Mono Sclerosis :: Stop MS in its tracks before it becomes Multiple

Vitamin D

As mentioned previously, there is a distinct latitude gradient associated with the spread of the condition throughout the world and this is, of course, most noticable in countries with large geographical areas like Australia. Canada and the USA. In the northern hemisphere countries(Canada and the USA) the high incidence areas are in the North which is furthest from the equator and, therefore, the areas with the least sunshine. In Australia, the opposite is true. The sunnier northern areas have a much lower incidence rate per head of population than the southern states and in both cases the incidence rate graduates with latitude.

So, the possible link between MS and lack of sunshine is clearly established but this is not the whole story. There are areas in the world where the level of sunshine is comparatively low and yet the rate of MS is also low but these are invariably communities whose diet is based primarily on fish.

Now, is this simply a coincidence or is there a possible link between these two phenomenon? Well, yes there is, Vitamin D3(Calciferol). The two main sources of Vitamin D just happen to be sunshine and oily fish. So, could it be that Vitamin D affords some level of protection against the condition for those fortunate enough to live in sunnier climates or who have a diet based primarily on oily fish and, if so, what mechanism is at work in the MS disease process?

Ashton answers both these questions in his paper Vitamin D Supplementation in the Fight Against MS and another interesting paper outlines how a study on British and Irish migrants to Australia found that the risk of developing MS was reduced by up to 75% dependant on the latitude of where the migrants settled. In other words, the further north they settled, the more sunshine, the more vitamin D3 and the less risk of MS.

Colleen Hayes Ph.D, from the University of Wisconsin, adds weight to the argument in favour of vitamin d3 as part of an effective therapy in the treatment of MS. In her paper Vitamin D: A Natural Inhibitor of MS, she suggests that MS may actually be preventable. Whilst not generally considered a genetically inherited condition, the children of an individual with MS do, apparently, have a 20 to 40 fold increased risk of developing the condition compared to unrelated individuals. However, she also states that "..the evidence that vitamin D might be a natural inhibitor of MS is compelling," and, as a consequence, suggests that "..it would be reasonable to provide supplemental vitamin d to individuals who are at risk of developing the condition."

A most important consideration is the situation during pregnancy. Quite simply, there is a well established reduction in MS attacks during pregnancy and an increased occurence following childbirth. Ashton quotes the plausible hypothesis of Swartz(1993) that this was due to the large increases in the production of the vitamin d hormone during pregnancy and its rapid decline after childbirth.

So, how much Vitamin D is required to prevent MS developing? How much is safe? How does one go about it?

Vitamin D Supplementation

Now, to return to the specific questions relating to vitamin D supplementation. Damien Downing argues, in his paper Vitamin D - A Time For Reassessment, that the current Recommended Daily Allowance(RDA), for vitamin D is woefully inadequate and based more on 19th century folklore than on any real science. Rheinhold Veith examines the safety issue in his paper Efficiacy and Safety of Vitamin D. He suggests that for individuals who spend little or no time in the sun an intake of 4000iu per day is not only perfectly safe but also necessary to raise 25(OH)D levels to the optimum range.

However, since then, a number of reports from both the US and from here in the UK, have suggested that the situation is not as simple or as clear cut as that. In a few cases, after a number of months of supplementation, the levels of vitamin D in the blood have failed to level out and have continued to rise to near danger level where bone loss could occur. As a result, Ashton Embry has put together specific and clear guidelines concerning supplementation with vitamin D and these are shown below.

The most reliable indicator of circulating vitamin D levels is the 25(OH)D test and regular testing of this, BOTH BEFORE AND DURING SUPPLEMENTATION IS ESSENTIAL. The key is to ensure a level of circulating vitamin D - 25(OH)D - of between 100 and 125nmol/l which is considered to be the optimum range to maintain good health and to reduce the risk of autoimmune reactions developing into full-blown autoimmune disease.

The advised procedure is this.

Arrange for a 25(OH)D blood test at your doctors BEFORE beginning supplementation.

Make sure they order the correct test. It is the 25(OH)D test and NOT the 1,25(OH)D test.

Be warned, it can take several weeks to obtain the results and, as mentioned previously, you should also have your serum calcium levels checked at the same time.

When the results are back, make sure they give you the actual figure. You will need this to compare with future readings. The so-called ?normal" range is up to 90nmol/L but, as explained above, you are aiming for the optimum range which is between 100nmol/L and 125nmol/L.

If you have children and intend to use vitamin D as a protection against them developing the condition, it is vitally important to discuss this with your doctor as well and have their levels of 25(OH)D and serum calcium checked BEFORE starting the process.

The table below, and the following introduction, have been produced by Ashton Embry himself to ensure that those who are supplementing with vitamin d, do so in full knowledge of the aims, objectives and possible safety issues involved..

"The key to vitamin D supplementation is to have one's 25D level between 100 and 125 nmol/l all year and to not exceed 150 nmol/l for too long. The trick is that there is no single supplement dosage which will achieve this. For some, 4000 IU all year will be fine. For others such a dosage will result in a very high and possibly problematic 25D level. For others such a dose may not be enough to achieve the optimal 25D level.

100-125 is the safest 25D level bracket given the current data is not very constraining. Vieth would claim that anything under 225 is safe but there are few hard data to support this. However data, which say that levels between 150 and 200 are a problem, are also very scarce. Krispin would say stay below 150 or perhaps even 125.

As Krispin emphasizes, the key is 6 month testing (once in October and once in April) in the first few years to determine what level of supplementation one needs in both the Oct-April and the May-Sept time periods to achieve a 25D level which stays year around in the 100-125 bracket. The table below should reflect these strategies. It is important to get this right."

Ashton Embry

Vitamin D Supplementation Table

Northern Hemisphere Countries (including UK)

Test every October and April for first 2-3 years.

If 25(OH)D is less than 75 nmol/L in Oct or April, then take 4000iu all year round.

If 25(OH)D is between 75 and 100 nmol/L in Oct, then take 4000iu Oct - Apr.

If 25(OH)D is between 75 and 100 nmol/L in April, then take 2000iu May-Sept.

If 25(OH)D is between 100 and 125 nmol/L in Oct, then take 2000iu Oct-Apr.

If 25(OH)D is between 100 and 125 nmol/L in April, then take 400 IU May-Sept.

If 25(OH)D is between 125 and 150 nmol/L in Oct, then take 1000iu Oct-Apr.

If 25(OH)D is between 125 and 150 nmol/L in April, then take none between May-Sept.