Below is an article writen by Ashton Embry for the New Pathways
magazine's January, 2008 edition
Vitamin D Supplementation in the Fight Against MS
On the 28th December 2007, vitamin D made Time magazine’s top 10 list of medical breakthroughs for that year, after a twelve month period in which the solid scientific support for the linkage with Multiple Sclerosis grew considerably.
When this latest information, summarized below, is combined with all the previous work it essentially leaves very little doubt that MS is a long latency vitamin D deficiency disease. Once this is accepted then it becomes obvious that adequate vitamin D intake from birth onward can protect a person from MS regardless of genetic susceptibility or exposure to other environmental factors involved in MS.
A year ago researchers at Harvard University (Munger et al) compared vitamin D levels in stored, blood samples of soldiers later diagnosed with MS to vitamin D levels of matched, healthy controls. This work demonstrated that “the risk of multiple sclerosis significantly decreased with increasing levels of 25 hydroxvitamin D” (the form of vitamin D which circulates in the blood). Furthermore, the researchers found that this correlation “was particularly strong for vitamin D levels measured before age 20”. Harvard researchers led by Alberto Ascherio followed up this paper with a comprehensive review article on environmental risk factors for MS and the evidence linking vitamin D to MS covered 5 pages. At the same time, George Ebers of Oxford University co-authored a major review paper on environmental causes of MS and pointed to vitamin D as one of the main factors. When researchers at two of the top universities in the world are touting vitamin D as a significant causal factor of MS in mainstream medical journals, you know that the concept is finally being taken seriously by the MS research establishment some 33 years after it was first proposed.
A study of regional differences in MS prevalence for French farmers was published in April 2007 by Vukusic et al. It is clear that the differences in MS prevalence, which are over two fold, are readily explained by variations in ultraviolet radiation/vitamin D supply over France. Such an interpretation is hard to challenge because genetics is not a confounding factor and the farmers are distributed evenly throughout the country. Additional convincing evidence of the MS/vitamin D linkage was provided by a study of childhood sun exposure and MS risk of identical twins in North America by Islam et al. The results demonstrated that “the risk of MS was substantially lower for the twin who spent more time suntanning in comparison with the co-twin”.
A third study by Kampman et al. looked at the risk of MS and differences in outdoor activities and diet of children and adolescents born and living in northern Norway. They found that increased outdoor activities in early life as well as cod liver oil supplementation were associated with a lower risk of MS. I would emphasize that these three, solid studies from different parts of the world all strongly support the concept that the higher one’s supply of vitamin D, the lower the risk of MS.
Also of importance were three other studies published in 2007, all of which looked at vitamin D status and disability in persons with MS. Van der Mei et al measured vitamin D levels in persons with MS in Tasmania and found that “increasing disability was strongly associated with lower levels of 25(OH)D (circulating vitamin D) and with lower levels of sun exposure”. In Finland, Soilu-Hanninen et al demonstrated that, for MS patients, there was “an inverse relationship between serum vitamin D levels and MS clinical activity”. Finally Woolmore et al in a British study found that there was an association between skin type and disability in female MS patients. Those with sun-sensitive skin types, which produce vitamin D faster, had lesser disability. These studies all point to the same conclusion that increased vitamin D, lessens disease progression and resulting disability.
Another key paper published in 2007 was that by Holmoy who came to the same conclusion I had in my 2004 paper on MS causal factors. He interpreted that adequate vitamin D in childhood prevents MS by regulating the immune system such that it does not produce myelin-sensitive immune cells during and after infections with childhood viruses such as Epstein-Barr. To me, this is by far the simplest and most reasonable explanation of how adequate vitamin D ensures MS does not develop in later life.
Perhaps the most important paper on vitamin D published in 2007 did not address MS but cancer. Lappe et al convincingly demonstrated with a 4 year, double blind, clinical trial involving over 1000 post-menopausal women that supplementing with 1000 IU of vitamin D reduced all-cancer risk by a very impressive 60%. One can only wonder what the result would have been with an adequate supplement of 4000-5000 IU. In terms of MS, cancer prevention is a welcome “side effect” of maintaining adequate vitamin D levels
The last publications I’ll mention deal with safety issues. A study by Hathcock et al provided clear evidence that an intake of 10,000 IU of vitamin D per day is perfectly safe and that such an amount should be adopted as the safe upper limit for vitamin D intake. Kimball et al showed that up to 40,000 IU a day did not result in any adverse side effects.
Given all the evidence which ties vitamin D to MS onset and progression and the recent data on the safety of 10,000 and perhaps as much as 40,000 IU/d, I would strongly recommend persons with MS consider using 6000 IU/d as an adequate supplement. This will ensure their circulating 25D level will always be in the 125 -200 nmol/l range and such a level may well have significant benefit. Furthermore I would recommend that all first degree relatives of persons with MS maintain a 25D level of at least 100 nmol/l and preferably closer to 150 nmol/l.
Ashton Embry PhD
Vitamin D Supplementation in the Fight Against MS(cont’d).
The Vitamin D Pandemic and its Health Consequences
Presented by Michael Holick, PhD, MD, Professor of medicine, physiology and biophysics and director of the General Clinical Research Center at Boston University Medical Center. (Keynote address at the opening ceremony of the 34th European Symposium on Calcified Tissues, Copenhagen 5 May, 2007)
Prospects for Vitamin D Nutrition
Presented by Rheinhold Veith, associate professor of nutritional sciences and pathobiology and laboratory medicine, University of Toronto.
Relevant Research Papers
Diagnosis and Treatment of Vitamin D Deficiency
JJ Cannell , BW Hollis, M Zasloff & RP Heaney
Atascadero State Hospital, 10333 El Camino Real, Atascadero, California 93422, USA
Ascherio A, Munger KL., 2007, Environmental risk factors for multiple sclerosis. Part II: Noninfectious factors. Ann Neurol. 61(6):504-13.
Giovannoni G, Ebers G., 2007, Multiple sclerosis: the environment and causation.
Curr Opin Neurol; 20(3):261-8.
Hathcock JN, Shao A, Vieth R, Heaney R., 2007, Risk assessment for vitamin D.
Am J Clin Nutr 85(1):6-18.
Holmøy T., 2008, Vitamin D status modulates the immune response to Epstein Barr virus: Synergistic effect of risk factors in multiple sclerosis.
Islam T, Gauderman WJ, Cozen W, Mack TM., 2007, Childhood sun exposure influences risk of multiple sclerosis in monozygotic twins. Neurology. 69(4):381-8.
Kampman MT, Wilsgaard T, Mellgren SI., 2007, Outdoor activities and diet in childhood and adolescence relate to MS risk above the Arctic Circle. J Neurol. 254(4):471-7.
Kimball SM, Ursell MR, O'Connor P, Vieth R., 2007, Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr. 86(3):645-51.
Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP., 2007, Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 85(6):1586-91.
Munger KL, Levin LI, Hollis BW, Howard NS, Ascherio A., 2006, Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA.296(23):2832-8.
Soilu-Hanninen M, Laaksonen M, Laitinen I, Eralinna JP, Lilius EM, Mononen I., 2007, A longitudinal study of serum 25-hydroxyvitamin D and intact PTH levels indicate the importance of vitamin D and calcium homeostasis regulation in multiple sclerosis.
J Neurol Neurosurg Psychiatry.
Van der Mei IA, Ponsonby AL, Dwyer T, Blizzard L, Taylor BV, Kilpatrick T, Butzkueven H, McMichael AJ., 2007, Vitamin D levels in people with multiple sclerosis and community controls in Tasmania, Australia. J Neurol. 254(5):581-90
Vieth R., 1999, Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety. Am J Clin Nutr. 69(5):842-56.
Vukusic S, Van Bockstael V, Gosselin S, Confavreux C., 2007, Regional variations in the prevalence of multiple sclerosis in French farmers. J Neurol Neurosurg Psychiatry. 78(7):707-9.
Woolmore JA, Stone M, Pye EM, Partridge JM, Boggild M, Young C, Jones PW, Fryer AA, Hawkins CP, Strange RC., 2007, Studies of associations between disability in multiple sclerosis, skin type, gender and ultraviolet radiation. Mult Scler.13(3):369-75.
Vitamin D Supplementation in the Fight Against MS.
Practical Information Sheet – Issue 1(Jan 2008)
Introduction: The most reliable indicator of circulating vitamin D levels is the 25(OH)D test and regular testing of this, both before and during supplementation, is essential.
The key is to ensure a level of circulating vitamin D - 25(OH)D - of between 125 and 150nmol/l which is considered to be the optimum range to maintain good health and to reduce the risk of autoimmune reactions developing into full-blown autoimmune disease.
The advised procedure is this.
1. Arrange for a 25(OH)D blood test at your doctors before beginning supplementation. You will need to obtain your GP's continued support for this and, in the circumstances, it would seem advisable to show him/her the attached letter(Jan 2008), with the very latest research linking MS with vitamin D deficiency. Indeed, it would make sense to send this to the surgery, marked for the attention of your GP, a few days in advance of your appointment to allow time to peruse both the online presentations and the latest paper by Cannell et al.
2. In the UK, this test should be available free of charge from your GP although some group members have had to pay a nominal fee in the past so don't be surprised if this is the case.
3. Make sure they order the correct test. It is the 25(OH)D test, NOT the 1,25(OH)D test.
4. Be warned, it can take several weeks to obtain the results and, as mentioned previously, you should also have your serum calcium levels checked at the same time and these should remain in the range 2.2-2.6 nmols/L, at all times, to ensure hypercalcemia does not develop.
5. When the results are back, make sure they give you the actual figures. You will need this to compare with future readings. The aim is to raise your levels to the range 125-150 nmols/L as quickly as possible and, as a starting point, the current advice is to use a daily supplement of 2000iu in summer and 4000iu in winter.
6. Different labs can use different units and while many will give the results in nmols/L, just as many will quote ng/ml(nanogramms per millilitre) but there is a simple conversion factor between the two. When the figures are given in the latter units, just multiply by 2.5 to convert to nmols/L. (Please note that ug/l and pg/ul are the same as ng/ml and, as such, the same conversion factor applies.)
7. We would ask that you remember to record your 25(OH)D and serum calcium test results on our website, as part of our online BBD Questionnaire(s). [Available March 2008] If you do not have internet access, just call (0)800 783 0518 and the MSRC staff will do this on your behalf.
8. It is essential(to prevent osteoporosis), that while supplementing with vitamin D3(cholecalciferol), you have an adequate intake of calcium/magnesium. If you are avoiding dairy(Best Bet Diet) you must also supplement with 1200mg essential calcium and 600-1200mg magnesium.
9. If you have children and intend to use vitamin D as a protection against them developing the condition, it is important to discuss this with your doctor as well and have their levels of 25(OH)D and serum calcium checked BEFORE starting the process.
10. Once again, we would ask that you let us know their figures for our study.