Vit D3>125nmol/L (50ng/ml) in blood. Goal for pwMS

[MarkW]

25-Hydroxyvitamin D deficiency and risk of MS among women in the Finnish Maternity Cohort
Kassandra L. Munger, ScD, Kira Hongell, MD, Julia Åivo, MD, Merja Soilu-Hänninen, MD, PhD, Heljä-Marja Surcel, PhD and Alberto Ascherio, MD, DrPH
Correspondence to Dr. Munger: kgorham@hsph.harvard.edu
Published online before print September 13, 2017, doi: http:/​/​dx.​doi.​org/​10.​1212/​WNL.​0000000000004489
Neurology 10.1212/WNL.0000000000004489

Conclusions: These results directly support vitamin D deficiency as a risk factor for MS and strengthen the rationale for broad public health interventions to improve vitamin D levels.

Objective: To determine whether and to what extent vitamin D deficiency is associated with multiple sclerosis (MS) risk.

Methods: We conducted a prospective nested case-control study among women in the Finnish Maternity Cohort (FMC). The FMC had 1.8 million stored serum samples taken during the pregnancies of over 800,000 women at the time of this study. Through linkages with hospital and prescription registries, we identified 1,092 women with MS diagnosed between 1983 and 2009 with at least 1 serum sample collected prior to date of MS diagnosis; ≥2 serum samples were available for 511 cases. Cases were matched to up to 3 controls (n = 2,123) on date of birth (±2 years) and area of residence. 25-Hydroxyvitamin D (25[OH]D) levels were measured using a chemiluminescence assay. We used conditional logistic regression adjusted for year of sample collection, gravidity, and parity to estimate relative risks (RRs) and 95% confidence intervals (CIs).

Results: A 50 nmol/L increase in 25(OH)D was associated with a 39% reduced risk of MS (RR 0.61, 95% CI 0.44–0.85), p = 0.003. Women with 25(OH)D levels <30 nmol/L had a 43% higher MS risk (RR 1.43, 95% CI 1.02–1.99, p = 0.04) as compared to women with levels ≥50 nmol/L. In women with ≥2 samples, MS risk was 2-fold higher in women with 25(OH)D <30 nmol/L as compared to women with 25(OH)D ≥50 nmol/L (RR 2.02, 95% CI 1.18–3.45, p = 0.01).

Conclusions: These results directly support vitamin D deficiency as a risk factor for MS and strengthen the rationale for broad public health interventions to improve vitamin D levels.

Received March 13, 2017.
Accepted in final form July 5, 2017.

[jimmylegs]

keeping in mind

Magnesium Supplementation in Vitamin D Deficiency (2017).
https://www.ncbi.nlm.nih.gov/pubmed/28471760

"Mg is essential in the metabolism of vitamin D, and taking large doses of vitamin D can induce severe depletion of Mg. Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy."

[THX1138]

And furthermore,

CONCLUSIONS: Vitamin D screening assay is readily available, but the reported lower limit of the normal range is totally inadequate for disease prevention. Based on the epidemiologic studies, ∼75% of all adults worldwide have serum 25(OH)D levels of <30 ng/mL. Because of the recent increase in global awareness, vitamin D supplementation has become a common practice, but Mg deficiency still remains unaddressed. Screening for chronic magnesium deficiency is difficult because a normal serum level may still be associated with moderate to severe deficiency. To date, there is no simple and accurate laboratory test to determine the total body magnesium status in humans. Mg is essential in the metabolism of vitamin D, and taking large doses of vitamin D can induce severe depletion of Mg. Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy.

Mg is essential in the metabolism of vitamin D, and taking large doses of vitamin D can induce severe depletion of Mg.

Can you say "SPASTICITY"

https://www.ncbi.nlm.nih.gov/pubmed/28471760

[MarkW]

To measure Vit D3 level is a blood test from your Physician. However, testing Mg is not reliable from tests. Please remember that foods that are good magnesium sources are foods with fiber (fibre). Foods that are high in fiber (fibre) are generally high in magnesium. Dietary sources of magnesium include legumes, whole grains, vegetables (especially broccoli, squash, and green leafy vegetables), seeds, and nuts (especially almonds). Getting Mg (and other trace elements) from natural sources is better than supplementation as it is more readily adsorped by our bodies. Of course, sunlight is the best source of vit D3 but it not been possible this 'summer' in England.

[jimmylegs]

re "testing Mg is not reliable from tests"

are you serious LOL come *on*.

starting point for some remedial reading:

Perspective: The Case for an Evidence-Based Reference Interval for Serum Magnesium: The Time Has Come
http://advances.nutrition.org/content/7/6/977.abstract
"What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health ,,, adopting a revised serum magnesium reference interval would improve clinical care and public health."

[MarkW]

The paper you cite: https://www.ncbi.nlm.nih.gov/pubmed/28471760
Has the conclusion:
"To date, there is no simple and accurate laboratory test to determine the total body magnesium status in humans."

The next paper you cite (http://advances.nutrition.org/content/7/6/977.full) says "What is needed is an evidenced-based serum magnesium reference interval that reflects optimal health and the current food environment and population" It adds: "A simple, rapid, and accurate test to assess total body magnesium status is lacking. Although STMC is most commonly used to assess the status of patients, >99% of total body magnesium (22–26 g in adults) is extravascular, mostly in the bones (>50%), with only 0.3% in the serum (25). Thus, this parameter does not necessarily reflect the true total body magnesium content."
As there is no reliable test for trace minerals including Mg & Ca. Hence, our best option is to change our diet. Hence my previous post. With Vit D3 there is a reliable test, but for Mg & Ca dietary intake measures have to replace serum level testing at present.

[jimmylegs]

and in the meantime serum magnesium is just fine as a starting point.

interested readers may refer to related content in the natural approach forum, eg

http://www.thisisms.com/forum/natural-a ... 29354.html

and

http://www.thisisms.com/forum/natural-a ... 8-150.html

warning: may contain research idiotically using serum magnesium status to inform conclusions

[THX1138]

The paper you cite: https://www.ncbi.nlm.nih.gov/pubmed/28471760
Has the conclusion:
"To date, there is no simple and accurate laboratory test to determine the total body magnesium status in humans."

I think it's important to include sufficient context with the quotes we use. So perhaps, more like this:

CONCLUSIONS:
Vitamin D screening assay is readily available, but the reported lower limit of the normal range is totally inadequate for disease prevention. Based on the epidemiologic studies, ∼75% of all adults worldwide have serum 25(OH)D levels of <30 ng/mL. Because of the recent increase in global awareness, vitamin D supplementation has become a common practice, but Mg deficiency still remains unaddressed. Screening for chronic magnesium deficiency is difficult because a normal serum level may still be associated with moderate to severe deficiency.
[To date, there is no simple and accurate laboratory test to determine the total body magnesium status in humans.] Mg is essential in the metabolism of vitamin D, and taking large doses of vitamin D can induce severe depletion of Mg. Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy.

The paper has an entire paragraph as its conclusions, not just one sentence.

[jimmylegs]

the point is, it's still not cool to advocate for a serum d3 target via supplementation without paying attention to cofactors like magnesium, both in the diet and in the serum. it gets less cool all the time.

[MarkW]

I was trained as an analyst in both pharmaceutical sciences and management consultancy, which are not cool in many other social circles. I simply post papers from researchers and readers of this thread can decided for themselves.

A major step forward was acheived when the goal of Vit D3>125nmol/L (50ng/ml) in blood for pwMS was established.

Most researchers ignore basic dietary requirements for pwMS, and simply increase one trace element at a time. It is not understood by many pwMS that a balanced intake of trace elements (like calcium, magnesium, etc) is vital. Also many forget that pwMS have dangerously low levels of D3 (along with most 'healthy' people). Obtaning vit D3 from diet is hard. However, supplementing D3 (not D2) is cheap and an accurate blood test is available to check levels. Unfortunately the same type of tests are not available for calcuim and magnesium. Also uptake is much better from the correct foods.

[MarkW]

More recent evidence on supplementing Vit D3. Uncool but factual...................

Brain Behav. 2017 Aug; 7(8): e00761.
Published online 2017 Jul 11. doi: 10.1002/brb3.761
PMCID: PMC5561321
Vitamin D supplementation differentially affects seasonal multiple sclerosis disease activity
Andrei Miclea,corresponding author 1 , 2 Marius Miclea, 1 Maximilian Pistor, 2 Andreas Hoepner, 3 Andrew Chan, 4 and Robert Hoepner 4
Author information ► Article notes ► Copyright and License information ►
Go to:

Abstract

Objectives
Low ultraviolet‐B (UVB) radiation causes hypovitaminosis D, which is a known risk factor for multiple sclerosis (MS) and associated with MS disease activity. Our objective is to test whether vitamin D supplementation is most effective in lowering disease activity during the period of the year with low UVB radiation and consequently low serum 25‐hydroxyvitamin D3 (25(OH)D3) concentration.

Methods
Retrospective analysis of medical records from our outpatient department identified 40 MS patients with available data of at least 6 months before and during oral vitamin D supplementation. Serum 25(OH)D3 concentration was analyzed using immunoassay. UVB radiation data were provided by the local government. Annualized and quarterly relapse rates before and during vitamin D supplementation served as outcome parameters.

Results
During vitamin D supplementation (18,950 international units/week (mean, SD 3,397)), serum 25(OH)D3 concentration increased by 51 nmol/L and the UVB‐related seasonal variability in 25(OH)D3 levels ceased (rho = −0.13, p > .05). Furthermore, the annualized relapse rate decreased by approximately 50%. This was almost solely driven by the prominent reduction in the quarterly relapse rate in late winter/early spring, when 25(OH)D3 levels of nonsupplemented patients were the lowest.

Conclusions
Our study demonstrated the modulation of seasonal MS disease activity through vitamin D supplementation. Given the prominent reduction in the quarterly relapse rate in late winter/early spring, our data indicate a beneficial effect of supplementing MS patients with vitamin D, especially during this period of the year.
Keywords: 25(OH)D3, Calcitriol, relapse, seasonality, ultraviolet‐B, winter

[MarkW]

A 'so what' paper..................
Why?? Because both pwMS and controls had mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. So the reasearch cannot have started with a full review of published data. A very basic error in the internet age.

Reminder: Goal for pwMS is Vit D3>125nmol/L (50ng/ml) in blood.

Abstract
Arq Neuropsiquiatr. 2017 Jan;75(1):3-8. doi: 10.1590/0004-282X20160173.
No correlation was observed between vitamin D levels and disability of patients with multiple sclerosis between latitudes 18° and 30° South.
Fragoso YD1, Adoni T2, Alves-Leon SV3, Apostolos-Pereira SL4, Arruda WO5, Brooks JB1, Cal HS6, Damasceno CA7, Gama PD8, Goncalves MV9, Jesus CA10, Machado SC11, Mansur LF3, Matta AP6, Mendes MF12, Morales RR13, Nobrega AW Jr11, Parolin MK14, Peres MP10, Ribeiro MC15, Ruocco HH16, Scherpenhuijzen S3, Siquinelli F17, Stoney PN18, Varela DL19, Eboni AC9, Spessotto CV1, Rocha ET7, Lacerda PE7.
Author information

Objective:
Vitamin D has taken center stage in research and treatment of multiple sclerosis (MS). The objective of the present study was to assess the serum vitamin D levels of a large population of patients with MS and controls living in a restricted tropical area.
Methods:
Data from 535 patients with MS and 350 control subjects were obtained from 14 cities around the Tropic of Capricorn.

Results:
The mean serum 25-OH vitamin D level was 26.07 ± 10.27 ng/mL for the control subjects, and 28.03 ± 12.19 ng/mL for patients with MS. No correlation was observed between vitamin D levels and the disability of patients over the disease duration.

Conclusion:
At least for the region around the Tropic of Capricorn, serum levels of vitamin D typically are within the range of 20 to 30 ng/mL for controls and patients with MS.

PMID: 28099554
DOI: 10.1590/0004-282X20160173
[Indexed for MEDLINE]
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