Introduction
In late 1999, immediately after reading Dr Reinold Vieth’s watershed paper on vitamin D supplementation (Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety), I experienced a “eureka” moment that vitamin D deficiency was very likely a major factor in the onset and progression of multiple sclerosis. Soon afterwards, I prepared a summary article, “Vitamin D supplementation in the Fight Against Multiple Sclerosis” and made it available on the internet. It presented all the epidemiological, experimental and immunological data which supported the need for adequate vitamin D intake to prevent and treat MS. The article was subsequently published in the Journal of Orthomolecular Medicine and can be accessed on the Direct-MS website (http://www.direct-ms.org) in the Science/Embry Papers/Published Papers section.
In 2003, Direct-MS prepared a 24 page booklet entitled “Protect Your Family from Multiple Sclerosis” and it provided robust scientific information demonstrating that adequate vitamin D supplementation in childhood would likely prevent most, if not all, cases of MS. The booklet can be downloaded from the Direct-MS website and is found in the Information/Booklets section. Notably, during this entire time the impressive and well documented vitamin D/MS relationship was completely ignored by the MS Society of Canada despite attempts to persuade them to let their members know this important information.
In this brief article I will present some recent, very significant scientific information, which combined with past data, leaves essentially no doubt that adequate vitamin D supplementation from birth onward can prevent MS and that supplementation can be of value for treating MS. Sadly, there is still extremely little information on Vitamin D on the MS Society of Canada website, a fact that disturbs me deeply.
Vitamin D for Preventing MS
The strongest evidence that adequate vitamin D can prevent MS comes from epidemiological studies which show a strong correlation between the amount of ultraviolet radiation from sunlight in a given area (main source of vitamin D) and MS prevalence in that area. One of the most convincing studies was done throughout Australia where it was found that there was almost a 1 for 1 relationship between MS rate and vitamin D supply. The more UV radiation and consequent vitamin D intake of an area, the lower the MS rate in that area. Impressively, MS was 7 times more common in temperate Tasmania than in tropical. northern Australia.
This study shows how effective adequate vitamin D is for preventing MS because all the other known genetic and environmental causal factors for MS are essentially constant over Australia. This leaves vitamin D intake as the key environmental factor which results in hardly anyone getting MS where adequate vitamin D is readily obtained from the sun.
Recent epidemiological studies in Europe and North America have added further strong support to the Australian study. Notably, a major compilation in 2010 looked at 54 studies from around the world and showed that there was an extremely close association between the amount vitamin D intake from sunlight and MS rate. The authors noted that the vitamin D/ UV radiation input factor was more than 20 times more important any other factor in terms of MS cause.
Other studies which have demonstrated that vitamin D intake can greatly reduce MS risk were those which showed that the amount of vitamin D intake in childhood strongly influenced one’s chance of getting MS later in life. These studies, which yielded consistent results, were done in places around the globe including Norway, Australia, Italy, Cuba and Martinique. One unique study involved determining the vitamin D levels of blood samples collected from US military persons upon induction (mainly late teens). It was shown that, the higher one’s vitamin D level, the lower the risk of later contracting MS with every 50 nmol/l increase resulting in a 40% risk reduction. Furthermore, the study revealed that a level of 100 nmol/l or higher at ages under 20 almost totally eliminated any risk of later contracting MS.
Migration studies in the past showed that persons over 16 took the risk of MS found in their place of origin to where they moved whereas those under 16 took on the risk of MS of the place to where they moved. Thus, young people who moved from high vitamin D supply area (low risk) to a low vitamin D supply area (high risk) ended up with a high risk of MS whereas older people who experienced the same change of location retained the low risk of their high supply area of origin. Thus it is clear that a high supply of vitamin D is required in childhood and adolescence to prevent MS.
Interestingly, recent studies have even shown that the supply of vitamin D during fetal development also affects MS risk with persons born in May (lowest vitamin D supply in 2nd and 3rd trimester) having a significantly higher risk of MS than those born in November (highest vitamin D supply in 2nd and 3rd trimester). This birth month and MS risk relationship has been found in various countries including England, Canada, Italy, Australia and Denmark leaving no doubt as to its validity.
All of the above studies in combination, leave no reasonable doubt, that adequate vitamin D intake in utero and throughout childhood and adolescence essentially cuts one’s risk of contracting MS as an adult to ZERO. What constitutes adequate vitamin D intake will be discussed in a later section of this article.
Vitamin D for Treating MS
Although we now know that adequate vitamin D during one’s youth can prevent MS, the question of whether or not adequate vitamin D intake can affect the progression of MS still remains. We now have diverse and robust scientific evidence to say that adequate vitamin D intake, so as to ensure the maintenance of an optimal circulating vitamin D (25D) level, most likely is very beneficial for MS.
The initial evidence to support the potential value of vitamin D in MS were various experimental and immunological studies which revealed that vitamin D had a significant effect on the immune system and regulated it such that inflammation was reduced. Vitamin D receptors were found on most types of immune cells and vitamin D reduced various inflammatory actions of the immune system Thus, in theory, a higher level of vitamin D was postulated to decrease the effects of autoimmune reactions in the CNS, which drive the MS disease process.
Some of the earliest evidence that indicated that vitamin D intake indeed did affect the MS disease process was the close relationship between seasonal differences in MS disease activity (attack occurrence, MRI lesion activity) and seasonal variations in vitamin D supply. A number of studies demonstrated that MS disease activity was highest in the spring when vitamin D levels were the lowest.
More recently, more specific studies have greatly supported the use of vitamin D supplementation for treating MS. A study in Australia in 2010 showed that every 10 nmol/l increase in vitamin D blood level resulted in a 9% reduced risk of a relapse occurring. Importantly it was found that a vitamin D level of 100 nmol/l was associated with a greater than 80% reduction in risk of a relapse. Similar results were found in a 2010 American study of pediatric MS patients in which every 25 nmol/l increase in vitamin D level resulted in a 34% reduction in the rate of relapse.
Lately, the same American researcher documented that, for adult MS patients, each 25 nmol/l increase in vitamin D was associated with a 15% lower risk of the development of a new lesion and that higher vitamin D levels were associated with lower relapse risk. A very recently published study in Norway confirmed these results and found that each 10 nmol/L increase in vitamin D was associated with 12.7% reduction in the formation of a new lesion. These data explain why lesion activity fluctuates with the season supply of vitamin D from the sun.
Another very recent (2012) study in France found that “vitamin D did indeed influence the relapse rate” and that every 10 nmol/l increase in vitamin D was associated with a reduction in the relapse rate of 13.7%. They also found that “relapse incidence rate ratio decreased as the blood vitamin D level increased up to 110 nmol/l, but a plateau effect was observed beyond this limit.”
When it comes to MS drugs and vitamin D, a 2012 study in Tasmania found that an interferon drug (e.g. betaseron) was only protective against relapse among persons with higher vitamin D levels. Astoundingly, it was found that an interferon drug increased relapse risk in those with a low vitamin D level!
One of the most interesting recent findings just published in July found that the beneficial effects of exercise in multiple sclerosis were really due to a higher vitamin D level in those who exercised. All of these studies when considered in combination leave no reasonable doubt as to the benefits of adequate vitamin D intake by persons with MS.
Vitamin D Supplementation for Adequate Vitamin Levels
One of the biggest controversies surrounding vitamin D supplementation is what level of circulating vitamin D (25D) is best for optimal health and how much vitamin D intake is needed to achieve such a level. The most straightforward way to determine an optimal level of vitamin D is to ask what level was present in humans during the last 4 million years of evolution of our species. This is the level under which evolution occurred and is the level needed for all the vitamin D requirements throughout the body and to maximize health.
Studies of modern people living in East Africa with a near Paleolithic lifestyle as well as people receiving lots of sun exposure in low latitude areas indicate that, for most of our evolutionary history, humans most likely had levels in the 125 – 175 nmol/l range. This level can be considered the optimal level of circulating vitamin D and is the one which provides the best health.
The question now remains how much daily vitamin D supplementation is needed to achieve and maintain such a healthy level of circulating vitamin D. There is no easy answer to this question because vitamin D can be gotten from UVR exposure as well as from supplementation and ultimate circulating levels will also depend on body weight.
Experiments have found that for most people an intake of between 6000 and 8000 IU a day will result in a circulating vitamin D level of 125 – 175 nmol/l. In Canada where very little vitamin D is gotten from sunlight for geographical and cultural reasons, any adult wanting to ensure an optimal level of circulating vitamin D should take a 6000 – 8000 IU supplement every day. Given that genetic differences also influence vitamin D levels this amount can be adjusted up or down on the basis vitamin D testing. These amounts have to be scaled downward for children. Of course the presence of any rare illness which contradicts vitamin D intake has to be also taken into account.
The question of safety of vitamin D supplementation is also sometimes raised. A comprehensive literature study in 2007 demonstrated that 10,000 IU a day is completely safe. It has been further suggested that 40,000 IU a day may be when problems start. Notably, a dose-safety study of high dose vitamin D found that doses up to 40,000 IU a day over short periods did not cause any adverse effects. Many of the participants had an average dose of 19,000 IU a day over the entire year of the study and none had any adverse effects.
In summary, a daily vitamin D supplement of 6000 – 8000 IU a day should be adequate for most healthy adults to maintain an optimal level of circulating vitamin D. Smaller does of 1000 – 4000 IU would be appropriate for children depending on age and size. Such dosages are completely safe and should be sufficient for preventing and treating MS. In Canada the cost of such a supplement would be about 5 -10 cents a day. Anyone with MS who is considering doses substantially higher than this should consult their doctors so as to ensure they are monitored for any adverse side effects.
Summary
Since 2000 there have been many scientific studies which in combination prove that adequate vitamin D intake from childhood onward will prevent most if not all cases of MS. Furthermore, additional studies have shown that adequate vitamin D intake is very beneficial for reducing the inflammatory component of MS which is a major part of the disease process.
Many MS doctors and organizations which receive substantial funding from pharmaceutical companies are downplaying the importance of vitamin D supplementation. Despite the very large, diverse, and robust scientific data base which supports the use of adequate vitamin D for preventing and treating MS, the doctors and organizations are demanding that multi-million dollar intervention trials be conducted over the next decade or two before they can recommend using a completely safe and extremely low cost vitamin D supplement.
Adequate vitamin D for preventing and treating MS is a ‘do-it-yourself” endeavour and I hope the information in this article will provide the impetus for everyone reading it to ensure their vitamin D intake and that of loved ones is sufficient to provide an optimal level of circulating vitamin D of 125 – 175 nmol/l. The required daily intake for most adults will be in the 6000 – 8000 IU range with smaller doses (1000 -4000 IU) for children. Such vitamin D supplementation is completely safe and costs pennies a day.