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Vitamin D and Multiple Sclerosis

Our Friend in the Battle Against Osteoporosis

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Updated November 15, 2010

Along with vitamin B12 deficiencies, many of us with multiple sclerosis (MS) also have deficiencies in vitamin D. Perhaps you have heard that research is revealing that low vitamin D levels may have made us susceptible to MS. Even so, we still need to take vitamin D, even if we already have MS and prevention is no longer an option.

There is some speculation and tenuous support from tiny studies and animal research that vitamin D could help slow down the MS disease process. However, there is irrefutable, concrete evidence that we all need vitamin D to help prevent osteoporosis – that’s enough for me to get with the vitamin D program. I urge all of you to consider joining me.

Why Should People with MS Care About Vitamin D?

The majority of people with MS have some degree of vitamin D deficiency. People who live in northern regions commonly have a vitamin D deficiency for 4 to 6 months of the year. Interestingly, relapses tend to happen more in the spring when vitamin D levels reach their lowest, as stores have been depleted.

What Is Vitamin D in MS for?

Osteoporosis: Vitamin D deficiency leads to osteoporosis, which is also very common in people with MS. In a study of women with MS, the average bone density and vitamin D levels were much lower than a control group without MS. Forty percent of study participants reported that they got very little to no exposure to sunlight.

Help for the Immune System: Animal studies (using EAE, the experimental animal form of MS) show that vitamin D deficiency worsened severity of symptoms and supplementation helped reduce symptoms.

MS Prevention? I imagine for most people reading this, MS is already a done deal – a diagnosis has been made and it is too late for prevention. However, it is interesting that in the Nurses’ Health Study, women who took vitamin D supplements had a 40% lower risk of MS. It has also been well-documented that MS is geographically distributed in such a way as to indicate that people without adequate vitamin D exposures from the sun are at higher risk for developing MS.

How Does Vitamin D Work?

Vitamin D helps with calcium absorption and works to prevent osteoporosis. Vitamin D also increases lymphocytes and reduces proinflammatory cytokines, meaning it works to reduce inflammation and possibly autoimmune activity.

How Effective Is It?

Although it has been suggested by epidemiological studies that vitamin D deficiencies increase the risk of developing MS, there is really no strong evidence to indicate that supplementing with vitamin D in people that already have MS will have much of a benefit in terms of disease progression. One very small study (11 people) showed a reduction in relapse rate in participants taking a combination of magnesium, calcium and fish oil with high levels of vitamin D. Another small study failed to show any effect of vitamin D supplementation. There are currently some long-term trials in progress to look at the role of vitamin D in MS.

What is the Usual Dosage of Vitamin D/How Is It Taken?

Vitamin D is a fat-soluble vitamin. It is naturally present in very few foods, which include:
  • Eggs (naturally found in yolks)
  • Liver
  • Fatty fish, such as sardines, salmon, tuna, mackerel
It is added as a fortification to other foods, such as:
  • Some ready-to-eat cereals
  • Milk and other dairy products
  • Other “fortified” products, such as orange juice, soy milk, rice milk, bread and flour
As a supplement, vitamin D should be taken in combination with calcium supplements, as calcium is not useful for bone health without vitamin D. 200 to 600 IU of vitamin D should be taken in combination with 1,000 to 1,200 milligrams of calcium daily. In addition, people should strive to get 10 to 15 minutes of sun exposure each day.

Side Effects of Vitamin D

At daily doses that most people take (up to 1,000 IU), there are virtually no negative effects associated with taking vitamin D supplements. However, there is a great deal of debate about what the upper doses of vitamin D should be, as plasma levels (amount of vitamin D circulating in blood) above 500 nmol/L have been shown to cause vitamin D toxicity. Dosages are difficult to establish, as people seem to have different rates at which they metabolize vitamin D. However, most experts agree that more than 50,000 IU/day for any length of time is not advisable (with others arguing for 20,000 IU/day as the limit), as doses in this range have been shown to lead to the dangerous plasma levels mentioned, with the following side effects:
  • Nausea and vomiting
  • Fatigue
  • Kidney damage

Potential Interactions and Warnings

Vitamin D supplementation should be undertaken with caution or avoided in people with:
  • Abnormal levels of calcium (hypercalcemia and hypocalcaemia)
  • Kidney disease
  • Sarcoidosis
  • Hypoparathyroidism
Vitamin D has also been shown to interact with some medications for the heart, called cardiac glycosides. These include digoxin (Lanoxin) and digitoxin (which has been discontinued in the US).

Costs

Vitamin D is extremely inexpensive and should be included in a calcium supplement.

My Bottom Line:

Will I take a vitamin D supplement? Well, sure. Despite having heard this for years, it finally just sunk in that a calcium supplement without vitamin D is pretty useless for preventing osteoporosis. I’m going to rethink my calcium supplement and make sure that it contains at least 200 mcg (8000 IU) of vitamin D per day. I’m also going to make sure that I get at least 15 minutes of exposure to sunlight a day – guess I’ll have to start having my morning coffee outside, before it gets too hot to justify staying in the sun for any amount of time.

Sources:

Heaney RP. Vitamin D: criteria for safety and efficacy. Nutr Rev. 2008 Oct;66(10 Suppl 2):S178-81.

Schwarz S, Leweling H. Multiple sclerosis and nutrition. Multiple Sclerosis. 2005 Feb;11(1):24-32.

Bowling, Allen C. Complementary and Alternative Medicine and Multiple Sclerosis. 2nd ed. Demos Publishing: New York. 2007.

Bowling, Allen C. and Stewart, Tom. So, what’s new about Vitamin D? InsideMS. October-November 2006. 57-58.

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