Is it sunshine or vitamin D that helps multiple sclerosis (MS) patients?

Posted on: October 16, 2015   by  John Cannell, MD

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The Journal of the Medical Association (JAMA) family of journals has recently been publishing a number of papers on vitamin D, including the recent paper that showed dementia progressed almost four times more rapidly in those with low vitamin D levels.

Now a JAMA Neurology paper from Harvard on the progression of MS showed higher serum vitamin D levels, much higher, are associated with benefits for MS patients.

Fitzgerald KC, et al. Association of Vitamin D Levels With Multiple Sclerosis Activity and Progression in Patients Receiving Interferon Beta-1b. JAMA Neurol. 2015 Oct 12:1-8.

The study included 1,482 patients from 26 countries, all treated with interferon beta-1b from the BEYOND cohort. Interferon beta-1b are small signaling proteins which help reduce the frequency in flare ups in MS patients. Participants were only followed for two years and had at least two 25(OH)D levels checked no more than 12 months apart. Data from the 26 countries were collapsed into four regions of the world, Eastern Europe, Western Europe, North America and the Southern hemisphere.

At baseline after standardization by age and region, subjects with higher 25(OH)D levels tended to have lower disability and severity scores, fewer relapses in the previous 2 years, fewer MRI lesions, and greater normalized brain volumes.

Overall, an average of at least two, but usually 3, measurements of 25(OH)D levels in 1482 patients were significantly inversely correlated with the cumulative number of new active lesions between baseline MRI and two-year MRI. A 20 ng/ml increase in serum 25(OH)D status was associated with a 31% lower rate of new lesions (relative rate  0.69; P = .001). The lowest rate of new lesions was observed among patients with 25(OH)D levels > 40 ng/ml (relative rate, 0.53; P = .002). Statistically insignificant trends were found for beneficial associations between 25(OH)D levels and change in brain volume, relapse rates and disability scores. The authors hypothesized these trends were not significant due to the relatively short follow up time. Results were unchanged following adjustment for vitamin D–binding protein status.

In Western Europe, those with 25(OH)D levels above 40 ng/ml had about 1/3 the risk (relative rate, .36) of developing a new lesion as did those with lower 25(OH)D levels. The benefit of higher 25(OH)D status on new MRI brain lesions showed no evidence of tapering with levels above 40 ng/ml, but that data is unreliable because so few subjects had such levels.

The authors concluded:

“The findings of this large prospective investigation comprising patients from 5 continents and a broad range of serum 25(OH)D levels suggest that adequate vitamin D status is an important determinant of MS activity not only early in the disease course but also several years after the diagnosis. These results also suggest that individuals with MS may benefit from vitamin D levels above those currently considered by many to be sufficient in healthy adults.

However, as unintuitive as it sounds, the authors point out that serum 25(OH)D levels are a marker of sun exposure as well as vitamin D levels so it may be a beneficial effect of sun exposure that is causing the benefit for MS, effects that have nothing to do with vitamin D. That’s why the Vitamin D Council recommends natural 25(OH)D levels, around 50 ng/ml, which are obtained by safe sensible full body brief noon-time sun-exposure when season and latitude permit it, as well as 5,000 to 10,000 IU/day of oral vitamin D3 on the days you can’t sunbathe.

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