Summary of Findings

  • Multiple Sclerosis (MS) is more common in Northern parts of the world which have less sunlight. (106)

  • Studies have shown that the risk of MS is decreased by exposure to sunlight in childhood. (107)

  • Epidemiology data suggests that Vitamin D deficiency in the last three months of pregnancy is particularly harmful to the fetus and raises the risk of MS in later life. (111)

  • Nurses who took 400IU per day of Vitamin D as part of a multivitamin demonstrated a 40% reduced risk of developing MS. (115)

  • Professor Ebers of Oxford University has shown that vitamin D interacts with a specific region of a gene, which is known to exert a direct influence on the risk of developing MS. (118)

  • Only 16% of MS patient experienced a relapse when treated with 14,000IU per day of Vitamin D for twelve months compared to 40% of patients treated with only 1000IU.
       (American Academy of Neurology April 2009)

Multiple Sclerosis and Vitamin D3

MS is believed to be an autoimmune disease in which part of the immune system (T cells) become activated, enabling it to attack normal tissue.  Such an attack produces inflammation and progressive damage. (108)  T cells are known to have Vitamin D receptors (VDR) and activation of these receptors results in suppression of the cell’s activity. Hence, a lack of Vitamin D allows these cells to act unchecked.  Vitamin D influences the immune system in several ways, and animal models of these mechanisms have shown that Vitamin D deficiency suppresses the system while correcting the deficiency results in dramatic improvements. (109).

It has long been known that Multiple Sclerosis (MS) is more common in Northern parts of the world which have less sunlight. At least two studies have shown that the risk of MS is decreased by exposure to sunlight or higher intakes of Vitamin D in childhood. (106,107)  Epidemiology data suggests that Vitamin D deficiency in the last three months of pregnancy is particularly harmful to the fetus. (111)
  
The incidence of MS in Scotland is one of the highest in the world where as many as 1:300 people suffer from the disease. This is a least twice the rate seen farther south in England. (110) Scotland is exposed to at least 50% less UV radiation than Southern regions of the UK, resulting in significantly lower Vitamin D levels.
 
This strongly suggests that an environmental factor rather than genetics are the primary cause of this condition. Studies in identical twins show that it is highly unlikely that both twins will develop the condition, which also is a strong argument against a genetic cause for MS. (111) 

Additional studies conducted in Australia support the connection between MS and Vitamin D deficiency.  Northern regions of Australia have a prevalence of the disease six times higher than in Southern areas. (112) In addition, migration studies show that moving to a sunny part of the world and working out of doors reduces the risk of developing MS. (113,114)

In the Nurses Health Study I and II, it was shown that nurses who took 400IU per day of Vitamin D as part of a multivitamin demonstrated a 40% reduced risk of developing MS. (115)

Furthermore, in MS patients the number of classic MS lesions in the brain has been shown to decrease in the summer when Vitamin D levels are highest. (116) Several small clinical studies have suggested that symptoms are improved by treatment with Vitamin D. (117)

The use of high doses of Vitamin D in MS have become common place. In 2007 the results of a Phase I study were published that explored the safety of these higher doses. Doses up to the equivalent of 40,000IU per day were used in patients suffering from MS.(143)

In this study, 12 patients with MS were given weekly doses of Vitamin D3 and the dose escalated every few weeks. The table below shows the dosing regimen:

Study WeekDose of D3/IU/week
1-20
3-428000
5-10   56000
   11-16  112000
   17-22  224000
   23-28  280000
The highest doses given equates to 40,000IU of Vitamin D per day. None of the patients developed hypercalcemia and no adverse events were seen in any patient throughout the 28 week trial. The mean serum Vitamin D levels at the start of the study were 31ng/ml and at completion of the trial were 154ng/ml.

While this publication showed the results of the first 28 weeks of therapy it has been reported that the study continued for 12 months and no adverse effects were seen.

At the annual meeting of the American Academy of Neurology (April 2009) the results of using high doses in patients were presented. The study compared the effects of 1000IU vis 14000IU of Vitamin D daily for one year in patients with mild relapsing MS. 

During the year of treatment 40% of patients on the low dose of Vitamin D experienced a relapse. Only 16% of those on the high dose had a relapse. When each treatment group was compared to their relapse rate in the year prior to receiving Vitamin D, those taking the high dose had 41% fewer relapses than they experienced in the prior year, compared to only a 17% reduction in episodes in those taking the low dose.

High dose Vitamin D appears to suppress the autoimmune responses thought to cause MS. In patients given the high dose Vitamin D, T-cell activity was reported to drop significantly. The investigator reported that it appears  MS patients do best with levels in excess of 40ng/ml which is in the same range that experts on Vitamin D recommended in other conditions.

Most recently, Professor Ebers of Oxford University has shown that Vitamin D interacts with a specific region of a gene, which is known to exert a direct influence on the risk of developing MS. (118) The authors of this paper concluded that taking Vitamin D supplements during pregnancy and the early years of life may significantly reduce the risk of developing MS later in life. These recent findings led to great excitement in the media and calls for the recommendations of daily Vitamin D supplements to be updated.

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    Multiple Sclerosis and Vitamin D3