Vitamin D and MS -- Let the Sunshine In

For those of you too young to appreciate my reference, Let the sunshine in, was the second of two songs in a medley for the musical, Hair, made popular by the 5th dimension in 1969. Heading west to find oneself as well as sunshine was all the craze at the time, but I am apparently a slow learner since it took me over 40 years to move out west. But I digress; I intended to talk about Vitamin D, the sunshine vitamin, and MS. If you bear with me, I will even provide the name of the first song in the hair medley that accompanied, Let the sunshine in.

First the facts:

1. Vitamin D supplementation is an essential part of your MS treatment
2. Most experts agree that Vitamin D3 (instead of Vitamin D2) is the best form to take as a supplement
3. The usual dose required to achieve the desired 25 hydroxy vitamin D level in your blood  (> 75 nmol/lt ) is usually 5,000 IU to 10,000 IU per day. Lower doses would probably work if the supplements actually contained as much Vitamin D3 as they state on their label. The only way to know if you are getting enough is to have your doctor check your total 25 OH Vitamin D level 3 months after starting supplementation
4. The best brand of supplement is unknown. Several studies have shown that the actual amount of vitamin D3 in any brand varies dramatically by brand and even within different capsules or tablets within the same bottle.  The best bet is to buy a brand that is USP certified. Nature made is one of those brands but others are available.

Why should you take Vitamin D for your MS?

For many years epidemiologists have appreciated a latitude gradient with MS incidence; namely, the further north you go from the equater in the northern hemisphere or the further south in the southern hemisphere, the incidence of MS rises.  Most evidence suggests that this latitude effect is due to decreasing exposure further from the equator to the ultraviolet B light required to make vitamin D in the skin. More recently we’ve learned that vitamin D is involved in the regulation of the innate and adaptive immune system as well as it’s typical role in calcium and bone metabolism. The evidence in support of a role for vitamin D deficiency in MS is mounting rapidly and includes the following information:

1. Case control studies in identical twins who do not both have MS reveal lower vitamin D levels in the twin with MS
2. Lower vitamin D levels in military personnel is a risk for MS at a later date
3. The nurses health study should a link between low vitamin D and risk of MS 
4. There is a higher risk of MS among offspring born between April and May compared to offspring born between October and November. This is reversed in the southern hemisphere. The lower vitamin D levels in the mother and fetus have been used to explain this risk during the 3rd trimester of pregnancies ending in April or May.
5. Preliminary studies suggest that vitamin D supplementation after the first attack of MS (say Optic neuritis) decreases the risk of a second attack. Larger studies are now underway
6. Decreased vitamin D levels are associated with a higher risk of relapses and progression although the studies are cross sectional and do not prove cause and effect.

To answer many of these questions, several controlled clinical trials are underway in the United States and Europe to determine if high dose vitamin D Supplementation is beneficial in MS.  If you are interested in learning about these studies, please go to clinicaltrials.gov and search for studies of vitamin D in Multiple Sclerosis. Since all studies suggest that doses under 10,000 IU a day are safe, it is most prudent to begin supplementation now unless there is a contraindication to treatment. Please check with your doctor first to determine if vitamin D supplements are safe in your situation.

Now back to the trivia question that started this blog; the first song in the Hair medley was called, The age of Aquarius.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego