#CMSC16 – MS Experts Agree on Benefits of Vitamin D Supplements, Despite Mostly Circumstantial Evidence

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MS patients should take vitamin D supplements, even though research did not yet prove a protective effect.

A roundtable discussion, provided as a webinar activity organized by the Consortium of Multiple Sclerosis Centers (CMSC) in advance of its June conference, considered the role of vitamin D in multiple sclerosis (MS). Researchers concluded that, while evidence is only circumstantial as to the vitamin’s ability to prevent disease relapses, its multiple health benefits justify its recommended use by all MS patients.

Discussion concerning the link between MS and vitamin D was conducted by Dr. Emmanuelle Waubant, a professor of Clinical Neurology and Pediatrics at the University of California, San Francisco, and Dr. Ellen Mowry, an associate professor of Neurology and Epidemiology at Johns Hopkins University in Baltimore, and moderated by June Halper, the chief executive officer of CMSC.

According to Dr. Waubant, research on the role of vitamin D in MS needs to take several factors into account, in addition to vitamin intake. Transport proteins, enzymes, hormones, and transcription factors are involved in the processing of vitamin D, and might affect the outcomes of supplements consumed.

Nevertheless, the vitamin has receptors scattered throughout the body, including on immune cells such as microglia, macrophages, and B- and T-cells — all key components of MS pathology.

Scientists know that vitamin D is crucial for many aspects of the immune response, and studies have shown that its levels in patients’ blood can determine the frequency and severity of infections. On the cellular level, vitamin D prompts cells to take on a more anti-inflammatory appearance, by secreting less inflammatory and more anti-inflammatory signaling factors. It also shifts T-cell composition to a more anti-inflammatory state, and prevents activated T-cells from entering the brain.

There is, therefore, little doubt that vitamin D provides a range of valuable health effects — effects of importance to everyone, but of particular importance to people with MS.

An entirely different question is whether vitamin D has specific benefits in MS, either by preventing disease development or by hindering relapses in people who are already ill.

Studies showed that children who have lower vitamin D levels more often develop MS as adults. And, as Dr. Waubant pointed out, the supplement levels often recommended in children to prevent deficiency syndromes, like rickets, are far lower than those recommended for children at high risk of developing MS.

Several observational studies also demonstrated that MS patients who have higher blood levels of vitamin D tend to relapse less frequently, according to Dr. Mowry. These studies often find a linear relationship between the two — that is, for every unit of increase in vitamin D levels, the risk for relapse decreases accordingly.

Studies using magnetic resonance imaging (MRI) to determine MS progression have also seen a link between blood levels of the vitamin and the prevention of new lesions. One study showed that vitamin D levels were linked to the loss of gray matter in the brain. If these results are confirmed in other studies, they would indicate that vitamin D has rather strong neuroprotective properties.

“Since loss of neurons seems to drive MS progression, perhaps vitamin D could be … test[ed] in individuals with progressive MS to see if it has any impact on worsening in those patient populations,” said Dr. Mowry.

One study did test the safety of high-dose supplements. Participants receiving up to 40,000 IU per day did not have a dangerous increase in serum calcium levels, the scenario clinicians worry about when prescribing high doses of vitamin D. However, Dr. Waubant warned MS patients against increasing the dose of supplements on their own, as there are no studies investigating long-term effects of very high doses — and too much of a potentially good thing does not necessarily produce better effects.

A particular group of patients needs to be mentioned in this context — pregnant women with MS. Currently, no studies have explored relapse risk and vitamin levels in this group, although neurologists recommend a 50 percent to 100 percent increase in supplementation.

“OBGYNs tend to be conservative about vitamin D, because there are some data in animal models of pregnant animals [showing] that too high vitamin D levels could have a negative impact on the development of the nervous system. But we’re talking here about levels that are really way below that risk,” Dr. Waubant said.

Nevertheless, the findings are observational only, and cannot tell us anything about the cause of a lowered relapse risk. The association between higher vitamin D blood levels and lower relapse rates might be explained by other factors, such as UV-light or melatonin, another factor produced in the skin that is dependent on sunlight. Studies have shown that UV-light seems to be protective in MS, independent of vitamin D levels.

To really conclude that vitamin D impacts the disease, randomized prospective clinical trials are needed. One such trial, the VIDAMS study, is currently underway. The study explores if high-dose supplements — 5000 IU per day — differ from standard 600 IU/day treatment in terms of relapse prevention and MRI measures. (This study, being conducted at a number of U.S. sites, is actively recruiting patients.)

It is crucial for researchers to investigate vitamin D’s impact, regardless of underlying MS treatment. One study found an effect in MS patients receiving interferon beta, but not in non-treated patients. This line of inquiry has not been explored with other treatments.

Studies also need to explore if effects differ depending on gender and ethnicity. Dark-skinned people have a lower production of vitamin D when exposed to sunlight, and physicians sometimes report they also have poorer outcomes.

A key point underscored by the researchers is the need for patients to stay on the supplements prescribed them. “It’s not something that you can just sort of rebuild the bank and then it’s fine. You really have to continue on the vitamin D if you want your levels to be maintained at a specific level,” Dr. Mowry said.

Many patients prefer to improve their vitamin D levels naturally, rather than by taking supplements. Studies, however, show that this is not an easy task considering modern lifestyles. “So, it’s pretty rare to find somebody who is able to maintain an adequate vitamin D level from food alone,” said Dr. Mowry.

The researchers also agreed that it is not advisable to stop taking supplements even during the summer months, when people spend more time in the sun.

“In terms of sun exposure, I think really we tend to overestimate the amount of sun exposure that we’re receiving, in terms of how much can have an effect on the vitamin D levels,”  Dr. Waubant concluded.

The possible link between MS and vitamin D levels will also be discussed at the CMSC 2016 Annual Meeting in Maryland on June 1–4. Multiple Sclerosis News Today will offer its readers onsite and continuous meeting coverage, including feature articles, interviews, and social media coverage on Facebook, Twitter, and Pinterest. Social media accounts for Multiple Sclerosis News Today can be found in the upper righthand corner of its homepage.

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Magdalena holds an MSc in Pharmaceutical Bioscience and an interdisciplinary PhD merging the fields of psychiatry, immunology and neuropharmacology. Her previous research focused on metabolic and immunologic changes in psychotic disorders. She is now focusing on science writing, allowing her to culture her passion for medical science and human health.
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  1. Steven D. says:

    An option for natural vitamin d synthesis when sunshine is not available is The Vitamin D Lamp, made in the USA by Sperti and cleared by the FDA. It’s UVB rays naturally generate vitamin d, easy to use, and sessions last only five minutes.

    • Shirley says:

      You’d figure these so called MS experts would have figured the lamp thing out Steven D. not getting help from us.
      This is all good but, what have they been doing for the past 50 years? For Pete’s sake … these so called MS experts are finally looking at this and all they have is Circumstantial Evidence? They are a joke beyond belief. Useless, waste of money. Living off the sick. Disgusting. (Rant over)

    • Merly says:

      Be very Careful of UVB output Lamps. it can Burn you very easy. (depends on a skin type) just FYI to all UVB is the Burning rays.

  2. Frances says:

    There is the PREVANZ Vit D trial being run in Australia. From the MSRA website:
    “The trial will assess the efficacy of oral vitamin D3 in preventing the development of multiple sclerosis in participants at high risk of MS (that is people with a first demyelinating event, FDE).

    The trial will compare three doses of oral daily vitamin D3 (1,000IU 5,000IU or 10,000IU/day) to placebo. After agreeing to participate, participants will be randomly and blindly assigned to one of these four study arms and will continue to take study medication for 48 weeks.”

    See more info on the Trials registration website:

  3. daan says:

    I would try it on myselft, but where can I get vitamin D3 at these high doses (5000IU or 10000IU/day)?

    If I use off-the-shelf supplements it means I have to start taking the pills in the morning and end in the evening.

    • Danny says:

      Daan, Amazon is a good source if you find a merchant that ships to your country. I assume that you are not from USA because here we have 10,000IU gel caps readily available in almost any store.

    • Laura says:

      If you are in NL, for example bodystore.nl, topvitamins.nl, many other online stores. Or order overseas, amazon, iherb.

    • Helene says:

      Go to a compound pharmacy, as they have made both quantities for me. I now take 5000lU every 3 days, at night only, after food, with a compound magnesium, which is a better magnesium to be absorbed by the body. It contains magnesium glycinate 900 mg, in which I take it
      Every 3 days as well. You should however, consult either the pharmacist or your doc, prior to having these, as all our medical facts differ and should be treated with caution. I am not a doctor or in any medical proffesion, just a girl with MS. Please investigate first!

    • Merly says:

      There’s a lot of Vitamin D3 form now a days. I am taking 5,000IU daily. no problem of finding it. if you need 10,000IU, just take 2.

    • daan says:

      thank you so much for your replies. I’m in Romania. It seems high doses of D3 are more common in northern countries (less sunlight)… I’ll do a more thorough online search.

  4. Mônica Lima Barros says:

    Here, in Brazil, Dr Cícero Galli Coimbra, neurologist, developed a protocol using very high dosis of vitamin D associated to restriction of dairy products (to avoid hypercalcemia) and ingestion of at least 2,5 l/day with outstanding results in treatment of MS.

    • Danny says:

      Coimbra is one of the few doctors that has the courage to put benefit for his patients as a priority. My wife with RRMS is under the care of one of his doctors and is in NEDA status with EDSS=0 and normal calcium levels (confirmed by MRI’s and lab tests). I have tested the Vit D anti-autoimmune hypothesis on myself by taking 20,000IU/day and completely ameliorated my vitiligo. I implore the physicians to start paying attention to Coimbra Protocol and help the patients all over the world.

  5. Cristina Cellina says:

    I’ve been diagnosed in 2011, never took official drugs, I started Protocol Coimbra with high dose of vitamina D in july 2015. High dose means more than 10.000 UI DAILY! SM people have a less power to synthesize vitamin D, sun or lower doses not daily are not enough. My Symptoms almost disappeared, my life greatly improved!

    • Shasha says:

      I take 5000IU of Vit D3 daily and try to get out in the sunlight. In the sunlight a person may get 40.000IU of Vit D in 15 minutes. When I first took 5000IU of Vit D3 I laughed for a week and then it wore off. Vit D is a hormone which our body needs. It recycles Ca so they say to take Vit D3 which is more actived with Vit K2 so it puts the Ca into the bones more than the tissues. I knew a person who was bipolar and put shingles on the roof of a house….then his bipolar was ok. We are like plants..need the sunlight…it gives us energy. Low sunlight can cause autoimmune issues/Celiac which can lower nutrients absorbed in the intestines as gluten hurts the intestines. Then the brain/body malfunction….cells are not made right to work right with low nutrients absorbed. My MS is due to Celiac/low sunlight heritage…Scotland/England/Ireland on my mom’s side which gives the mitochondria (engines of the cells) to me.

      • daan says:

        Shasha, you said “Vit D is a hormone which our body needs”. I totally agree.

        The hormone part is my dilemma, I’ve read that the hormone is called calcitriol, but the D3 in supplements is biologically inert and must undergo two hydroxylations in the body for activation.

        So, supplement > calcidiol > calcitriol hormone ready to be used by the body. That’s what I read.

        This is kind of a followup on my first question here, “where to get high doses of vitamin D3?” which should have been “where to get high doses of hormone (calcitriol) vitamin D3”.

        I’m very new to this D3 thing and please correct me if I’m wrong. Any comments are greatly appreciated in my quest to find the best D3 version.

        • Danny says:

          Calcitriol is possible to buy by prescription only. It is NOT used for Vit D deficiency nor it is used in Coimbra Protocol because of extremely high probability of hypercalcemia. When you use cholecalciferol, your body converts it to calcidiol and then calcitriol naturally. The body has mechanisms that prevent forming too much calcitriol, so mega doses of cholecalciferol daily provide the abundant reserve for people with autoimmune diseases who have impaired function of Vit D biological utilization. To conclude, you need cholecalciferol form of Vitamin D which is the one in basically every supplement. Do NOT search for calcitriol, the active hormone, you may seriously damage your body, regardless of dietary calcium restrictions.

        • Shasha says:

          I take 5000IU of Vit D3 daily and get sunlight also. My son had his parathyroids removed which should not have happened and they said he needed a different kind of Vit D to help, but I think he is fine with Vit D3. You can try both Vit D and Vit D3 and see what difference you feel in yourself. Amazon sells supplements. The Vit D3 is awesome help for me.

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