Tuesday, 29 May 2012

Research: Vitamin D levels correlate with MRI lesions

Ellen et al. Vitamin D status predicts new brain MRI activity in multiple sclerosis Ann Neurol DOI: 10.1002/ana.23591


Objective: The investigators sought to determine if vitamin D status is associated with developing new T2 lesions or contrast-enhancing lesions on brain MRI in relapsing MS.


Methods: EPIC is a 5-year longitudinal MS cohort study at the University of California, San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. From the overall cohort, they evaluated MSers with clinically isolated syndrome or relapsing-remitting MS at baseline. 


Results: 2,362 MRI scans were acquired from 469 subjects. Each 10ng/mL higher 25-hydroxyvitamin D was associated with a 15% lower risk of a new T2 lesion (incidence rate ratio [IRR]= 0.85, 95% CI [0.76, 0.95], p=0.004) and a 32% lower risk of a gadolinium-enhancing lesion (IRR=0.68, 95% CI [0.53, 0.87], p=0.002). Each 10ng/mL higher vitamin D level was associated with lower subsequent disability (-0.047, 95% CI [-0.091, -0.003], p=0.037). Higher vitamin D levels were associated with lower, but not statistically significant, relapse risk. Except for the EDSS model, all associations were stronger when the within-person change in vitamin D level was the predictor.


Interpretation: Vitamin D levels are inversely (lower the levels the worse MS) associated with MS activity on brain MRI. These results provide further support for a randomized trial of vitamin D supplementation.

"The other option is for MSers to make sure they vD replete; there are health benefits outside of MS to justify this approach, for example bone health, reduce your risks of infection to reduce your risks of certain tumours."


"The case for making sure the whole population is vD replete is very compelling; but then I would say that as I have a conflict of interest." 

9 comments:

  1. Should you still take your 5000 iu's a day if you've spent a lot of the time outside in the sun as the weather is at the moment- I know you should be wearing sunscreen, but if you've been out for say an hour without it?

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  2. Re: "Should you still take your 5000 iu's a day if you've spent a lot of the time outside in the sun as the weather is at the moment- I know you should be wearing sunscreen, but if you've been out for say an hour without it?"

    I do; what is important is what happens to your levels across the year. The current opinion of several vD experts is that we should prevent cycling of levels, i.e. high at the end of summer and low at the end of winter. To do this you need to make sure you get enough vD throughout the year. Sunblock prevents the skin making vD. Similarly pollution filters sunlight and reduces the amount of UVB you get.

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  3. Maybe you've already explained this, but what does vitamin D do re MS? Is it neuroprotective?

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  4. Re: "Maybe you've already explained this, but what does vitamin D do re MS? Is it neuroprotective?"

    It is likely to be anti-inflammatory and may help the developing immune system; i.e. prevent autoimmunity from developing in the first place.

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  5. Hi Gavin,

    When I was diagnosed my vitD levels was 31, now, after half a year of supplements, its on 121.

    However, reading the research paper:
    http://jcem.endojournals.org/content/early/2012/05/09/jc.2012-1176.abstract

    Kindda indicates that, that is a bad idea.

    So, two questions!

    Would it be possible to get your comments on this paper in relations to MS?

    And what do you reckon is a good stable level of vitD in the blood?

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  6. Re: "However, reading the research paper:
    http://jcem.endojournals.org/content/early/2012/05/09/jc.2012-1176.abstract"

    I have asked Bruce Hollis for advice on this. As soon I get some answer from him I will get back to you.

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  7. Re: "However, reading the research paper: http://jcem.endojournals.org/content/early/2012/05/09/jc.2012-1176.abstract"

    The following is the response from Bruce Hollis:

    "My guess is that the high values , and they are relatively few, had some health issue and were put on vitamin D to help but they were sick relative to the remainder of the population. In Denmark they can only get doses to achieve these high levels from their doctor, who knew they were sick. In the states this would be more unlikely because we can get any vD dose we want at any store. We have not seen this here in fact the opposite."

    What Bruce is describing is potential bias in the Danish study. Therefore this will need to be noted and hopefully a definitive study will be done, controlling for biases, to ascertain if this is a real finding. Based on this I would not change my current recommendations regarding vD supplementation.

    Please note we do not recommend pharmacological doses of vD, but physiological doses. 5,000U is what you would get from upper body sun exposure for ~15 minutes in mid summer. If in doubt have your blood vD levels measured.

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  8. "In Denmark they can only get doses to achieve these high levels from their doctor, who knew they were sick"

    That is not entirely correct. In DK, only 38 mcg is allowed in a single supplement pill. However, its easy to take more than one pill pr day, and vitD supplements are over the counter buys. As said earlier, my levels have raised from 31 to 121, buy taking 3x vitD pills everyday. This i've done on my own, without instructions (or help) from my GP or neuro.

    So i'm still confused about the conclusions in this research paper. Am I actually bringing myself at risk, my having such a high dose of VitD in my body (the whole year). But again, if I dont to that, well "Research: Vitamin D levels correlate with MRI lesions" describes that pretty much.

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  9. Re: "So I'm still confused about the conclusions in this research paper. Am I actually bringing myself at risk, my having such a high dose of VitD in my body (the whole year). But again, if I dont to that, well "Research: Vitamin D levels correlate with MRI lesions" describes that pretty much."

    No you are not putting yourself at risk; having a level above 100 is what a large number of people run at if they live and work in places with year round sunshine. Being above 100 is normal.

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