Vitamin D
What are the links to Vitamin D and MS?
There is a well-known geographical phenomenon in the incidence of multiple sclerosis, with increasing risk for MS being demonstrated with increasing distance from the equator. This can also be demonstrated within countries. In Australia, it has been shown that there are less cases of MS in sunny, tropical Queensland, than there are in the more temperate states, with the most cases being in Tasmania, which is much closer to Antarctica.
Since this distribution was discovered, there has been speculation about what it means, but if this is a genuinely proven and indisputable factor in MS distribution, then by the present standards of ‘science’, it would appear to point directly to a very significant causal factor in MS. Despite this being a huge clue to the cause of the disease, very little seems to have been done to pursue the rigorous and relentless, coordinated work that is necessary to definitively understand why we see this geographic effect.
Without ‘evidence based science’ on this matter, it would nevertheless appear fairly obvious that this effect has something to do with either sunlight or temperature, or both. Speculation has been based on the notion that more people with the necessary genetic predisposition are gathered in relatively greater densities in more temperate areas that are further from the equator. This demographic effect may even potentially be demonstrated within countries like Australia. There doesn’t appear to have been much in the way of study on the direct physiological effects of cold on the body, but other speculations have revolved around the idea that people consume more saturated fat in colder climes, that infectious agents are more prevalent or have the upper hand in temperate zones, and that in colder areas, people are suffering from Vitamin D deficiency.
One of the factors that points towards a strong causal link to Vitamin D deficiency is that the geographic distribution of MS holds true, except where there is high consumption of oily fish, which are high in Vitamin D. Another factor that points to Vitamin D is that studies appear to show a connection with the development of MS in later life, and a person’s month of birth, which is thought to correlate to the low Vitamin D status of the mother over colder months. There is also data that shows that higher levels of sun exposure between the ages of six to fifteen in particular is somewhat protective against MS later in life.
The incidence of MS is increasing and one significant factor which may be influencing this is the skin cancer messages that have relentlessly emphasised the need to stay out of the sun, or to cover up with clothing or sunscreen when exposed to the sun. Another causal factor may well be the fact that populations are increasingly urbanised and that sedentary, indoor occupations predominate.
Many studies in humans have now found a correlation with low Vitamin D and MS incidence. Correlation is not causation, and Vitamin D has not been shown to be curative in MS, but nevertheless, for people with MS, ensuring they get sufficient sunlight all year round, or supplementing with Vitamin D may well be prudent.
Part of the problem in unscrambling correlation versus causation in the role of Vitamin D and MS, is the role of genetics, and the nature of Vitamin D metabolism in each individual. Another problem is the role of sunlight in particular, as opposed to supplementation with Vitamin D. It seems that humans were meant to move their bodies, and to be outside in the sunshine.
What is Vitamin D and where do we get it from?
Vitamin D is a fat soluble vitamin that comes in two forms, Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol), which will circulate in the blood or about 24 hours after production in the skin, after which it will be stored in the fat for around two months. When called on, Vitamin D is converted into the active form of the vitamin (25 – hydroxyvitamin D) which is released from fat storage and can circulate for around three weeks. Vitamin D is made in the skin during exposure to the sun and once a given patch of skin has made as much Vitamin D as it can make (usually by about fifteen minutes), it can’t make any more for the day. So exposing as much of the body as possible to the sun for about fifteen minutes a few times a week would ordinarily be enough to supply our Vitamin D needs. Vitamin D production is blocked by most sunscreens and if sunshine is filtered through glass.
Vitamin D and sunlight:
For many people with MS, getting sufficient sun exposure could be very problematic. Firstly, if a person is still working (and living in a sunny place), finding the opportunity to strip down to a bathing suit for fifteen minutes in the sunshine a few times a week may be difficult to organise. In colder climes, even if the sun is shining and responsibilities permit the scheduling of regular sunbathing, it may be too cold to tolerate such a long period outside with minimal clothing on. In late autumn, winter, and early spring, it may be completely impractical.
Short of taking an outdoor job, which may bring its own challenges, it may be very difficult for a person with MS who retains a busy schedule to get sufficient sun. The fact that sun exposure and the associated heat stress may cause PWMS to suffer pseudo exacerbations, may also cause people to actively avoid sun exposure. To suggest to PWMS that they must actively seek out an experience they would prefer to avoid, may underestimate the heat stress challenges that many people face.
In cases of advanced MS when people may be experiencing problems with dressing and undressing, walking, getting about in a wheelchair, or spending a lot of time indoors due to fatigue and/or incontinence, opportunities for getting sun exposure become increasingly restricted.
Even in cases of optimal sun exposure, it is thought that people who live at latitudes above or below 37 degrees north or south of the equator can’t get enough energy from the sun to make all the vitamin D they need, except perhaps during the short summer months.
Vitamin D and supplements:
In cases where people are restricted by climate, microclimate, personal logistics or the challenges of MS from getting sufficient sun to meet their year round Vitamin D needs, the alternative is to supplement. Supplementing is unlikely to be as good as getting Vitamin D from sunlight, and it is not possible to overdose on Vitamin D if you are getting it from the sun, but most sources warn about the dangers of toxicity from supplementation.
The right dose of Vitamin D for MS:
Vitamin D3 is the more natural form of Vitamin D, and is far more potent than Vitamin D2. But how much should we take if we have MS? The normal ranges for Vitamin D in the blood were developed in relation to the prevention of rickets, and may not have much relevance to the dosages needed if you are at risk of (already have) a neurological illness like MS. Many doctors may not be aware of the recent research into Vitamin D and MS and may warn people against taking larger doses than previously recommended.
Professor George Jelinek, writing in his book Overcoming Multiple Sclerosis covers the issue of Vitamin D supplementation very thoroughly. His recommendations can be found here https://overcomingms.org/ms-a-to-z/ms-encyclopedia/sunlightvitamin-d-and-ms/
This page links to an article where neurologists disclose that they would take Vitamin D3 if they had clinically isolated syndrome or definite MS, but would not necessarily prescribe it for patients https://overcomingms.org/neurologists-take-vitamin-d-diagnosed-not-prescribe-patients/
Vitamin D3 supplementation is very inexpensive with a very low side effect profile. This page links to a 2012 article where a prominent neurologist queries why so much effort is placed on studies into drug therapies when Vitamin D is most likely the single most important environmental factor that can be adjusted to minimise MS risk. https://overcomingms.org/wp-content/uploads/Mult-Scler-2011-Hutchinson-13524585114340691-1.pdf
This study has shown that low Vitamin D is likely to cause MS, and rules out reverse causality (where MS might cause low Vitamin D). It does not however show that supplementing with Vitamin D can prevent MS developing in high risk individuals, speed recovery, prevent degeneration, or cure MS. http://www.msra.org.au/new-study-strengthens-link-between-vitamin-d-deficiency-and-ms
If supplementation of Vitamin D was effective in treating MS, it would provide a low cost therapy with virtually no side effects. The PrevANZ prevention clinical trial is aimed at discovering whether an oral dose of Vitamin D3 can prevent people with clinically isolated syndrome (a single demyelinating event) from going on to develop multiple sclerosis. http://www.mstrials.org.au/PrevANZ-Trial
All of the studies are now pointing towards Vitamin D deficiency as playing a central role in the development of MS. The PrevANZ study is the first large study to determine whether supplementation with Vitamin D has a role in the prevention of the disease. Whilst the MS community waits for the results, people with MS may wish to research the optimum level of Vitamin D3 supplementation, and discuss the supplementation and ongoing monitoring of serum Vitamin D levels with their doctor and/or neurologist.
Links:
This site details a Brazilian treatment for MS with very high dose Vitamin D protocol (with calcium monitoring) which seems to provide remarkable results
http://mscure.aussieblogs.com.au/the-bloggers-treatment-3/
This page outlines the reasoning behind the treatment by Cícero Galli Coimbra
Internist and Neurologist, Associate Professor, Federal University of São Paulo, UNIFESP, President, Autoimmunity Investigation and Research Institute
http://mscure.aussieblogs.com.au/for-a-new-paradigm-of-medical-treatment-2/
This page further outlines the treatment and includes video testimony from Clarice Cataldi (with English sub-titles) detailing her remarkable recovery using this protocol
http://vitamindprotocol.blogspot.com.au/p/dr-cicero-galli-coimbra.html
Hypothyroidism
What are the links to Vitamin D and MS?
There is a well-known geographical phenomenon in the incidence of multiple sclerosis, with increasing risk for MS being demonstrated with increasing distance from the equator. This can also be demonstrated within countries. In Australia, it has been shown that there are less cases of MS in sunny, tropical Queensland, than there are in the more temperate states, with the most cases being in Tasmania, which is much closer to Antarctica.
Since this distribution was discovered, there has been speculation about what it means, but if this is a genuinely proven and indisputable factor in MS distribution, then by the present standards of ‘science’, it would appear to point directly to a very significant causal factor in MS. Despite this being a huge clue to the cause of the disease, very little seems to have been done to pursue the rigorous and relentless, coordinated work that is necessary to definitively understand why we see this geographic effect.
Without ‘evidence based science’ on this matter, it would nevertheless appear fairly obvious that this effect has something to do with either sunlight or temperature, or both. Speculation has been based on the notion that more people with the necessary genetic predisposition are gathered in relatively greater densities in more temperate areas that are further from the equator. This demographic effect may even potentially be demonstrated within countries like Australia. There doesn’t appear to have been much in the way of study on the direct physiological effects of cold on the body, but other speculations have revolved around the idea that people consume more saturated fat in colder climes, that infectious agents are more prevalent or have the upper hand in temperate zones, and that in colder areas, people are suffering from Vitamin D deficiency.
One of the factors that points towards a strong causal link to Vitamin D deficiency is that the geographic distribution of MS holds true, except where there is high consumption of oily fish, which are high in Vitamin D. Another factor that points to Vitamin D is that studies appear to show a connection with the development of MS in later life, and a person’s month of birth, which is thought to correlate to the low Vitamin D status of the mother over colder months. There is also data that shows that higher levels of sun exposure between the ages of six to fifteen in particular is somewhat protective against MS later in life.
The incidence of MS is increasing and one significant factor which may be influencing this is the skin cancer messages that have relentlessly emphasised the need to stay out of the sun, or to cover up with clothing or sunscreen when exposed to the sun. Another causal factor may well be the fact that populations are increasingly urbanised and that sedentary, indoor occupations predominate.
Many studies in humans have now found a correlation with low Vitamin D and MS incidence. Correlation is not causation, and Vitamin D has not been shown to be curative in MS, but nevertheless, for people with MS, ensuring they get sufficient sunlight all year round, or supplementing with Vitamin D may well be prudent.
Part of the problem in unscrambling correlation versus causation in the role of Vitamin D and MS, is the role of genetics, and the nature of Vitamin D metabolism in each individual. Another problem is the role of sunlight in particular, as opposed to supplementation with Vitamin D. It seems that humans were meant to move their bodies, and to be outside in the sunshine.
What is Vitamin D and where do we get it from?
Vitamin D is a fat soluble vitamin that comes in two forms, Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol), which will circulate in the blood or about 24 hours after production in the skin, after which it will be stored in the fat for around two months. When called on, Vitamin D is converted into the active form of the vitamin (25 – hydroxyvitamin D) which is released from fat storage and can circulate for around three weeks. Vitamin D is made in the skin during exposure to the sun and once a given patch of skin has made as much Vitamin D as it can make (usually by about fifteen minutes), it can’t make any more for the day. So exposing as much of the body as possible to the sun for about fifteen minutes a few times a week would ordinarily be enough to supply our Vitamin D needs. Vitamin D production is blocked by most sunscreens and if sunshine is filtered through glass.
Vitamin D and sunlight:
For many people with MS, getting sufficient sun exposure could be very problematic. Firstly, if a person is still working (and living in a sunny place), finding the opportunity to strip down to a bathing suit for fifteen minutes in the sunshine a few times a week may be difficult to organise. In colder climes, even if the sun is shining and responsibilities permit the scheduling of regular sunbathing, it may be too cold to tolerate such a long period outside with minimal clothing on. In late autumn, winter, and early spring, it may be completely impractical.
Short of taking an outdoor job, which may bring its own challenges, it may be very difficult for a person with MS who retains a busy schedule to get sufficient sun. The fact that sun exposure and the associated heat stress may cause PWMS to suffer pseudo exacerbations, may also cause people to actively avoid sun exposure. To suggest to PWMS that they must actively seek out an experience they would prefer to avoid, may underestimate the heat stress challenges that many people face.
In cases of advanced MS when people may be experiencing problems with dressing and undressing, walking, getting about in a wheelchair, or spending a lot of time indoors due to fatigue and/or incontinence, opportunities for getting sun exposure become increasingly restricted.
Even in cases of optimal sun exposure, it is thought that people who live at latitudes above or below 37 degrees north or south of the equator can’t get enough energy from the sun to make all the vitamin D they need, except perhaps during the short summer months.
Vitamin D and supplements:
In cases where people are restricted by climate, microclimate, personal logistics or the challenges of MS from getting sufficient sun to meet their year round Vitamin D needs, the alternative is to supplement. Supplementing is unlikely to be as good as getting Vitamin D from sunlight, and it is not possible to overdose on Vitamin D if you are getting it from the sun, but most sources warn about the dangers of toxicity from supplementation.
The right dose of Vitamin D for MS:
Vitamin D3 is the more natural form of Vitamin D, and is far more potent than Vitamin D2. But how much should we take if we have MS? The normal ranges for Vitamin D in the blood were developed in relation to the prevention of rickets, and may not have much relevance to the dosages needed if you are at risk of (already have) a neurological illness like MS. Many doctors may not be aware of the recent research into Vitamin D and MS and may warn people against taking larger doses than previously recommended.
Professor George Jelinek, writing in his book Overcoming Multiple Sclerosis covers the issue of Vitamin D supplementation very thoroughly. His recommendations can be found here https://overcomingms.org/ms-a-to-z/ms-encyclopedia/sunlightvitamin-d-and-ms/
This page links to an article where neurologists disclose that they would take Vitamin D3 if they had clinically isolated syndrome or definite MS, but would not necessarily prescribe it for patients https://overcomingms.org/neurologists-take-vitamin-d-diagnosed-not-prescribe-patients/
Vitamin D3 supplementation is very inexpensive with a very low side effect profile. This page links to a 2012 article where a prominent neurologist queries why so much effort is placed on studies into drug therapies when Vitamin D is most likely the single most important environmental factor that can be adjusted to minimise MS risk. https://overcomingms.org/wp-content/uploads/Mult-Scler-2011-Hutchinson-13524585114340691-1.pdf
This study has shown that low Vitamin D is likely to cause MS, and rules out reverse causality (where MS might cause low Vitamin D). It does not however show that supplementing with Vitamin D can prevent MS developing in high risk individuals, speed recovery, prevent degeneration, or cure MS. http://www.msra.org.au/new-study-strengthens-link-between-vitamin-d-deficiency-and-ms
If supplementation of Vitamin D was effective in treating MS, it would provide a low cost therapy with virtually no side effects. The PrevANZ prevention clinical trial is aimed at discovering whether an oral dose of Vitamin D3 can prevent people with clinically isolated syndrome (a single demyelinating event) from going on to develop multiple sclerosis. http://www.mstrials.org.au/PrevANZ-Trial
All of the studies are now pointing towards Vitamin D deficiency as playing a central role in the development of MS. The PrevANZ study is the first large study to determine whether supplementation with Vitamin D has a role in the prevention of the disease. Whilst the MS community waits for the results, people with MS may wish to research the optimum level of Vitamin D3 supplementation, and discuss the supplementation and ongoing monitoring of serum Vitamin D levels with their doctor and/or neurologist.
Links:
This site details a Brazilian treatment for MS with very high dose Vitamin D protocol (with calcium monitoring) which seems to provide remarkable results
http://mscure.aussieblogs.com.au/the-bloggers-treatment-3/
This page outlines the reasoning behind the treatment by Cícero Galli Coimbra
Internist and Neurologist, Associate Professor, Federal University of São Paulo, UNIFESP, President, Autoimmunity Investigation and Research Institute
http://mscure.aussieblogs.com.au/for-a-new-paradigm-of-medical-treatment-2/
This page further outlines the treatment and includes video testimony from Clarice Cataldi (with English sub-titles) detailing her remarkable recovery using this protocol
http://vitamindprotocol.blogspot.com.au/p/dr-cicero-galli-coimbra.html
Hypothyroidism