MS and Vitamin D

Vitamin D has been a hot topic lately. If you have MS, you should find out why.

Vitamin D:Why do you need it?

Many factors may contribute to your risk of having low levels of vitamin D, and their combined impact may be significant. The more factors that apply to you, the greater the likelihood that you may be vitamin D-insufficient.

You have MS.

Vitamin D may be especially important in MS because of its immune-modulating effect, early research suggests.

You live in Canada.

All Canadians are at risk of vitamin D insufficiency due to our northern latitude, which limits sun exposure. A study of almost 200 people living in Calgary, which receives more hours of sunshine per year than any other Canadian city, found that 34% of this population had vitamin D insufficiency at least once out of the four samples taken, one during each season of the year. Overall, vitamin D levels were highest during the spring and summer and lowest during fall and winter.

You are female.

Your gender places you at increased risk for osteoporosis (thinning and weakening of the bones), as it does for all women after menopause (natural or surgical). Having MS may compound the problem. Significantly low vitamin D levels are seen in many women with MS, along with low bone density that has the potential to increase their fracture risk two to three-fold.

You aren’t physically active.

Lack of mobility is a common problem as MS advances, and also increases the risk of bone loss and subsequent fracture. That’s because weight-bearing activity is important to build and maintain bones.

You have received corticosteroids.

If used often or for long periods of time, corticosteroid therapy may also contribute to bone loss. Sufficient intake of vitamin D and calcium is important to offset this risk.

You don’t get out in the sun much.

It might be the weather, or physical disability that tends to keep you inside a lot of the time. Having no natural sunlight exposure increases your odds of being deficient in vitamin D, and is common among people with MS (40% of respondents in one study reported no weekly sun exposure).

How much D is enough?

The evidence is clear: vitamin D is important for all Canadians. However, experts have yet to reach aconsensuson the ideal dosage of vitamin D. The Multiple Sclerosis Society of Canada notes that Health Canada guidelines recommend an intake of 800 International Units (IU)/day. Recent research findings suggest that higher doses of vitamin D are needed.

• The University of Calgary reported that on average it takes about 2000 units/day to get most people with MS out of their D deficiency.
• The University of Toronto recently reported its results on using doses of vitamin D supplementation at levels above 4000 IU per day and found no real toxicity, at least in the short term.
• MS expert Dr. Paul O’Connor recommends 2000-4000 IU per day for people with MS. Until more research is completed, 4000 units is probably as high as one should go unless levels are to be checked. It can be taken as a full once-per-day dose, or can be divided. Many people will experience nausea at doses above 2000 units, and if this is the case, dividing the dose is suggested. Before you make any decision on adding dietary supplements or vitamin D to your diet, please discuss this with your doctor.

What if I get too much Vitamin D?

Excessive levels of vitamin D can cause:

• Calcium deposition in soft tissues such as the heart and lungs (potentially reducing their ability to function) 
• Kidney stones
• Vomiting
• Muscle weakness

How will you get your D?

In Canada, sun exposure is reduced between October and March, and sun exposure alone may be insufficient to cause the body to produce enough vitamin D. To help address any possible deficiency, vitamin D could be taken orally, either through foods rich in vitamin D or as a nutritional supplement.

Vitamin D and sun safety

Although the sun may be our natural source of vitamin D, too much exposure is well known to cause skin damage and skin cancers. It’s important to achieve a safe balance. Timely use of sunscreen can help. In summer, 10 minutes of sun exposure generally allows your body to produce 400 IU of vitamin D. You may want to allow for limited sun exposure, e.g., 15 minutes, and then apply sunscreen to protect your skin for the rest of the day.

A note about supplements

Although vitamin D supplements are widely available and recommended for use by most people, including those with MS, the same is not true of all dietary supplements. Some natural and herbal treatments, such as Echinacea and ginseng, may boost the immune system and worsen MS symptoms. Zinc is sometimes used to prevent colds or attenuate symptoms, but this mineral can also activate some immune cells and pose a risk to MS patients. Always discuss complementary therapies with your physician before starting to take them, so that you will both know what you are taking and how it might affect you.

What's so great about vitamin D?

Vitamin D (more specifically, vitamin D3*) has been in the news a lot lately. This naturally occurring bodily substance has been linked to stronger bones and lower rates of diabetes, colon cancer, and prostate cancer, and many believe it also plays an important role in the development of certain immune-mediated conditions such as rheumatoid arthritis and multiple sclerosis.

Vitamin D insufficiency is more common in people who live in northern countries like Canada than in those residing in sunnier, more southern regions of the globe. This pattern of geographic distribution can be translated to MS, as the number of people with MS is low in the tropics, and increases with distance to the equator in both hemispheres.

Vitamin D is increasingly promoted as part of a healthy lifestyle for all Canadians, but if you have MS, vitamin D may be an important addition to your health care routine, right alongside taking your treatment as prescribed and living a healthy lifestyle.

The ABCDs of caring for your MS

Active participation in your own care: the diagnosis of MS brings with it a lot of challenges, not the least of which is being prepared to take good care of yourself. Learning about MS and how it is treated will help you get involved in your MS care, so you can benefit as much as possible from all that is known about MS today.

Belief that your efforts to care for yourself well can make a difference: that is what will help you stay on track in maintaining a healthy lifestyle. Place treating your MS at the centre of your self-care regime, and build on it. Develop a daily routine around your MS treatment that includes taking your daily vitamin supplements and making healthy lifestyle choices in terms of your diet and activity.

Consistency in your self-care: every day matters. When you consistently take your MS treatment and your vitamins and supplements, eat for good nutrition, and get a healthy balance of activity and rest every day, it all adds up to you feeling better for longer. These are the best tools you have to manage your MS; it’s up to you to use them.

D is the vitamin in the limelight: ongoing research suggests it appears to be especially important for people with MS. Once you understand why, you may find it easy to make getting enough vitamin D a part of your daily self-care routine.

Vitamin D and MS: what’s the link?

Studies of populations worldwide have shown increased rates of MS in people living in northern countries, where they get less exposure to sunshine. Vitamin D is known as the “sunshine vitamin,” because the skin manufactures the vitamin after being exposed to sunlight. People who live in areas with less sunshine tend to have lower levels of vitamin D in their blood and tissues. Insufficient vitamin D levels have also been observed in some people with MS.

In addition to keeping our bones healthy, vitamin D could support the good functioning of the immune system.

Vitamin D and MS risk

Much of the research into vitamin D has highlighted its benefits in preventing the development of chronic diseases, including MS.

• Healthy women who used supplemental vitamin D, largely from multivitamins, had a 40% reduction in risk of MS compared with women who did not use vitamin D supplements.
• A recent University of Toronto study has linked reduced sun exposure and less-thanoptimal vitamin D status during childhood with the development of MS.
• Another study found that higher sun exposure when aged six to 15 years (an average of two to three hours or more a day in summer during weekends and holidays) was associated with a decreased risk of MS. Higher levels of sun exposure in winter seemed more important than higher levels of exposure in summer.

Vitamin D and MS management

While there is no conclusive clinical or scientific evidence that supplementing with vitamin D helpsmanageMS, early laboratory evidence obtained in animal models suggests it may play a role in disease activity.

Imaging studies in people with MS have observed seasonal fluctuations in subclinical (i.e., symptomless) disease activity; these ups and downs reflect known seasonal variations in episodes of clinical symptoms, and are thought to be at least partially due to seasonal changes in sun exposure.

As well, laboratory studies suggest that vitamin D may have an immunomodulatory effect within the CNS during an ongoing immune response. Authors concluded that vitamin D may have a beneficial effect in people with MS, although further studies are needed. However, to date, vitamin D has not been recommended as a
therapy for MS.

*Note: All references to vitamin D in this article refer to vitamin D3.