JAMA Neurol. 2014;71(3):306-314. doi:10.1001/jamaneurol.2013.5993. Text Alberto Ascherio, MD, DrPH1; Kassandra L. Munger, ScD1; Rick White, MSc2; Karl Köchert, PhD3; Kelly Claire Simon, ScD1; Chris H. Polman, MD4; Mark S. Freedman, MD5; Hans-Peter Hartung, MD6; David H. Miller, MD7; Xavier Montalbán, MD8; Gilles Edan, MD9; Frederik Barkhof, MD4; Dirk Pleimes, MD10; Ernst-Wilhelm Radü, MD11; Rupert Sandbrink, MD3,6; Ludwig Kappos, MD11; Christoph Pohl, MD3,12
1Harvard School of Public Health, Boston, Massachusetts
2University of British Columbia, Vancouver, Canada
3Bayer HealthCare, Berlin, Germany
4VU University Medical Center, Amsterdam, the Netherlands
5Ottawa Hospital Research Institute, Ottawa, Canada
6Heinrich-Heine Universität, Düsseldorf, Germany
7University College London Institute of Neurology, London, England
8Hospital Universitari Vall d’Hebron, Barcelona, Spain
9CHU-Hôpital Pontchaillou, Rennes, France
10Bayer HealthCare Pharmaceuticals, Montville, New Jersey
11University Hospital Basel, Basel, Switzerland
12Department of Neurology, University Hospital of Bonn, Bonn, Germany
Importance It remains unclear whether vitamin D insufficiency, which is common in individuals with multiple sclerosis (MS), has an adverse effect on MS outcomes.
Objectives To determine whether serum concentrations of 25-hydroxyvitamin D (25OHD), a marker of vitamin D status, predict disease activity and prognosis in patients with a first event suggestive of MS (clinically isolated syndrome).
Design, Setting, and Participants The Betaferon/Betaseron in Newly Emerging multiple sclerosis For Initial Treatment study was a randomized trial originally designed to evaluate the impact of early vs delayed interferon beta-1b treatment in patients with clinically isolated syndrome. Serum 25(OH)D concentrations were measured at baseline and 6, 12, and 24 months. A total of 465 of the 468 patients randomized had at least 1 25(OH)D measurement, and 334 patients had them at both the 6- and 12-month (seasonally asynchronous) measurements. Patients were followed up for 5 years clinically and by magnetic resonance imaging.
Main Outcomes and Measures New active lesions, increased T2 lesion volume, and brain volume on magnetic resonance imaging, as well as MS relapses and disability (Expanded Disability Status Scale score).
Results Higher 25(OH)D levels predicted reduced MS activity and a slower rate of progression.
A 50-nmol/L (20-ng/mL) increment in average serum 25(OH)D levels within the first 12 months predicted a
- 57% lower rate of new active lesions (P < .001),
- 57% lower relapse rate (P = .03),
- 25% lower yearly increase in T2 lesion volume (P < .001), and
- 0.41% lower yearly loss in brain volume (P = .07) from months 12 to 60.
Similar associations were found between 25(OH)D measured up to 12 months and MS activity or progression from months 24 to 60. In analyses using dichotomous 25(OH)D levels, values greater than or equal to 50 nmol/L (20 ng/mL) at up to 12 months predicted lower disability (Expanded Disability Status Scale score, −0.17; P = .004) during the subsequent 4 years.
Conclusions and Relevance Among patients with MS mainly treated with interferon beta-1b, low 25(OH)D levels early in the disease course are a strong risk factor for long-term MS activity and progression.
Note: The doctors did not give extra vitamin D, but just observed that those MS patients whose vitamin D levels increased by 20 ng had much better outcomes
- Overview MS and vitamin D contains the following summary
Clinical interventions have shown that Vitamin D can prevent, treat, and even cure Multiple Sclerosis, at a tiny fraction of the cost of the drugs now used to treat it, and without side effects.
- Fact: Low Vitamin D results in higher risk of getting MS
Increase latitude leads to decreased Vitamin D, which leads to increased risk of MS
Dark skinned people are far more likely to get MS (dark skin people typically have low vitamin D)
Elderly (who typically have low vitamin D) are more likely to get MS
Is there increased risk in people who already have diseases associated with low vitamin D - TB, for example ? ? ?
Women typically have 3X increased MS risk then men (note: women typically have 20% lower levels of vitamin D than men)
Exception: women in very sunny climates and dark-skinned women have the same MS risk as men
Obese are 60% more likely to get MS
Smokers - smokers have lower level of vitamin D and have higher incidence of MS (also, smokers are difficult to cure of MS in Brazil)
MS recurrence is much higher in spring - the lowest time of the year for vitamin D
increase in clouds/rainfall (which reduces available Vitamin D) is associated with increased risk of MS (Scotland, Western Washington)
MS incidence has increased 70% in a decade while the incidence of vitamin D deficiency doubled
Less MS in those with outdoor occupations PDF file, not a web page
- Fact: MS uses up Vitamin D
- Fact: Lower vitamin D (due to MS using up Vitamin D while fighting the disease) results in many other health problems (such as broken bones), so depleted vitamin D levels must be restored.
- Fact: Vitamin D looks so promising for preventing and treating MS that there were 25 INTERVENTION clinical trials as of Feb 2014
- Fact: Vitamin D reduced the MS relapse rate far better than Fingolimod which is now used for that purpose.
- Note: Fingolimod costs $25,000/year while vitamin D, which works better and has no site effects is 1000 times less expensive.
- Fact: 98% of the genes affected by Interferon are also affected by Vitamin D
- Note: 1 week of Interferon = $4,700, 1 week of vitamin D 10,000X lower cost
- Fact: MS Doctors in Brazil recommending 40-100 ng/mL of Vitamin D
- Fact: Many MS forums are recommending vitamin D to treat MS, with some taking 5,000 to 10,000 IU daily
Observation: Risk of going from pre-MS to MS reduced 68 percent with 7100 IU vitamin D – RCT Dec 2012
- This is an observation instead of a fact - it has not yet been confirmed.
- Fact: VERY LARGE doses of vitamin D have CURED 2,000 people of MS in Brazil
- Controversy: UVB fron sunlight or UVB bulb may be BETTER than Vitamin D for reducing the risk of getting MS
- Hypothesis: In addition to Vitamin D there are many other photoproducts produced by UVB that may promote health.
Summary: lack of consensus on how much to prevent, treat, or cure MS.
- How much Vitamin D to prevent many diseases - such as MS
- How much Vitamin D is needed to treat MS? There is currently no agreement
The recommendations range from 40 to 100 ng - which can result of a dose ranging from 3,000 to 20,000 IU/day
- How Vitamin D is needed to Cure MS?: It appears that 20,000-140,000 IU daily may be needed to CURE the disease
You must be under the supervision of a doctor who knows what to watch for in your individual situation.
High doses of Vitamin D cannot be used as a monotherapy.
You will need to adjust the cofactors: Typically increasing Magnesium and Vitamin K2, and reducing Calcium intake.
Your doctor will monitor these and might increase your intake of Vitamins B2, C, as well as Omega-3