RE: VITAMIN D IN MS

[Guest guest]

Someone requested information on how much Vitamin D to supplement for MS.

The following information is taken from the Best Bet Diet and has all the information you should need including links for Vit D.

Rep. Ireland

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What is MS? Well, it is now widely accepted that MS is an autoimmune disorder which means that one's own immune system attacks the myelin in the cells in the Central Nervous System(CNS) but this raises a number of interesting questions. Why? What starts the process? Why are some countries devastated by the condition while the population of others remains largely unaffected? And why are the incidents of the condition generally spread, even within the same country, dependent on distance from the equator - a latitude gradient, in other words. Ashton Embry argues convincingly in his series of essays on the subject that diet, in conjunction with low levels of natural sunshine(vitamin D3), is the main cause of the condition in genetically susceptible individuals. It is estimated that around 0.5% of northern Europeans carry the gene that makes them susceptible to the condition and they, and their descendants, are most at risk. As a result, the USA, Canada, NZ and Australia are all high incidence areas. In the first of his essays, Multiple Sclerosis and Food Hypersensitivities, he sets out to identify the most likely cause of the condition and, in the process, establishes 9 constraints that the answer, whatever it proves to be, must satisfy. Only diet satisfied all nine constraints and should, therefore, be considered the most likely cause. In his essay The Best Bet Diet, he goes on to discuss the most likely disease process involved and to establish the therapy that will give the greatest chance of success which has become known as The Best Bet Diet. It should be remembered, however, that this essay was written some time ago and, in this field, the latest research can change quite quickly. As a result, the suggested list of supplements shown in this essay is now out of date and the list shown in the Getting Started Guide is the most up to date. N.B. An excellent example of how the latest research can change already well-researched findings is in the case of vitamin D3. Ashton readily admits that, had the latest findings on vitamin D3 been available some years ago, these two essays would have been somewhat different. Vitamin D3 is the missing piece of the puzzle. The lynchpin that holds the whole argument together and, as such, it takes pride of place in the next section. Distribution of MS As mentioned previously, there is a distinct latitude gradient associated with the spread of the condition throughout the world and this is, of course, most noticable in countries with large geographical areas like Australia. Canada and the USA. In the northern hemisphere countries(Canada and the USA) the high incidence areas are in the North which is furthest from the equator and, therefore, the areas with the least sunshine. In Australia, the opposite is true. The sunnier northern areas have a much lower incidence rate per head of population than the southern states and in both cases the incidence rate graduates with latitude. So, the possible link between MS and lack of sunshine is clearly established but this is not the whole story. There are areas in the world where the level of sunshine is comparatively low and yet the rate of MS is also low but these are invariably communities whose diet is based primarily on fish. Now, is this simply a coincidence or is there a possible link between these two phenomenon? Well, yes there is, vitamin D3(Cholecalciferol). The two main sources of Vitamin D just happen to be sunshine and oily fish. So, could it be that vitamin D affords some level of protection against the condition for those fortunate enough to live in sunnier climates or who have a diet based primarily on oily fish and, if so, what mechanism is at work in the MS disease process? Ashton answers both these questions in his paper Vitamin D Supplementation in the Fight Against MS and another interesting paper outlines how a study on British and Irish migrants to Australia found that the risk of developing MS was reduced by up to 75% dependant on the latitude of where the migrants settled. In other words, the further north they settled, the more sunshine, the more vitamin D3 and the less risk of MS. Colleen Ph.D, from the University of Wisconsin, adds weight to the argument in favour of vitamin d3 as part of an effective therapy in the treatment of MS. In her paper Vitamin D: A Natural Inhibitor of MS, she suggests that MS may actually be preventable. Whilst not generally considered a genetically inherited condition, the children of an individual with MS do, apparently, have a 20 to 40 fold increased risk of developing the condition compared to unrelated individuals. However, she also states that "..the evidence that vitamin D might be a natural inhibitor of MS is compelling," and, as a consequence, suggests that "..it would be reasonable to provide supplemental vitamin d to individuals who are at risk of developing the condition." A most important consideration is the situation during pregnancy. Quite simply, there is a well established reduction in MS attacks during pregnancy and an increased occurence following childbirth. Ashton quotes the plausible hypothesis of Swartz(1993) that this was due to the large increases in the production of the vitamin d hormone during pregnancy and its rapid decline after childbirth. So, how much vitamin d is required to prevent MS developing? How much is safe? How does one go about it? These questions are all answered later but, for now, we need to return to the discussion on the implications that diet can have for the development of the condition. MS Disease Process First, we need to examine the basic disease process of MS and it is believed that the most likely scenario is this.

The autoimmunity process is ignited by intact(undigested) food proteins escaping through the gut walls, a process known as Leaky Gut Syndrome, and into the circulatory system where the immune system response is to attack the invaders. The molecular structure of parts of the proteins in certain foods is so similar to parts of the proteins in myelin that the immune system cannot differentiate between invaders and self (known as Molecular Mimicry) and ends up also attacking the myelin, in the cells in the CNS. For this attack to take place, however, it must do so across a compromised Blood Brain Barrier that, under normal circumstances, would have prevented this attack from taking place. So, it would appear that the individual with MS is someone whose food is not properly digested, possibly due to low stomach acid contents and who, as a result, may have had a history of stomach problems prior to the diagnosis of MS. The gut wall, which in parts is only one cell thick, has become porous and is allowing these undigested food proteins to leak into the blood system where their immune system automatically creates antibodies to attack the invaders.The individual is also someone whose blood brain barrier has been compromised, for whatever reason, and the myelin in the cells in the Central Nervous System is open to

attack. Ashton Embry's Best Bet Diet(BBD) works on five fronts.

To stop, or at least restrict, the consumption of foods whose molecular structure is so similar to the myelin in our own bodies that they could ignite the autoimmunity process. This includes dairy, gluten(wheat, rye, barley and oats), legumes(beans and peas) and yeast. Refined sugar is also avoided because it can make the leaky gut worse and can also adversely affect the immune system. Eggs are allowed in limited quantities as long as the individual shows no specific allergic reaction to them. The diet is low in saturated fat and also aims to reduce the intake of Omega 6 fats and, at the same time, increase the intake of Omega 3 fats, in order to achieve a far healthier balance than is the normal in today's western society, where the condition is now rife. Both these approaches have been seen to be of benefit to PWMS. To take supplements which are known to dampen down the immune system in such a way that autoimmune reactions are far less likely. These include vitamin d3(calciferol), calcium, magnesium and omega 3 fish oil and vitamin E. To take supplements which are known to repair the leaky gut(these include acidophilus, glutamine, evening primrose oil, grape seed extract, fish oil and enzymes) and thereby eventually prevent the escape of intact food proteins into the circulatory system in the first place. To take supplements which are known to strengthen and heal the blood brain barrier to prevent any attacks on the myelin in the cells in the Central Nervous System. These supplements include gingko biloba, grape seed extract/pycnogenol and co-enzyme QIO. To have an EL1SA blood test done to identify which, if any, specific foods may have escaped across the leaky gut in the past and caused the individual's immune system to create an lgG antibody as part of it's defence mechanism. The individual may be hypersensitive to these foods and they may be contributing to the pourous nature of the gut. It would be necessary to avoid, or at least rotate, these foods in the diet, at least for a time, to give the leaky gut a chance to heal.

Now, given the amount of scientific research data already to hand in this area, we believe this to be a strategy that is both prudent and sensible for anyone with MS to adopt, particularly when considered together with the wealth of anecdotal evidence of improvement from members of this group and beyond. Vitamin D Supplementation Now, to return to the specific questions relating to vitamin d supplementation. Damien Downing argues, in his paper Vitamin D - A Time For Reassessment, that the current Recommended Daily Allowance(RDA), for vitamin D is woefully inadequate and based more on 19th century folklore than on any real science. Rheinhold Veith examines the safety issue in his paper Efficiacy and Safety of Vitamin D. He suggests that for individuals who spend little or no time in the sun an intake of 4000iu per day is not only perfectly safe but also necessary to raise 25(OH)D levels to the optimum range. However, since then, a number of reports from both the US and from members of this group, here in the UK, have suggested that the situation is not as simple or as clear cut as that. In a few cases, after a number of months of

supplementation, the levels of vitamin D in the blood have failed to level out and have continued to rise to near danger level where bone loss could occur. As a result, the group have found it necessary to ask Ashton Embry to put together specific and clear guidelines concerning supplementation with vitamin D and these are shown below. The most reliable indicator of circulating vitamin D levels is the 25(OH)D test and regular testing of this, BOTH BEFORE AND DURING SUPPLEMENTATION IS ESSENTIAL. The key is to ensure a level of circulating vitamin D - 25(OH)D - of between 100 and 125nmol/l which is considered to be the optimum range to maintain good health and to reduce the risk of autoimmune reactions developing into full-blown autoimmune disease. The advised procedure is this.

Arrange for a 25(OH)D blood test at your doctors BEFORE beginning supplementation. You will need to obtain your GP's continued support for this and, in the circumstances, it would seem advisable to take copies of the vitamin D essays with you to explain what you intend to do. Papers IPS-03, IPS-04, and IPS-05, certainly, and perhaps even IPS-10, and IPS-11. It would make sense to send these papers down to the surgery in advance of your appointment to allow your GP time to study them. Of course, as more and more PWMS learn about the potential benefits of supplementation with vitamin D,

you may find that you are not the first in your GP's practice to request the test and they may already know about it. In the UK this test should be available free of charge from your GP although some group members have had to pay a nominal fee in the past so don't be surprised if this is the case. Make sure they order the correct test. It is the 25(OH)D test and NOT the 1,25(OH)D test. Be warned, it can take several weeks to obtain the results and, as mentioned previously, you should also have your serum calcium levels checked at the same time. When the results are back, make sure they give you the actual figure. You will need this to compare with future readings. The so-called "normal" range is up to 90nmol/L but, as explained above, you are aiming for the optimum range which is between 100nmol/L and 125nmol/L. We would appreciate if you could let us know the figures for our study each time you have the test done. Just call the MSRC freephone number and give the staff details of your 25(OH)D reading, your serum calcium level, how long you have been supplementing with vit d and how much vit d you take each day. They may also ask you questions relating to your age, general exposure to sun and the area of the country in which you live and work but details are still being finalised. If you have children and intend to use vitamin D as a protection against them developing the condition, it is vitally important to discuss this with your doctor as well and have their levels of 25(OH)D and serum calcium checked BEFORE starting the process. Once again, we would ask that you let us know the figures for our study. The table below, and the following introduction, have been produced by Ashton Embry himself to ensure that those who are supplementing with vitamin d, do so in full knowledge of the aims, objectives and possible safety issues involved. "The key to vitamin D supplementation is to have one's 25D level between 100 and 125 nmol/l all year and to not exceed 150 nmol/l for too long. The trick is that there is no single supplement dosage which will achieve this. For some, 4000 IU all year will be fine. For others such a dosage will result in a very high and possibly problematic 25D level. For others such a dose may not be enough to achieve the optimal 25D level. I think 100-125 is the safest 25D level bracket given the data we currently have which is not very constraining. Vieth would claim that anything under 225 is safe but there are few hard data to support this. However data, which say that levels between 150 and 200 are a problem, are also very scarce. Krispin would say stay below 150 or perhaps even 125. This is playing it safe which I endorse. As Krispin emphasizes, the key is 6 month testing (once in October and once in April) in the first few years to determine what level of supplementation

one needs in both the Oct-April and the May-Sept time periods to achieve a 25D level which stays year around in the 100-125 bracket. The table below should reflect these strategies. It is important to get this right." Ashton Embry

Vitamin D Supplementation Table Northern Hemisphere Countries (including UK) Test every October and April for first 2-3 years.

If 25(OH)D is less than 75 nmol/L in Oct or April, then take 4000iu all year round. If 25(OH)D is between 75 and 100 nmol/L in Oct, then take 4000iu Oct - Apr. If 25(OH)D is between 75 and 100 nmol/L in April, then take 2000iu May-Sept. If 25(OH)D is between 100 and 125 nmol/L in Oct, then take 2000iu Oct-Apr. If 25(OH)D is between 100 and 125 nmol/L in April, then take 400 IU May-Sept. If 25(OH)D is between 125 and 150 nmol/L in Oct, then take 1000iu Oct-Apr. If 25(OH)D is between 125 and 150 nmol/L in April, then take none between May-Sept.

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