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Posted: Mon Jul 07, 2008 7:27 pm Post subject: Vitamin D Supplementation in the Fight Against MS
Below is an article writen by Ashton Embry for the New Pathwaysmagazine's January, 2008 edition.
Cheers
Nick
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.
Vitamin D Supplementation in the Fight Against MS(cont’d).
Online Presentations.
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)
http://www.vitamind-holick.ms-diet.org/
Prospects for Vitamin D Nutrition
Presented by Rheinhold Veith, associate professor of nutritional sciences and pathobiology and laboratory medicine, University of Toronto.
http://www.vitamind-veith.ms-diet.org/
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
http://www.vitamind-cannell.ms-diet.org
References
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.
Med Hypotheses.70(1):66-
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.
Posted: Tue Jul 08, 2008 3:39 am Post subject: Re: Vitamin D supplementation in the fight against MS
Hi Nick,
Thanks for sharing this article.
Quote:
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.
This quote makes me wonder what vitamin D may or may not do for other autoimmune diseases?
Posted: Tue Jul 08, 2008 8:30 am Post subject: Re: Vitamin D supplementation in the fight against MS
NHE wrote:
Hi Nick,
Thanks for sharing this article.
Quote:
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.
This quote makes me wonder what vitamin D may or may not do for other autoimmune diseases?
NHE
N
I believe vitamin D is the common denominator to most if not all of the AI disorders. For instance Hypponen et al demonstrated that infants given 2,000 IU/d via CLO for the first year of life had a risk reduction of 80 % for type 1 diabetes.
Joined: Sep 11, 2007 Posts: 662 Location: southern California
Posted: Tue Jul 08, 2008 12:50 pm Post subject:
Thanks for all the info, Nick.
I really appreciate your posts.
I began giving my 13 yr. old son vitamin D supplements when my husband was dx last year. This, and lots of so cal sunshine, should help protect his immune system.
My husband grew up in California, and spent alot of time outside in the sun. (He has the basal cells to prove it.) His serum vit. D levels are normal with supplementation. I continue to wonder if there is something interfering with vit D production and absorption in MSers. Perhaps a melanin disorder, cholesterol or liver problem? Could vit. D depletion be part of the autoimmune disease process?
AC _________________ Husband diagnosed RRMS March 2007
pursuing endothelial healing
Copaxone, Swank, supplements, laughter
Thanks for all the info, Nick.
I really appreciate your posts.
I began giving my 13 yr. old son vitamin D supplements when my husband was dx last year. This, and lots of so cal sunshine, should help protect his immune system.
My husband grew up in California, and spent alot of time outside in the sun. (He has the basal cells to prove it.) His serum vit. D levels are normal with supplementation. I continue to wonder if there is something interfering with vit D production and absorption in MSers. Perhaps a melanin disorder, cholesterol or liver problem? Could vit. D depletion be part of the autoimmune disease process?
AC
Hi AC
I'm glad someone does
You mention your man's levels are normal. Normal by what standards? A GP's or an evolutionary or immunoregulatory standard? The only way to pass judgement is to know what his actual measured serum concentration is. Which doesn't necessarily speak for his historical levels.
I agree that as a longtime resident of California he probably had ample opportunity for sun exposure and you say he did spend a lot of time outside so he is an unlikely candidate to develop MS (or any other AI disease for that matter). Yet there could still have been opportunites in his past to have had sub optimal levels of vitamin D.
His history of sun exposure probably endowed him with advantages though, such as a later age of MS diagnosis implying a immunosuppressive advantage, the status of his disease progression and degree of disabilty etc. Can you comment on this factors please?
To my knowledge a malfunction of his ability to produce vitamin D is possible though not probable. The higher his cholesterol the better for producing vitamin D so he would have to have very low cholesterol for it to be an issue. Again possible though not probable. Ditto with the liver although vitamin D is also produced elsewhere throughout the body. I guess your guy is just... lucky, as in bad luck.
Joined: Sep 11, 2007 Posts: 662 Location: southern California
Posted: Wed Jul 09, 2008 4:41 pm Post subject:
Hi Nick-
Jeff was diagnosed last year. He has 20 lesions in his brain (mostly corpus callosum) and one on his cervical spine. He has not progressed since his first attack, however he has terrible residual fatigue, muscle spasms and leg pain since that attack. I believe he has had MS most of his adult life, which first manifested as depression in his late twenties. He is now 45 years old.
I began his vitamin D supplementation and many other supplements the first week after his diagnosis. Here's his story, and the program I put together for him:
http://www.thisisms.com/ftopict-4975.html
He lived in Rochester, NY and New York City six years during his late teens and early twenties- when we were in college and starting our careers, and I'm sure his vitamin D levels were low then. Lots of snow, not much sun. His GP says his serum levels of vit. D are high normal now, but I don't have the numbers in front of me.
Thanks for all you're doing to help the cause. I read many of your posts while putting together Jeff's program.
all the best,
the Aging Cheerleader _________________ Husband diagnosed RRMS March 2007
pursuing endothelial healing
Copaxone, Swank, supplements, laughter
Wow, I can see who wears the pants in your household .... and who tells him when to take them off and put them on. Bravo for your proactive actions.
There are two points I'd like to comment on.
You write that Jeff has residual fatigue and don't state his dietary regime includes a prohibition of gluten. Is it accurate to say he still consumes gluten containg products, even if it is non-white flour?
Ron Hoggan believes partly digested proteins, called peptides, can pass through the intestinal wall, and into the circulation. In gliadin (i.e. gluten) there are five distinct peptides, all of which have been shown to be both psychoactive and to bind to opioid receptors in the brain. He believes this accounts for the overrepresentation of pshychiatric disorders (e.g. depression, schizophrenia) in celiacs and could account for such phenomena in MS as brain fog and fatigue.
Anecdotally, one of the first improvements I noticed after embracing diet revision was the markedly reduced/elimination of my consistently overwhelming fatigue.
Joined: Sep 11, 2007 Posts: 662 Location: southern California
Posted: Thu Jul 10, 2008 1:13 pm Post subject:
Ha! No pants, here. I wear the apron. Since I'm chief cook and bottle washer in the family, Jeff lets me dictate nutrition. He trusts me to help him navigate this disease, as he truly does not have the time to. He's currently working on three TV shows and one film. He's taking control of his MS, by following the program I've spent hours and hours researching. We're a good team.
Jeff's been off gluten for years, first for weight maintenance, now for his MS diet. He also has been off simple carbohydrates...no pasta, bread, potatoes, sweets for at least ten years. He likes staying slender. Ah, vanity! I sometimes make side dishes of brown rice or pasta for myself and son, but Jeff does not indulge. His only carbs are veggies and some fruits. He even gave up wine
I'm glad the gluten free diet helped your fatigue...you're absolutely right about the peptides.
I attribute Jeff's fatigue to the location of his lesions...the corpus callosum connects the left and right hemispheres of his brain, and is in constant use as he composes music. His neuro couldn't believe his lack of disability after studying his MRI. He's rerouted his brain...would be a good case study for Oliver Sacks! Also, he does not sleep soundly, since his spasms continually kick him out of deep sleep. He's never truly rested, poor man.
Thanks for the personal input...nothing like having the internet to bounce around ideas across the continents. I truly believe the vit. D , diet, and supplements will allow Jeff many more years of healthy, productive living...and will benefit many others.
best,
the pantless cheerleader _________________ Husband diagnosed RRMS March 2007
pursuing endothelial healing
Copaxone, Swank, supplements, laughter
Cheer there are some proteins called heat sock proteins.
They regulate partly the way fatique comes and affect the body some hours after meals usualy with high ambients so if MSers eat frequently foods that contain them they are more prone to fatique in hot climates than other people, by the way bread is a big source of those proteins.
"Heat shock proteins (HSPs), also called stress proteins, are a group of proteins that are present in all cells in all life forms. They are induced when a cell undergoes various types of environmental stresses like heat, cold and oxygen deprivation."
The weather is quite warm in southern California now, and Jeff feels the fatigue most in the afternoon, after working for several hours. He takes a short "siesta" and feels better, but he wold love to get his energy levels up. He doesn't eat any bread or gluten and wheat products at all. He eats mostly fish, eggs, salads, veggies, fruits, nuts and chicken.
Keeping him cool seems to help a bit-
best,
AC _________________ Husband diagnosed RRMS March 2007
pursuing endothelial healing
Copaxone, Swank, supplements, laughter
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