Hello

[jimmylegs]

hi are you sure the CRP is exactly 0.3 mg/L? any chance the units are slightly different? because this uses 3 mg/l as its cutoff

Dietary magnesium intake is inversely associated with serum C-reactive protein levels: meta-analysis and systematic review
http://www.nature.com/ejcn/journal/v68/ ... 0147a.html
A data set derived from seven cross-sectional studies including 32 918 participants was quantitatively assessed. A weighted inverse association between Mg intake and serum CRP levels was observed (β-coefficient: −0.0028; 95% confidence interval (CI), −0.0043 to −0.0013; Ptrend=0.001) from four cross-sectional studies. The pooled OR (95% CI) of having CRP greater than or equal to 3 mg/l was 1.49 (1.18–1.89) on comparing the lowest to the highest group of Mg intake from three studies with the data available. Qualitative assessment among five intervention studies also showed a potential beneficial effect of Mg intake on serum CRP levels.

This meta-analysis and systematic review indicates that dietary Mg intake is significantly and inversely associated with serum CRP levels. The potential beneficial effect of Mg intake on chronic diseases may be, at least in part, explained by inhibiting inflammation.

re LDL. last time i helped someone deal with elevated cholesterol issues specifically, it was personal real life stuff and ended up being was the impetus for going vegan in the 90s. worked short term. big mistake long term. maybe more bran and exercise???

glad you are feeling better. fwiw it's worth i don't take paracetamol or other similar pain killers - only extra one or two magnesium glycinate powder caps if it comes right down to it.

[Zyklon]

Yes I am sure it is 0.3 mg/L. Normal range is 0 to 5 mg/L. I suspect my first Rebif side effect today, the day after flu like symptoms.

I do plenty walking. Maybe little bit high mono saturated fats so I will decrease my fat intake. I had lots of cortisol treatment in the last month. The bad result may be related with it. 1 month later I will have all cholesterol related tests.

Update Liver Tests:

The only test I had before was ALT 60 U/L. 3 weeks of %20 dose.

New test is after 1 weeks of %20 and 2 weeks of %50 dose.

ALT increased to 64 U/L (I expected much more increase)
AST is 24 U/L
GGT is 50 U/L

I guess 1 liter of water after injection in two hours works for me.

[jimmylegs]

ok i misread what you had said on the last page. i thought your doc had said it was high, not that it should be *higher*. i am used to hearing about elevated CRP not depressed levels!

brushing up:
C-Reactive Protein, Inflammation, and Cardiovascular Disease
Clinical Update
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1336715/
"For high sensitivity assays of CRP or “hsCRP,” we say that less than 1 mg/L is low risk, 1 to 3 mg/L is moderate risk, and greater than 3 mg/L is high risk—that's simple enough. But the continuum extends beyond that. The patients with the very highest levels of hsCRP —5 to 10, 10 to 20, or even greater than 20 mg/L"

not sure what this contributes exactly, but here it is fwiw:

Very low C-reactive protein in apparently healthy individuals: physiological status or just a reflection of an improved health profile.
https://www.ncbi.nlm.nih.gov/pubmed/17852082
"The arbitrary cut-off point of hs-CRP (<or=0.16 mg l(-1)) was determined at the lower detection level of the assay. A total of 6588 apparently healthy individuals were screened following exclusion of recent infection/inflammation by using a detailed questionnaire. One hundred and sixty (2.4%) individuals out of the above-mentioned cohort presented hs-CRP concentrations of <or=0.16 mg l(-1). They were found to be significantly younger and lean, had an improved lipid profile and an attenuated acute-phase response in terms of lower erythrocyte sedimentation rate and fibrinogen concentration as well as white blood cell count. In addition, these individuals had less atherothrombotic risk factors..."

just looking around for causes of / issues with low CRP, nothing specific coming up so far.
https://labtestsonline.org/understandin ... /test#what
"If the CRP level is initially elevated and drops, it means that the inflammation or infection is subsiding and/or responding to treatment."

i have no idea how cortisol might affect LDL (or not). hopefully next month things are all sorted out

[Zyklon]

https://www.ncbi.nlm.nih.gov/pubmed/15350158

https://www.drugs.com/sfx/rebif-rebidos ... fects.html Lymphopenia (14%)

https://en.wikipedia.org/wiki/Lymphocytopenia Lymphocytopenia, but not idiopathic CD4+ lymphocytopenia, is associated with corticosteroid use

I just love internet, another unknown gone. My neutrophil blood level is 7.02 tho/uL (previous test 6.08 tho/uL) which is in the limits 2-7.8 tho/uL. However my lymphocyte blood level is off, 0.75 tho/uL (previous test 3.72 tho/uL, massive decrease) and normal range is 1-4 tho/uL. That explains abnormal neutrophil percentage.

So lymphopenia and first flu-like side effect today. I will visit my neurologist tomorrow and find an MS specialized dietitian soon. I see monitoring is extremely important after CIS. I will continue monthly tests for everything.

[jimmylegs]

rebif's impacts on serum nutrient levels also interest me, eg:
https://www.ncbi.nlm.nih.gov/pubmed/24713402
"positive associations between... vitamin E and chemokine (C-X-C motif) ligand 16 during interferon-β1a treatment."
and
https://link.springer.com/article/10.10 ... 4150050399
"β-Interferon increased plasma α-tocopherol levels (P < 0.001) but not the lipid corrected α-tocopherol value"

[Zyklon]

B12 increased 286 pg/mL to 540 pg/mL (maybe decrease supplement to 500mcg B12 or 1 day off)
D3 increased 14.2 ng/mL to 38.1 ng/mL (very good increase without any megadose, 10000 IU single tablet on the way)

And no urinary or respiratory infection, core temperature normal. So flu-like side effects for the first time scared me yesterday

Any recommendations for increasing phosphorus?

[NHE]

Yes I am sure it is 0.3 mg/L. Normal range is 0 to 5 mg/L. I suspect my first Rebif side effect today, the day after flu like symptoms.

I do plenty walking. Maybe little bit high mono saturated fats so I will decrease my fat intake. I had lots of cortisol treatment in the last month. The bad result may be related with it. 1 month later I will have all cholesterol related tests.

Update Liver Tests:

The only test I had before was ALT 60 U/L. 3 weeks of %20 dose.

New test is after 1 weeks of %20 and 2 weeks of %50 dose.

ALT increased to 64 U/L (I expected much more increase)
AST is 24 U/L
GGT is 50 U/L

I guess 1 liter of water after injection in two hours works for me.

I did Avonex for 10 years. I found that ibuprofen was indispensable for counter acting the side effects. Try taking 200 mg of ibuprofen at the time of your shot and then another 200 mg about 4 hours later.

[jimmylegs]

now that your b12 levels are up for sure sounds like an idea to taper. daily maintenance requirements are far lower than amounts used in a typical therapeutic megadose regimen.

same for d3. 'long term' d3 megadose studies (usually no more than 3-6 months) are not tracking all potential side effects over long enough time periods. patients are in this for life. consider dialing it back and monitoring serum levels. i would suggest keeping it in the 40 ng/ml ballpark, at least/especially until you have other factors sorted out.

i don't often hear about low phosphorus. related:
http://onlinelibrary.wiley.com/doi/10.1 ... .1856/full
"Hypocalcemia (total calcium level below 2.10 mM) and hypophosphatemia (phosphorus level below 0.9 mM) were observed in 6.2% and 14.5%, respectively, of subjects with severe hypovitaminosis D."

i wonder if improving phosphorus status would have helped boost serum d3 levels, without megadosing d3 as occurs with increased magnesium levels.

speaking of which once again, nothing in that study about magnesium. would be nice if i could find an explanation for this seeming blind spot in the research, rather than just noting the gap most of the time ... glad i have been able to find some studies that do examine this d3/mag relationship..

more phosphorus info:

daily intake recommendations 700mg (RDA) - 4000mg (upper limit) mg
http://www.hc-sc.gc.ca/fn-an/nutrition/ ... bl-eng.php

healthy food sources
http://www.whfoods.com/genpage.php?tnam ... #foodchart

[lyndacarol]

B12 increased 286 pg/mL to 540 pg/mL (maybe decrease supplement to 500mcg B12 or 1 day off)
D3 increased 14.2 ng/mL to 38.1 ng/mL (very good increase without any megadose, 10000 IU single tablet on the way)

There is no worldwide consensus on acceptable B12 levels.

In Japan, the recommended minimum level of B12 is 500 pg/mL (Jpn J. Psychiatry Neurol. 1988 Mar: 42:65-71)

In the book I recommended earlier, Could It Be B12? An Epidemic of Misdiagnoses by Sally M. Pacholok, RN, BSN, and Jeffrey J. Stuart, D.O., the authors state on page 11: “For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/mL.” http://b12awareness.org/could-it-be-b12 ... diagnoses/

Some B12 experts consider the optimal range to be 1100-1300 pg/mL

In view of these experts' opinions, 540 pg/mL is not at all excessive. In my opinion (I have no medical background), it is not necessary to decrease your supplement (but this should be discussed with your doctor).

As for vitamin D, your level of 38.1 ng/mL is approaching the minimum recommendation of GrassrootsHealth (40-60 ng/mL). Some vitamin D experts recommend a level between 70-100 ng/mL for patients with neurological symptoms.

[jimmylegs]

after sorting out cofactors i should hope.

[jimmylegs]

re https://www.ncbi.nlm.nih.gov/pubmed/3398357 i had spent some time trying to figure out 1. when and where the 500 lower end came from in 1988, and as referenced in another older letter, also 2. what any more recent updates might have been and the rationale behind them.

can't get into the full text of this and if i could, not sure i'd get anything out of it :S

[A case of subacute combined degeneration with normal serum vitamin B12 level].
[Article in Japanese]
Nagaishi A1, Takashima H, Fukuda Y, Kuroda Y.
Author information
Abstract
A 40-year-old woman was admitted to our hospital because of pancytopenia with megaloblastic anemia. Two months later she complained of rapidly progressive gait disturbance and numbness in the distal part of limbs. She also told that her hair had turned totally gray in the third decade. Neurologically, mental state, cranial nerves and cerebellar functions were normal. Superficial sensations were impaired below the lower thoracic level and deep sensations were completely lost in the lower limbs. Moderate weakness was found in the lower limbs, symmetrically. Deep tendon reflexes were diminished in the upper limbs and absent in the lower limbs. Babinski's reflex was positive bilaterally. MR images of the spinal cord showed hyperintensity in the posterior column below the thoracic cord. Although the serum level of vitamin B12 was within normal range, serum homocysteine level was elevated markedly. Under the diagnosis of subacute combined degeneration (SCD) due to possible vitamin B12 deficiency, the treatment with intravenous injections of 500 micrograms/day of mecobalamin was undertaken. Muscle strength and sensory impairment improved progressively and she became able to walk with a cane. The coloration of her gray hair was also noted. After treatment, pancytopenia and megaloblastic anemia also markedly improved. Vitamin B12 became high in serum concentration and the serum level of homocysteine became normal. These clinical and laboratory findings support the diagnosis of SCD with normal serum level of vitamin B12 in our case, suggesting that the level of vitamin B12 in serum does not always correlate with that in tissue and, therefore, SCD should not be excluded just only by the reason of normal serum vitamin B12 level.

[Zyklon]

Visited my neurologist today. Nothing to worry about my results. He said Rebif maybe related with my temperature regulation and flu like problems.

I want to decrease b12 intake because of fast increase.

I aim 80 ng/mL for D3. It increases nicely.

I did my first Rebif 44 full dose injection 30 minutes ago and 400mg ibufen 1 hour ago. Let's see what will happen in the next hours. Water must do its job and I trust my body

Update 1 hour after injection: Nothing, 0.5 liter water so far.

[jimmylegs]

please consider normalizing phosphorus, calcium, and other nutrients that may interact with d3 prior to pushing levels higher. i speak from unpleasant prior xp (not with phosphorus however)

while hypercalcemia is an established consequence of excess d3 intake, and a high calcium to magnesium ratio can be expected to be problematic in similar ways to normal calcium with low magnesium, i know less about phosphorus. hence:

Interactions between Vitamin D Deficiency and Phosphorus Depletion in the Rat
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC371957/

i have not yet taken the time to absorb the implications of the above, or look at related studies for clarification and context.

[Zyklon]

As you say cross interactions can be messy. I know it is a balance issue and can be very complex. For now I try to achieve OK levels. MS optimal levels will be tricky and sure it will require professional consultancy.

Weird thing is phosphorus deficiency is rare. I bet my body uses plenty for neurological repairs. Need more research.

Rebif update 90 minutes: nothing with 1 liter of water, drinking more

[jimmylegs]

hi again, more interesting stuff:

Disorders Involving Calcium, Phosphorus, and Magnesium
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486454/
"By convention, hypophosphatemia is often graded as mild (< 3.5 mg/dl), moderate (< 2.5 mg/dl) and severe (< 1.0 mg/dl)."

see also:
Box 2 - Etiology of Hypophosphatemia

also interesting. in the absence of other factors, suggests low vit d3 in the etiology of hypophosphatemia. if this is the case for you, i expect that means you should see serum P coming up as serum 25(OH)vitd3 increases. something else going on perhaps..

also interesting. non-response to d3 when phosphorus is low (hereditary apparently, and given your d3 dose response so far, seemingly not your situation):
http://emedicine.medscape.com/article/922305-overview

yet another interesting *old* track.
Magnesium-dependent vitamin-D-resistant rickets. (1974)
https://www.ncbi.nlm.nih.gov/pubmed/4133647

too bad there's nothing there but the title. got some more digging to do.. LATER!