An award-winning writer and scientist believes a deficiency of Vitamin D in pregnant women is behind the increase in conditions such as MS, diabetes, schizophrenia and asthma.
Scientists often liken the process of discovery to doing a jigsaw. At first, few pieces fit and the picture is a mystery. Then suddenly two or three pieces lock together and an image starts to take shape.
This is what is happening in the study of apparently unrelated, chronic diseases such as multiple sclerosis, schizophrenia, diabetes and asthma. These conditions are increasingly common both in the UK and elsewhere; their causes have puzzled doctors and scientists for decades.
Now pieces of the jigsaw are starting to fit together – and they focus on vitamin D which is produced naturally in the skin when exposed to sunlight.
A deficiency in this crucial vitamin, thanks to our increasingly indoor lifestyles, is already blamed for the reappearance of rickets, the painful and deforming bone disease in children, in the UK. But gradually, evidence is emerging that links low vitamin D levels to a rise in a whole host of “modern” diseases, some of which were virtually unheard of in the pre-industrial era.
As a scientist and writer, I first realised the significance of vitamin D for prevention of ill-health some 12 years ago, at a time when it was only recognised as important for bone growth. I have researched and written extensively on the topic, including a report on the health benefits of sunlight - this at a time when official advice was to avoid the sun at all costs, especially when the sun is at its highest.
The report, published in 2004, gained support from the late Sir Richard Doll, the eminent epidemiologist who co-discovered the link between smoking and lung cancer. He had completed a clinical trial which found that people who took vitamin D supplements may live longer - and had he lived had wanted to do another. It has taken eight years to get that clinical trial started with Professor Julian Peto of the London School of Hygiene and Tropical Medicine. Called VIDAL, the trial is looking at benefits of supplementation and for any increase in life expectancy in over 65s.
Highlighting the benefits of vitamin D has led to at least some degree of change in official attitudes. We are now advised to spend some time in the sun at midday, while vitamin D supplements are advised for breastfed (but not bottlefed) babies from the first month of life.
My belief is that we could go much further – that vitamin D, given freely to all women in pregnancy, could be used to curb or prevent some major diseases including multiple sclerosis, diabetes, schizophrenia, asthma and several cancers; and that it might also be used to treat established disease, at least in early stages.
One crucial piece in the jigsaw has come from the study of birthdays. Links between birthdays and future life events have long been the territory of clairvoyants and mediums; and when evidence first emerged about a decade ago that people born at the end of winter were more likely to get multiple sclerosis and those born in autumn less so, many scientists found it hardly credible.
“It looked as if we were interested in star signs and futurology,” said George Ebers, emeritus professor in the Department of Department of Clinical Neurology at the Wellcome Trust Centre for Human Genetics, University of Oxford, whose career has never deviated from scientific correctness. “But now we know that MS is associated with end of winter births, when shortage of sunshine is demonstrable and vitamin D levels are lowest. This suggests, in line with other observations, that vitamin D protects against the disease.”
THE POWER OF THE SUMMER SUN
Summer sun is at its maximum in June and July but vitamin D, generated in the skin by sunlight, takes two or three months to get into the general circulation. So we reach our maximum level of vitamin D in about September. Babies born in October or November have the best chance of a relatively high level of vitamin D during their final months in the womb. And this, the birthday evidence suggests, can protect them from MS, while the risk is higher for babies born at the end of winter.
This seasonal pattern in the risk of MS has now been found in eight different countries including Australia, winning over previously sceptical scientists. Less well known is the link between end of winter birthdays and an increased risk of several other diseases. Studies of thousands of birthdays in Europe, Canada and Australia over some 30 years have found that people born at this time are also at greater risk of type 1 diabetes, coeliac disease (gluten intolerance), schizophrenia and autism.
For a long time experts did not know what to make of this data, since these diseases had no obvious links. But now more conditions are being added to this list by the Oxford team. Writing in the peer-reviewed journal, BMC Medicine, in July 2012, Professor Ebers, working with Dr Sreeram Ramagopalan, has shown that the risk of rheumatoid arthritis, a digestive disease called ulcerative colitis and a distressing condition called systemic lupus erythematosus follows the same pattern of seasonal births. These are all autoimmune diseases, which occur when the body is attacked by its own immune system. Diabetes type 1 is also an autoimmune disease and in the case of coeliac disease the immune reaction is to wheat in the bowel. To date, at least 18 autoimmune diseases have been linked to low vitamin D levels – more than enough to demonstrate a pattern.
''These immune-mediated diseases are one of the most common disease groups in modern economies today, affecting some 10% of the world population. Vitamin D deficiency is the most obvious risk factor” says Dr Ramagopalan. To test this theory Dr Ramagopalan has examined blood taken from the umbilical cords of 50 healthy babies born in November and 50 born in May when, after winter, levels of vitamin D are low. The May babies had a far higher frequency of newly generated white blood cells called T cells which are normally programmed to react against infection by an outside agent and to tolerate the body’s own tissues.
However certain types of T cells react against the body tissues and they may cause autoimmune disease later on if they persist. These unwanted T cells are normally removed from the body in the first year of life by a clever arrangement - they are deleted in the thymus gland, a process that requires vitamin D. So a low vitamin D level leaves the baby at risk. Dr Ramagopalan has explained his findings in detail in the open access, peer-reviewed PLOS Genetics, 2009, in which he writes: “The prevalence of diseases, such as multiple sclerosis, type 1 diabetes, inflammatory bowel disease, and rheumatoid arthritis correlate positively with latitude and reduced ultraviolet radiation exposure which is the primary determinant of vitamin D levels.”
The scientific jigsaw is now making more sense, but some pieces still do not seem to fit. Why should schizophrenia, a mental health condition, be linked to season of birth? In fact the birthday evidence on schizophrenia has provided a vital scientific clue to a disease which has puzzled doctors for over 100 years. Researchers now recognise that schizophrenia also has features of an autoimmune disease in which the body attacks its own tissues.
Schizophrenia and MS are both diseases of the nervous system. In MS myelin nerve sheaths deep in the nervous system are attacked by an immune reaction. If this can happen in MS, surely it is not so strange that schizophrenia may be explained similarly by an immune attack on crucial areas of the brain.
Dr John McGrath, international expert in schizophrenia based at the University of Queensland, Australia, says the evidence suggests that sun exposure in pregnancy and early life protects against schizophrenia and “raises the tantalising prospect that optimising vitamin D status during pregnancy may lead to the primary prevention of the disease”. “Being born in the country where there is more opportunity for sun exposure is associated with a lower risk of schizophrenia - while moving subsequently to an urban area where more time is spent indoors does not seem to increase the risk,” he points out.
Could lack of vitamin D in pregnancy also explain autism? The latest evidence suggests that a low vitamin D level in the mother’s body during pregnancy may induce her immune system to make antibodies which can damage the baby’s brain, as well as causing certain genes to malfunction. Last month, Rhonda Patrick and Bruce Ames from the Children’s Hospital Oakland Research Institute, in California, published research findings that these genes normally make the chemical serotonin.
Too little of this neurotransmitter is associated with abnormal social behaviour while too much in the digestive tract causes sensitivity to foods which may explain some autistic children’s difficult eating habits.
Patrick and Ames, both well-respected scientists in the field of autism, suggest: “Supplementation with vitamin D and tryptophan [which is made into serotonin in the brain] is a practical and affordable solution to help autism and possibly ameliorate some of the symptoms of the disorder.”
But the vitamin D jigsaw puzzle is not finished yet. Some 15 or more different cancers have been consistently associated with low vitamin D levels in a way that accords with established criteria, according to epidemiologist Dr William B Grant, from the non-profit organisation the Sunlight Nutrition and Health Research Center in California. In his paper published in 2009, the link is most clearly seen in breast and bowel cancer. Insufficient vitamin D leads to loss of control of several genes which regulate proliferation of cancer cells and inhibit the cell cycle.
In fact there are more than 900 genes that Vitamin D is now known to switch on and off - and in doing so alters our vulnerability to disease. The large number of genes involved explains how so many quite different diseases can be caused by insufficient sunshine. In this way sunshine exposure directly alters the action of genes which may actually be passed on in their altered state – a newly understood process known as epigenetics. So it is possible to see how some diseases may emerge for the first time in one generation and be passed on to the next.
There is understandable opposition to these theories from some in the medical establishment. In an editorial published last December,the journal The Lancet argued that failure of “gold standard” clinical trials of vitamin D to treat disease in adults disproves the possibility that insufficient vitamin D is a causal factor.
In my view, this ignores a wealth of experimental and observational evidence associating low vitamin D levels with higher risk of certain diseases. Also, vitamin D given in adulthood cannot necessarily be expected to cure a condition that has arisen through lack of vitamin D in early life. This is an error in scientific reasoning which I call the The Lancet’s “gold standard fallacy”.
INDOOR LIFESTYLES BLAMED
At the same time researchers are finding links between vitamin D and chronic disease, the world is facing an epidemic of these same conditions, caused by our indoor lifestyles. Even in the height of summer people in cities often have sub-optimal levels of vitamin D, and so babies born at any time of year may develop these diseases. It’s well recognised that multiple sclerosis has become increasingly common in the UK over the last century. Today, in cloudy Orkney, off the north of Scotland, one in 150 women suffer from MS, believed to be the highest prevalence in the world.
Less well known is that a generation ago the disease was much less common in southern than in northern Europe. But MS has increased rapidly in the Mediterranean over recent years, reflecting the increased movement of people away from rural subsistence farming to town and a life in urban apartments. In the Greek island of Crete MS has increased almost four fold over the last generation.
One striking example of the rise in MS is in Iran where, after the Islamic revolution in 1979, women were compelled by law to wear the veil outdoors together with clothing covering most of the body. Between 1989 and 2006, the incidence of MS in Iran increased more than eight fold, from an incidence of about one case in 100,000 to nearly one in 10,000 in the city of Isfahan.
“The Islamic revolution can potentially explain the observed increase in MS incidence in Iran in just over 30 years,” said Dr Ramagopalan. “Veiled women have lower vitamin D levels compared to unveiled women, giving an increased risk of low vitamin D in pregnancy which can account for the increase in MS.”
There have been similar increases in other autoimmune diseases, some rare or even unknown a century ago. Type 1 diabetes has seen an annual 4 per cent increase across Europe in a generation, with larger increases in the under-fives and the number of cases in this age group expected to double between 2005 and 2020. Crohn’s disease, a life threatening inflammation of the bowel, has since the 1930s become increasingly common in most developed countries.
Between 1965 and 1997 the incidence of schizophrenia doubled in London’s Camberwell. Much, but not all, of the increase is attributed to second generation dark-skinned immigrants who have a five times greater risk of the disease than their parents or people with white skin. Dark skin blocks absorption of weak northern sunlight, preventing vitamin D synthesis.
Autism was also rarity a generation ago. Between 1988 and 1995 the incidence in UK children increased some five fold, according to a nationwide survey by a 1000 GPs; arguably such a large rise cannot all be explained as improvements or changes in diagnosis of the condition, which is generally held to be difficult to miss. A similar increase occurred in the United States in the 1990s.
Over the last generation there has also been a global increase in asthma. Tests on frozen blood show that the epidemic is not caused by changes in diagnosis. Allergic reactions to mixed pollens, animal dander and house dust mites have increased by 4.5 per cent per decade in the UK during last quarter of the 20th epidemic has been followed closely by a rapid increase in food allergy. In extreme cases allergy can cause anaphylactic shock which has increased in England by 50 per cent between 2001 and 2005.
Professionals dealing with overflowing clinics are talking about a 'double tsunami’ – a giant wave of asthma followed by a second wave of food allergy, suggesting that they are two parts of a continuing epidemic. Two distinguished professors, Augusto Litonjua and Scot Weiss, from Harvard University School of Medicine calculate that some 300 million people worldwide now suffer from asthma and blame social changes: “...as populations grow more prosperous and more westernised”, they say, “more time is spent indoors and there is less exposure to sunlight, leading to vitamin D deficiency, subsequently resulting in more asthma and allergy.”
Why has the wave of food allergy followed the wave of asthma rather than occurring simultaneously: and why are second generation immigrants more at risk of diseases such as schizophrenia or Crohn’s than their first generation parents? The new science of epigenetics explains how the environment can influence genes which are then passed on in an altered state, in apparent contradiction of classical genetics.
Women who are severely vitamin D deficient may pass on de-activated genes, which make their children more vulnerable to disease. Multiple sclerosis, Type 1 diabetes, Crohn’s, schizophrenia, autism, asthma and food allergy have all been increasing in the same overlapping time frame and all have links to low vitamin D and low sunshine exposure. A further 11 autoimmune diseases have been linked to serious vitamin D deficiency in an Oxford study published in BMC Medicine in 2013. This makes at least 18 autoimmune diseases clearly linked to low vitamin D levels - more than enough to demonstrate a pattern.
PREVENTION IS CRUCIAL
Although The Lancet may insist otherwise, some clinical trials have shown that people with MS, asthma or Crohn’s may do better or have fewer relapses when they take vitamin D, if disease is not too advanced. For example, MS begins with optic neuritis, a temporary form of blindness, in 20 per cent of cases. Doctors at Isfahan University, Iran, have shown in a clinical trial that giving vitamin D (about 7,000 IUs per day) at this early stage can reduce risk of a relapse in blindness by 68 per cent and lower the incidence of lesions and “black holes” in the brain. They are hopeful that vitamin D may delay the usual conversion of optic neuritis to subsequent MS. Symptoms of Crohns’ disease can be reduced dramatically by 5,000 IUs per day of vitamin D according to a clinical trial at the Center for Molecular Immunology, University of Pennsylvania. Another study at Massachusetts General Hospital, described in the journal Inflammatory Bowel Disease, 2013, shows that risk of surgery is reduced in Crohns’ patients who took a vitamin D supplement that increased their blood level to normal.
While the Lancet remains trapped in its “gold standard” fallacy, doctors working with these autoimmune diseases, previously sceptical, are now privately hopeful that vitamin D will prove to be a useful addition to treatment. But increasing vitamin D later in life cannot always restore what has been lost when vitamin levels are low: for example, in the case of diabetes type 1, an enterovirus may attack the islet cells in the pancreas that make insulin, wiping them out. This is why prevention is so crucial: the link between high vitamin D levels in pregnancy and a reduction in diabetes risk was shown as long ago as 2001.
BRITAIN'S CLOUDY SKIES ARE BAD NEWS
THE UK has least sunshine of almost any advanced economy; our cloudy weather is arguably one of the unhealthiest climates in the world. And even when the sun shines we spend too much time indoors, detained by our computers and TVs. Fear of sunlight has been spread by misguided advice from cancer charities urging people to “seek the shade” rather than enjoy the sun safely and often. Extensive use of suncreams since the 1970s, has reduced exposure to UVB, the part of sunlight which generates vitamin D. The Chief Medical Officer, Dame Sally Davies, has said she is “profoundly ashamed” at the return of rickets in the UK. But the increase in rickets is small compared with the pandemic of immune system disease, the cost of which can be calculated in billions. MS costs the UK £3 billion a year, type 1 diabetes £9 billion, and schizophrenia £12 billion IN 1942, when Britain was besieged by German submarines, the government was eager to maintain the nation’s health by providing all children with cod liver oil, the best natural source of vitamin D. Since then successive governments have pursued a false economy and restricted free supplies of vitamin D supplements to a small percentage of pregnant and breastfeeding women and under-fives who are on state benefits.
I believe a great advance could be made by returning to heroic wartime thinking, providing all pregnant women and babies with free vitamin D supplements. I would argue that an intensive programme reaching 80-90 per cent of people, as modern vaccinations do, would greatly reduce and might even virtually eradicate MS, type 1 diabetes and several other autoimmune diseases.
Even lesser measures could at least halt or slow the pandemic. At little cost, the government could encourage voluntary fortification of foods such as milk and bread with vitamin D and give better advice on benefits of sunshine and how to enjoy the sun safely. Failure to act soon will be a cause for profound national shame.
Source: Daily Telegraph © Copyright of Telegraph Media Group Limited 2014 (10/03/13)
Vitamin D status appears to be associated with reduced disease activity in patients with multiple sclerosis (MS) and a slower rate of disease progression, according to a study by Alberto Ascherio, M.D., Dr.P.H., of the Harvard School of Public Health, Boston, and colleagues.
MS is a common cause of neurological disability and vitamin D status may be related to the disease process, according to the study background.
Researchers examined whether blood concentration of 25-hydroxyvitamin D (25[OH]D), a marker of vitamin D status, was associated with MS disease activity and progression in patients with a first episode suggestive of MS.
Blood 25[OH]D levels were measured as part of a randomized trial originally designed to study patients given interferon beta-1b treatment. A total of 465 patients (of the 468 enrolled) had at least one 25[OH]D measurement. Patients were followed for up to five years with magnetic resonance imaging.
Increases of 50-nmol/L in average blood 25[OH]D levels within the first 12 months appeared to be associated with a 57 percent lower risk of new active brain lesions, 57 percent lower risk of relapse, 25 percent lower yearly increase in T2 lesion volume and 0.41 percent lower yearly loss in brain volume from months 12 to 60.
"Among patients with MS mainly treated with interferon beta-1b, low 25[OH]D levels early in the disease course are a strong risk factor for long-term MS activity and progression," the study concludes.
Source: MNT © 2004-2014 All rights reserved (21/01/14)
Researchers have discovered a vitamin D-based treatment that can halt and even reverse the course of the disease in a mouse model of Multiple Sclerosis (MS).
The treatment involves giving mice that exhibit MS symptoms a single dose of calcitriol, the active hormone form of vitamin D, followed by ongoing vitamin D supplements through the diet.
Lead scientist biochemistry professor Colleen Hayes said that all of the animals just got better and better, and the longer we watched them, the more neurological function they regained.
While scientists don’t fully understand what triggers MS, some studies have linked low levels of vitamin D with a higher risk of developing the disease.
Hayes has been studying this “vitamin D hypothesis” for the past 25 years with the long-term goal of uncovering novel preventive measures and treatments.
Over the years, she and her researchers have revealed some of the molecular mechanisms involved in vitamin D’s protective actions, and also explained how vitamin D interactions with estrogen may influence MS disease risk and progression in women.
First, Hayes’ team compared the effectiveness of a single dose of calcitriol to that of a comparable dose of a glucocorticoid, a drug now administered to MS patients who experience a bad neurological episode.
Calcitriol came out ahead, inducing a nine-day remission in 92 percent of mice on average, versus a six-day remission in 58 percent for mice that received glucocorticoid.
Next, Hayes’ team tried a weekly dose of calcitriol. They found that a weekly dose reversed the disease and sustained remission indefinitely.
But calcitriol can carry some strong side effects it’s a “biological sledgehammer” that can raise blood calcium levels in people, Hayes says – so she tried a third regimen: a single dose of calcitriol, followed by ongoing vitamin D supplements in the diet.
Source: AM Authint Mail © AMPL 2014 (20/01/14)
Vitamin D could represent a natural therapeutic method against multiple sclerosis (MS), according to a new study. Researchers at John Hopkins University School of Medicine have discovered that the so-called sunshine vitamin can block nerve damage in a mouse model of the autoimmune disease. The findings may represent a significant step towards halting and ultimately reversing one of our most debilitating disorders.
For some time, researchers have been trying to figure out why the incidence of MS is significantly lower in regions close to the equator. Many now believe that the sustained sunlight of these areas may have a protective effect against the nerve-destroying disease. Published in the journal Proceedings of the National Academy of Sciences, the current study sought to determine whether vitamin D — a key nutrient derived from sunlight — is associated with this effect.
To investigate, the researchers designed a trial involving lab rodents afflicted with a mouse model of MS. They found that subjects who received a high dose of vitamin D did not exhibit the usual symptoms associated with the disorder. According to lead author Anne R. Gocke, this suggests that the “sunshine vitamin” may offer MS protection that parallels that of current drugs. "With this research, we learned vitamin D might be working not by altering the function of damaging immune cells but by preventing their journey into the brain," she said in a press release. "If we are right, and we can exploit Mother Nature's natural protective mechanism, an approach like this could be as effective as and safer than existing drugs that treat MS."
As subsequent biological analyses nonetheless confirmed a strong disease presence in the form of nerve-damaging T cells, the researchers theorize that vitamin D suppresses debilitating symptoms by keeping the disease out of the brain. "Vitamin D doesn't seem to cause global immunosuppression," Gocke explained. "What's interesting is that the T cells are primed, but they are being kept away from the places in the body where they can do the most damage."
According to the Mayo Clinic, MS is a so-called autoimmune disorder that turns the body’s own defenses against its most essential parts. Rogue T cells begin to erode myelin, the protective sheath that covers nerves. The degeneration, which disrupts communications between essential organs, eventually results in irreversible nerve damage.
Source: Medical Daily © Medical Daily 2013 (10/12/13)
Many people with MS start using some kind of mobility aid -- cane, walker, scooter or wheelchair -- by 45 or 50, and those with the most severe cases are typically bed-bound by 60. The medications that are currently available don't do much to slow the relentless march of the disease.
In search of a better option for MS patients, a team of University of Wisconsin-Madison biochemists has discovered a promising vitamin D-based treatment that can halt -- and even reverse -- the course of the disease in a mouse model of MS. The treatment involves giving mice that exhibit MS symptoms a single dose of calcitriol, the active hormone form of vitamin D, followed by ongoing vitamin D supplements through the diet. The protocol is described in a scientific article that was published online in August in the Journal of Neuroimmunology.
"All of the animals just got better and better, and the longer we watched them, the more neurological function they regained," says biochemistry professor Colleen Hayes, who led the study.
MS afflicts around 2.5 Million people worldwide, with 200 new cases diagnosed each week. Early on, this debilitating autoimmune disease, in which the immune system attacks the myelin coating that protects the brain's nerve cells, causes symptoms including weakness, loss of dexterity and balance, disturbances to vision, and difficulty thinking and remembering. As it progresses, people can lose the ability to walk, sit, see, eat, speak and think clearly.
Current FDA-approved treatments only work for some MS patients and, even among them, the benefits are modest. "And in the long term they don't halt the disease process that relentlessly eats away at the neurons," Hayes adds. "So there's an unmet need for better treatments."
While scientists don't fully understand what triggers MS, some studies have linked low levels of vitamin D with a higher risk of developing the disease. Hayes has been studying this "vitamin D hypothesis" for the past 25 years with the long-term goal of uncovering novel preventive measures and treatments. Over the years, she and her researchers have revealed some of the molecular mechanisms involved in vitamin D's protective actions, and also explained how vitamin D interactions with estrogen may influence MS disease risk and progression in women.
In the current study, which was funded by the National Multiple Sclerosis Society, Hayes' team compared various vitamin D-based treatments to standard MS drugs. In each case, vitamin D-based treatments won out. Mice that received them showed fewer physical symptoms and cellular signs of disease.
First, Hayes' team compared the effectiveness of a single dose of calcitriol to that of a comparable dose of a glucocorticoid, a drug now administered to MS patients who experience a bad neurological episode. Calcitriol came out ahead, inducing a nine-day remission in 92 percent of mice on average, versus a six-day remission in 58 percent for mice that received glucocorticoid.
"So, at least in the animal model, calcitriol is more effective than what's being used in the clinic right now," says Hayes.
Next, Hayes' team tried a weekly dose of calcitriol. They found that a weekly dose reversed the disease and sustained remission indefinitely.
But calcitriol can carry some strong side effects -- it's a "biological sledgehammer" that can raise blood calcium levels in people, Hayes says -- so she tried a third regimen: a single dose of calcitriol, followed by ongoing vitamin D supplements in the diet. This one-two punch "was a runaway success," she says. "One hundred percent of mice responded."
Hayes believes that the calcitriol may cause the autoimmune cells attacking the nerve cells' myelin coating to die, while the vitamin D prevents new autoimmune cells from taking their place.
While she is excited about the prospect of her research helping MS patients someday, Hayes is quick to point out that it's based on a mouse model of disease, not the real thing. Also, while rodents are genetically homogeneous, people are genetically diverse.
"So it's not certain we'll be able to translate (this discovery to humans)," says Hayes. "But I think the chances are good because we have such a broad foundation of data showing protective effects of vitamin D in humans."
The next step is human clinical trials, a step that must be taken by a medical doctor, a neurologist. If the treatment works in people, patients with early symptoms of MS may never need to receive an official diagnosis.
"It's my hope that one day doctors will be able to say, 'We're going to give you an oral calcitriol dose and ramp up the vitamin D in your diet, and then we're going to follow you closely over the next few months. You're just going to have this one neurological episode and that will be the end of it,'" says Hayes. "That's my dream."
Source: ScienceDaily Copyright 2013 by ScienceDaily, LLC (30/09/13)
In the time it took to cross a Melbourne suburban street, Simon McKeon went from seeing the world in full colour to one of fuzzy darkness. It was 1999 and the investment banker, philanthropist and former Australian of the Year had experienced an episode of multiple sclerosis, a disease that attacks the brain and spinal cord.
“I left the pavement on one side and by the time I got to the other side I could only literally see a vague shape of a tree,” he says.
“I hugged this tree because it happened without warning.”
McKeon was not far from his home, so shuffled along the path and doesn’t remember much from there. He was helped into hospital and did not recover his sight for about 10 days. He didn’t make the link between an episode a few months before when he suddenly experienced paralysis from the hip down. But his neurologist quickly tied the two events together to diagnose MS.
McKeon, who is executive chairman of Macquarie Bank, Melbourne, began working with MS Australia and in 2004 became the founding chairman of MS Research Australia.
MS occurs when white blood cells produced as part of a normal immune response erroneously attack myelin, which is like insulation that wraps around the nerves. The insulation allows electrical impulses to travel quickly to and from the brain, but when it is damaged, the messages are not relayed, which causes symptoms such as blindness and paralysis.
The disease afflicts about 23,000 Australians and this number is increasing at a rate of 5 per cent each year. Three out of four cases afflict women. There is no cure.
EQUATOR OFFERS CLUE
But a new trial being undertaken by MS Research Australia, the largest of its kind in the world, hopes to identify a link between the progression of MS and levels of Vitamin D in the body.
Researchers have long suspected such a link exists because of the varying incidence of MS depending on how far away from the equator a location is, said MSRA chief executive Matthew Miles.
Vitamin D is activated in the body by sunlight. How many degrees of latitude away from the equator a person lives generally gives a good indication of their levels of sun exposure and Vitamin D in the blood.
“The incidence of MS in Tasmania, Victoria or the ACT is much, much greater than the incidence in tropical far north Queensland or the Northern Territory,” Miles says. “That leads us to two things – either MS may be related to Vitamin D levels, or it might be related to UV radiation levels.”
The organisation hopes to recruit about 260 patients across 21 hospitals in Australia and New Zealand who have had their first clinically recognised episode of MS. Patients will be given one of three different doses of Vitamin D or a placebo.
The trial is double blind, which means neither the patient nor the doctor knows who gets which course of treatment. Participants’ exposure to sunlight will also be measured.
“What we’re hoping to find is that there is an ability of Vitamin D to prevent the onset or the incidence of people developing diagnosed MS,” Miles says.
CORPORATE WORLD BEHIND CAUSE
McKeon is excited about the prospects of the trial. “There really hasn’t been a large-scale [trial] done on this anywhere around the world, particularly on such a spread of population and with a placebo and different doses,” he says.
MSRA has tapped into corporate networks and received commitments to fund $3 million worth of research annually for the next 10 years. Within five years of its establishment, the annual amount spent on new medical research into MS increased five-fold to just over $2 million.
McKeon has since been replaced as chair by former Goldman Sachs banker and company director Paul Murnane, although he is patron.
MS is one of a number of causes that McKeon backs but, unlike his work on indigenous disadvantage and the environment, he says it was his only philanthropic interest with a direct personal link. He calls it his “selfish” work.
“I can remember saying at the time, ‘my gosh – have I sailed my last yachting race and kicked my last footy with my kids?’? [I thought] if I somehow am not sentenced to a life in a wheelchair or whatever else, I will never take a day for granted. I’ve had my own version of a near-death experience. I didn’t die, but I’ve had that taste of what vulnerability is all about.”
“Sometimes in the philanthropic space it’s okay to be a bit self-motivated, so long as it’s not the only motivation,” he said. “It does add to the passion. For me it’s not just a another disease.”
McKeon doesn’t talk much about his own condition. His reluctance stems from a relatively clean bill of health after the initial episodes that lasted for about 18 months more than a decade ago. He is one of the lucky ones.
Source: Financial Review © Copyright 2013 Fairfax Media Publications Pty Ltd (24/09/13)
A new study out of Iran has found that vitamin D status correlates with severity of multiple sclerosis in Iranian patients.
There is a well-known link between vitamin D and multiple sclerosis (MS). Studies have shown that getting enough vitamin D throughout life reduces your risk of getting MS. The incidence of MS is also higher in countries further from the equator, leading many researchers to believe that sun exposure and vitamin D are protective against MS.
In Iran, despite the country being close to the equator, people dress in heavy clothing, restricting the skin’s ability to produce vitamin D. Thus vitamin D deficiency is much more prevalent in Iran than you might expect. In recent years, researchers have noticed an increase in MS prevalence in the country.
In the present study, researchers out of Shaheed Beheshti University in Iran studied 98 patients with relapsing-remitting MS. They matched these patients with 17 healthy controls. They wanted to know, were MS patients more likely to be deficient in vitamin D compared to controls? They also wanted to know if vitamin D status correlated at all with disability in MS and disease severity.
They found that in general, MS patients only had slightly lower vitamin D levels than healthy controls, with mean levels of 31.7 ng/ml in MS patients and 35.8 ng/ml in healthy controls.
They did find, however, that in patients with MS, disease severity correlated with vitamin D levels. Those with severe relapsing-remitting MS had mean levels of 21.5 ng/ml, while those with a milder relapsing-remitting MS had mean levels of 33.6 ng/ml.
Lastly, when the researchers assessed each patient’s disability score using the Expanded Disability Status Scale (EDDS), they found that vitamin D status correlated with the score. The worse the EDDS score, the lower the vitamin D score (P=0.049, R=−0.168).
The researchers concluded,
“Our findings reveal a lower level of vitamin D in MS patients and suggest that vitamin D could be involved in the regulation of clinical disease activity in MS, based on its inverse correlation with disease severity, as measured using the EDSS score.”
What next? The researchers stated that they believed we need more trials using vitamin D as therapeutic agent in patients with MS, to see if there is indeed any benefit in MS patients supplementing with vitamin D.
Publication Source:Shahbeigi S et al. Vitamin D3 Concentration Correlates with the Severity of Multiple Sclerosis. Int J Prev Med, 2013
Source: The Vitamin D Council (13/08/13)
Increased exposure to sunlight may help alleviate the depression and fatigue associated with multiple sclerosis (MS), and may even reduce the overall level of disability caused by the disease, research suggests.
Prior research has linked both vitamin D deficiency and lower levels of unprotected sun exposure to a higher risk of developing MS. Likewise, other studies have linked lower vitamin D levels to higher rates of depression. Because depression, along with anxiety, fatigue and cognitive impairment, are common and potentially disabling symptoms of MS, researchers from Maastricht University Medical Center in the Netherlands recently conducted a study to examine the relationship between these separate factors. The study was recently published in the journal Acta Neurologica Scandinavica.
The researchers followed 198 MS patients for an average of 2.3 years. Twice per year, participants reported on their levels of sun exposure, and researchers measured participants' vitamin D blood levels and evaluated the participants for depression, anxiety and fatigue. Once a year, participants were evaluated for cognitive impairment. The researchers found that higher levels of sun exposure were significantly associated with lower levels of depression and fatigue. Notably, while they also found an association between higher vitamin D levels and lower depression and fatigue levels, this association disappeared after adjusting for the influence of sunlight. Thus the researchers concluded that it is exposure to sunlight and not vitamin D levels that lead to improvement in symptoms of depression and fatigue among MS patients.
Because the vitamin D levels found in the study were all relatively low, however, the researchers did not rule out the fact that higher levels might lead to further improvements in depression and fatigue.
No association was found between sun exposure or vitamin D levels and levels of anxiety or cognitive impairment.
Sunlight improves more than mood
Another recent study suggests that for some MS patients, exposure to sunlight may also reduce their risk of disability. The study was based on a survey given to 1,372 people registered with the Flemish MS Society in Belgium. Participants reported their sun exposure, skin type and disability-related MS symptoms. Researchers assigned each participant a score on the Expanded Disability Status Scale, with a score of 6.0 or higher indicating disability. A score of 6.0 indicates an inability to walk without at least some assistance.
The researchers found that among people with relapsing-remitting MS (RRMS), those who "always" wore sunscreen were 1.8 times more likely to suffer from disability then those who "sometimes" or "never" wore sunscreen. Similarly, RRMS patients whose sun exposure was equal to or greater than that of the non-MS population were 30 percent less likely to suffer from disability.
The researchers also found that among respondents with primary progressive MS (PPMS), those who reported "sun sensitivity" from birth were 1.8 times more likely to suffer from disability than those who had not had lifelong sensitivity. Sun sensitivity was defined as being able to spend only 30 minutes or less in the sun without burning.
Of course, such research does not prove that exposure to sunlight is a direct cause of less MS-related disability, or that such exposure would equally benefit all MS patients. However, given the widespread prevalence of vitamin D deficiency and insufficiency, increasing numbers of doctors are now recommending that people try to increase the amount of time that they spend exposing their unprotected skin to sunlight. For light skinned people, a minimum of 15 to 30 minutes per day of sun on the face and hands are recommended, while people with darker skin may need significantly more exposure.
Researchers have uncovered molecular and genetic evidence that vitamin D benefits patients with multiple sclerosis (MS) who are receiving therapy.
The analysis showed that genes associated with increased vitamin D levels — 25-hydroxyvitamin D or 25(OH)D — and with interferon β-1b are also associated with a decrease in gadolinium-enhancing lesion (Gd+ lesion) counts.
While other studies have shown that vitamin D may reduce the risk for MS and may even be important in the progression of the disease, that research couldn't "tease out" the molecular or genetic mechanisms behind this effect, said study author Kassandra L. Munger, ScD, research associate, Harvard School of Public Health, Boston, Massachusetts.
The new analysis, reported here at the 5th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research In Multiple Sclerosis (ACTRIMS), used data from the BEtaferon (BEtaseron) in Newly Emerging MS For Initial Treatment (BENEFIT) study that examined the safety and efficacy of early interferon β-1b treatment in 468 patients with clinically isolated syndrome.
Patients were randomly assigned to interferon β-1b (250 μg subcutaneously) every other day (early treatment) or to placebo (delayed treatment) and followed for 2 years for the development of MS.
Patients underwent MRI and had blood samples taken at baseline and at 2, 3, 12, and 24 months.
The main results of the BENEFIT study showed significant improvements in clinical and radiologic outcomes in patients who received early treatment compared with those who had delayed treatment with interferon β-1b after a follow-up of up to 8.7 years.
In this analysis, the researchers used samples from this population to assess levels of 25(OH)D and measured gene expression.
They observed a seasonal fluctuation in vitamin D levels that "mirrored" fluctuations in Gd+ lesion counts, although this could be "purely correlational," said Dr. Munger.
Looking at quintiles of vitamin D levels, the researchers noted that the highest vitamin levels were associated with lower lesion counts. "There is about a 57% reduced risk of new gadolinium lesions with every 50 nmol/liter increase in vitamin D," said Dr. Munger.
When the researchers included interferon β-1b, which is known to reduce lesions, into the model, the study found that both vitamin D levels (P = .0001) and interferon (P < .0001) were statistically significantly protective against the development of new lesions.
"This suggests that vitamin D is contributing something," said Dr. Munger.
But she and her colleagues also wanted to see whether genes play a role. The gene expression analysis of whole blood samples showed there were 63 genes associated with vitamin D, 770 genes associated with interferon β-1b, and more than 5000 genes associated with the Gd+ lesions.
It also showed a fair amount of overlap between all 3 gene sets, suggesting shared pathways. Further, a functional classification showed that these overlapping genes tend to fall into categories associated with immune response, suggesting a defense response to bacteria.
Adding Vitamin D
Asked for his opinion of this latest vitamin D research, Robert P. Lisak, MD, Wayne State University Medical Center, Detroit, Michigan, said it's useful.
"It's an add-on study and add-ons are useful to show probability," he said. "It suggests that on the basis of MRI predominantly that there's additional benefit above and beyond interferon's benefit, which is considerable."
The study "doesn't prove that vitamin D by itself does anything, but suggests that adding vitamin D to interferon beta certainly wouldn't hurt," said Dr. Lisak.
However, he stressed that vitamin D should not be at a "toxic level," and patients should not have hypercalcemia.
That adding vitamin D to other MS therapies would have the same benefit "wouldn't surprise me," added Dr. Lisak.
Research was supported by Bayern HealthCare Pharmaceuticals Inc. Dr. Munger has disclosed no relevant financial relationships.
5th Cooperative Meeting of the Consortium of Multiple Sclerosis Centers (CMSC) and the Americas Committee for Treatment and Research In Multiple Sclerosis (ACTRIMS). Poster DX10. Presented May 30, 2013.
Source: Medscape News Today Copyright © 1994-2013 by WebMD LLC (03/06/13)
Scottish pharmacies set to hand out free vitamin D tablets in attempt to fight illnesses linked to lack of sunshine(20/04/13)
A lack of sunshine in Scotland has left Scots more prone to suffering illnesses such as multiple sclerosis, osteoporosis and rheumatoid arthritis.
Pharmacies are to dish out free vitamin D pills to fight diseases linked to a lack of sunshine.
Scotland is hit by higher than average levels of a string of conditions related to low levels of the so-called sunshine vitamins.
They include multiple sclerosis, allergies, childhood rickets, osteoporosis, breast and prostate cancers, rheumatoid arthritis and bowel disease.
Our dull weather means we don’t get enough sunshine on our skin for half the year to boost vitamin D production.
And we don’t eat enough of the foods that contain the vitamin – such as oily fish.
Schoolboy Ryan McLaughlin – whose mum Kirsten has multiple sclerosis – launched a nationwide campaign four years ago to highlight the importance of vitamin D.
He led protesters on a march to Holyrood.
Previously, children and pregnant women had to make an appointment with their GP or health visitor, or visit a specialist health centre, to get access to free vitamin pills.
But from May 6, eligible patients – including those on income support, jobseekers or young pregnant women – will be able to pop into their local pharmacy to pick up the Healthy Start pills for free.
After a successful pilot scheme in Glasgow, the Scottish Government hope the move will encourage an increased uptake of free vitamin tablets, which contain 100 per cent of recommended vitamin D.
Margaret Watt, of Scotland Patients’ Association, said: “If a vitamin can help keep our bodies safe and healthy, then making them more accessible for people is definitely a positive thing.”
Edinburgh University allergies expert Professor Aziz Sheikh said: “There is an increasing body of work which shows that asthma and other chronic disorders are related to vitamin D deficiency.
A Scottish Government spokeswoman said: “From May 6, the healthy start vitamins will be available from community pharmacies in Scotland.”
Source: Daily Record Copywrite MGN Ltd 2013 (20/04/13)
A newborn's immune system development, vitamin D levels and risk for multiple sclerosis may be influenced by the month of birth, new research suggests.
A study conducted in London found that babies born in May have significantly lower levels of vitamin D and a potentially greater risk for developing MS than babies born in November. Multiple sclerosis is a disabling neurological condition that can lead to problems with vision, muscle control, hearing and memory.
The findings suggest that more research is needed to explore the benefits of prenatal vitamin D supplements, according to the report, published in the April 8 issue of the journal JAMA Neurology.
The study involved cord blood samples taken from 50 babies born in November and 50 more samples taken from babies born in May between 2009 and 2010. The samples were collected in London, where the "month of birth" effect is particularly evident. Previous studies suggested the risk of MS is highest for people born in May and drops for those born in November, the study authors noted.
The blood samples were analyzed to assess levels of vitamin D and white blood cells involved in the body's immune response. White blood cells are capable of attacking the body's own cells, as they do in MS, the researchers said.
The study found that May babies had vitamin D levels roughly 20 percent lower than babies with November birthdays. The May babies also had roughly double the level of potentially harmful autoreactive T-cells than the November babies.
"By showing that month of birth has a measurable impact on in utero immune system development, this study provides a potential biological explanation for the widely observed 'month of birth' effect in MS," study co-author Dr. Sreeram Ramagopalan, a lecturer in neuroscience at Barts and The London School of Medicine and Dentistry at the Queen Mary University of London, said in a university news release.
"Higher levels of autoreactive T-cells, which have the ability to turn [against] the body, could explain why babies born in May are at a higher risk of developing MS," he added.
Because vitamin D is formed when skin is exposed to sunlight, the birth-month effect is viewed as evidence that vitamin D levels during pregnancy play a role in MS risk, the study authors said in the news release.
"The correlation with vitamin D suggests this could be the driver of this effect," said Ramagopalan. "There is a need for long-term studies to assess the effect of vitamin D supplementation in pregnant women and the subsequent impact on immune system development and risk of MS and other autoimmune diseases."
The study uncovered an association linking birth month to vitamin D levels and MS risk. It did not prove cause-and-effect.
Source: WebMD ©2005-2013 WebMD, LLC (09/04/13)
Do you think you are getting enough vitamin D? New evidence shows for the first time, even if your level is not low, higher levels of the vitamin could have an important role for fighting heart disease, cancer, autoimmune diseases and infection. Research shows how vitamin D changes gene expression when levels in the bloodstream are higher to boost immune defenses.
Boosting levels of the so-called sunshine vitamin in the body could help fight a variety of diseases even for people whose vitamin D status is considered normal, according to the findings based from Boston University School of Medicine (BUSM).
Gene analysis gives clues about vitamin D role in immunity
Researchers studied 8 healthy men and women who were vitamin D deficient of insufficient at the start of the investigation and whose average age was 27.
For two months, 3 of the participants took 400 International Units (IUs) of vitamin D per day and 5 received 2,000 IUs daily.
The researchers took blood samples to measure white blood cells at the beginning and at the end of the study.
Researchers analyze more than 22, 500 genes to see if their activity declined or increased in response to higher levels of the vitamin.
At the end of the study the group that took 2000 IUs had sufficient vitamin D status of 34 ng/ml. The group that received 400 IUs was considered insufficient at 25 ng/mL.
Vitamin D status is measureable with a simple blood test.
Deficiency is considered <20ng/ml and is linked to poor bone health and musculoskeletal diseases. Insufficient vitamin D levels between 21-29 ng/mg is associated with higher risk of cancer, autoimmune diseases, infections, type 2 diabetes and heart and blood vessel disease.
Higher vitamin D level favorably alters gene activity
The researchers specifically found a higher level of vitamin D favorably alters gene expression discovered in 291 genes that included 160 biologic pathways linked to cancer, autoimmune diseases, infectious diseases and cardiovascular disease (CVD).
New genes were also discovered that relate to vitamin D status. The researchers looked at gene sequences of DNA bases that interact with vitamin D receptors to regulate how are genes are expressed, frequently referred to as epigenetics. To ensure accuracy of their findings 12 genes that don’t change expression were examined that remained stable through the study period.
Do you take extra vitamin D for specific health conditions? It may be that higher levels have a more important role in boosting immunity that is implicated in a variety of diseases including cancer.
No one has yet to determine what level is optimal for human health, making it difficult to know how much is too much. The vitamin can also have side effects if you take too much.
Michael F. Holick, PhD, MD, professor of medicine, physiology and biophysics at BUSM, corresponding author and leading vitamin D expert said in a press release that more studies are needed to confirm the researchers’ observations.
He adds, “… the data demonstrates that improving vitamin D status can have a dramatic effect on gene expression in our immune cells and may help explain the role of vitamin D in reducing the risk for CVD, cancer and other diseases."
One autoimmune disease vitamin D status has been linked to is multiple sclerosis. Studies have suggested the vitamin can improve outcomes for cancer patients, could help thwart heart disease and even treat Alzheimer’s disease.
According to the Vitamin D Council, levels of 25(OH) D, the form that is measureable in the blood up to 100 ng/mL “implies a degree of safety… since concentrations twice this amount have yet to ever be associated with toxicity.”
It should be noted that too much vitamin D during pregnancy might contribute to infant food allergies, found in a recent study. This study is the first to look at how higher levels of the vitamin could help healthy people without low levels because of how vitamin D has now been found to change gene expression. Do you think we are all getting enough vitamin D with current recommendations?
Source: EmaxHealth Copyright eMaxhealth.com 2005-2013 (22/03/13)
Summary: This study from the US looked at the relationship of sun exposure history, supplementation and environmental factors to vitamin D levels in multiple sclerosis patients and evaluated the associations between sun exposure and MRI measures.
264 MS patients underwent neurological and 3 T MRI examinations as well as blood tests to measure vitamin D metabolites using mass spectroscopy. Results showed that vitamin D supplementation, BMI, summer sun exposure and darker eye colour had the strongest associations with vitamin D metabolite levels in the MS group.
Interestingly, summer sun exposure was associated with increased grey matter volume (GMV) and whole brain volume (WBV) after correcting for EDSS in the MS group. Inclusion of 25-hydroxy vitamin D3 levels did not substantially affect the positive associations of sun exposure with WBV and GMV in the MS group. Therefore, sun exposure may have direct effects on MRI measures of neurodegeneration in MS, independent of vitamin D.
PURPOSE: To assess the relationships of sun exposure history, supplementation and environmental factors to vitamin D levels in multiple sclerosis (MS) patients and to evaluate the associations between sun exposure and MRI measures.
METHODS: This study included 264 MS patients (mean age 46.9±10 years, disease duration 14.6±10 years; 67.8% relapsing-remitting, 28% secondary progressive and 4.2% primary progressive MS) and 69 healthy controls. Subjects underwent neurological and 3 T MRI examinations, provided blood samples and answered questions to a structured questionnaire. Information on race, skin and eye colour, supplement use, body mass index (BMI) and sun exposure was obtained by questionnaire. The vitamin D metabolites (25-hydroxy vitamin D3, 1, 25-dihydroxy vitamin D3 and 24, 25-dihydroxy vitamin D3) were measured using mass spectrometry.
RESULTS: Multivitamin supplementation (partial correlation r(p)=0.29, p<0.001), BMI (r(p)=-0.24, p=0.001), summer sun exposure (r(p)=0.22, p=0.002) and darker eye colour (r(p)=-0.18, p=0.015) had the strongest associations with vitamin D metabolite levels in the MS group. Increased summer sun exposure was associated with increased grey matter volume (GMV, r(p)=0.16, p=0.019) and whole brain volume (WBV, r(p)=0.20, p=0.004) after correcting for Extended Disability Status Scale in the MS group. Inclusion of 25-hydroxy vitamin D3 levels did not substantially affect the positive associations of sun exposure with WBV (r(p)=0.18, p=0.003) and GMV (r(p)=0.14, p=0.026) in the MS group.
CONCLUSIONS: Sun exposure may have direct effects on MRI measures of neurodegeneration in MS, independently of vitamin D.
Authors: Zivadinov R, Treu CN, Weinstock-Guttman B
source: J NeurolNeurosurg Psychiatry. 2013 Feb 5 & Pubmed PMID: 23385850 (14/02/13)
High levels of Vitamin D in the blood could prevent multiple sclerosis (MS) in mothers, more so than in babies, according to a new study published in the journal Neurology.
Study author Jonatan Salzer, MD and neurologist at Umeå University Hospital says: "In our study, pregnant women and women in general had a lower risk for MS with higher levels of the vitamin, as expected. However, a mother's levels of vitamin D during early pregnancy did not have an effect on MS risk for her baby."
Previous research has told us that low levels of vitamin D decrease risk for developing diabetes. Low vitamin D levels are associated with clinically isolated syndrome, a precursor to MS, as well as the occurrence of a second episode and higher incidence of relapse.
Separate research also suggests that MS is not as prominent in sunnier countries, a possible explanation linking high vitamin D levels to less risk of developing MS. Vitamin D, made in the skin, regulates the immune system and therefore can be extremely helpful in easily treating MS, a condition where the immune system attacks the covering that protects nerve fibers because it recognizes it as foreign to the body.
During the study, a team of researchers analysed data of 291,599 blood samples from 164,000 people gathered in the northern part of Sweden since 1975. One hundred and ninety-two of these people developed MS, on average nine years after their blood sample was taken. In total, 37 blood samples were taken during pregnancy from mothers whose kids developed MS in the future.
The findings showed that women with high levels of vitamin D in their blood had a risk of developing MS 61 percent lower than those who had low levels of vitamin D in their blood.
In total, only some had high levels of vitamin D. Just seven of 192 people who had MS, approximately four percent, also had high vitamin D levels, in contrast to 30 out of 384 controls, around 8 percent, who did not have the disease.
No link was seen between the mother's vitamin D level and her offspring developing MS.
Salzar said: "Since we found no protective effect on the baby for women with higher levels of vitamin D in early pregnancy, our study suggests the protective effect may start in later pregnancy and beyond. Another interesting finding in our study was that the vitamin D levels became gradually lower with time from 1975 and onward. It is possible that this decline in vitamin D status is linked to the increasing numbers of MS cases seen worldwide."
Sufficient sources of vitamin D include supplements, sun, and certain foods.
Source: Medical News Today Copywrite MediLexicon International Ltd © 2004-2012 (21/11/12)
Analysis backs birth-month effect in MS (16/11/12)
Birth month had a significant association with multiple sclerosis (MS), suggesting as much as a 12% swing in risk, probably reflecting ultraviolet (UV) light exposure and maternal vitamin D levels, authors of a meta-analysis concluded.
Data on more than 150,000 patients with MS showed a 5% excess of cases among patients born in April and 5% to 8% reductions in MS risk associated with birth in October or November.
A more conservative analysis showed even greater excess risk in April and May and greater reductions in risk in October and November, as reported online in the Journal of Neurology, Neurosurgery, and Psychiatry.
"This study, which uses the largest number of patients to date, confirms and extends the month of birth effect seen in MS," Ruth Dobson, MRCP, of Queen Mary University of London, and co-authors wrote. "Through the demonstration of an interaction between month of birth effect magnitude and latitude, it supports ambient UV radiation, and hence maternal vitamin D levels, as prenatal environmental modulators of MS risk.
"This finding, which supports concepts hypothesized some years previously, surely adds weight to the argument for early intervention studies to prevent MS through vitamin D supplementation," they added.
The outcome of the analysis continues a longstanding discussion about the origin of multiple sclerosis, which some specialists in the field believe occurs as a result of interaction between genes and environment. One hypothesis implicates a deficiency in vitamin D, which forms in the skin in response to UV light, which also figures into several gene/environment theories, according to the article's introduction.
Vitamin D hypotheses have received support from evidence that people born in the spring have an increased risk of MS and those born in the winter have a lower risk, suggesting a prenatal role for vitamin D in MS risk. Specifically, maternal vitamin D levels might affect the immune status of the developing fetus to increase or decrease MS risk.
Several studies have examined the month-of-birth effect, but investigations have taken place across a range of latitudes, resulting in substantial interstudy variation in UV light exposure. No large-scale study has investigated the potential variation.
To address limitations of previous studies, the authors performed a systematic review and meta-analysis.
"By interrogating the available data for both risk of MS and any interaction between population latitude and the effect of month of birth on MS risk, we hope to more accurately describe the magnitude of this phenomenon, in addition to demonstrating the effect of seasonal UV light variation on the month-of-birth effect," the authors wrote.
Their review included studies published since 2000 that had MS and control groups and that provided data on month or season of birth for both groups.
The search of databases yielded 10 studies suitable for inclusion and a total of 151,978 MS births. Nine studies reported data by month, and one by season.
The authors performed four analyses:
One that included all of the studies
One that excluded studies suspected of evaluating duplicate populations (population-conservative)
One that used a geographically conservative approach limited to studies of populations living in latitudes more than 52° from the equator, areas with greater seasonal variation in UV light exposure
One that excluded all studies from the other two conservative analyses
Risk was expressed in observed:expected (O:E) ratios.
The analysis involving all studies showed a statistically significant 5% lower risk of MS among individuals born in October (O:E=0.95, P=0.04) and an 8% lower risk among those born in November (O:E=0.92, P=0.01). In contrast, a 5% excess of MS births occurred in April (O:E=1.05, P=0.05).
In the population-conservative analysis, only November was associated with a statistically significant O:E ratio (O:E=0.93, P=0.04).
The geographically conservative analysis showed an excess of MS births in April (O:E=1.08, P=0.001), May (O:E 1.11, P=0.007), and June (O:E=1.06, P=0.05). Significantly fewer MS births occurred in October (O:E=0.94, P=0.006) and November (O:E=0.89, P=0.004).
When the authors limited their analysis to populations <52°N, the only month with significant variation was June, which had an excess of MS birth (O:E=1.21, P=0.04).
The overall-conservative analysis showed a significant excess of MS births in April (O:E=1.08, P=0.004) and May (O:E=1.09, P=0.002) and significantly fewer MS births in October (O:E=0.95, P=0.03) and November (O:E=0.90, P=0.03).
"Through combining existing datasets for month of birth and subsequent MS risk, this study provides the most robust evidence to date that the month-of-birth effect is a genuine one," the authors wrote of their findings.
"While these data support the month-of-birth effect being a result of UVB (and hence vitamin D) variation, it could result from any factor that varies in a similar seasonal and latitudinal manner," they added. "It must be noted that there is a large body of evidence supporting the importance of vitamin D in MS, and so maternal vitamin D levels would appear to be the most likely explanation for this effect."
The study was supported by the MS Society of Great Britain and Northern Ireland, Medical Research Council, and the Roan Charitable Trust.
Dobson had no disclosures. One or more authors disclosed relationships with Bayer-Schering Healthcare, Biogen-Idec, GW Pharma, Merck Serono, Merz, Novartis, Teva, sanofi-aventis, Eisai, Elan, Fiveprime, Genzyme, Genentech, GlaxoSmithKline, Ironwood, Pfizer, Roche, Synthon BV, UCB Pharma, and Vertex Pharmaceuticals.
Primary source: Journal of Neurology, Neurosurgery, and Psychiatry
Source reference: Dobson R, et al "The month-of-birth effect in multiple sclerosis: Systematic review, meta-analysis, and effect of latitude" J Neurol Neurosurg Psychiatry 2012; DOI: 10.1136/jnnp-2012-303934.
Source: MedPage Today © 2012 MedPage Today, LLC (16/11/12)
Researchers said Thursday they have found evidence that Vitamin D supplements for pregnant women in the world's colder, darker countries may stave off multiple sclerosis (MS) in their offspring.
The finding adds to a growing body of work showing a link between low Vitamin D levels and the debilitating disease, which sees the immune system attacking the body's own nerve fibers.
Data on more than 150,000 MS patients born in places north of 52 degrees, revealed a heightened risk for those born in April -- a month preceded by a long period without sunlight, said a paper in the Journal of Neurology, Neurosurgery and Psychiatry.
Of the total, 13,300 were born in April compared to 11,600 in November -- a lower-risk month after summer in the northern hemisphere, British researchers wrote.
"Month of birth has a significant effect on subsequent MS risk," they said.
"This is likely to be due to ultraviolet light exposure and maternal Vitamin D levels."
They added, though, it could also be "any factor that varies in a similar seasonal and latitudinal manner."
The data was taken from individuals born between 1930 and 1980, from studies done in Britain, the United States, Italy, Israel, Finland, Scotland, Sweden, and Canada -- parts of which see little sunlight between the months of October and March.
About 100,000 people in Britain and about 400,000 in the United States are believed to suffer from MS, a disease that affects vision, movement, balance, sensation, bladder control, and eventually also memory and thinking. There is no cure.
Study co-author Sreeram Ramagopalan from the Queen Mary University of London told AFP the findings amounted to an added MS risk of five percent for people born in April -- about five extra births per million.
"Pregnant mothers need to ensure they are Vitamin D replete at all times," Ramagopalan said in an email exchange.
"Because Vitamin D deficiency is a massive problem at the moment due to living at high latitudes and lifestyle changes (wearing sunscreen etc), mothers may need to take several thousand international units of Vitamin D3 to become Vitamin D replete."
Humans need Vitamin D, which our bodies produce from exposure to sunlight or extract from food, for healthy bones.
Suspected links between a lack of vitamin D and an increased risk of death, including from heart disease and certain types of cancer, have been the subject of medical research for several years.
Researchers have also focused on its possible role in MS.
"It is thought that maternal Vitamin D levels during pregnancy affect the immune status of the developing fetus, and hence modulates subsequent MS risk," wrote the authors.
North of 52 degrees latitude lies the northern parts of England, the Scandinavian countries, and most of Russia and Canada.
No studies from the southern hemisphere were included in the analysis.
Source: Interaksyon (15/11/12)
MS trial to explore vitamin D links(17/10/12)
A world-first clinical trial beginning in Hobart today will assess if vitamin D can stall or prevent the development of multiple sclerosis (MS).
The cause of the condition is not known, but research shows those living further from the equator are at higher risk.
People who live in Tasmania are 10 times more likely to develop the condition than their counterparts in the Northern Territory.
It has long been suspected that vitamin D, or a lack of it, has a large part to play in the development of MS.
Menzies Research Institute professor Bruce Taylor says a placebo-controlled trial to begin at Royal Hobart Hospital today will hopefully give scientific proof to that hypothesis.
"We know that MS is not evenly distributed around the world," he said.
"The further you get away from the equator in a genetically susceptible population, the greater your risk of getting MS.
"That means about 90 per cent of your risk of getting MS can be due to your environment.
"Our science all points to this, that vitamin D, derived from solar radiation, may be one of the clues," Professor Taylor said.
MS is an inflammatory disease that affects the brain and spinal chord, but those with MS can have varying symptoms.
'Major step forward'
Professor Taylor says MS is one of the most difficult diseases to study.
"And that's why it's unfortunately been very badly studied in the past, because it has a huge what we call interpersonal and intrapersonal variation," he said.
"So one can have very bad MS for a period of time and then they can just stop having attacks.
"We spent a lot of time designing the study, which means that if there is a significant effect of MS, we will be able to pick this is up in this study.
"And this is unique - no-one else in the world is doing this.
"This is an Australian and New Zealand first and this is really a major scientific step forward for MS," Professor Taylor said.
MS Research Australia chief executive Jeremy Wright says the study will provide new hope to those battling MS.
"We know a lot about the circumstantial evidence that links vitamin D deficiency and MS and we want to take that fact and act on it and see if vitamin D at the earliest stage of MS can really affect the progress of the disease, slow it or stop it," he said.
Sharlene Brown, 40, is one Tasmanian who hopes that this study will make sense of how she developed the disease.
She has looked at her lifestyle to see if it may have contributed to MS.
"I'm a bit of a bookworm, I must say I spend a lot of time inside," she said.
"I often wonder whether if I'd spent more time out in the playground instead of the library, whether that would have made a difference."
But despite being in remission from MS for more than nine years, her future health remains uncertain.
She hopes the results of this study will prevent a similar outcome for people yet to develop the condition.
"If you can help prevent future generations suffering from this type of illness and it can be done as simply as monitoring your vitamin D levels, then that's really exciting I think for people who have it or for those people who think they might actually be in the early stages of it," she said.
"I think that's the exciting part of the study.
"It could be something so simple."
Source: ABC News © 2012 ABC (17/10/12)
Low blood levels of vitamin D are associated with an increased number of brain lesions and signs of a more active disease state in people with multiple sclerosis (MS), a new study finds, suggesting a potential link between intake of the vitamin and the risk of longer-term disability from the autoimmune disorder.
But researchers, led by Ellen M. Mowry, M.D., M.C.R., an assistant professor of neurology at the Johns Hopkins University School of Medicine and principal investigator of a multicenter clinical trial of vitamin D supplementation in MS patients, caution that more research is needed to determine if large doses of vitamin D help without harming MS patients.
Mowry's study, conducted mostly when she worked at the University of California, San Francisco, shows a strong correlation between vitamin D levels in the body (measured through blood samples) and the characteristic brain lesions of MS as measured with MRI images. Results were described in the August issue of Annals of Neurology.
"Even though lower levels of vitamin D are associated with more inflammation and lesions in the brain, there is no evidence that taking vitamin D supplements will prevent those symptoms," she says "If we are able to prove that through our currently-enrolling trial, it will change the way people with multiple sclerosis are treated."
In people with MS, the body's immune system attacks the coating of nerve fibers in the brain and spinal cord. The coating, made of a fatty protein called myelin, insulates the nerves and helps them send electrical signals that control movement, speech and other functions. When myelin is attacked, inflammation interferes with message transmission, activity that shows up on an MRI as lesions, which look like white spots.
In the most common form of MS, called relapsing-remitting MS, patients may at times have no symptoms, but at other times may suffer from "attacks" (or "relapses") of symptoms such as blurred vision, numbness and weakness. There is currently no cure for the disease but there are medications to help reduce the number of attacks and to help reduce symptoms left over if a person hasn't fully recovered from an attack.
For the study, Mowry and her colleagues used data from a five-year study of 469 people with MS. Each year, beginning in 2004, researchers drew blood from, and performed MRIs on, the brains of study participants, looking for both new lesions and active spots of disease, which lit up when a contrast dye was used. The investigators found that each 10-nanograms-per-milliliter increase in vitamin D levels was associated with a 15 percent lower risk of new lesions and a 32 percent lower risk of spots of active disease, which require treatment with medication to reduce likelihood of permanent nerve damage. Higher vitamin D levels were also associated with lower subsequent disability.
The impact of vitamin D levels remained even after other factors that can affect disease progress were accounted for, including smoking status, current MS treatment, age and gender. At least early in MS, the more new lesions and active spots of disease, the more likely a patient is to develop longer-term disability, Mowry says. Some people with relapsing-remitting MS progress to a more serious form due to damage of the underlying nerve cells.
From one year to the next, Mowry says, she and her colleagues were able to predict the appearance of new lesions and active disease spots based on vitamin D levels from the year before.
Active and new lesions indicate that a patient's MS is not under optimal control. Previous studies have indicated that lower vitamin D levels are associated with increased relapse risk in certain MS patients. Those studies relied on patients to report their attacks, which is sometimes a less reliable assessment than MRI. Some patients already take extra vitamin D because of publicity about earlier studies. However, Mowry says that there is no research proving vitamin D alleviates symptoms or suggesting what dose is best or safest. And nothing is known about whether vitamin D can prevent the autoimmune disorder, she says. "People think vitamin D is available over the counter so it must be safe," Mowry says. "But vitamin D is a hormone, and any medication really does need to be thoroughly tested before we definitely recommend it. That's the main reason why we are now performing a randomized trial of vitamin D supplementation. People with MS should talk with their doctors about the pros and cons of taking vitamin D before starting the supplement."
Source: Medical Xpress © Medical Xpress 2011-2012 (02/10/12)
OBJECTIVE: 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. ANN NEUROL 2012;72:234-240.
Mowry EM, Waubant E, McCulloch CE, Okuda DT, Evangelista AA, Lincoln RR, Gourraud PA, Brenneman D, Owen MC, Qualley P, Bucci M, Hauser SL, Pelletier D.
Multiple Sclerosis Center, Department of Neurology, University of California at San Francisco, San Francisco, CA.
Source: Ann Neurol. 2012 Aug;72(2):234-40. doi: 10.1002/ana.23591. Copyright © 2012 American Neurological Association. & Pubmed PMID: 22926855 (30/08/12)
Objective: Vitamin D deficiency and Epstein-Barr virus (EBV) infection may be associated with the development of multiple sclerosis (MS).
We investigated serum 25-hydroxyvitamin D (25-OH-D) levels and anti-EBV immunoreactivity in 25 individuals before the first clinical manifestation of MS.
Patients and methods:
• 56 serum samples of 25 individuals who had donated blood prior to the first clinical MS manifestation (clinically isolated syndrome (CIS))
• Four male subjects, 21 female subjects,
• Mean age 31.5 years at time of pre-CIS blood sampling;
• Mean age at disease onset 33.4 years…
….were available, covering an interval of 7.3 years-2 months (mean 31.5 months) before CIS.
In 18 of 25 patients serum samples were also obtained after established diagnosis of MS.
Longitudinal age- and gender-matched healthy blood donors (four male subjects, 21 female subjects, 39 samples, mean age 32.5 years) served as controls.
Serum 25-OH-D was measured by isotope dilution-liquid chromatography-tandem mass spectrometry. 25-OH-D levels were deconvoluted using published seasonal coefficients from a German population.
Immunoglobulin G (IgG) against Epstein-Barr virus nuclear antigen-1 (EBNA1) were assessed using commercially available ELISA.
• Low 25-OH-D levels were observed during the 24-month pre-CIS interval (47.8 (32.5-77.2) nmol/l, median (IQR); healthy controls: 81.6 (57.7-98.5), p=0.004,
• However, still higher than after established diagnosis (24.5 (13.7-47.7), p
• IgG against EBNA1 during the 36-month pre-CIS interval was increased (185.9 (91.2–460.0) IU/ml, median (IQR); healthy controls 63.7 (29.5–121.6), p=0.002).
Conclusions: Low vitamin D and remote EBV infection may be associated with clinical MS breakthrough within 2–3 years.br>
By Brenard F Decard, Andrew Chan, et albr>
Source: Journal of Neurology, Neurosurgery and Psychiatry, Aug 11, 2012. PMID:22888143br>
Source: ProHealth Copyright © 2012 ProHealth, Inc (20/08/12)
The European Panel on Dietetic Products, Nutrition and Allergies has recently increased their tolerable upper limit for vitamin D. Following a request from the European Commission, the panel took a look at research to date to re-evaluate if a change in the upper limit was necessary.
In result, the panel raised the upper limit to 4,000 IU of vitamin D/day for adults and teenagers older than eleven, despite finding no evidence of hypercalcemia or hypercalcuria in supplementation up to 11,000 IU/day. The panel cited that they did not want to raise the upper limit higher for the time being in order to take “into account uncertainties associated with these studies.
Children between 1-10 years old, the panel proposed an vitamin D upper limit of 2000 IU/day. For infants under one year old, the upper limit was set at 1,000 IU/day.
Their scientific opinion can be found in full in the European Food Safety Journal.
Source: Vitamin D Council © Vitamin D Council 2012 (15/08/12)
Vitamin D links to MS supported by study(27/07/12)
Scientists have moved a step closer to understanding how to better treat multiple sclerosis (MS) after more evidence emerged of a crucial link to vitamin D.br>
In the latest study, University of Tasmania researchers discovered that MS sufferers treated with interferon-beta, a common MS drug, had higher vitamin D levels than those not on the treatment.
Interferon-beta caused patients to become far more efficient at making vitamin D in their skin, senior researcher Professor Bruce Taylor said.
MS sufferers taking the drug had nearly three times as much vitamin D from the same amounts of sun exposure than those who didn't take interferon-beta, he said.
The results also shed light on how the therapy works, which has previously been unclear although it was thought to effect the immune system.
Interferon-beta only reduced the risk of having an MS attack if patients had sufficient levels of vitamin D in their system, Prof Taylor said.
MS sufferers in Tasmania and other areas of low latitude, where it was impossible to absorb enough vitamin D from sunlight in winter, may need to consider vitamin D supplementation, he said.
The study analysed around 200 people living with MS in southern Tasmanian between 2002 and 2005.
The research was instigated by the high rates of MS in the state, Prof Taylor said. The condition is more common in populations living further from the equator.
Tasmanians are seven times more likely to have MS than people in Northern Queensland and the Northern Territory and rates are three times higher than in NSW, Prof Taylor said.br>
He said the findings would need to be tested further in clinical trials.br>
However, the discovery will also be examined in an upcoming Australian study investigating the effect of taking vitamin D supplements on people with early MS symptoms.
That research will be carried out between 2012 and 2016 by MS Research Australia and the Florey Neuroscience Institutes in Melbourne.br>
"Hopefully, there will be a major public health initiative in the future about how to treat or prevent MS," Prof Taylor told AAP.
The study was published in the journal Neurology.br>
Source: 9 News © 1997-2012 ninemsn Pty Ltd (27/07/12)
Aberdeen scientists have found that artificial sunlight can have a “striking effect” in helping treat sufferers of diseases such as multiple sclerosis.
Researchers from Aberdeen University studied patients in the north of Scotland – which has the highest rate of MS in the UK - who were being treated during winter with artificial UV (ultraviolet)-B light therapy for skin diseases caused by their immune systems acting inappropriately.
The research - published in the Journal of Allergy and Clinical Immunology – shows how UV-B light boosts vitamin D, as well as cells in our body that are responsible for regulating or balancing the immune system. Vitamin D is made in our bodies by UV-B light from the sun.
Some studies have suggested a link between vitamin D deficiency and autoimmune diseases such as MS. This possible link might also explain the increasing prevalence of autoimmune disease among those living far from the equator, where there are lower levels of winter sun.
Autoimmune diseases - like MS and type 1 diabetes - are diseases where the immune system mistakenly attacks the body’s own tissues or harmless substances that enter the body.
Dr Anthony Ormerod, clinical reader in dermatology at the university, said: “Our study shows that UV-B light, which mimics sunshine, can have a striking effect on the immune system of patients.
“We found that UV-B light boosted the production of vitamin D, and of regulatory T cells, which play an important role keeping our immune systems in check.
“Our findings have important implications for future interventions including the recommendations for healthy lifestyle and a possible role for phototherapy and/or vitamin D supplementation in the prevention or treatment of autoimmune and inflammatory diseases.
“While too much exposure to sunlight is harmful and increases skin cancer risk, these results suggest that subjects in our study would have some benefits from small amounts equivalent to summer exposure in the winter but more work needs to determine the role of sunlight and the role of supplementing the diet with vitamin D.
Dr Helen Macdonald, senior lecturer in nutrition and translational musculoskeletal research at the university and chair of the National Osteoporosis Society Nutrition and Lifestyle forum, said: “There are risks associated with high levels of both therapies, so it is important that we get the balance right.
“We would also want to stress that we are not advocating sun bed use since this is not the same type of radiation produced by sun beds which already have well-documented health risks.
“The average dose of UV light that the volunteers received was the equivalent to sunlight exposure in Aberdeen over spring and summer and further work is required to determine if lower doses are effective.”br>
Professor Mark Vickers, chair in applied medicine at the university, added: “Ours is the first study to demonstrate in patients a cause and effect between UV light, vitamin D and systemic immune function in people.&rdquo
Source: STV News Copyright © 2007–2012 STV. (18/07/12)
A world-first clinical trial to determine the role vitamin D plays in preventing multiple sclerosis (MS) is about to get underway in Perth.
The four-year trial is being spearheaded by prominent local neurologist and 2012 Western Australian of the Year in the field of business and professions, Bill Carroll, from Sir Charles Gairdner Hospital.
The Multiple Sclerosis Society of Western Australia (MSWA), which is contributing almost $1.1 million to the $2.5 million trial, said 290 patients from Australia and New Zealand who had experienced their first episode of MS symptoms would be recruited for the study.
Professor Carroll said about 80 per cent of people who experienced a first attack of MS-like symptoms would go on to experience a second episode or show further disease activity.
"In this prevention trial we'll be giving patients three different levels of vitamin D while others will be given a placebo," Prof Carroll said.
"We want to investigate whether there is a correlation between a patient's vitamin D blood levels and the prevention of further disease activity, which we can monitor using MRI (magnetic resonance imaging) scans."
He said the link between vitamin D and the inflammatory disease appeared strong, with a 2008 study confirming a significantly higher incidence of MS in places further away from the equator, where there was less sunlight.
"Variations in genes involved in vitamin D metabolism have also been implicated in susceptibility to MS, and vitamin D deficiency has also been shown to be associated with a higher rate of relapses in people with established MS," Prof Carroll said.
MSWA chief executive Marcus Stafford said there were currently no evidence-based interventions to prevent the development of MS.
"That's why this study is so important," he said.
Source: 9 News © 1997-2012 ninemsn Pty Ltd (05/07/12)
Vitamin D, the "sunshine vitamin", is vital for health and can be obtained from food, sunlight or supplements. In addition, individuals with high vitamin D levels are less likely to develop multiple sclerosis (MS).
Now, Iranian researchers have found that vitamin D supplements at levels above the physiologically recommended dose are safe for MS patients.
Results from the study were presented at the 22nd Meeting of the European Neurological Society (ENS) in Prague.
A neurological condition called clinically isolated syndrome (CIS) is a common precursor to MS and presents itself as an episode of a vision disorder or affective sensation disorder traceable to damage in certain parts of the central nervous system.
Doctor Vittorio Martinelli, a neurologist from San Raffaele Hospital in Milan, Italy, and his team examined the medical histories of 107 patients who had been diagnosed with CIS. The team conducted magnetic resonance images (MRIs) of the study participants, examined cerebrospinal fluid test values, the reactions to sensory stimuli in the EEG (known as multimodal Evoked Potentials), as well as the serum concentration of vitamin D3 (known as calcidiol, or 25-hydroxyvitamin D, after its conversion in the liver).
The researchers found that 21% of study participants developed MS within 1 year, 36% developed the disease within two years, and 44% withing five years. Low vitamin D levels increase the risk of developing MS, say the researchers.
Dr Martinelli explained: "Vitamin D is even suitable for predicting MS risk in patients with clinically isolated syndrome as long as they have only a few lesions and their cerebrospinal fluid is still free of inflammation."
According to the researchers, low vitamin D levels are linked to a shorter interval between CIS and the occurrence of a second episode. In addition, it is also associated with a higher annual rate of relapse. The researchers explained:
"If inflammation occurs in the cerebrospinal fluid (oligoclonal bands), the most important predictive factors for short-term development of MS are the clinical course, multimodal Evoked Potential results and visible lesions in the MRI."
More studies are demonstrating that vitamin D deficiency is a possible risk factor for MS. Furthermore, studies are also showing that vitamin D3 supplementation is beneficial for MS patients or for patients with other auto-immune diseases.
Another study presented at the ENS Meeting examined what risk a pharmaceutical dose of vitamin D3 poses to individuals with MS. The study was conducted by Dr Seyed Massood Nabavi from Shahed University in Teheran, Iran.
The researchers enrolled 44 patients who had been diagnosed with MS no longer than one year before to participate in the study. The patients, who showed slight functional disorders at the start of the action but no disabilities, were given a vitamin D3 dose of 50,000 IUs (international units; 1 IU=0.025 µg) per week - 4 times the daily maximum dose of 2000 IUs the European Commission recommends.
In this group the researchers found that the concentration of calcidiol in the blood increased from 7.3 ±15 ng/dl, (severe vitamin D deficiency), to the favourable level of 45.6 ± 34.9ng/dl in the sixth month. The team also found no clinical signs of vitamin D poisoning among study participants. In addition, all patients stayed in the normal range of reference values for calcium in the blood, for creatinine, and for 24 hour urinary calcium excretions. None of the participants showed any sign of toxicity.
The researchers said:
"The data supported the tolerability of a pharmaceutical dose of vitamin D3, at least 50,000 international units a week. In other words, vitamin D intake is safe for MS patients at levels above the physiologically recommended dose."
Source: Medical News Today © MediLexicon International Ltd 2004-2012 (13/06/12)
Autonomic dysfunction: A unifying MS theory, linking CCSVI, vitamin D3, and Epstein-Barr virus(08/05/12)
Multiple sclerosis (MS) is a disease with multiple etiologies. The most recent theory of the vascular etiology of MS, Chronic Cerebrospinal Venous Insufficiency (CCSVI), suggests that cerebral venous obstruction could lead to cerebral venous reflux, promoting local inflammatory processes.
This review article offers strong evidence that the route of the observed narrowing of cerebral veins arises from autonomic nervous system dysfunction, particularly cardiovascular autonomic dysfunction.
The dysfunction of this system has two major effects: 1) the reduction of mean arterial blood pressure, which has the potential to reduce the cerebral perfusion pressure and the transmural pressure, and 2) the failure of cerebral autoregulation to maintain constant cerebral blood flow in the face of fluctuations in cerebral perfusion pressure. Alterations in cerebral autoregulation could in turn raise the critical closure pressure, indicated to be the cerebral perfusion pressure at which the transmural pressure will be sub-sufficient to overcome the active tension imparted by the smooth muscle layer of the vessel. These two effects of autonomic nervous system dysfunction (reduction in arterial blood pressure and alterations in cerebral autoregulation), when combined with inflammation-induced high levels of nitric oxide in the brain, will lower transmural pressure sufficiently to the point where the threshold for critical closure pressure is reached, leading to venous closure.
In addition, cerebral vessels fail to overcome the closure as a result of low central venous pressure, which is also regulated by autonomic nervous system function. Furthermore, through their neuroregulatory effects, infectious agents such as the Epstein-Barr virus and vitamin D3 are able to alter the functions of the autonomic nervous system, influencing the rate of CCSVI occurrence.
The absence of CCSVI specificity for MS, observed in recent clinical studies, may stem from a high prevalence of autonomic nervous system dysfunction in control groups which were recruited to these studies. Future studies should investigate CCSVI in relation to cardiovascular autonomic function.
ANS, autonomic nervous system; BBB, blood brain barrier; BP, blood pressure; CCSVI, chronic cerebrospinal venous insufficiency; CIS, clinically isolated syndrome; CP, chronic progressive; CrCP, critical closure pressure; EBV, Epstein-Barr virus; EDSS, expanded disability status scale; HR, heart rate; IJV, internal jugular vein; MBP, myelin basic protein; PTA, percutaneous transluminal angioplasty; RR, relapsing remitting; SLE, systemic lupus erythematosus; Vit D, 1,25-dihydroxyvitamin D
Zohara Sternberg, Department of Neurology, Baird MS center, Jacobs Neurological Institute, 100 High St. Buffalo, NY 14203, USA
Source: Autoimmunity Reviews Copyright © 2012 Published by Elsevier B.V. (08/05/12)
Vitamin D is a sterol hormone implicated in several immunologic pathways, and therefore it may help to prevent isolated immune-mediated central nervous system attacks from developing into recurrent disease. Low levels of 25-hydroxyvitamin D have been linked to greater risk for multiple sclerosis (MS) and higher relapse rates in patients with MS. The goal of this retrospective analysis was to evaluate the association between low serum levels of vitamin D and recurrent spinal cord disease.
Investigators at Johns Hopkins Transverse Myelitis Center in Baltimore, Maryland, measured 25-hydroxyvitamin D levels in 77 patients who had monophasic and recurrent inflammatory diseases of the spinal cord. After adjustment for season, age, sex, and race, patients who developed recurrent spinal cord disease had significantly lower vitamin D levels.
Study limitations include retrospective design, small sample size, and failure to account for some covariates of vitamin D. In addition, vitamin D levels were not obtained at the same time in the disease state for each patient. Nonetheless, the findings suggest a possible association between lower total 25-hydroxyvitamin D levels in patients with recurrent inflammatory spinal cord disease compared with patients who have monophasic disease. The findings from this study justify conducting a prospective trial to measure 25-hydroxyvitamin D levels in these patient populations and determine the effect of vitamin D supplementation on the frequency of relapses in patients with recurrent inflammatory spinal cord disease.
Low serum vitamin d levels and recurrent inflammatory spinal cord disease.
Arch Neurol. 2012; 69(3):352-6 (ISSN: 1538-3687)
Mealy MA; Newsome S; Greenberg BM; Wingerchuk D; Calabresi P; Levy M Department of Neurology, Johns Hopkins University, 600 N Wolfe St, Pathology 509, Baltimore, MD 21287.
BACKGROUND: Low 25-hydroxyvitamin D levels have been associated with a higher risk of developing multiple sclerosis and increased relapse rates in patients with multiple sclerosis. As a sterol hormone involved in multiple immunologic pathways, vitamin D may play a role in preventing monophasic immune-mediated central nervous system attacks from developing into recurrent disease.
OBJECTIVE: To investigate the association between low serum vitamin D levels and recurrent spinal cord disease. Design, Setting, and Patients We performed a retrospective analysis at Johns Hopkins Transverse Myelitis Center, Baltimore, Maryland, evaluating 25-hydroxyvitamin D levels in 77 patients with monophasic and recurrent inflammatory diseases of the spinal cord. Main Outcome Measure Levels of 25-hydroxyvitamin D.
RESULTS: Vitamin D levels are significantly lower in patients who developed recurrent spinal cord disease, adjusting for season, age, sex, and race.
CONCLUSIONS: This study provides a basis for a prospective trial of measuring 25-hydroxyvitamin D levels in these patient populations and assessing the influence of vitamin D supplementation on the frequency of relapses in those with recurrent inflammatory spinal cord disease.
Source: Medscape News Copyright © 1994-2012 by WebMD LLC (17/04/12)
Effect of vitamin D3 supplementation on relapses, disease progression and measures of function in persons with MS(01/03/12)
Exploratory outcomes from a double-blind randomised controlled trial.
Summary: The authors report data from a 96-week randomised controlled treatment trial of vitamin D(3) supplementation on annualised relapse rate (ARR), EDSS, multiple sclerosis functional composite (MSFC) components, grip strength, and fatigue.
In patients with multiple sclerosis supplemented with 20,000 IU vitamin D(3) weekly there was no significant difference in ARR, EDSS, MSFC components, grip strength, or fatigue. Although the study was not powered to address clinical outcomes, none of the results were suggestive of a clinically meaningful effect of vitamin D(3) in this unselected population of fully ambulatory persons with multiple sclerosis.
Abstract Background: High vitamin D levels may reduce the risk of relapses and disease progression in multiple sclerosis.
Methods: This 96-week randomised controlled trial was designed to assess the effect of vitamin D(3) supplementation on bone mineral density in persons with multiple sclerosis.
Supplementation with 20,000 IU vitamin D(3) weekly raised median serum 25-hydroxy vitamin D (25[OH]D) to 121 nmol/L. The modified intention to treat analysis included 35 persons in the vitamin D(3) group and 33 in the placebo group.br>
Participants were age 21 to 50 years and fully ambulatory (median Expanded Disability Status Scale (EDSS) 2.5). We studied the effect of supplementing vitamin D(3) on the exploratory outcomes annualised relapse rate (ARR), EDSS, multiple sclerosis functional composite (MSFC) components, grip strength, and fatigue.br>
Results: After 96 weeks, there was no significant difference between groups in ARR (absolute difference 0.10, 95% CI -0.07 to 0.27; p = 0.25), EDSS (absolute difference -0.01, 95% CI -0.35 to 0.35; p = 0.97), MSFC components, grip strength, or fatigue.
Conclusion: Supplementation with 20,000 IU vitamin D(3) weekly did not result in beneficial effects on the measured multiple sclerosis-related outcomes. This study was not powered to address clinical outcomes, but none of the results were suggestive of an effect in this unselected population of fully ambulatory persons with multiple sclerosis.
Kampman MT, Steffensen LH, Mellgren SI, Jørgensen L.
Source: Mult Scler. 2012 Feb 21 Copyright © 2012 by SAGE Publications & Pubmed PMID: 22354743 (01/03/12)
A Clinical trial will test whether Vitamin D can help fight multiple sclerosis (MS).
If successful, researchers say the trial could open the door to a treatment which is 100 times cheaper than other drugs available.
The $2 million trial, announced today by MS Research Australia, will begin recruiting in Victoria, NSW, Tasmania and New Zealand from April.
Researchers hope to find 150 people with early or suspected symptoms of MS and put them on varying doses of Vitamin D.
"If we can ... watch to see if that actually slows the progress or stops the progress, and they don't actually get MS, then we know Vitamin D is having an effect," MS Research Australia CEO Jeremy Wright said.
The vitamin, which can be sourced from sunlight and some foods, is gaining credence as an effective treatment in preventing MS.
But all the evidence so far has been circumstantial, Mr Wright said.
"If we can prove the efficacy we are going to come up with a treatment which, would you believe, is about 100 times cheaper than the current treatments," Mr Wright said.
"But it won't be a solo treatment. It will join the other treatments and add impacts, is what we expect."
He said it was hoped the study would show some results in five years.
Some 20,000 Australians are diagnosed with MS, an incurable disease which attacks the central nervous system and can cause bladder dysfunction, spasticity, depression and cognitive problems.
Source: The Australian © 2012 The Australian (23/02/12)