How Often Should The Test Be Performed
With daily or weekly dose, at least 3 months of supplementation is needed to reach a plateau . Thus, measurement of 25D is recommended after 3 months of therapy . In case of resolving the insufficiency and deficiency, the panel recommended routine check of serum vitamin D level at least two times a year especially the beginning of spring and autumn .
The panel also recommends monitoring of calcium level at baseline and after 3 months of supplementation in deficient patients .
Therefore, the panel recommended that further monitoring of PTH, and urinary and serum calcium be performed according to physician decision .
Data Collection And Analysis
Two review authors independently extracted data and assessed the methodological quality of studies, while another review author sorted any disagreements. We expressed treatment effects as mean differences for continuous outcomes gadoliniumenhancing T1 lesions), as standardised MDs for healthrelated quality of life, as rate differences for annualised relapse rates, and as risk differences for serious adverse events and minor adverse events, together with 95% confidence intervals .
Vitamin D Deficiency Linked To Early Cognitive Impairment In Ms
Nancy A. Melville
Vitamin D deficiency detected at the time of diagnosis of multiple sclerosis is associated with cognitive impairment and may also affect disability, according to new research that adds to the known adverse relationship between low vitamin D and MS.
“We confirmed that low vitamin D may affect not only early disability but also cognition in newly MS diagnosed patients,” first author Eleonora Virgilio, MD, of the MS Center, Neurology Unit, University of Eastern Piedmont, Novara, Italy, told Medscape Medical News.
“The possible effects of Vitamin D on both cognition and early disability in newly diagnosed MS patients needs to be further investigated because this association might represent a marker of future disability, supporting the need for prompt supplementation,” she said.
The findings were presented February 25 at the Americas Committee for Treatment and Research in Multiple Sclerosis Forum 2021.
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Who Should Be Tested For Serum 25d Level And What Is The Optimal Range Of Vitamin D
Although there is inconstancy in the results of cross-sectional studies that compare vitamin D status in MS patients and healthy subjects, the high prevalence of vitamin D deficiency in general population including MS patients is predominantly accepted. Thus, there was a general consensus of vitamin D assessment in all MS patients especially early after diagnosis and in first demyelinating event .
The normal range of 25D have been revised in recent years. Normality is currently between 30 and 100 ng/ml . Less than 10 ng/ml is considered as deficiency and a range between 11 and 30 ng/ml considered as insufficiency . However for many of the non-classic, extra-bone effect of vitamin D including MS prevention, 40 ng/ml was suggested . Previous studies recommended a threshold of 30 ng/ml for patients with hyperparathyroidism and renal disease stage 35 .
What Can You Do To Manage Vitamin D Deficiency
The experts suggest spending regular time in the sun of at least 30 minutes daily especially during summer. Also, use sun protection as needed.
Apart from getting adequate sunlight, which is the simplest and most natural way to get Vitamin D, heres how to manage vitamin D deficiency:
- Eat a nutritious diet: Vitamin D is naturally found in a number of food items such as fish, yoghurt, milk, mushrooms and eggs.
- Maintain a healthy lifestyle: Effective metabolization of vitamin D requires us to refrain from activities such as smoking and drinking. Moreover, exercising regularly can also increase vitamin D production in our body.
- Consider supplements: There are various vitamin D supplements available, which can give a boost to your health. However, do consult with a doctor before taking any such supplements.
Remember that limited sun exposure and/or low levels of vitamin D have also been associated with other conditions. These include Parkinsons disease, Alzheimers and other types of dementia, as well as schizophrenia and other auto-immune diseases like Type 1 diabetes, Crohns disease and lupus.
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How Does Vitamin D Impact Ms Risk
In the 1970s, vitamin D deficiency was proposed to be a risk factor for MS. Since then, a body of epidemiological data has sustained this hypothesis.
Over time, researchers discovered that vitamin D acts as a hormone involved with the immune and nervous system. It drives the specialisation and growth of different types of immune cells, and a number of these cells have vitamin D receptors on their surface. These immune cells are important in MS as they are involved in mounting an immune response, which in MS can lead to the damage of myelin in the brain and spinal cord. Potentially explaining some of the links between vitamin D and MS.
MS Research Australia funded researchers at the Westmead Institute for Medical Research, who have examined vitamin D and the epigenetics of the vitamin D receptor on immune cells. Epigenetics is the science of how cells chemically modify their DNA to switch specific genes on or off. When genes are switched off, the protein they encode is no longer produced in the cell. In this study, the researchers analysed chemical modification of the vitamin D receptor gene to determine whether it was switched on or off in specific immune cells.
Can Vitamin D Help Ms
You may have heard some buzz about vitamin D and multiple sclerosis. There are some hopeful signs that it can ease your symptoms, but researchers still have a lot of work to do before we know for sure.
“There’s no perfect study,” says Matthew McCoyd, MD, an MS specialist at Loyola University Medical Center. But some research suggests several ways that vitamin D can be good for you, whether you have MS now or want to keep it at bay:
Slows down the disease. Researchers checked the symptoms of people in an early stage of MS. They found that after 5 years, those with more vitamin D in their blood had fewer problems.
Prevents MS. Studies show that children who get a lot of sunlight, which is one way to get vitamin D, are less likely to get the disease when they grow up.
Some research also shows that people who live away from the equator, where there’s less sunlight, have a higher rate of MS.
It’s not yet clear how vitamin D helps, McCoyd says. It may be good for your immune system. This is your body’s defense against germs, and when you have MS, it isn’t working right.
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Can Vitamin D Reverse Ms
While vitamin D cannot cure MS, studies have shown that increasing vitamin D level can help slow progression of the disease. Some studies have also suggested that vitamin D may help prevent MS relapse and reduce the severity of flare-ups.
Since it is common for MS patients to have low levels of vitamin D, and higher levels of vitamin D have been tied to better MS outcomes, it is important that those with MS take steps to maintain a sufficient vitamin D level. Restoring vitamin D levels to a healthy range has been shown to help patients with autoimmune diseases.
Could Vitamin D Be A Viable Choice
MS Research Australia is in the final stages of its world-first vitamin D MS Prevention Trial called PrevANZ. This study aims to see whether vitamin D supplementation can delay the onset of MS. In this gold standard double-blind placebo-controlled trial, people who had experienced their first MS-like episode and were diagnosed with CIS were recruited. They were then randomised into different groups, given either a mock treatment or different doses of vitamin D and then observed for 12 months.
202 people were enrolled in the trial, and the last participant has just finished the 12-month observation period. Statisticians and clinicians are now busy compiling the results, and we look forward to releasing the results in mid-2021.
It is important to note that excessive vitamin D consumption can lead to a build-up of toxic levels of vitamin D. Symptoms include nausea, vomiting, constipation and more. Any supplementation should be done in consultation with a healthcare professional.
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What If Low Vitamin D Is Just Correlated With Ms But Is Not A Cause
The recent study of Finnish women, as well as previous studies with a similar observational design, can only identify correlations between variables. In other words, they can conclude that people who end up diagnosed with MS are more likely to have had low vitamin D levels earlier in life, but they cant definitively show that low vitamin D played a role in causing MS.
In epidemiology, were always concerned about that, says Munger. Are there alternative explanations, or is something else going on? For example, perhaps its not vitamin D specifically, but sun exposure, that affects MS risk.
However, Munger points to recent genetic studies, including one published in April 2017 in the journal Neurology and several more published in the last two years, that show that genes associated with lower vitamin D levels are also associated with an increased risk of multiple sclerosis.
Those studies have all suggested that there quite likely is a causal relationship between vitamin D and MS, confirming what the observational studies are showing and removing some of that doubt, Munger says.
Agreements And Disagreements With Other Studies Or Reviews
Despite the growing body of evidence indicating that vitamin D is unlikely to be efficacious for people with MS, some study authors strongly support its use in MS , emphasising benefit reported by observational studies and its relatively low toxicity. For these researchers, the lack of benefit noted in most trials should be attributed to participants not sufficiently deficient in vitamin D at baseline or to inadequate supplementation or a too short treatment period, as well as to the low quality of studies.
The discrepancy between epidemiological studies, which reported an association between low serum 25OHD concentration and MS, and randomised interventional trials, which did not find benefit of vitamin D supplementation for people with MS, can be explained by the assumption that low vitamin D is not a cause but a consequence of ill health. Inflammatory processes involved in disease occurrence and clinical course would reduce 25hydroxyvitamin D , which would explain why low vitamin D status is reported in a wide range of disorders .
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What Dosage Is Best
Experts canât say how much vitamin D is needed to prevent or slow MS. Different medical groups disagree on the ideal amount.
Official recommendations for adults is 400 to 600 international units of vitamin D daily.
Ask your doctor whatâs right for you. Be careful not to overdo it. Vitamin D helps your body absorb calcium, and you might end up with too much of that mineral. High calcium levels can weaken bones, damage the heart, and increase the risk for kidney stones.
If you already have MS, your doctor can check whether your vitamin D levels are too low. If so, it might make sense for you to take a supplement.
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Quality Of The Evidence
Most of the included studies had major weaknesses. The most common flaws were inadequate or unclear method of allocation concealment, high dropout rates after randomisation, and imprecision. Using GRADE criteria, we considered the evidence to be of very low certainty for relapse rate, worsening of disability, and MRI gadoliniumenhancing T1 lesions measured at 52 weeks’ followup, and of low certainty for serious and minor adverse events. Our review did not find evidence of benefit of vitamin D for patients with MS, but conservative interpretation of the results is warranted because they were reported by a few small trials that we considered to be at high risk of bias.
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Ms And Vitamin D Deficiency
Vitamin D is an essential nutrient derived from exposure to sunlight or through supplementation.
Previous studies have shown that African-Americans tend to have lower vitamin D levels than whites, possibly due to the higher levels of melanin in their skin. Melanin is a pigment in the skin that acts as a filter of ultraviolet light, which limits the amount of vitamin D that the body can produce in response to sunlight exposure.
In this study, published in Neurology, researchers compared vitamin D levels in 339 African-Americans with multiple sclerosis and 342 without the disease.
The results showed 77% of those with MS were vitamin D deficient compared with 71% of those without the disease. Vitamin D levels were not associated with disease severity.
Researchers say people with MS were exposed to a lower monthly UV index and lived an average of one degree of latitude farther north than those without the disease. They say the link between low vitamin D levels and MS was weaker but still significant after accounting for these differences.
The study also showed that people with a higher proportion of European ancestry in their genes were less likely to have low vitamin D levels.
Researchers say further studies are needed in multiple ethnic groups to explore the relationship between vitamin D levels and multiple sclerosis.
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Do I Need More Vitamin D
It’s common for people with MS to be low on this vitamin. It may be hard for you to get outside to get sun often enough. Low vitamin D can also be a side effect of corticosteroids and other MS medications.
Your doctor can run a blood test to check your vitamin D level. You might be able to make up the difference by eating more fatty fish, eggs, and other foods that are high in vitamin D. Or, your doctor might suggest you take a supplement.
It’s not clear whether taking a daily vitamin D supplement protects people from getting MS, or slows the disease in those who already have it. Studies suggest it might help, but this hasn’t been proven. But since supplements are usually safe to take, it may not hurt to try them.
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How Is Vitamin D Deficiency Detected
There are 2 forms that can be detected in the blood:
1,25 OH-D 1,25 dihydroxyvitamin D 1,25 D is a less accurate representation of Vit D status.
| Vit D results | |
|---|---|
| Deficiency | |
| Toxic | > 150 ng/ml |
Many labs do not report Vit D2 or Vit D 3 levels separately. Some labs do report them separately and then give a total Vit 25 hydroxy level by combining both Vit D2 and D3 scores.
The cost of Vit D 25 hydroxy level at CCF is approximately $201 dollars.
More than 50% of women and 40% of men have Vit D deficiency :266-81.). This may be higher in Northeastern Ohio.
Who Should Be Considered For Vitamin D Deficiency
Multiple Sclerosis patients should be considered and especially, marginally ambulatory or nonambulatory patients.
- Elderly patients
- Patients that have had fractures
- Any patient on long term steroid Rx
- African American, Hispanic patients as darker skinned people have decreased absorption of Vitamin D from sunlight exposure
- Gastric bypass patients
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Vitamin D And Ms Recommendations
The Multiple Sclerosis Society of Canada has launched evidence-based recommendations on vitamin D supplementation that can help people affected by MS make informed decisions about their health.
To develop these recommendations, the Society convened a panel of scientific and clinical experts as well as representatives from other national MS Societies and an individual living with MS to discuss the available evidence on the link between vitamin D and MS. Fruitful discussions between the panel of experts led to the development of evidence-based statements which formed the basis of the recommendations.
The MS Society recommendations provide information about the general role of vitamin D in the human body as well as reference the Health Canada recommendations, including sources of vitamin D. The purpose of these recommendations is to provide the suggested daily intake of vitamin D for various populations affected by MS including the at-risk population , and individuals diagnosed with MS. In addition to the recommended daily intake of vitamin D, information on maintaining vitamin D levels is provided. Vitamin D levels are measured through a blood test. Comorbid conditions such as osteoporosis and vitamin D toxicity are also discussed in the recommendations.
Resources:
Challenges With Vitamin D Research
One of the major challenges facing researchers examining the link between vitamin D and MS is that many of the studies thus far have been observational in nature. Observational studies produce correlational evidence rather than causal evidence. However, in such studies background factors that may not be anticipated and controlled for can, muddy our understanding of how vitamin D relates to MS. In other words, most observational studies cannot determine whether vitamin D deficiency results from something to do with MS or whether MS results from low vitamin D status. For example, interpretation of studies examining the relationship between vitamin D status and clinical disability are complicated by the observation that participants with a high degree of disability are more likely to remain indoors, thus reducing their exposure to sunlight47. Therefore, although it is helpful to know that people with MS are at a higher risk of vitamin D deficiency, these studies do not allow us to draw conclusions about whether low vitamin D status results in MS-related disability, or whether individuals with greater disability receive less sunlight exposure and produce less vitamin D.
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