During winter months when the skies are gray and the ground is wet, our bodies do not have as much opportunity to transform sunlight into vitamin D.  During summer months, our exposed skin works to transform sunshine into the hormone we know as vitamin D.  20 minutes of full-body UV-B sun exposure for a light-skinned person produces at least 10,000IU (international units) of vitamin D.  I don’t know about you, but I’m a bit reluctant to sunbathe for 20 minutes when it’s only 34 degrees outside.

Add a diagnosis of multiple sclerosis and it becomes even more important to make sure that you get enough vitamin D through sunlight, food, and/or supplementation.  The connection between vitamin D deficiency and MS susceptibility, as well as increased disease activity, has been studied in great detail in recent years.  The evidence of this connection has contributed to the mainstream practice of neurologist’s prescribing or recommending D supplementation (calciferol or cholecalciferol) to MS patients. 

How much D should an MS patient take?  1000IU daily?  5000IU daily?  50,000IU weekly?  Is it really necessary?

The amount of vitamin D an MS patient should take is highly dependent upon his/her current serum levels or low-D deficiency as determined by the 25-hydroxyvitamin D (25-OH-D) blood test.  In the general population, a serum result is consider adequate if it is above 30 ng/mL (or 75 nm/L).  However, many neurologists (my own included) recommend that their patients maintain a 25-OH-D level above 50 ng/mL (up to 80 ng/mL).

When I was initially tested for a suspected vitamin D deficiency, my serum level was 7.8 ng/mL which is practically non-existent!  I was having a lot of pain, including very tender bones and achy muscles.  In fact, my bones almost felt “squishy” when squeezed.  Vitamin D, in conjunction with Calcium, is necessary to maintain bone density.  It took two years, close monitoring, and certain experimentation to find the amount of supplementation I needed to raise my serum levels from 7.8 ng/mL to 61 ng/mL. 

The amount of supplementation you might need to take varies upon your age, body weight, BMI, skin pigmentation, the season, and amount of sun exposure.  I have a larger BMI and do not get much direct sun exposure.  To maintain a current serum level of 68 ng/mL, I take 10,000IU daily of vitamin D3 which is an amount considered to be safe based on various studies using even higher levels.  (see Hathcock JN, Shao A, Vieth R, Heaney R. Risk assessment for vitamin D. Am J Clin Nutr. 2007;85(1):6-18.)

Please note that you should consult with your doctor and be tested before beginning supplementation or altering current supplementation.  Your needs will vary depending upon your current situation.

One concern with taking higher levels of vitamin D, with or without extra calcium, is the development of a condition called hypercalcemia.  In a new case study published in the January 2012 edition of Archives of Neurology, researchers share that “overexposure to vitamin D produces symptomatic hypercalcemia, with possible weakness, fatigue, depression, confusion, stupor or coma, polyuria, nephrolithiasis, renal failure, ectopic calcification, conjunctivitis, fever, chills, anorexia, nausea, vomiting, and constipation.”  (see Marcus JF, Shaley SM, etc. Severe Hypercalcemia Following Vitamin D Supplementation in a Patient With Multiple Sclerosis: A Note of Caution. Arch Neurol. 2012;69(1):129-132.)