Susan J. Epstein, MS, MEd, is the Program Coordinator at the Jacobs Neurological Institute. In her new book The Life Program For MS: Lifestyle, Independence, Fitness, and Energy, she addresses the limitations imposed by Multiple Sclerosis which results in patients becoming sedentary, gaining excess weight and developing poor eating and exercise habits. Epstein provides a user-friendly teaching tool that helps sufferers to incorporate new behaviors into their daily routines. In the original article below Epstein looks at the role of vitamin D in MS.
A deficiency in vitamin D is currently one of the most studied environmental risk factors for MS and is potentially the most promising in terms of new clinical implications. In particular, this vitamin could alter the immune response taking a positive role in the central nervous system. There are two main types of risk factors for MS: genetic and environmental. In today’s world many genetic predispositions for various conditions have been discovered, and the various environmental triggers identified; making this an exciting time for learning specific ways to change behavior to improve or protect health.
The following environmental factors influence the risk of MS:
1. latitude
2. past exposure to sun
3. serum level of vitamin D
Worldwide, latitude has an undeniable effect on the prevalence of MS which occurs with much greater 
frequency in areas further away from the equator. Lower incidence of the disease is found in tropical regions where the high degree of sunlight is recognized as the correlate. Latitude has an overall influence on the amount of sunlight in a given region making geographical location advantageous. So if we know that the level of exposure to sunlight directly affects the level of vitamin D in our bodies and this vitamin is known as the “sunshine vitamin” where does that leave those of us who live in the northern hemisphere? Does this suggest people even without disease are deficient in vitamin D? Also, the western diet lacks this crucial vitamin providing less than 100 IU a day, falling far below the daily requirement of 2,000 IU/d. It is thought that vitamin D is most likely involved in a number of regulatory activities besides just bone health, and could have a dramatic effect on immune function. Such low average levels of vitamin D raise serious public health issues and there is an urgent need for national health institutes to take preventative measures. With this knowledge should come behavior change, not only for the MS patient but also the general population.
Clinically most MS patients have low levels of vitamin D in their blood and are in a state of deficiency compared to the international norm. A recent study found a direct link between the level of vitamin D circulating in the blood and the disease, without factoring in the effect of latitude or sun exposure. Further research trials are necessary before any firm recommendations can be made but in the meantime, physicians can no longer ignore that many MS patients have a lack of vitamin D, which could be detected through systematic blood tests. Vitamin D supplements are appropriate to restore their levels to within normal range. This should be considered a general medical recommendation simply to increase levels in the blood to the current recommended amount of at least 2,000 IU/d. This would mean taking between 1,000 and 3,000 IU of vitamin D3 (cholecalciferol) on average per day. There are two types of vitamin D: D2 and D3. Vitamin D3 is the healthy kind your body makes when exposed to sunshine. D2 is the synthetic form used in prescriptions and is considered inferior to D3.
Having this knowledge regarding the benefits of vitamin D as well as the current published research indicating the prevalence of vitamin D deficiency; behavioral strategies seem appropriate and can be very safe when discussed with your physician. Since moving to a tropical region is unlikely, the options available are:
safe sun exposure, vitamin supplementation, and a diet with foods rich in vitamin D.
Optimizing sun exposure is a topic in itself and comes with some risk along with conflicting opinions and recommendations from experts in the field though it seems reasonable to get a dose of fresh air and sunshine on days when the weather is in your favor. Some experts recommend exposing your body to sunlight for 15-minutes before applying sunscreen in order to get the benefits from the UV rays which naturally provide the vitamin D needed for good health. Luckily a vitamin D3 supplement can provide the same benefits when given in the appropriate dose to bring blood levels to within normal range.
Before purchasing a supplement you should have a blood test to determine your baseline levels of vitamin D. Your neurologist can then take the results and prescribe the amount of vitamin D3 to bring your levels up to within normal range. MS patients are seen regularly to monitor their disease status and can systematically have blood levels measured. You also may want to search for MS Centers that are running clinical trials to study the effects of Vitamin D on MS and inquire about being a subject.
Vitamin D3 supplements are available in both liquid and capsule form. They can be purchased at any pharmacy for as little as $4.49 for 100 capsules containing 1000.0 IU. Check the label to make sure the primary ingredient is Vitamin D (as cholecalciferol). As mentioned earlier the Western diet is commonly very low in vitamin D but there are good food choices to increase the amount in your diet. Excellent food sources include: oily fish like salmon, mackerel, and sardines; vitamin D-fortified milk and cereals; whole eggs, liver, and beef. A combination of the three available sources of vitamin D is optimal, and purely from a medical point of view, supplementation is unavoidable in order to improve the general health of the MS patient. And with clinical research trials underway all over the globe, supplementation may soon be proven to be neurologically beneficial.
As the resent research on vitamin and MS used an dose of 14000IU a day, on average, for a year with absolutely no sign of overdose, it appears that the optimum dose is higher than 3000IU a day.
My neurologist tested my Vitamin D level while I was having difficulty with balance, numbness in my face and limbs. I was also having difficulty sleeping and cognitive/memory issues. The blood test determined I was severely deficient in Vitamin D. He asked me to start taking 2000IU gel caps 23 years ago. I can only hope that Vitamin D supplements are the answer to solve the MS diagnosis mystery. For now, I’m a believer and I am anxious to see what my follow-up MRI of my head shows next month. If your doctor has not checked your levels, have him do so. It could make a huger difference with your symptoms.
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The correlation between Vitamin D deficiency and MS is well-established. For a recently-diagnosed patient, a suitable protocol would involve rapidly establishing a high serum level of 80-100 ng/ml of Vitamin D3 either by injection (British nursing home physicians routinely provide doses of 600,000 iu in a single injection) or by a rapid loading phase, 50,000 iu every two days for three weeks, then level out to 10,000 iu per week for six weeks and then provide a 25 hydroxyvitamin D test [25(OH)D test] followed by appropriate increase or decrease in daily dosage. An individual I am familiar with has taken 10,000 iu per day + 600 mg calcium, 300 mg magnesium, 10 mg zinc per day for longer than three years. Her MS symptoms (left leg gait disturbance) do not appear to have progressed over a five-year period. She is taking other MS medication as well. In the long term, 10,000 iu per day of Vitamin D3 should achieve a serum level from 80 to 120 ng/ml – ideal for an MS patient. 200 ng/ml is probably the lowest dose associated with excess calcium in the urine, which would be the first sign of an excessive dose. R. Vieth wrote a survey of dosage studies involving 40,000 iu Vitamin D3 per day and found no reports of toxicity, concluding that 10,000 iu/day is safe. There are suggestions in the literature that direct sun exposure provides additional benefits to MS patients, not related directly to Vitamin D3. Sunbathing may by some different mechanism. Whatever course you take, your Vitamin D3 dosage should be quite high – 10,000 iu should not cause harmful side-effects. I am a layman; my comments are based on my reading of the medical literature. Key sources: H F Deluca, M Holick, R Vieth, P Goldberg, M Catorna. A good layman’s site is http://www.vitamindcouncil.org.
[…] Potential Role of Vitamin D in Multiple Sclerosis OUPblog – New York,New York,USA Vitamin D supplements are appropriate to restore their levels to within normal range. This should be considered a general medical recommendation simply to … Not sure – supposedly based on a book written by a doctor, this one really does blatantly set out to sell you vitamin D tablets to combat MS. Oh yes, the reference to OUP has nothing to do with ‘the’ Oxford University Press. […]