Vitamin D and Multiple Sclerosis: Where do I Stand?
Last month, I was catching up on the doctors' visits and routine blood work. While at the neurologist's office, I picked up an order for the appropriate laboratory tests which would satisfy the needs of all three of my doctors (neurologist, rheumatologist, internist), including a test to measure vitamin D levels.
One blood draw + One laboratory report
= Three satisfied doctors + One happy patient
When requesting to have your vitamin D levels checked, it is important to ask for the 25(OH)D(3) or 25-hydroxyvitamin D test which is necessary to detect true deficiency.
In September 2008, I measured severely deficient in vitamin D at 7.8 ng/mL. Since then, we have been randomly checking the progress on my attempt to increase those levels. So far the highest I have obtained is 44 ng/mL.
Vitamin D Deficiency
As you begin to read the vast amount of research conducted on vitamin D and its effect on various diseases, you will soon see that finding a recommendation for optimum serum levels can be difficult. For one thing, the recommendations have changed dramatically over time. For another, there are two different measuring systems referenced in the literature.
nanograms per millilitre (ng/mL) or nanomoles per litre (nmol/L)
For simplicity, here is a chart which summarizes the current recommendations:
25(OH)D Levels and Health Implications
You can see how my measly 7.8 ng/mL is nonexistent. Last month's results came back at 36 ng/mL. Good, right? 36 ng/mL measures "sufficiency." Well, not really.
My neurologist would prefer to see vitamin D levels above 50 ng/mL (>125 nmol/L) and gave me a new prescription for vitamin D2 (50,000 UL of ergocalciferol), something I had taken previously. In contrast, my internist was satisfied with 36 ng/mL. When I asked my rheumatologist what level she prefers, she responded that between 50-80 ng/mL would be safe, then she gave me a back-up prescription for when the other one ran out.
Two out of three of my personal physicians recommend a higher level of serum vitamin D than the limits of the "normal range" which my laboratory uses. The Vitamin D Council recommends that serum levels of vitamin D should be at least 50 ng/mL in healthy individuals. However, this doesn't mean that YOUR doctors would recommend 50-80 ng/mL for YOU.
How much Vitamin D should I take?
The type of vitamin D which is formed when sunlight containing ultraviolet light (UVB) hits bare skin is called cholecalciferol. Enormous quantities of cholecalciferol, on average 20,000 units, is rapidly made in the skin if:
- the sun is high in the sky which occurs at midday (10 AM-3 PM), in the summer months, and at higher altitudes
- your skin is not covered by clothes or sunblock (exposing the face and hands is not enough)
- you stay in the sun until your skin just begins to turn pink, not red (which takes longer for individuals who have more skin pigmentation)
- you are not behind glass (as glass blocks UVB, preventing vitamin D from being made)
Over the counter vitamin D supplements provide cholecalciferol, also referred to as vitamin D3. These tablets are available in doses anywhere from 100 IU to 5000 IU, or even 10,000 IU. Although I had been taking daily doses of 5000 IU vitamin D3 for several months, my serum levels were still too low at the end of this winter.
The only prescription form available in the United States is the vitamin D analogue ergocalciferol (vitamin D2) which is available in 50,000 IU capsules. Ergocalciferol is present in plants and some fish, however this pharmacological substance is synthetic and creates different by-products than does cholecalciferol. Many sources I found do not recommend vitamin D2.
Ergocalciferol is said to be less effective in raising serum levels (about only 2/3 as effective as cholecalciferol or vitamin D3), however it had successfully raised my levels to 44 ng/mL last summer before I transitioned to taking 5000 IU vitamin D3 daily. Trying again to get my serum levels above 50 ng/mL, I will continue with 5000 IU of vitamin D3 daily and add once weekly 50,000 IU vitamin D2.
I asked my neurologist about increasing my daily D3 supplementation, but since summer has arrived we're holding off on that until after the next 25(OH)D(3) test. It is known that obesity itself can cause vitamin D deficiency since vitamin D is quickly sequestered in the fat cells and taken out of circulation where it's used by the body. This increases my personal need for higher levels of supplementation.
Please note that the numbers above taken from my personal situation do not represent recommendations, however the Vitamin D Council states that daily intake of 5000-10,000 IU vitamin D from all sources is safe in adults, 1000 IU for infants.
Vitamin D and Multiple Sclerosis
Studies have shown that vitamin D affects the growth and differentiation of immune cells such as macrophages, dendritic cells, T cells, and B cells. This immune-modulatory effect, especially by regulating T1-helper cells, has implications for a variety of autoimmune diseases including multiple sclerosis, rheumatoid arthritis, and type I diabetes.
Several studies in the past 30 years have investigated the importance and effectiveness of vitamin D in preventing the development of or in treating multiple sclerosis. A simple search of PubMed.gov for "multiple sclerosis and vitamin d" turns up 281 references (too many to quote or list here) including 234 free, full text journal articles.
SELECTED SOURCES FOR FURTHER READING:
Pierrot-Deseilligny C. Clinical Implications of a Possible Role of Vitamin D in Multiple Sclerosis. J Neurol 2009 September; 256(9):1468-1479.
Kimball SM, Ursell MR, O'Connor P, Vieth R. Safety of Vitamin D3 in Adults with Multiple Sclerosis. Am J Clin Nutr 2007; 86:645-51.
Kulie J, Groff A, Redmer J, et al. Vitamin D: An Evidence-Based Review. J Am Board Fam Med 2009; 22:698-706.
Cannell JJ, Hollis BW. Use of Vitamin D in Clinical Practice. Altern Med Rev 2008; 13(1):6-20.
Holick MF. The Vitamin D Epidemic and its Health Consequences. J Nutr 2005; 135: 2739S-2748S.
Grant WB, Holick MF. Benefits and Requirements of Vitamin D for Optimal Health: A Review. Altern Med Rev 2005; 10(2):94-111.
Holick MF. Sunlight and Vitamin D for Bone Health and Prevention of Autoimmune Diseases, Cancers, and Cardiovascular Diseases. Am J Clin Nutr 2004; 80(suppl):1678S-1688S.