Sunday, 2 September 2012

Vitamin D status predicts new brain lesion activity


We sought to determine whether vitamin D status is associated with developing new T2 lesions or contrast-enhancing lesions on brain magnetic resonance imaging (MRI) in relapsing multiple sclerosis (MS).
 
METHODS:  EPIC is a 5-year longitudinal MS cohort study at the University of California at San Francisco. Participants had clinical evaluations, brain MRI, and blood draws annually. From the overall cohort, we evaluated patients with clinically isolated syndrome or relapsing-remitting MS at baseline. In univariate and multivariate (adjusted for age, sex, ethnicity, smoking, and MS treatments) repeated measures analyses, annual 25-hydroxyvitamin D levels were evaluated for their association with subsequent new T2-weighted and gadolinium-enhancing T1-weighted lesions on brain MRI, clinical relapses, and disability (Expanded Disability Status Scale [EDSS]).
 
RESULTS: A total of 2,362 3T brain MRI scans were acquired from 469 subjects. In multivariate analyses, each 10ng/ml higher 25-hydroxyvitamin D level was associated with a 15% lower risk of a new T2 lesion (incidence rate ratio [IRR], 0.85; 95% confidence interval [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 to -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 associated with MS activity on brain MRI. These results provide further support for a randomized trial of vitamin D supplementation

The lower the Vitamin D levels the more MS activity on brain MRI was detected. Further reason to supplement

23 comments:

  1. I am convinced by the Vitamin D argument and hope that neurologists the country over recommend this to their patients.

    A few questions though:

    1. Has Vitamin D levels in people with PPMS been studied? It seems the evidence between Vitamin D and relapses is increasingly becoming established - but in the absence of relapses?

    2. I am a little confused with the findings here:

    http://www.ncbi.nlm.nih.gov/pubmed/17287117

    "It concluded that a north-south gradient was observed for serum 25(OH)D in the Euronut (sic?) and MORE studies with higher levels in Scandinavia and lower levels in Italy and Spain and some Eastern European countries.... In conclusion, vitamin D deficiency is common in Southern Europe, the Middle East, India, China and Japan. It is less common in Northern Europe and Southeast Asia. "

    This is a weird finding. Either this is bad science or it challenges the idea that MS is more prevalent in Northern Europe because of our lack of sunshine. Or there is another major factor at play that is not Vitamin D (genes / a virus?)...

    Thoughts?

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    1. I think the Northern Europeans take more supplements.

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    2. That's not very convincing - if northern Europeans have higher vit d levels they should have less MS, supplements or not

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    3. If vD is acting in the womb then MSers today are linked to vD levels 30-40 years ago. What needs to be done is a historical study looking at vD levels in the past. We are onto this and are in the process of trying to do this.

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  2. Is there a greater likelihood that younger siblings might have a greater chance of developing MS? I ask because - perhaps - women with young children might (due to breastfeeding and general chores) spend greater time indoors after their first born than before...

    Though the flip side of this, of course, is that many women scale down work after their first and so might have more daylight hours to spend outside than before when they may have been office/factory bound.

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    1. There was data to the contrary; i.e. 1st and only siblings had a higher chance of getting MS. This was felt to be due to the hygiene hypothesis, i.e. less children to play with therefore less infections. It was not reproduced. So at present birth order itself is not considered an MS risk factor.

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  3. Just a personal observation of the last couple of weeks regarding Vit D. It seems to improve symptoms as well almost immediately. I have been testing if by increasing my VitD intake my symptom would get better and it does. Actually, months before getting my formal diagnosis or taking DMTs I had suffered symptoms and once I took VitD they got better, however, I was not sure at that time what helped, now I am.

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  4. I've had MS for over 10yrs. In 2005 while in Africa for medical research I noticed a dramatic improvement in my health. Thought it could be the better food, sun, exposure to infections, or a combination. After 5 years in sub-Sahara Africa working with patients suffering from a whole host of infectios diseases, I never felt better.

    Not wanting to wait for formal research, and since the safety profile of VitD was relatively well known, I began "experimenting" on myself. In 2008 took higher dose
    VitD between 10-15,000 IUs for a couple of months, and since then between 3 and 6,000 IUs/day when not in the field. Have not had any MRI changes since 2008, nor any changes in synptoms. I am not and never have been on disease-modifying drugs. Also don't deworm myself... But that's another theory...

    This is not a formal study. But as a research scientist in the medical field, I know a lot of times formal research is much slower than it needs to be. And I am quite happy to experiment on myself.

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    1. Correction: that should read "between 4 and 6,000 IUs/day when not on the field".

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    2. Do you have any symptoms at all?

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    3. Question: why no dmt? Was it because you had no access to one or did you decide not to take one?

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  5. I would be very interested to know what you mean by 'deworm'.

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  6. Replies
    1. Get rid of intestinal worms
      Children in 3rd world counries are given deworming tablets regularly

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    2. What has this item got to do with MS?

      Is it some tenuous link to worMS where they are infecting MSers with worms to get rid of their MS

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    3. This was an answer to "I would be very interested to know what you mean by 'deworm'"

      Parasitic worms are endemic in some parts of the world and they make children malnourished, underweight, etc. So governments and others are working on getting rid of them.

      The link with MS is the hygiene hypothesis. People without worms may be more susceptible to autoimmune diseases and having worms may make the disease milder.
      http://ms.about.com/od/newsresearch/a/worm_soup.htm

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  7. I am an 'early adopter' to Vitamin D supplementation too. I'm often happy to try something that has some sort of reasonable clinical trial done and seemingly is not likely to kill me. I started upping my dose of Vitamin D to 5,000 iu per day - now sometimes 10,000 iu a couple of days if no sun - and sure enough no relapses since 2007. I don't believe there were any other confounding behaviours.

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    1. What would interest me is this: if you say 'no relapses since 2007' does it mean that you have not experienced any worsening of your symptoms, has they stayed the same as pre-2007 or even got better?

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    2. My symptoms have basically stayed the same. No new symptoms. A couple of niggling things like some burning arm pain seem to have disappeared. I had a review on Wednesday with a Pilates studio that I previously visited four years ago and the physiotherapist who had assessed me at that time also did the follow up assessment. She had kept accurate case notes and did not consider that my physical condition had deteriorated. I also credit the maintenance of physical function to the fact that I work at weight training and exercises to sustain my balance, and have definitely seen improvement, fortunately the MS Society in Australia does pre and post testing of the classes that they run, so I am able to track my progress.

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  8. This has all been very helpful, thanks. Like Helen, I upped my dose to 5000 IU a day. I also enjoy walks in the summer sun. At my last neuro visit, I asked to have my levels checked. His office called me a few days later and said I was up to 125 ng/ml and to stop taking vitamin D for a while. Then scale back to 2500 IU.

    The good news is that I learned how easy it is to get a vitamin D level blood test ordered. Way easier than, say, an MRI. I'll ask for another blood test around February.

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  9. So if one reaches levels of around 120-150 ng/ml then it should be a good protection right?

    I read somewhere that VitD can re-set one's DNA. It this true? What's the relationship Team G?

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    1. 120-150 is normal. vD can change the status of your DNA by affecting the methyl groups that are attached to it. vD does not change the DNA code; or at least I am not aware of it doing this.

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  10. To answer some of the questions. But keep in mind that MS varies from person to person, and it could very well be mine was a milder form from the start (although the myelitis/brainstem demyelination that got me into hospital was not mild at all).

    --- why no DMT? A bit of both reasons. I could not afford the DMTs AND pursue my dream specialisation and career. Either or. Even if I could, no way to transport/store the drugs in the communities I was working and living in during my yrs in the field. Still true to a certain extent. Also, I work with pts with some highly infectious diseases (incl. drug resistant tuberculosis). I prefer to keep my immune system as strong as it is.

    Also, the Dx came a few yrs after signs/symptoms onset, and I rationalised it to myself that I "missed the boat" to start Tx at the ealry stages and have the greatest chance of modifying the disease course.

    I decided in the end not to go on MDT, in part because I was not convinced the potential benefits of the individual drugs were worth my stopping my life for. Cost-benefit. It was an educated and calculated risk, although I knew there was no guarantee of the MS not progressing. It was a risk I was prepared to take. And still am until further deterioration, or new research convinces me otherwise.

    --- symptoms? Nothing new since 2007. Only slight flares of existing ones depending on how exhausted/overworked/sleep deprived I am! The last relapse in 2007, was sensory on 2 fingers. And I was in the field in an armed conflict setting (stress). I requested a cervical MRI a year later (again I was nowhere near an MRI when it happened) and saw the cervical lesion that may have explained it. I can still play football, badminton, etc. The slight limp that has been there for about 10 yrs is here to stay though, and the fatigue/brain fog also doesn't seem to be going anywhere :/ But no real changes that I can discern, and none in my regular follow-up neuro exams.

    -- deworming issue. Many children, and adults/tourists/field workers/etc, who spend time in rural communities in Africa and elsewhere where sanitation and hygiene are poor, are given deworming medication every so often. However, it's not only the hygiene theory that was the reason for my choices. Certain worms are known to secrete molecules, to evade our immune system, that suppress and/or modulate the immune system. Some are even being looked at as adjunct treatments for some autoimmune diseases; yes, studies infecting pts with small numbers of worms to see if it decreases disease severity.

    I have always generally been happy to host some parasites. Immune system is there for a reason: use it or lose it. I dont get rid of them unless they cause problems.

    Yes parasites are endemic worldwide actually, and yes governments are trying to eradicate them (specific ones at least). Yes, they can and do cause malnutrition in children that already have an underlying poor health condition. The effects you describe depend also on the parasite load. A few hookworms or ascaris worms are both asymptomatic and generally don't cause any problems. Other conditions (diarrhoea, chronic illness, etc.) also cause malnutrition, etc. I believe controlling them is absolutely crucial, but fully elimminating gastrointestinal worms is both unrealistic and counterproductive IMHO. Everything in moderation.

    Again, these are my own choices, to deal with a condition that varies from person to person. I'm not saying go out and get some worms in your system (although I would like about 15 hookworms or so!). I am a strong believe in VitD, not over-sanitizing everything, letting the immue system take care of things as much as possible by not medicating every sniffle/slight fever/cold, and just as important: good mental health! I love my job and what I do. Being happy/content makes a huge difference.

    Sorry for the verbal diarrhoea, hope that all makes sense.

    Peace,
    Dr Bil Harzia

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