This Is MS Multiple Sclerosis Community: Knowledge & Support

I'm no expert on this, but I have one comment. In terms of dosage, the tolerable upper intake level is 2000iu in North America and the EU (don't know about the rest of the world). That level is based on the authorities agreeing that it is safe. In the EU's study to determine that level, I think they looked at every study done on vit D consumption and found that there were a very small number of subjects in one study who experienced toxicity at 4000iu, so they made their upper level half of that, just to be safe. I think the Direct-MS folks take issue with some of the studies used to arrive at 2000iu, but I'm not educated enough to comment.

Anyway, I feel completely safe taking 2000iu myself.

Thanks to you all for your comments on dosage.

I'll start with the facts - I am no expert either!

So I rely on the facts from experts. Patrick Holfold - who I respect as a nutritionist, quotes in his Bible that, as Lisa said, vitamin D is the most likely to give toxic reactions. He says it encourages calcium absorption and can lead to calcification of soft tissue. He does add that levels likely to create this are in excess of 3,000mcg, and more like 15,000mcg. He says a daily intake of should not exceed 6,600mcg for adults and 330mcg for children.


This does not compare with the 100mcg = 4000 IU I am taking!!

However, I will double check this - and probably see a nutritionist, since I am aware it may not be a simple as a book reads. The last time I was tested - about 6 months ago - my B12 and Vitamin D levels were extremely low.

Thanks
J.

Jaded, 4000iu is perfectly fine. I have been taking it daily for getting on for two and a half years now with absolutely no ill effects. Having said that, many people would say it is way too much. Not so, since if you live in Sub Saharan Africa you can easily take in 7000iu just by walking down the High Street.....Sarah

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An Itinerary in Light and Shadow Completed Dr Charles Stratton / Dr David Wheldon abx regime for aggressive secondary progressive MS in June 2007, after four years. Still improving with no relapses since starting. Can't run but can paint all day.

Thanks for the reasurance Sarah.

J.

Here is something that might be helpful, an abstract by Vieth et al. 2004. This paper also supports the 4000 IU dose as safe.

Abstract copied below, link to full-text here:

http://www.pubmedcentral.gov/articleren ... d=15260882


^^^^^^^^
Nutr J. 2004 Jul 19;3:8.
Randomized comparison of the effects of the vitamin D3 adequate intake versus 100 mcg (4000 IU) per day on biochemical responses and the wellbeing of patients.

Vieth R, Kimball S, Hu A, Walfish PG.

Department of Laboratory Medicine and Pathology, University of Toronto, Canada. rvieth@mtsinai.on.ca

BACKGROUND: For adults, vitamin D intake of 100 mcg (4000 IU)/day is physiologic and safe. The adequate intake (AI) for older adults is 15 mcg (600 IU)/day, but there has been no report focusing on use of this dose. METHODS: We compared effects of these doses on biochemical responses and sense of wellbeing in a blinded, randomized trial. In Study 1, 64 outpatients (recruited if summer 2001 25(OH)D <61 nmol/L) were given 15 or 100 mcg/day vitamin D in December 2001. Biochemical responses were followed at subsequent visits that were part of clinical care; 37 patients completed a wellbeing questionnaire in December 2001 and February 2002. Subjects for Study 2 were recruited if their 25(OH)D was <51 nmol/L in summer 2001. 66 outpatients were given vitamin D; 51 completed a wellbeing questionnaire in both December 2002 and February 2003. RESULTS: In Study 1, basal summer 25-hydroxyvitamin D [25(OH)D] averaged 48 +/- 9 (SD) nmol/L. Supplementation for more than 6 months produced mean 25(OH)D levels of 79 +/- 30 nmol/L for the 15 mcg/day group, and 112 +/- 41 nmol/L for the 100 mcg/day group. Both doses lowered plasma parathyroid hormone with no effect on plasma calcium. Between December and February, wellbeing score improved more for the 100-mcg/day group than for the lower-dosed group (1-tail Mann-Whitney p = 0.036). In Study 2, 25(OH)D averaged 39 +/- 9 nmol/L, and winter wellbeing scores improved with both doses of vitamin D (two-tail p < 0.001). CONCLUSION: The highest AI for vitamin D brought summertime 25(OH)D to >40 nmol/L, lowered PTH, and its use was associated with improved wellbeing. The 100 mcg/day dose produced greater responses. Since it was ethically necessary to provide a meaningful dose of vitamin D to these insufficient patients, we cannot rule out a placebo wellbeing response, particularly for those on the lower dose. This work confirms the safety and efficacy of both 15 and 100 mcg/day vitamin D3 in patients who needed additional vitamin D.

PMID: 15260882 [PubMed]
^^^^^^^^^^^

Dr. Vieth is a major researcher into Vitamin D and has published a lot on VItamin D, and has painstakingly gone back to the roots of the doses associated with toxicity and found that much of the concern about potential toxicity of vitamin D at lower doses are unfounded. It IS toxic at high doses as mentioned already by Jaded, but as can be seen in this study, 4000 IU for six months did not cause any problems in the adult subjects.

Now that it is winter, I would personally go up to 4000 IU, but not higher, and I plan on increasing gradually to let my PTH adjust down if it needs to.

I'm not an endocrine expert, but I suspect that in people whose Vitamin D levels are so low they actually have secondary hyperparathyroidism, a sudden big jolt in Vitamin D intake might cause a transient jump in plasma calcium until PTH adjusts down in response to improved Vitamin D levels. An endocrinologist would know the answer to that! If someone knows one, please ask for me!

Lisa

Another article about sunshine / Vit D and possible protection againt MS.

http://c.moreover.com/click/here.pl?j444965538&w=464753


Think of me tomorrow as I hit the beaches of southern Spain (no suntan cream)! I'll spare a thought for all you Canadians stuck in front of you fires as the blizzards rage outside.

Ian

Ian,

Have a safe journey and a super time. Get that Vitamin D topped up and see you back on this board soon!


J.

I mentioned my vitamin D supplementation to my GP and he didn't seem to think 4000 IU would be a problem at all. However, he did add that since Vit D is stored in fat, many people have trouble losing weight when taking the supplement. I find this very puzzling, as many vitamins are stored in fat, but don't necessarily affect the body's ability to burn fat. I have also never read anything about Vitamin D and it's hinderance of fat burning.


Has anyone ever heard this or is this doc just misinformed?

I'd be interested to see what he has based a weight gain on Vitamin D on. It doesn't make sense and I can't find anything on it. Sorry but I think he got confused. My opinion only

Again, vitamin D seems to be very important but we don’t know yet what the mechanism is or how it relates to environment and individual biochemistry — but there may be a correlation between rising rates of obesity and vitamin D deficiency. If you are having difficulty with weight gain — or can’t keep the pounds off once you lose them — you may want to have your vitamin D levels checked by your healthcare practitioner.

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Maybe it is I that is misinformed not the Doctor. Did some more digging

What's the connection?
Just how does calcium help in weight reduction? A possible rationale for the relationship between body weight and calcium is the effect calcium has on the body's energy metabolism.

When your calcium levels are low, a hormone called parathyroid hormone (PTH) and vitamin D increase in response to the low level of calcium. High levels of PTH and vitamin D are also seen during food shortage. In this starvation mode, your body will absorb and store more energy for later use.

Therefore, if your calcium levels are consistently low, the elevated levels of PTH and vitamin D may trick your body into thinking you are starving. As a result, you may store more energy in the form of fat and gain more weight.
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John was diagnosed Jan 2005. On lipitor 20mg .On Copaxone since July 4,2005. Vitamin D3 2000iu-4000iu (depending on sunshine months)June 10 2005(RX::Dr. O'Connor) Omega 3 as well Turmeric since April 2005. Q10 60mg. 1500mg liquid Glucosamine Nov 2005.

An interesting paper on sunshine, Vit D and autoimmune disease.

Highlight:

But as always it seems


Link : http://phot.allenpress.com/pdfserv/10.1562%2F2005-02-15-IR-441

_________________
John
I am what I am

I remember that Dignan reported somewhere in the drug pipeline that vitamin D is undergoing a trial in MS patients in Toronto. I wonder if there are any updates on that.

Lisa

i take approx 4000IU of D per day. have not had my levels tested yet - it's in the works. my doc at the ms clinic looked at my vitamin list and he agreed with the D. don't think he cared much about the rest of it tho!

hi turns out that my serum 25-hydroxy-vitamin d was 72 nmol/l. after what turned out to be just over 3400 IU per day from supplements for over 90 days, plus some dietary from fish (approx 2x per week) and recent addition of egg 2x per week for the last two weeks.

the docs say my target serum d should be 125-150 nmol/l. so, a long way to go. liver and renal function are fine therefore i am able to hydroxylate to calcitriol properly. it's just a matter of getting more in i suppose!

Clin Lab Med. 2000 Sep;20(3):569-90.
Calcium and vitamin D. Diagnostics and therapeutics.
Holick MF.
Department of Medicine, Boston University School of Medicine, Massachusetts, USA.

Vitamin D is neither a vitamin nor a nutrient if adequate exposure to sunlight is available to produce adequate quantities of vitamin D3 in the skin. It is well known that an adequate supply of vitamin D, either from the diet or from the skin, is important for maximum bone health throughout life. The new revelation that 25(OH)D can be metabolized to 1,25(OH)2D in the colon, prostate, and skin opens a new chapter in the vitamin D story. It is quite possible that there are two levels of vitamin D sufficiency. One level requires that the serum 25(OH)D levels be at least 20 ng/mL to satisfy the body's requirement for the renal production of 1,25(OH)2D that regulates calcium absorption, and bone calcium mobilization and bone mineralization. The second level may need higher circulating levels of 25(OH)D for maximum cellular health because of the conversion of 25(OH)D to 1,25(OH)2D in extrarenal tissues, such as the prostate, colon, and skin.

American Journal of Clinical Nutrition, Vol. 69, No. 5, 842-856, May 1999
© 1999 American Society for Clinical Nutrition
Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety1,2
Reinhold Vieth

For adults, the 5-µg (200 IU) vitamin D recommended dietary allowance may prevent osteomalacia in the absence of sunlight, but more is needed to help prevent osteoporosis and secondary hyperparathyroidism. Other benefits of vitamin D supplementation are implicated epidemiologically: prevention of some cancers, osteoarthritis progression, multiple sclerosis, and hypertension.

Total-body sun exposure easily provides the equivalent of 250 µg (10000 IU) vitamin D/d, suggesting that this is a physiologic limit. Sailors in US submarines are deprived of environmentally acquired vitamin D equivalent to 20–50 µg (800–2000 IU)/d. The assembled data from many vitamin D supplementation studies reveal a curve for vitamin D dose versus serum 25-hydroxyvitamin D
[25(OH)D] response that is surprisingly flat up to 250 µg (10000 IU) vitamin D/d. To ensure that serum 25(OH)D concentrations exceed 100 nmol/L, a total vitamin D supply of 100 µg (4000 IU)/d is required. Except in those with conditions causing hypersensitivity, there is no evidence of adverse effects with serum 25(OH)D concentrations <140 nmol/L, which require a total vitamin D supply of 250 µg (10000 IU)/d to attain. Published cases of vitamin D toxicity with hypercalcemia, for which the 25(OH)D concentration and vitamin D dose are known, all involve intake of 1000 µg (40000 IU)/d. Because vitamin D is potentially toxic, intake of >25 µg (1000 IU)/d has been avoided even though the weight of evidence shows that the currently accepted, no observed adverse effect limit of 50 µg (2000 IU)/d is too low by at least 5-fold.

American Journal of Clinical Nutrition, Vol. 80, No. 6, 1706S-1709S, December 2004
© 2004 American Society for Clinical Nutrition
VITAMIN D AND HEALTH IN THE 21ST CENTURY: BONE AND BEYOND
Functional indices of vitamin D status and ramifications of vitamin D deficiency1,2,3,4
Robert P Heaney
1 From Creighton University Medical Center, Omaha

Serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations are currently recognized as the functional status indicator for vitamin D. Evidence is reviewed that shows that serum 25(OH)D3 concentrations of < 80 nmol/L are associated with reduced calcium absorption, osteoporosis, and increased fracture risk. For typical older individuals, supplemental oral intakes of 1300 IU/d are required to reach the lower end of the optimal range. Evidence of substantial problems in routine clinical measurement of serum 25(OH)D3 concentrations among patients is cited. There is great need for standardization and improved reproducibility and sensitivity of measurements of serum 25(OH)D3 concentrations.

Medscape (WebMD)
Vitamin D Linked With Neuromuscular Performance in the Elderly
Linda Little

Sept. 28, 2005 (Nashville) — Low serum levels of vitamin D in the body may make elderly persons more susceptible to falls, Netherlands researchers reported here at the American Society of Mineral and Bone Research (ASBMR) 27th annual meeting.

"Low levels of vitamin D were associated with low physical performance," said Ilse Wicherts, a doctorate student at Vu University Medical Center in Amsterdam, the Netherlands. "This study shows that neuromuscular performance in those with lower levels of vitamin D was significantly lower than those with adequate levels.

"These individuals already are fragile," added Ms. Wicherts, the winner of an ASMBR Young Investigator Award. "The lack of mobility places them at high risk of falls and fractures."

In the study 1,238 men and women (mean age, 75 years) by Ms. Wicherts and colleagues, a low serum level of vitamin D was associated with lower neuromuscular performance. The study was undertaken within the framework of the Longitudinal Aging Study Amsterdam (LASA).

Neuromuscular performance was measured by five chair stands for muscle strength, a walking test for balance, and tandem stand testing coordination and mobility where participants must stand with one foot in front of the other. Each performance test was scored in seconds and was classified with scores from 1 to 4 according to quartiles of distribution. The total performance score for muscle strength and balance ranged from 0 to 12. The researchers used a multivariate regression analysis adjusted for age, sex, and body mass index.

Eleven percent of the participants had serum vitamin D levels less than 25 nmol/L, 37% had levels between 25 and 50 nmol/L, 33% had levels between 50 and 75 nmol/L, and 17% had levels of 75 nmol/L or above.

Scores for chair stands, the walking test, and tandem stand each showed significant improvement with increased serum levels of vitamin D.

Participants with vitamin D at 25 nmol/L had a performance score of 4.9 while those with vitamin D levels between 25 and 50 nmol/L had scores of 6.82 and those with levels between 50 and 75 nmol/L had scores of 8.10. Participants with vitamin D levels of 75 nmol/L or higher had performance scores of 8.72.

"There was a linear progression," Ms. Wicherts said. "The change in performance scores with increasing serum 25(OH)D was significant for all steps."

When researchers adjusted for age, sex, body mass index, smoking, and alcohol consumption, the performance score increased significantly with serum vitamin D levels up to 50 nmol/L.

Performance was reduced 18% if the vitamin D levels were lower than 25 nmol/L compared with participants with levels of 75 nmol/L or higher and 5% if vitamin D levels were between 25 and 50 nmol/L after adjusting for other risk factors, Ms. Wicherts said.

"Persons with low serum vitamin D levels had a higher risk for low physical performance," Ms. Wiecherts told Medscape. "The strongest effects were found in persons with a major deficiency."

"This is a very important study because it suggests that vitamin D is not only important for bone health, but is important in neuromuscular stability," said Elizabeth Shane, MD, president-elect of ASBMR. "Bone fracture is due to not only bone issues, but issues contributing to falls.

"There is a two-pronged effect here that can increase the propensity for fractures in the elderly," Dr. Shane said. "Adequate Vitamin D can aid in improving muscle strength and preventing falls in this older age group."

ASBMR 27th Annual Meeting: Abstract 1134. Presented September 26, 2005.
Reviewed by Gary D. Vogin, MD

Vitamin D: a natural inhibitor of multiple sclerosis
Author: Hayes C.E.
Source: Proceedings of the Nutrition Society, Volume 59, Number 4, November 2000, pp.
531-535(5)
Publisher: CABI Publishing

Abstract
Inheriting genetic risk factors for multiple sclerosis (MS) is not sufficient to cause this demyelinating disease of the central nervous system; exposure to environmental risk factors is also required. MS may be preventable if these unidentified environmental factors can be avoided. MS prevalence increases with decreasing solar radiation, suggesting that sunlight may be protective in MS. Since the vitamin D endocrine system is exquisitely responsive to sunlight, and MS prevalence is highest where environmental supplies of vitamin D are lowest, we have proposed that the hormone, 1,25-dihydroxycholecalciferol (1,25-(OH)2D3), may protect genetically-susceptible individuals from developing MS. Evidence consistent with this hypothesis comes not only from geographic studies, but also genetic and biological studies. Over-representation of the vitamin D receptor gene b allele was found in Japanese MS patients, suggesting it may confer MS susceptibility. Fish oil is an excellent vitamin D source, and diets rich in fish may lower MS prevalence or severity. Vitamin D deficiency afflicts most MS patients, as demonstrated by their low bone mass and high fracture rates. However, the clearest evidence that vitamin D may be a natural inhibitor of MS comes from experiments with experimental autoimmune encephalomyelitis (EAE), a model of MS. Treatment of mice with 1,25-(OH)2D3 completely inhibited EAE induction and progression. The hormone stimulated the synthesis of two anti-encephalitogenic cytokines, interleukin 4 and transforming growth factor -1, and influenced inflammatory cell trafficking or apoptosis. If vitamin D is a natural inhibitor of MS, providing supplemental vitamin D to individuals who are at risk for MS would be advisable.

Vitamin D nutrition and multiple sclerosis
If vitamin D is a natural inhibitor of MS, it would be reasonable to provide supplemental vitamin D to individuals who are at risk for MS. It is noteworthy that vitamin D supplementation during childhood significantly decreased the risk of type I diabetes mellitus, an autoimmune disease (EURODIAB Substudy 2 Study Group, 1999). A reassessment of vitamin D nutrition is underway, and there is good evidence that the currently recommended adequate intakes are too low (Vieth, 1999). The adequate intake for adults is currently 5 mg/d, but this does not prevent osteoporosis and secondary hyperparathyroidism (Holick, 1998; Malabanan et al. 1998). To prevent secondary hyperparathyroidism a serum 25-hydroxycholecalciferol concentration › 50 nmol/l is required (Malabanan et al. 1998). Adults living or working in sunny environments, where MS prevalence is lowest, have circulating 25-hydroxycholecalciferol levels between 105 and 163 nmol/l (Vieth, 1999).

Thus, a serum 25-hydroxycholecalciferol concentration >= 100 nmol/l may be optimal to prevent MS. To maintain serum 25-hydroxycholecalciferol at approximately 100 nmol/l an adult who is not exposed to sunlight would need to ingest 100 mg/d (Vieth, 1999). This estimate is between the 95 mg/d that Goldberg (1974b) calculated might prevent MS, and the 125mg/d that was given in the small clinical trial of fish oil (Goldberg et al. 1986).

J Nutr. 2005 Nov;135(11):2739S-48S.
The vitamin D epidemic and its health consequences.
Holick MF.
Boston University School of Medicine, Department of Medicine, Section of Endocrinology, Vitamin D Laboratory, Boston, MA 02118, USA. mfholick@bu.edu

Vitamin D deficiency is now recognized as an epidemic in the United States. The major source of vitamin D for both children and adults is from sensible sun exposure. In the absence of sun exposure 1000 IU of cholecalciferol is required daily for both children and adults. Vitamin D deficiency causes poor mineralization of the collagen matrix in young children's bones leading to growth retardation and bone deformities known as rickets. In adults, vitamin D deficiency induces secondary hyperparathyroidism, which causes a loss of matrix and minerals, thus increasing the risk of osteoporosis and fractures. In addition, the poor mineralization of newly laid down bone matrix in adult bone results in the painful bone disease of osteomalacia. Vitamin D deficiency causes muscle weakness, increasing the risk of falling and fractures. Vitamin D deficiency also has other serious consequences on overall health and well-being. There is mounting scientific evidence that implicates vitamin D deficiency with an increased risk of type I diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and many common deadly cancers. Vigilance of one's vitamin D status by the yearly measurement of 25-hydroxyvitamin D should be part of an annual physical examination.