This Is MS Multiple Sclerosis Knowledge & Support Community

Hello Silver,

Jimmylegs is likely to able to answer the quesion better than me. There are deficencies (Zinc is important) which need to be guarded against or the absorption of Vi D is poor. Personally I take a multimineral to be sure I have everything I need in that regard. If you review the thread history you will find more details. Jimmylegs may spot your question in her admin role or you send her a pm.

MarkW

you need the copper because your body requires a healthy zinc to copper ratio. if you only supplement zinc you can drive the copper down. one example of why we need it:

"Elimination of Free Radicals

Superoxide dismutase (SOD) is a copper-dependent enzyme that catalyzes the removal of superoxide radicals from the body. Superoxide radicals are generated during normal metabolism, as well as when white blood cells attack invading bacteria and viruses (a process called phagocytosis). If not eliminated quickly, superoxide radicals cause damage to cell membranes. When copper is not present in sufficient quantities, the activity of superoxide dismutase is diminished, and the damage to cell membranes caused by superoxide radicals is increased. When functioning in this enzyme, copper works together with the mineral zinc, and it is actually the ratio of copper to zinc, rather than the absolute amount of copper or zinc alone, that helps the enzyme function properly."

when you take high dose d3 you should also take the right amount of calcium, magnesium, and zinc (balanced with copper to maintain the ratio).

in my experience multi-vitamins are so-so. i take one as a sort of substrate for a wide variety of targeted megadoses including b-complex, C, D3, vit E8 complex, magnesium, selenium, zinc/copper, and... i think that's about it oh no wait and fish oil.

From Rocky Mountain MS Center
Multiple Sclerosis and Bone Health Another Vitamin D Connection?
Dr. Timothy Vollmer

It commonly known that patients who have been long-diagnosed with multiple sclerosis (MS) are at increased risk for low bone mass, osteopenia, and osteoporosis. What has not been clear is whether this is a result of the disease, perhaps a side effect of medication or a sedentary lifestyle, or whether it is another clue to the cause of disease. A new study suggests the latter.

Researchers at Oslo University Hospital in Norway proposed that if Vitamin D exerts a major effect on MS risk, then evidence of Vitamin D deficiency should be apparent shortly after the onset of MS.

"We've known that people who have had MS for a long time are at a greater risk of low bone density and broken bones, but we didn't know whether this was happening soon after the onset of MS and if it was caused by factors such as their lack of exercise due to lack of mobility, or their medications or reduced Vitamin D from lack of sun exposure," said study author Stine Marit Moen, MD, of Oslo University Hospital Ulleval in Norway.

The study involved 99 people with an average age of 37 who were newly diagnosed with MS or clinically isolated syndrome, which means they had an episode of symptoms similar to MS but had not yet been diagnosed. All had no or minor physical disability from the disease. Study participants had BMD tests an average of 1.6 years after they had any symptoms that suggested the presence of MS.

Results revealed that 51% of those with MS had either osteoporosis or osteopenia, compared to 37% of those who did not have the disease. Even after the researchers adjusted for confounders such as smoking history and alcohol use, the results remained significant.

These results suggest that people in the early stages of MS, with their doctors, need to consider steps to prevent osteoporosis and maintain good bone health. This could include diet changes to ensure adequate Vitamin D and calcium levels and starting or increasing strength training activities.

These findings also suggest that MS and low bone mass may have a common cause, including Vitamin D insufficiency, increased activity of polypeptide regulators, and low levels of the protein osteopontin.

Thankyou Jimmy /markw for your replys a slight confusion but Jimmy I ment to say advice on Multi MINERALS and not vitiamins .

Silver

yea i meant to say multi-vitamin/mineral and they're still something i take as a foundation but do not rely on them exclusively.

i consider multis okay for maintenance/upkeep for healthy people who have a perfectly healthy diet (not necessarily that found in western national food guides). i consider multis inadequate to provide therapeutic dosing for people who have health concerns.

in your friend's case, if i had to choose a multi or nothing to go with vit d3, i would say a regular multi is better than nothing. (but i bet it doesn't provide 1000mg calcium, 600mg magnesium, and 25-50mg zinc per day!)

My advice remains:
PwMS should take 5 to 10,000 IU a day of D3. It is safe for adults.
Target range for pwMS is 100 to 150 nmol/L of 25-hydroxyvitamin D in blood (measure in Feb-Mar not Aus/NZ).
I post recent research, just in case someone says you are over dosing with Vit D3. Please note this is not directly applicable to pwMS.
MarkW

Curr Opin Clin Nutr Metab Care. 2011 Nov;14(6):598-604.
Short-term and long-term consequences and concerns regarding valid assessment of vitamin D deficiency: comparison of recent food supplementation and clinical guidance reports.
Hollis BW.
Medical University of South Carolina, Charleston, South Carolina, USA.
Abstract
PURPOSE OF REVIEW:
The function and use of vitamin D supplementation has become very controversial. This review attempts to provide a balanced perspective with respect to the experimental findings published in the past 18 months.
RECENT FINDINGS:
The recent contrasts between the Institute of Medicine (IOM) report and the Endocrine Societies report have caused great confusion with respect to the dietary requirement for vitamin D as well as the amount of circulating 25-hydroxyvitamin D that is desirable. Much recent data contradict the suggestions of the IOM report with respect to vitamin D's role in chronic disease such as cancer, cardiovascular function, immune function and autoimmune ailments such as multiple sclerosis.
SUMMARY:
Controversy regarding supplementation with vitamin D is fueled by the different purposes of the IOM (guidance for food fortification and not to individualized patient care) and the Endocrine Societies (patient care) reports. Healthcare providers should formulate their own opinions with respect to vitamin D as it pertains to the care of their patient.
PMID: 21934610

Bumped for masci.

That 'useful' neuro journal publishes the reasons why you should not take vit D2.
Reading TiMS would give you the answer and if you want lots of info ask Jimmylegs and she will educate you. Tell your neuro 'I take D3 not D2 for the long term, if challenged'.
MarkW

Neurology. 2011 Oct 25;77(17):1611-8.
A randomized trial of high-dose vitamin D2 in relapsing-remitting multiple sclerosis.
Stein MS, Liu Y, Gray OM, Baker JE, Kolbe SC, Ditchfield MR, Egan GF, Mitchell PJ, Harrison LC, Butzkueven H, Kilpatrick TJ.
Source
Department of Endocrinology, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia Mark.Stein@mh.org.au.
Abstract
OBJECTIVE:
Higher latitude, lower ultraviolet exposure, and lower serum 25-hydroxyvitamin D (25OHD) correlate with higher multiple sclerosis (MS) prevalence, relapse rate, and mortality. We therefore evaluated the effects of high-dose vitamin D2 (D2) in MS.
METHODS:
Adults with clinically active relapsing-remitting MS (RRMS) were randomized to 6 months' double-blind placebo-controlled high-dose vitamin D2, 6,000 IU capsules, dose adjusted empirically aiming for a serum 25OHD 130-175 nM. All received daily low-dose (1,000 IU) D2 to prevent deficiency. Brain MRIs were performed at baseline, 4, 5, and 6 months. Primary endpoints were the cumulative number of new gadolinium-enhancing lesions and change in the total volume of T2 lesions. Secondary endpoints were Expanded Disability Status Scale (EDSS) score and relapses.
RESULTS:
Twenty-three people were randomized, of whom 19 were on established interferon or glatiramer acetate (Copaxone) treatment. Median 25OHD rose from 54 to 69 nM (low-dose D2) vs 59 to 120 nM (high-dose D2) (p = 0.002). No significant treatment differences were detected in the primary MRI endpoints. Exit EDSS, after adjustment for entry EDSS, was higher following high-dose D2 than following low-dose D2 (p = 0.05). There were 4 relapses with high-dose D2 vs none with low-dose D2 (p = 0.04).
CONCLUSION:
We did not find a therapeutic advantage in RRMS for high-dose D2 over low-dose D2 supplementation. Classification of evidence: This study provides Class I evidence that high-dose vitamin D2 (targeting 25OHD 130-175 nM), compared to low-dose supplementation (1,000 IU/d), was not effective in reducing MRI lesions in patients with RRMS.
PMID: 22025459 [PubMed - in process]

mark i think i missed answering a question you had for me waaay earlier onl as in page 1, re a serum level of 271 nmol/L. the reason i said it was dangerous is just because the risk zone for hypercalcemia starts at 250. don't know if that got covered since on the pages between now i can't find a study to support that 250 number. here is one source that mentions 375:

Vitamin D
http://www.merckmanuals.com/professiona ... =&sc=&alt=
A history of excessive vitamin D intake may be the only clue differentiating vitamin D toxicity from other causes of hypercalcemia. Elevated serum Ca levels of 12 to 16 mg/dL (3 to 4 mmol/L) are a constant finding when toxic symptoms occur. Serum 25(OH)D levels are usually elevated >150 ng/mL (>375 nmol/L).

will keep hunting around to rediscover where i got that 250 number from.

Hello Jimmylegs,
I will not argue against a max of 250, because I cannot find a study of D3 in Sri Lankan fishermen which I think recorded 400.
My target range for pwMS is 100 to 150 nmol/L of 25-hydroxyvitamin D in blood (measured in Feb-Mar in northern hemisphere). The problem is that large numbers of the general UK population are below this range, not sure about rest of world.
No doubt you will remind readers about other essential minerals to measure (especially if D3 does not increase when taking 5,000 iu/day).
Kind regards,
MarkW

found something but i don't have full text access - this is just a snippet from a search:

Vitamin D: What is an adequate vitamin D level and how much supplementation is necessary?
H Bischoff-Ferrari - Best Practice & Research Clinical Rheumatology, 2009 - Elsevier
http://www.sciencedirect.com/science/ar ... 4209000989
"... Heaney and colleagues, in a study of healthy men, estimated that 1000 IU cholecalciferol per day are needed during winter ... in healthy outdoor workers are 135 nmol/L in farmers[47] and 163 nmol l/L in lifeguards. [48] ..."

it's great to measure magnesium and zinc when you test d3 - refractory d3 problems can be due to suboptimal zinc status. high dosing d3 can mess with your magnesium status. etc. knowledge is power

here's an oldie but a goodie. i have hard copies of some of these tables in my files from years ago:

http://www.ajcn.org/content/69/5/842.full.pdf
All of the reports of vitamin D toxicity showing the convincing evidence of hypercalcemia involve serum 25(OH)D concentrations well above 200 nmol/L ...

also

Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes
http://www.ajcn.org/content/84/1/18.short
"... As a first sign of toxicity, only serum 25(OH)D concentrations of >220 nmol/L have been associated with hypercalcemia..."

HYPOVITAMINOSIS D PREVALENCE
http://www.ishib.org/journal/ethn-15-4s5-97.pdf
"Although the level of intake at which vitamin D becomes toxic is unknown, hypercalcemia due to vitamin D intake is generally associated with serum levels of 25(OH) D3 in excess of 220 nmol/L..."

i think we may need to broaden the definition of d3 toxicity too. in addition to hypercalcemia, i think hypomagnesemia should be considered a toxic effect (of d3 supplementation specifically) also. not sure what the 25(OH)d3 to magnesium ratio needs to be for optimal health.. perhaps it's ok to just make sure serum mag stays above 0.90 mmol/L. that's where i'm at currently, anyway

I noticed an advert for Vit D home test on the TiMS banner:
http://www.vitamindproject.co.uk/?gclid ... tAodfE1bFQ
In the UK your GP should do the test free (home test is 39gbp) so that is
my testing route. Essential minerals can be tested with the same blood
sample.

MarkW

Hello Jimmylegs,
Thanks for the extra data on D3. Do you have a list essential minerals and target ranges ?? It would be useful for TiMS members.
Kind regards,
MarkW

hey no probs

re targets, sure do! see the first two links of my 'signature' below. first one provides an overview, the second includes specifics.