Vitamin D for the management of multiple sclerosis
DOI:10.1002/14651858.CD008422.pub3
Vanitha A Jagannath Graziella Filippini Carlo Di Pietrantonj G V Asokan Edward W RobakLiz Whamond Sarah A Robinson
Summary by VitaminDWiki
Low-dose vitamin D by itself has not been found by Randomized Controlled Trials to treat MS
MS has, however been reversed by Vitamin D by doctors - but not in randomized controlled trials
Much higher doses of vitamin D are given
Other nutrients are also changed - not just monotherapy
- Cochrane Reviews might be influenced by big Pharma – 5 board members leave in 1 day – Sept 2018
- 73 Cochrane reviews of MS as of Oct 2018 Included Cyclophosphamide, Statins, Mitoxantrone Natalizumab. Teriflunomide Alemtuzumab Dimethyl fumarate Azathioprine Laquinimod Methotrexate ,Intravenous immunoglobulins, Mycophenolate mofetil, Daclizumab, Aminopyridines Interferon, Rituximab Fingolimod, Sodium channel blockers, Corticosteroids
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
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
Multiple Sclerosis 42X more likely if light brown skin and smoke (both associated with low vitamin D) – July 2020
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 side 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.
- Coimbra Protocol (using Vitamin D) is safe and effective for Multiple Sclerosis and Autoimmune diseases – April 2022
- 54,000 IU of vitamin D daily with no Calcium (1,000 IU per kg: Coimbra protocol) – July 2024
- 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 - Epstein-Barr virus increases risk of Multiple Sclerosis by 32X - Jan 2022
- Multiple Sclerosis treated by Vitamin D, recommends investigating high dose Coimbra - Oct 2021
- Multiple Sclerosis patients had fewer COVID-19 problems (Note: many MSers take Vitamin D) – April 30, 2021
- Vitamin D Resistance hypothesis confirmed by Coimbra high-dose vitamin D protocol – April 2021
- Multiple Sclerosis relapses cut in half by 100,000 IU of Vitamin D every 2 weeks– RCT 2019
Background
This review is an update of a previously published review, "vitamin D for the management of multiple sclerosis" (published in the Cochrane Library; 2010, Issue 12). Multiple sclerosis (MS) is characterised by inflammation, demyelination, axonal or neuronal loss, and astrocytic gliosis in the central nervous system (CNS), which can result in varying levels of disability. Some studies have provided evidence showing an association of MS with low levels of vitamin D and benefit derived from its supplementation.
Objectives
To evaluate the benefit and safety of vitamin D supplementation for reducing disease activity in people with MS.
Search methods
We searched the Cochrane Multiple Sclerosis and Rare Diseases of the CNS Specialized Register up to 2 October 2017 through contact with the Information Specialist with search terms relevant to this review. We included references identified from comprehensive electronic database searches and from handsearches of relevant journals and abstract books from conferences.
Selection criteria
We included randomised controlled trials (RCTs) and quasi‐RCTs that compared vitamin D versus placebo, routine care, or low doses of vitamin D in patients with MS. vitamin D was administered as monotherapy or in combination with calcium. Concomitant interventions were allowed if they were used equally in all trial intervention groups.
Data collection and analysis
Two review authors independently extracted data and assessed the methodological quality of studies, while another review author sorted any disagreements. We expressed treatment effects as mean differences (MDs) for continuous outcomes (Expanded Disability Status Scale and number of magnetic resonance imaging (MRI) gadolinium‐enhancing T1 lesions), as standardised MDs for health‐related quality of life, as rate differences for annualised relapse rates, and as risk differences (RDs) for serious adverse events and minor adverse events, together with 95% confidence intervals (CIs).
Main results
We identified 12 RCTs enrolling 933 participants with MS; 464 were randomised to the vitamin D group, and 469 to the comparator group. Eleven trials tested vitamin D₃, and one trial tested vitamin D₂. vitamin D₃ had no effect on the annualised relapse rate at 52 weeks' follow‐up (rate difference ‐0.05, 95% CI ‐0.17 to 0.07; I² = 38%; five trials; 417 participants; very low‐quality evidence according to the GRADE instrument); on the Expanded Disability Status Scale at 52 weeks' follow‐up (MD ‐0.25, 95% CI ‐0.61 to 0.10; I² = 35%; five trials; 221 participants; very low‐quality evidence according to GRADE); and on MRI gadolinium‐enhancing T1 lesions at 52 weeks' follow‐up (MD 0.02, 95% CI ‐0.45 to 0.48; I² = 12%; two trials; 256 participants; very low‐quality evidence according to GRADE). vitamin D₃ did not increase the risk of serious adverse effects within a range of 26 to 52 weeks' follow‐up (RD 0.01, 95% CI ‐0.03 to 0.04; I² = 35%; eight trials; 621 participants; low‐quality evidence according to GRADE) or minor adverse effects within a range of 26 to 96 weeks' follow‐up (RD 0.02, 95% CI ‐0.02 to 0.06; I² = 20%; eight trials; 701 participants; low‐quality evidence according to GRADE). Three studies reported health‐related quality of life (HRQOL) using different HRQOL scales. One study reported that vitamin D improved ratings on the psychological and social components of the HRQOL scale but had no effects on the physical components. The other two studies found no effect of vitamin D on HRQOL. Two studies reported fatigue using different scales. One study (158 participants) reported that vitamin D₃ reduced fatigue compared with placebo at 26 weeks' follow‐up. The other study (71 participants) found no effect on fatigue at 96 weeks' follow‐up. Seven studies reported on cytokine levels, four on T‐lymphocyte proliferation, and one on matrix metalloproteinase levels, with no consistent pattern of change in these immunological outcomes. The randomised trials included in this review provided no data on time to first treated relapse, number of participants requiring hospitalisation owing to progression of the disease, proportion of participants who remained relapse‐free, cognitive function, or psychological symptoms.
Authors' conclusions
To date, very low‐quality evidence suggests no benefit of vitamin D for patient‐important outcomes among people with MS. vitamin D appears to have no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), and MRI lesions. Effects on health‐related quality of life and fatigue are unclear. vitamin D₃ at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven ongoing studies will likely provide further evidence that can be included in a future update of this review.
Plain language summary
vitamin D for the management of multiple sclerosis
Review question
Does vitamin D supplementation reduce disease activity in people with multiple sclerosis (MS)?
What is the issue?
Several epidemiological, immunological, and genetic studies have reported an association between low vitamin D, measured as low blood 25‐hydroxyvitamin D levels, and MS before and after the disease is triggered. Hence people with MS are screened for vitamin D deficiency, and vitamin D preparations are given along with immunomodulatory therapy. Whether vitamin D supplementation improves relevant clinical outcomes (recurrence of relapse, worsening of disability) or decreases the number of lesions observed by magnetic resonance imaging (MRI) is not clear.
What did we do?
We evaluated the benefits and harms of vitamin D in people with MS. We included randomised controlled trials (RCTs) and quasi‐RCTs that compared the effects of vitamin D supplementation versus placebo, routine care, or low doses of vitamin D.
What did we find?
Our systematic search identified 12 studies enrolling 933 people with MS. Research shows that vitamin D has no effect on recurrence of relapse, worsening of disability measured by the Expanded Disability Status Scale (EDSS), or new MRI gadolinium‐enhancing T1 lesions. Its effects on health‐related quality of life and fatigue are unclear. Our confidence in these results is very low because vitamin D has been evaluated in only a few small trials that we judged as having high risk of bias. vitamin D supplementation appears to be safe for people with MS included in our review, but available data are limited.
Conclusions
For people with MS, vitamin D supplementation appears to have no effect on relevant clinical outcomes or new MRI lesions. vitamin D supplementation at the doses and treatment durations used in the included trials appears to be safe, although available data are limited. Seven trials are ongoing; they will likely provide further evidence for a future update of this review.
Currentness of evidence: This evidence is up‐to‐date as of October 2017.