Vitamin D and Multiple Sclerosis-How They're Connected
Multiple Sclerosis and Vitamin D
Vitamin D is best known for working with calcium to build strong bones — in fact, it’s essential to absorbing the calcium in your diet. Less well-known is that vitamin D deficiency is thought to play a possible role in the development of multiple sclerosis (MS).
The body’s main source of vitamin D isn’t from diet, but from sunshine. Vitamin D is produced in your skin when you're exposed to the sun. For years, MS experts puzzled over why multiple sclerosis is more common in people who live in northern parts of the world. Now they're fairly sure that less sun exposure and low levels of vitamin D are risk factors for multiple sclerosis. The causes aren’t completely understood, but they include genes you inherit and things that trigger those genes to become active. Experts now believe that a lack of vitamin D is probably one of those triggers.
High levels of vitamin D decrease inflammation caused by the immune system. Low levels of vitamin D increase that inflammation. Multiple sclerosis symptoms are caused by attacks on the brain and spinal cord due to inflammation. All of this makes the vitamin D link make sense.
Science Behind the MS-Vitamin D Deficiency Theory
"Numerous studies show that vitamin D deficiency is related to MS risk,” explains Rock Heyman, MD, director of the Pittsburgh Institute for MS Care and Research at the University of Pittsburgh in Pennsylvania. “The Nurses' Health Study found that an intake of 400 international units or more of vitamin D lowered later multiple sclerosis risk by over 40 percent,” he says. “A study of American military personnel found that males with the highest vitamin D blood levels had lower MS risk later in life."
During a recent study done in Sweden, published in the journalNeurology,researchers examined blood samples from 164,000 people collected since 1975. They checked the blood samples for vitamin D levels and identified 192 people who later went on to be diagnosed with multiple sclerosis. Their conclusion? High levels of vitamin D were associated with a lower risk for MS in future years.
"What we can say at this time is that vitamin D deficiency is linked to multiple sclerosis, and studies suggest that adequate vitamin D levels lower the risk of developing the disease," notes William Hwang, MD, a neurologist on the staff of Methodist Charlton Medical Center in Dallas.
What If You Already Have MS Symptoms?
"We now also see that low vitamin D levels may be associated with the risk of a relapse or attack in someone already diagnosed with multiple sclerosis because vitamin D has a role in immune function, not just bone health," Dr. Heyman explains.
Studies have found that vitamin D levels tend to be low in people with MS and may be particularly low when a person with multiple sclerosis has a relapse. Numerous studies now in progress are trying to determine if vitamin D can be an effective part of multiple sclerosis treatment. "Vitamin D supplements may slow the progression of MS in some people," Dr. Hwang says.
Because of the complex link between vitamin D and multiple sclerosis, knowing your vitamin D level is important. "We routinely check vitamin D blood levels in all people with MS," says Mary Rensel, MD, a neurologist who specializes in multiple sclerosis at the Cleveland Clinic in Ohio.
Dr. Heyman agrees. "I believe vitamin D levels should be checked in people with multiple sclerosis," he says. "I also believe that people who have a first relative with MS should consider vitamin D supplementation and blood testing as well."
The Challenge of Determining the Right Dose of Vitamin D
Although experts agree on vitamin D testing, the jury is still out on how much vitamin D you should take as a supplement. "We usually recommend 2,000 international units (IU) a day," Dr. Rensel says.
Another study inNeurologyattempted to find the best level of vitamin supplements for people with multiple sclerosis. The researchers divided 23 participants into two groups, with one group taking 1,000 IU of vitamin D every day and the other group taking 7,000 IU a day. During the next six months, those taking the higher dose of vitamin D actually had more MS symptoms. Other studies, however, show wide variety in outcomes, and an optimal dose for vitamin D supplementation still isn’t clear.
"I currently don’t try to boost a normal vitamin D level with supplementation," Heyman says. "The best study showing a protective effect used ‘only’ 400 IU as a cutoff for vitamin D intake. The possible benefits of trying higher doses as an MS therapy [in addition to standard treatments] are beginning to be explored in a research setting." He noted, however, that "too much vitamin D can harm anyone, and the potential immune benefits for a person with MS could actually be less instead of more at extremely high levels.”
The Bottom Line on MS and Vitamin D
Multiple sclerosis experts agree that low levels of vitamin D may be a risk factor and contribute to MS causes. There is also agreement that anyone with a strong family history of multiple sclerosis or a diagnosis of MS should avoid vitamin D deficiency. There’s also growing evidence to suggest that at least adequate levels of vitamin D may help prevent symptoms in people with the disease.
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