Vitamin Di Supplementation in Multiple Sclerosis
Brief introduction
Vitamin D is a steroid hormone; it has long been known to be concerned in the regulation of body levels of calcium and phosphorus, and in the mineralization of bone. In recent years it has become clear that Vitamin D receptors are present in numerous cell types. Evidently it has wide-ranging effects in a number of systems. Vitamin D3, or cholecalciferol, is generated in the skin by the action of sunlight on a precursor; it is also taken in the diet. Unsupplemented dietary sources are probably inadequate. Of itself, D3 has little biological activity, but, in a two-step process, it is firstly hydroxylated in the liver to 25-hydroxycholecalciferol which is alpha-hydroxylated in the kidney to 1,25-dihydroxycholecalciferol. This is the biologically active form of vitamin D. The second reaction is tightly controlled; it is induced primarily by parathyroid hormone.
Vitamin D and Multiple Sclerosis.
It has long been known that MS has a geographical distribution. This is more complex than is usually stated [Kurtzke JF. A reassessment of the distribution of multiple sclerosis. Acta Neurol Scand. 1975 Feb;51(2):137-57] implying a multifactorial background. The incidence is lower in those who have a diet high in fish oils [Esparza ML, Sasaki S, Kesteloot H. Nutrition, latitude, and multiple sclerosis mortality: an ecologic study. Am J Epidemiol. 1995 Oct 1;142(7):733-7.] In general, though, the incidence of MS accords with the amount of sunlight received which in turn accords with latitude and other factors such as cultural dictates. Vitamin D deficiency is common in MS. [Nieves J, et al., High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology. 1994 Sep;44(9):1687-92.] These authors found the bone marrow density (BMD) of the lumbar spine and femoral neck was 1 to 2 SDs lower in women with MS against controls. BMD was lower in patients with more severe disease. The mean 25-hydroxycholecalciferol level of the sample population (43 nmol/l) was in the insufficient range, and 12 patients (23%) had frank vitamin D deficiency (< 25 nmol/l). BMD and age-related BMD at all skeletal sites measured were lowest when 25-hydroxycholecalciferol levels were deficient. Parathyroid hormone (PTH) was frankly elevated in 13% of patients. PTH levels were negatively correlated with 25-hydroxycholecalciferol levels and with BMD. The authors comment: 'Vitamin D deficiency in the female MS patient might be safely and inexpensively corrected by the routine use of vitamin D supplementsi.' Peterlik and Cross have written an excellent review of the results of hypovitaminosis D in chronic disease: the paper is informative and well-referenced. [Peterlik M, Cross HS. Vitamin D and calcium deficits predispose for multiple chronic diseasesi. Eur J Clin Invest. 2005 May; 35 (5): 290-304. Review.] These authors comment: 'In addition to skeletal disorders, calcium and vitamin D deficits increase the risk of malignancies, particularly of colon, breast and prostatei gland, of chronic inflammatory and autoimmune diseases (e.g. insulin-dependent diabetes mellitus, inflammatory bowel diseasei, multiple sclerosis), as well as of metabolic disorders (metabolic syndrome, hypertension).' In a key study on vitamin D supplementation and the development of MS Munger and colleagues [Munger KL, et al., Vitamin D intake and incidence of multiple sclerosis. Neurology. 2004 Jan 13;62(1):60-5] found that intake of vitamin D from supplementsi was inversely associated with risk of MS; the relative risk comparing women with an intake of 400 IU/day or more with women with no supplemental vitamin D intake was 0.59 (95% CI = 0.38 to 0.91; p for trend = 0.006). Supplementation with Vitamin D in MS was followed by elevation of Transforming Growth Factor-beta (TGF-b) [Mahon BD et al., Cytokinei profile in patients with multiple sclerosis following vitamin D supplementation. J Neuroimmunol. 2003 Jan;134(1-2):128-32.] TGF-b is a large family (with perhaps as many as 100 members) of broadly anti-inflammatory signalling proteins which, though incompletely understood, promote wound healing, inhibit macrophage and lymphocyte proliferation. Interestingly, in a small prospective study, supplementation of the diet with Omega 3 fish oils (which is rich in 25(OH)D) in people with MS brought about moderate benefit. [Weinstock-Guttman B, et al., Low fat dietary intervention with omega-3 fatty acid supplementation in multiple sclerosis patients. Prostaglandins Leukot Essent Fatty Acids. 2005 Nov;73(5):397-404.] Supplementation with Vitamin D, calcium and magnesium has resulted in a decrease of relapse rate in young people with RRMSi. [Goldberg P, Fleming MC, Picard EH. Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Med Hypotheses. 1986 Oct;21(2):193-200] though this was a small study.
Supplementation: what dose?
Supplementation with D3 seems, on this evidence, reasonable and even advisable. What would be a reasonable and advisable daily dose? The safe upper limit of supplementation in adults is officially declared to be 50 micrograms (2,000 iu.) Vieth and colleagues state that 100 micrograms (4000 iu.) may be safely given (and, in older persons may be necessary) [Vieth R, Chan PC, MacFarlane GD. Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr. 2001 Feb; 73(2): 288-94.] The authors support their statement with convincing evidence. This paper is recommended reading. High dose Vitamin D will be of particular importance to those receiving doxycycline or minocycline, both of which can cause photosensitivity reactions. It is important to take the D3 form.
[Note: Caution in sarcoid. Disordered calcium metabolism is a frequent occurrence in sarcoid, a non-caseating granulomatous condition. Hypercalcaemia may be found in 20% of patients with sarcoid, while hypercalciuria may be even more common, and is of major clinical importance. [reviewed by Adams JS, et al., Metabolism of 25-hydroxyvitamin D3 by cultured pulmonary alveolar macrophages in sarcoidosis. J Clin Invest. 1983 Nov; 72(5): 1856-60.] Sarcoid granulomas abound in macrophages; the sarcoid macrophage has been found to to synthesize 1,25-dihydroxycholecalciferol. The excess circulating 1,25-dihydroxyvitamin D produced extrarenally causes increased intestinal absorption of calcium, enhanced bone resorption, and resultant hypercalciuria with or without hypercalcaemia.]
___________________________________________________________
D W - [Myalgia and hypertensioni (typically 155/95.) Began (2003) taking doxycycline and macrolide and later adding metronidazoleii. No medication now; just supplementsi and IR sauna. Morning BP typically 105/75]
Dear David , I wonder if
 When I told my mother
When I told my mother about the VitaminD/Sunlight/MSi connection, she offered that: In the 1930's and 40's "all the kids had to take Cod Liver Oil; it was the only vitamin we had."
She and I share a perception that the Baby Boomers tended to develop MS more frequently than their parents.
It's hardly even anecdotal; but it's intriguing to me.
Thank you for sharing the results of your research, all sifted and sorted. It's a lot easier to connect the dots when the fly-specks have already been taken out of the picture.
Ron
On Stratton protocol for CFSi starting 01/06.
___________________________________________________________
Ron
On CAPi for CFSi starting 01/06 (NE Ohio, USA)
Began rifampin trial 1/14/09
Currently: on intermittent
Everybody else's inputs are
 An excellent compilation.
An excellent compilation. Thanks David!
On Wheldon/Stratton protocol for Cpni in CFSi/FMSi since December 2004.
___________________________________________________________
CAPi for Cpni 11/04. Dxi: 25yrs CFSi & FMSi. Currently: 250 aithromycin mwf, doxycycline 100mg BIDi, Tinii 1000mg/day pulses; Vit D2000 units, T4 & T3, 12mg Iodoral
Read the bottle, Vlad! It
Read the bottle, Vlad! It clearly states in the ingredient list what the makeup is. In my case it says Vitamin Di on the front and "D3 (as cholecalciferol)" in the ingredient listing box.
The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi
___________________________________________________________
The difference between what we do and what we are capable of doing would suffice to solve most of the world’s problems. Mohandas Gandhi
As regards the official
As regards the official advice that 2000 IU/day can be toxic, it seems worth quoting a short passage from Vieth's review of the safety literature:
(quoted from R. Vieth, Vitamin D Supplementation, 25-hydroxyvitamin D Concentrations, and Safety, American Journal of Clinical Nutrition, Vol. 69, No. 5, 842-856, May 1999; http://www.ajcn.org/cgi/content/full/69/5/842)
Hello, I am new here. I
Hello, I am new here.
I still hesitate with Cholecalciferol suplementing. I have Vitamin Di from Member´s Mark - 800IU. I have neurological problems - attack, which comes in aprox two moonths periods with headache, visual problems (loss of part visual field), paralysis of arm (left or right) and light paralysis of one side of face. All this attack problems dissapeared after 20-40 minutes. Between of this attack I have still visual problems - visual snow, and problems with contrasts and light sources, floaters. It is typicaly for neuroinfection or demyelization. So - I am from DW protocol because finding of CPNi infection. DW recommended me suplementation by Vit. D. But I study Trevor Marshall protocol, he do not recommend Vit. D suplementation for people with intracellulari infection on Th1 level. This is my reason of hesitate, please, do you have any experience with this suplementation? Can I start with it?
BTW: sorry for my bad english
CPN Inf. demyelinization attacks, demyel. of optic nerve, fibromyalgiai, vertigo, tinnitusi
___________________________________________________________
On Wheldon protocol from 1. October 2006 - CPNi Inf. demyelinization attacks, demyel. of optic nerve, fibromyalgiai, vertigo, tinnitusi
Ella has MSi and starting
Ella has MS and starting taking vitamin D3 in the dosage recommended by the Wheldon Protocol in March 2006, and it had an immediate effect on her body temperature and in a couple of weeks there were visible improvements to her skin. She was having visual problems at the time, which neither improved nor worsened in the short term. After 8 months on the protocol (mainly the bacteriostatic ABXi and supplementsi) her visual problems are better, not perfect but better.
Michele: on Wheldon protocol since 1st May 2006 for a variety of long standing ailments including IBSi, sinusitis, alopeciai, asthmai, peripheral neuropathy, also spokesperson for Ella started Wheldon CAPi 16th March 2006 for RRMSi
___________________________________________________________
Michèle (UK) GFAi: Wheldon CAPi 1st May 2006. Daily Doxyi, Azi MWF, metroi pulse.
Yes Hunter DW and Marshall
___________________________________________________________
CAPi since 11/06 for Cpni, Lyme, Bartonella, Babesia, Myco P, CMV, HHV-6 infectionsi. Rifampin 600mg daily, Zithromax 500mg daily. NACi 2250mg daily. All other supplementsi. Now Bicillin LA 2.4 mil injection weekly.
 Welcome Hunter,I am not
Welcome Hunter,
I am not an expert on the Marshall protocol at all, but the Vit D may be one of many reasons why we here are having such success and that doesn't. I have done all the prescribed suggestions on this complicated, demanding (way of life, magic potion, drug list - whatever name you give it, it is still a rose) for almost 28 months and I'm sure that by all the usual standards I should be dead or close. My husband is a very well-educated doctor and cannot give any rational reason why there is such a strong (rote?) belief that those doses of D are "toxic".
Rica PPMSi EDSSi 6.7 at beginning - now 2. Began CAPi Sept, 2004 with Rifampin 150 mg 2xd, Doxyi 100 mg 2xd, added regular pulses Jan 2005. Jan 2006 switched to Doxy, Azith, cont. flagyli total 35 pulses NC USA
___________________________________________________________
3/9 Symptoms returning. Began 5 abxi protocol 5/9 Rifampin 600, Amoxicillini 1000, Doxyi 200, MWF Azith 250, flagyli 1000. Caffeine pills with AM abxi Began Sept 04 PPMSi EDSSi 6.7 Now good days EDSS 1
katman, thanks for answer,
katman, thanks for answer, mycoplasma1 too.
I am sure that 4000IU is not toxic. But what I mean is effect of vit. D to immunei system. I studied Marshall protocol very slightly, because he is known opponent of vitamin Di suplementation. Cholecalciferol after metabolisation can stimulate immune system. If I have autoimmune inflammationi on intracellulari level, then is probably possible, that is can made intensidy of immune more worse. It is only "uneducated" opinion, based on my slightly study of Marshall protocol, correct me please, when I said nonsenses.
On Wheldon protocol from 1. October 2006 - CPNi Inf. demyelinization attacks, demyel. of optic nerve, fibromyalgiai, vertigo, tinnitusi
___________________________________________________________
On Wheldon protocol from 1. October 2006 - CPNi Inf. demyelinization attacks, demyel. of optic nerve, fibromyalgiai, vertigo, tinnitusi
Hunter, Marshall developed
Hunter, Marshall developed his regime because he had sarcoid, of which he apparently cure himself. If you read David's piece above, there is something toward the end as to why sarcoid is slightly different:
[Note: Caution in sarcoid. Disordered calcium metabolism is a frequent occurrence in sarcoid, a non-caseating granulomatous condition. Hypercalcaemia may be found in 20% of patients with sarcoid, while hypercalciuria may be even more common, and is of major clinical importance. [reviewed by Adams JS, et al., Metabolism of 25-hydroxyvitamin D3 by cultured pulmonary alveolar macrophages in sarcoidosis. J Clin Invest. 1983 Nov; 72(5): 1856-60.] Sarcoid granulomas abound in macrophages; the sarcoid macrophage has been found to to synthesize 1,25-dihydroxycholecalciferol. The excess circulating 1,25-dihydroxyvitamin D produced extrarenally causes increased intestinal absorption of calcium, enhanced bone resorption, and resultant hypercalciuria with or without hypercalcaemia.]
With MS I have taken 4000iu of D3 per day for over the last three years, without the least sign of toxicity. Even now that I have finished full-time medication, it is one of the three supplementsi which I still make sure I take at full dose every day. So unless you actually have sarcoid, and from reading the list of your symptoms, it doesn't sound as though you do, I would say you are worrying unnecessarily......Sarah
___________________________________________________________
Great answer Sarah, thank
Great answer Sarah, thank you very much. I know that Marshall protocol was developed for sarcoid, but your informations about it is logical and support vitamine D suplementation. I have only neurological problems, very similar as MS, but on MRI no problems. I will take vit. D for support of my treatment. Thanks again.
On Wheldon protocol from 1. October 2006 - CPNi Inf. demyelinization attacks, demyel. of optic nerve, fibromyalgiai, vertigo, tinnitusi
___________________________________________________________
On Wheldon protocol from 1. October 2006 - CPNi Inf. demyelinization attacks, demyel. of optic nerve, fibromyalgiai, vertigo, tinnitusi
Vit D - My dosage for
Vit D - My dosage for RRMSi. I take 4000iu daily in winter and 2000iu in summer and have done so for a long time without any toxic effect. Note - I do a lot of sunbathing from April to October (not in Oxford !). Summer supplementation can be lower if you are a sun worshipper, like me. When I was checking out a safe Vit D dosage, I read a paper which measured Vit D of people working outside in India. They had very high levels of circulating Vit D with no toxic effects. I am confident to advise that 4000iu daily is not toxic for most people and should be taken by everyone with MS. (I cannot find the paper and unless there there many people worried about Vit D toxicity I will not spend time searching for it) ...... Mark
PS There can be skin problems with Doxyi and UV light (ie a slow start to any sunbathing is advised).
Mark Walker - Oxford, England.
RRMS since 91, Dxi 97. CFSi from Jan03. DW Patient-Feb06, started emp CAPi(DW) in Mar06, with Copaxone. Pharma Consultant (worked til Jan 03).
___________________________________________________________
Mark Walker - Oxford, England.
RRMSi Nov 91, Dxi 97. CFSi Jan03. Copaxone + continuous CAPi (NACi, Dox, Rox) Feb06 to May 07. Met pulses from Jun06. Intermittent Abxi from June 07 onwards.
Several important studies
Several important studies published during 2004
highlight the importance of vitamin Di, especially
for the elderly.
In one, vitamin D supplementation reduced the risk
of falls in the elderly by more than 20 percent
(JAMA 2004 Apr 28;291(16):1999-2006);
another found that low serum vitamin D concentrations
were associated with higher incidence of periodontal
disease in individuals over 50 years of age
(Am J Clin Nutr 2004 Jul;80(1):108-113);
another found that good vitamin D status is associated
with improved muscle strength in both active and inactive
ambulatory persons over 60 years of age.
In women over 60, vitamin D protects against colon
cancer (Cancer Epidemiol Biomarkers Prev 2004
Sep;13(9):1502-8).
Vitamin D protects against breast cancer in women
of all ages.
One study found that women with the lowest vitamin D
intake were four times more likely to develop breast
abnormalities than women with the highest intake
(Cancer Epidemiol Biomarkers Prev 2004 Sep;13(9):1466-72).
Researchers are finding that serum levels of vitamin D
should be at least greater than 20 ng/ml, with maximum
improvement at 50 ng/ml.
Dr. Reinhold Veith, a prominent vitamin D researcher in
Canada, recently found that vitamin D improves depressive
symptoms (Nutr J 2004 Jul 19;3(1)8).
He compared doses of 600 IU and 4,000 IU and found
that taking 4,000 units per day helped depressive symptoms
the most, resulting in all subjects achieving levels greater than
40 ng/ml. One way that vitamin D works is by increasing
serotonin levels in the brain.
http://www.westonaprice.org/causticcommentary/cc2004wi.html
Diana
Vlad, I've only just seen
Vlad, I've only just seen your post: I'm sorry. The D3 form is advised; it should say on the bottle; it does on ours. I've taken to taking it this winter; it is said to give you a sunny disposition.
Diana, a very useful post.
D W - [Myalgia and hypertensioni (typically 155/95.) Began (2003) taking doxycycline and macrolide and later adding metronidazolei. I
___________________________________________________________
D W - [Myalgia and hypertensioni (typically 155/95.) Began (2003) taking doxycycline and macrolide and later adding metronidazolei. No medication now; just supplementsi and IR sauna. Morning BP typically 105/75]
Lovely work DW! And we can
Lovely work DW!
And we can add this link for the Marshall protocol comparisons. IF YOU ARE CONFUSED ON THE MPi ISSUES PLEASE DO READ THIS! http://stuff.mit.edu/people/london/universe.htm
This excellant informative review and assessment of the marshall protocol is a must read for anyone thinking it is a contender for their health care plan.
marie
On CAPi since Sept '05 for MSi, RAi, Asthmai, sciatica. EDSSi at start 5.5. Currently on: Doxy 200, Azith 3x week, Tini 2x month, all supplementsi.
"Color out side the lines!"
___________________________________________________________
On CAPi since Sept '05 for MSi, RAi, Asthmai, sciatica. EDSSi at start 5.5.(early cane) Now 6 (cane full time) Originally on: Doxyi 200, Azith 3x week, Tinii cont. over summer '07, Revamp of protocol in Summer '08 by Stratton due to functional loss; clarithromy
Well, that is good to
Well, that is good to know. I've diligently had hubby on Vitamin Di since starting the protocol. Just checked the bottle, and no reference to D3! Needless to say, I am bummed.......
Thanks for the info!
Hubby DXi 10-05 by LLMD; positive for Borreliosis; took 200-400 mg Doxyi for 2 mons; followed by zithi daily for 6 wks; small does of flagyli daily for 3 mons; tested by ID for Cpni 6-06; Tested positive and took Ketek for 6 weeks; Began Capi 8-06
___________________________________________________________
Hubby DXi 10-05 by LLMD; positive for Borreliosis; took 200-400 mg Doxyi for 2 mons; followed by zithi daily for 6 wks; small does of flagyli daily for 3 mons; tested by ID for Cpni 6-06; Tested positive and took Ketek for 6 weeks; Began Capi protocol