Health and Wellness

Introduction

The Health and Wellness column is a new addition to The Motivator. In each issue, this column will feature news and information about diet, exercise, and various alternative therapies that some people may be considering as an adjunct treatment for their MS.

The topics for the first few issues of this column will relate to nutritional factors and MS. These will be written by Ashton Embry, PhD, a research scientist whose son was diagnosed with MS nine years ago. Following his son's diagnosis, Dr. Embry "plunged" into the scientific literature for MS, and discovered abundant scientific evidence pointing to various nutritional factors that could play major roles in the onset and progression of MS.

The topics presented in this column are for informational purposes only, and MSAA does not endorse any specific product or treatment. All changes to one's diet, exercise, treatment, or lifestyle, should only be done under the guidance of a medical professional.

Nutritional Factors and Multiple Sclerosis

Part II Vitamin D

The concept that various nutritional factors may play a role in the onset and progression of MS was introduced in the winter 2004 issue of The Motivator. In the Health and Wellness column, "prime suspects" were identified on the basis of the available scientific evidence. A deficiency in vitamin D, the sunshine vitamin, was one of the nutritional factors that could potentially figure prominently in the MS disease process.

Vitamin D first reached the public's attention in the 1920s when it was isolated and named. At that time, a deficiency in vitamin D was shown to be responsible for rickets, a serious bone disease that affected many children in North America and Europe. Notably, vitamin D is found only in a few foods, with fatty fish (such as salmon and mackerel) being the best sources.

The main source of vitamin D for most people comes from the sun. When skin is exposed to ultraviolet B rays of the sun, cholesterol in the skin is converted into vitamin D. The vitamin D is then transported to the liver where it changes form and is released into the blood circulation. Many cells in the body from the kidneys to the brain to various immune cell types, convert the circulating vitamin D into an active hormone that is required for proper cell functioning.

The action of this vitamin D hormone is usually associated with its ability to facilitate the absorption of calcium from the intestines. Calcium is a mineral that is essential for many critical physiological functions and thus vitamin D's role in this regard is of the utmost importance. When vitamin D levels are too low, various biochemical reactions occur to ensure calcium levels are maintained and one result of these actions is the loss of calcium from the bone. Thus a long-term deficiency in vitamin D may result in osteoporosis in later adulthood.

Cells of the immune system also require vitamin D for proper functioning. This is why vitamin D deficiency may be a factor in MS, a disease of a malfunctioning immune system. A deficiency in vitamin D was first hypothesized to be a significant factor in MS 30 years ago, when variations in the rates of MS were noted to closely follow changes in vitamin D supply.

For example, in Australia, where there are very large variations in the rate of MS, the MS rate correlates almost perfectly with the supply of ultraviolet light from the sun, the main source of vitamin D. A similar relationship has also been documented in North America, where decreasing sunshine and vitamin D supply provide a possible explanation of why MS is four times as common in Washington State compared with southern California.

Other very diverse scientific data also support the concept that a deficiency in vitamin D might play a significant role in MS. Animal experiments have demonstrated that injections of vitamin D hormone or just simple exposure to ultraviolet light will prevent or halt the animal form of MS in mice. Immunological studies reveal how vitamin D may play an important role in affecting the MS disease process that is dominated by the attack of immune cells on myelin, the fatty substance that wraps around nerve axons in the central nervous system. The vitamin D hormone has been shown in animal experiments to significantly slow down such an immune attack by preventing the problematic immune cells from multiplying.

Other important scientific evidence which demonstrates that vitamin D could be involved in MS include: a study which showed that nurses who took a vitamin D supplement had a 40 percent lower risk of MS; a study which showed that people who work in jobs where they are exposed to lots of sunshine had low rates of MS; and a study which showed that people who were exposed to lots of sunshine as children had an 85 percent lower chance of contracting MS. (References listed at end of article.)

Such studies provide support to the theory that adequate vitamin D could potentially prevent the onset of MS, but please note that more studies are needed before any firm conclusions may be made. Should this theory prove to be true, the obvious question that follows, asks if adequate vitamin D can affect MS disease activity in those who are already diagnosed with the disease. In the 1980s, a small clinical trial using 5000 IU of vitamin D per day demonstrated a marked reduction in attack rate over the two years of the study. The study, however, was quite small, so the results need to be confirmed by a larger better-controlled study. (Such a study is planned to begin in the near future.)

Recently, in a small study that used fish oil (a good dietary source of vitamin D) as the therapeutic agent, 85 percent of the participants went attack-free over the two-year study period. Finally, in another study, MS disease activity as revealed by lesion activity on MRI scans, increased and decreased in concert with seasonal changes in vitamin D levels. Please note that other factors could be involved, which is another reason why larger studies are needed to confirm these findings. (References listed at end of article.)

People living in latitudes greater than 35 degrees, which includes most of the United States and Europe, as well as all of Canada, do not produce much vitamin D from sunshine for up to 6 months of the year. This is because of the low angle of the sun in the winter months and a consequent substantial lessening of UVB rays. This could be one reason why MS is so common in these higher latitudes.

Researchers have estimated that humans use up to 4000 International Units (IU) of vitamin D per day and that many people in the higher latitudes average only 500-1000 IU per day from all sources over the year. This relatively low intake results in a fluctuating blood level of circulating vitamin D of 20-30 ng (nanogram) per ml (milliliter). This is about half of the estimated optimal level of 40-60 ng/ml found in people living in lower latitudes where MS is rare. This deficiency in circulating vitamin D results in many cell types, including immune cells, being unable to manufacture adequate vitamin D hormone for proper functioning.

Given the study results mentioned, some individuals with MS, and their close relatives who have a higher susceptibility to MS, are making sure they have an optimal amount of circulating vitamin D. This would allow all of their cells, especially their immune cells, to have access to all the vitamin D required. Vitamin D supplements provide one way of obtaining adequate vitamin D. Fish oil provides vitamin D as well. Increased sun exposure would be of benefit for increased vitamin D, but this may also raise the risk of skin cancer.

Individuals considering vitamin D as a part of their treatment plan should note that a definitive link between vitamin D and MS has yet to be confirmed. Large, controlled studies need to be conducted. Individuals considering a vitamin D supplement should consult their physician before making any change to their dietary regimen; they also need to be sure they are taking the correct amounts, because too much vitamin D can be toxic and not enough will have little beneficial effect.

Because of differences in genetics, lifestyle, geographic location, and sun exposure, the amount of supplement required will differ from person to person depending on their individual circumstances. With the help of a physician, an individual can determine what level of supplementation is needed to ensure his or her circulating blood level of vitamin D stays above 40 and below 60 ng/ml. For many people, an adequate supplement level seems to be about 4000 IU per day from October to March and 2000 IU per day from April through September. Yearly checks of one's circulating vitamin D level and a discussion with a physician are absolutely essential for making sure one's level is not too low or too high.

In summary, a very diverse scientific database suggests that lower than optimal levels of circulating vitamin D could be associated with MS. With this in mind, some people with MS and their close relatives are taking an adequate vitamin D supplement, especially in winter, to ensure they do not become deficient in this important nutrient. In the next issue of The Motivator, food proteins and their potential effect on the development and progression of MS will be presented.

For more information, readers may go to www.direct-ms.org or call (403) 282-0028 to reach "Direct-MS," (DIet REsearch into the Cause and Treatment of Multiple Sclerosis). Located in Calgary (Alberta, Canada), this federally registered charity was formed to provide science-based information on nutritional factors which may play a role in MS, as well as to fund scientific research to test the effectiveness of dietary strategies for slowing or halting MS progression.

Editor's note: Any vitamin that is not water-soluble, including vitamin D, may be stored in the body if too much is taken, and this may result in toxicity. Readers are strongly advised to contact their physician before making any changes to their diet or supplement regimens.

References:

Freedman DM, Dosemeci M, Alavanja MC: Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates. Occup Environ Med, 2000; 57: 418-421.

Van der Mei IAF, Ponsonby A, Dwyer T, et al: Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ, 2003; 327: 316-321.

Munger KL, Zhang SM, O'Reilly E, Hernan MA, Olek MJ, Willett WC, Ascherio A: Vitamin D intake and incidence of multiple sclerosis. Neurology, 2004 Jan 13;62(1):60-5.

Goldberg P, Fleming M, Picard E: Multiple Sclerosis: Decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Medical Hypotheses, 1986; 21: 193-200.

Nordvik I, Myhr KM, Nyland H, et al: Effect of dietary advice and n-3 supplementation in newly diagnosed MS patients. Acta Neurol Scand, 2000; 102: 143-149.

Embry AF, Snowdon LR, Vieth R: Vitamin D and seasonal fluctuations of gadolinium-enhancing magnetic resonance imaging lesions in multiple sclerosis. Ann Neurol, 2000; 48: 271-272.

Comments about Vitamin D from Jack Burks, MD, MSAA Vice President & Chief Medical Officer

Dr. Embry has summarized encouraging data and put forth a theory linking vitamin D and MS. The validity of the theory remains to be proven with clinical trials involving vitamin D in MS patients. Therefore, I remain cautious based on my 30 years of experience with MS research, where I have witnessed many good theories on MS fade away because of negative or insufficient data in MS clinical trials. In fact, one small study of short duration, using a vitamin D-like substance was found not to be helpful in MS patients (Ref. John Fleming: AAN abstract 2002).

The proof will be found through a well-designed clinical trial in MS. Dr. Embry also states that "more studies are needed before conclusions may be made." I agree. Fortunately for individuals with MS, Dr. Embry is working on this project. I applaud Dr. Embry's efforts, and MSAA may become involved with helping to fund a clinical trial that is presently in the planning stages. I anticipate a question from my patients who read Dr. Embry's article, asking that even though the theory has yet to be proven, should they start taking extra vitamin D immediately? After all, vitamin D is ‘natural' and vitamins are a necessary part of our diet anyway. And it is inexpensive and easily accessible at the supermarket without a prescription. So why not just take some vitamin D instead of waiting for the research results?

If you are so inclined, I recommend that you talk to your doctor first and get a vitamin D blood level to determine if you have a vitamin D deficiency. If so, vitamin D supplements seem reasonable. If nothing else, it may help prevent osteoporosis, which is seen in MS patients. Dr. Embry suggests taking an extra 4000 I.U. in the winter and 2000 I.U daily in the summer, along with yearly blood tests. Ask your doctor if he or she agrees.

I also want to emphasize Dr. Embry's warning: "Too much vitamin D can be toxic." Vitamin D is not water soluble and therefore can accumulate in the body. High doses may cause symptoms such as fatigue, irritability, and muscle problems, as well as problems with calcium in the body. Individuals taking vitamin D need to be sure that they don't over do it.

In summary, the data presented is encouraging, but other data is less favorable. Taking vitamin D supplements is reasonable if you are deficient, as determined by a blood test. Taking too much can be harmful so your doctor should be involved in the decision. MSAA supports more definitive research with vitamin D in the future.
—Jack Burks, MD

Back