Table of contents
JAMA Neurol. 2014 Jan 20. doi: 10.1001/jamaneurol.2013.5993.
Ascherio A1, Munger KL1, White R2, Köchert K3, Simon KC1, Polman CH4, Freedman MS5, Hartung HP6, Miller DH7, Montalbán X8, Edan G9, Barkhof F4, Pleimes D10, Radü EW11, Sandbrink R12, Kappos L11, Pohl C13.
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.
12Bayer HealthCare, Berlin, Germany 6Heinrich-Heine Universität, Düsseldorf, Germany.
13Bayer HealthCare, Berlin, Germany 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 (25[OH]D), 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.
For years Dr.s in Brazil have added 120 ng of vitamin D (150 ng total) to achieve reversal of Multiple Sclerosis.
- Multiple Sclerosis category listing
- Multiple Sclerosis patients who increased their vitamin D levels by 20 ng had better outcomes – March 2014 another entry for this paper in VitaminDWiki
- 98 pcnt of genes that Vitamin D activates to reduce MS are also activated by Interferon -May 2013
- Fewer white spots in MRI brain scans if had more vitamin D – Jan 2014
- Prevention with vitamin D in Multiple Sclerosis is logical – editorial April 2013
- Appears that Vitamin D can induce remission in recent Multiple Sclerosis
- Less MS (MRI) decline after raising Vitamin D levels – clinical trial Oct 2012
- Review of clinical trials for Multiple Sclerosis with Vitamin D intervention – 2013
- 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
MS updates from Brazil
- Treatment with daily high doses of vitamin D Overcoming MS May 2013
Of course, this is not a cure it's a life-long treatment.. but at least it stops the progression and in many cases even revert back some (sometimes all) of the brain lesions.
- Huge page - all in Portuguese about Coimbra's work
- Web site of patients who have been cured by Dr. Coimbra Australia 150 ng is the target
Great sequential posts, over a year. by an Australian patient whose MS was reversed by Dr. Coimbra
- I Have Multiple Sclerosis: I Am Treating My MS With High Doses Vitamin D experienceproject. May 2013
Gives a fair amount of details, such as taking lots of water and monitoriing for excess Calcium.
Note A home test kit for excess Calcium in the urine is available $10 for 10 tests
- Dr. Holick visited with the patients in Brazil Sept 2013
Published: Jan 24, 2014
This week, Friday Feedback takes a second look at a reported correlation between vitamin D and slower disease progression in multiple sclerosis patients.
We reached out to a diverse group of physicians by email and asked them to respond to the following question:
On the strength of these observational data, how would you use these findings in the clinical management of your MS patients?
The participants this week:
- Cherie C. Binns, RN, an independent multiple sclerosis-certified nurse based in Wakefield, R.I.
- Marian L. Evatt, MD, MS, Department of Neurology, Emory University School of Medicine
- Robert Fox, MD, an MS specialist in the Mellen Center for Multiple Sclerosis at the Cleveland Clinic
- J. William Lindsey, MD, professor of neurology at the University of Texas Health Science Center at Houston (UTHealth) Medical School and a member of the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center
- Eva-Maria Maida, MD, professor and chair, department of neurology, Evangelical Hospital Vienna, Austria
- Anthony T. Reder, MD, professor of neurology with a focus in multiple sclerosis, The Committees on Neurobiology and Immunology, University of Chicago Medicine
Study Adds to the Evidence
Marian L. Evatt, MD, MS: "This doesn't surprise me - - because of available data on MS and bone health, I've been trying to keep MS (and other neurology) patients >30 ng/mL for a while. So this study won't change what I do for MS patients. That said, I don't know how well these kinds of findings have gotten out to the general practice community, so this adds to the body of evidence to support general neurologists and primary care physicians paying attention to vitamin D levels in patients with newly diagnosed MS. Compared with many of my neurology colleagues, I am relatively aggressive about keeping 25OH vitamin D levels replete because there's plenty of evidence vitamin D interventions work for bone health and fall prevention (issues MS and other neurology patients commonly have)."
Eva-Maria Maida, MD: "I have been measuring the blood level of vitamin D in MS patients for several years. Nearly no one shows a normal level in Austria. I find this data very interesting. The methods of evaluating and looking for the correlation of vitamin D to MS progression, especially in the early stage of the disease, are convincing."
Robert Fox, MD: "There is a growing collection of data indicating that vitamin D deficiency is associated with poor outcomes in patients with MS. This study adds to that dataset and suggests that vitamin D supplementation may be beneficial in MS, even in patients already taking a standard MS therapy. Perhaps just as importantly, this study confirms previous observations that higher levels of vitamin D beyond normal levels do not confer further benefit. Vitamin D supplementation is not a "more is better" issue, but rather a "correct the deficiency" issue."
Cherie C. Binns, RN: "Many of the neurologists with whom I communicate are now trying to dose supplemental D3 to elevate serum levels to 80 or greater in their patients with MS. However, it's the People with Multiple Sclerosis (PWMS) who seem to be taking this far more seriously than their healthcare team and many admit to taking megadoses (100,000 IU or more weekly)."
J. William Lindsey, MD: "These observations agree with multiple previous studies reporting that low vitamin D levels are associated with more disease activity."
Anthony T. Reder, MD: "It is a correlation, but that is still important."
Reder: "An alternative explanation for these findings could be healthy people play outside and have higher vitamin D from more sunshine.
My recommendation to patients is take 4000 U per day in the winter, or take a winter vacation in a sunny place."
Binns: "Unfortunately, the FDA continues to maintain its low Recommended Daily Allowances (RDA) for D and there do not seem to be clear guidelines as to maximum dose of benefit or dose, when exceeded, that may be problematic. There is far too little information available as to signs of D toxicity or overdose. Please address this topic this year."
Evatt: "Presence and or worsening of several neurologic diseases have recently been associated with low vitamin D levels; the trouble is we don't know if the disease causes the low D or low D contributes to the disease/disease worsening. Evidence is strong that optimal bone health levels should be above 30, but we can't say whether it's better to get vitamin D levels higher ... e.g., above 40 or 60 or 70."
Lindsey: "The outstanding remaining question is whether treatment to increase vitamin D levels will have a clinical benefit in MS.
The results from a few small studies of vitamin D supplementation in MS are contradictory.
At present, it is reasonable to measure vitamin D levels in MS patients, and give supplements to those with low vitamin D."
Fox: "Confirmation that vitamin D supplementation is indeed helpful in MS still awaits a formal clinical trial."