutic. Unfortunately, since it is challenging to reliably measure BMAA in PALS, it will be difficult to identify the subset most likely to respond. Until a reliable assay for measuring BMAA exposure in living people arises, or a follow up trial confirms safety and demonstrates benefit independent of this, we cannot recommend L-serine as a treatment for ALS.
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