Tuesday, 28 June 2011

Vitamin D: effects on immune cell function in MS'ers

Kimball et al. Cholecalciferol Plus Calcium Suppresses Abnormal PBMC Reactivity in Patients with Multiple Sclerosis. J Clin Endocrinol Metab. 2011 Jun 22. [Epub ahead of print]

The active metabolite of vitamin D is a potent modulator of immune cells. In this study the investigators' determined whether vitamin D, a sun-dependent nutrient can affect the cells athat are associated with the immune abnormalities in MS. Treated MS'ers received increasing doses of vitamin D (4,000-40,000 IU/d) plus calcium (1200 mg/d), followed by equilibration to a moderate, physiological dose of vitamin D of 10,000 IU/d (the amount you get from 20-30 minutes of sun exposure in mid summer). Control subjects did not receive supplements. Results: At 12 months, the average serum vitamin D concentrations were 83 nmol/liter and 179 nmol/liter in control and treated participants, respectively (P < 0.001). In treated MS'ers,  the abnormal immunological responses of lymphocytes (an important immune cell in MS) against components of nerve cells and myelin were suppressed. Interpretation: MS-associated, abnormal T cell responses that are believed to trigger MS were suppressed in subjects with vitamin D concentrations in their blood higher than 100 nmol/liter.

"This study would indicate that you would need to keep your serum vitamin D levels above 100 nmol/litre to have effects on the immune system; this would mean most of us taking 10,000U of vitamin D per day; in comparison we only need 400U per day to prevent bone  thinning. This is why we are trying to get public health officials to recognise this and increase the RDA of vitamin D."

"Interestingly, if you lived as a hunter-gatherer, i.e. out in the open as our ancestors did, your serum levels would be above 100nmol/litre. We know this from studies done on farmers, life guards and other groups of people who work outdoors. It makes you think about what we are doing to ourselves by changing, and continuing to change, our lifestyles so dramatically over the last 2 generations. Any thoughts about what the digital revolution is doing to our immune systems?"

CoI: Nil

9 comments:

  1. My thoughts are that it is not doing us much good! But so useful in so many ways... I guess the message is to make sure you get exposure to sunlight/take a vitD supplement. But what other, less obvious, effects could there be? (Rhetorical question)

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  2. I'm a young person with MS. I have no children, and since my diagnosis, have made my mind up to never have them. Even if there is only a 2% chance I can pass on the illness then that’s 2% too much for me. Also, no doubt my disease will become progressive and I don't want my kids being my carers. I think it's selfish for MS'ers to have children after diagnosis.

    I do, however, have nephews. They are hooked on videogames and junk food. They hardly play outside. I tell my sister to get them out more but she seems aloof. I worry that a lack of quality sunshine may have a nasty legacy for them.

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  3. Prof G,

    I'm confused. It's been shown that MS: has a genetic component (Prof Ebers and findings on twins); a gender component c.three times as many woman as men); has (highly likely) a viral component (EBV); a VitD component. Si it appears that there are many risk factors. How we unpick all this? Are we ever likely to find a cause given that, in reality, getting the disease comes down to very bad luck i.e. being born female, getting EBV at wrong age, having a mother with insufficent VitD during pregnancy....

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  4. MS is a state of mind, not a disease.

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  5. MS is a disease that makes your mind a state

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  6. Re "They are hooked on videogames and junk food. They hardly play outside. I tell my sister to get them out more but she seems aloof. I worry that a lack of quality sunshine may have a nasty legacy for them.": I suggest you get your sister to get them on supplements. I recommend 5,000U per day. Two useful websites are the "vitamin D council" and "Shine on Scotland".

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  7. Re "I'm confused. It's been shown that MS:....": Although MS is a complex disease there may be one pivotal factor, which if you remove or neutralise it you don't develop MS. I think EBV may be this factor. Although it may be bad luck, we should do everything we can to minimise the risk. Two things we can do at a population level is to reduce the incidence of smoking and to make sure we are vitamin D replete. Unfortunately, both these things are very hard to achieve.

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  8. Re "MS is a state of mind, not a disease." I disagree with this; in my book it ticks all the boxes of being a disease. It is a clinico-pathological entity and can be defined using a set of criteria. If it was simply a state of mind we could treat it very easily; I think.

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  9. Re "MS is a disease that makes your mind a state.": Tell me about it; I spend most of my time thinking about it.

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