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Can sunlight decrease depression in people with MS?
eMS News, 7/25/2013

A growing body of evidence points to a clear connection between low vitamin D levels and multiple sclerosis (MS). But with the emergence of frequent articles and studies on the topic, it can be hard to know how to interpret the various results. Speaking with your personal physician about vitamin D is always the best idea, as is approaching study results and the media’s interpretation of them with caution. 

Take, for example, a study that was recently published in Acta Neurologica Scandinavica. The study followed 198 people with MS for an average of 2.3 years. The purpose of the study was to explore the associations between sun exposure and serum 25-hydroxyvitamin D (vitamin D levels), and depression, anxiety, fatigue and cognition. The researchers’ question: does sun exposure or vitamin D levels impact any of these symptoms? According to preliminary study results, participants who reported higher levels of sun exposure, rather than those who had high vitamin D levels, had fewer depressive symptoms and less fatigue. Does that mean that sunshine alleviates depression and fatigue, but not higher vitamin D levels?

According to Dr. Teri Schreiner, of the Rocky Mountain MS Center at Anschutz Medical Campus, caution is recommended when reading these and other such study results: 

“Although preliminary data show that people who spend more time outdoors and in the sun have fewer depressive symptoms, and that vitamin D levels were inversely associated with depression scores, this study does not identify other confounders—other possible factors. It could be that sun exposure has an effect that is independent of vitamin D, but further research is needed. In order to prove that sun exposure lessens depressive symptoms, you would have to prove that it isn’t other things that you do outside. For example—exercise. We know that exercise treats depression. Therefore, if the people who are spending time outdoors are exercising, then it may be the exercise that is decreasing the depressive symptoms and the sun may have absolutely nothing to do with it. These study results need to be interpreted with caution.”

So what is important to consider with vitamin D? It is important to have your vitamin D levels tested to see where you stand. Vitamin D supplementation coupled with safe amounts of sun exposure can bring vitamin D levels to a healthier level. The current recommended dietary allowance (RDA) for vitamin D is 600 IU a day for adults and 700 IU for those over age 70. It is important to note that doses above 10,000 IU a day can increase the risk of hypocalcaemia and other complications and should always be discussed with your doctor. In addition to vitamin D supplements, the doctors at the Rocky Mountain MS Center recommend getting 15-20 minutes of sunshine on your arms and legs 2 to 3 times a week.

Vitamin D: Do You Need it and How Much?

eMS News, 12/11/2012

A new study out of Sweden on Vitamin D and multiple sclerosis (MS) adds to the growing body of evidence that suggests that the sunshine vitamin may help prevent MS. Furthermore, data from the study may help us understand what levels of vitamin D are most protective.

During this study, published in the November 20, 2012 issue of Neurology, researchers accessed two population-based biobanks, which were cross referenced with a national birth registry. These biobanks contained 291,500 samples from 164,000 persons collected since 1975 in the northern half of Sweden. From these samples researchers identified and analyzed the vitamin D levels of 192 people who had MS and 37 gestational samples from pregnant mothers whose offspring later developed MS.

This study suggests that people who maintain blood levels above 30 ng/ml of the circulating form of vitamin D are less likely to develop MS compared to people with vitamin D levels below 30 ng/ml. Furthermore, this study suggests that maintaining levels of vitamin D above 30 ng/ml from the third trimester until 26 years of age decreases the risk of developing multiple sclerosis.

Tom Stewart, PAC and co-author of a book about dietary supplements and MS, explains that, when considered in context with other studies, this study raises the possibility that at least some cases of MS may be prevented by maintaining modest blood levels of vitamin D.  “For starters, children and siblings of people with MS should have their vitamin D levels checked and vitamin D deficiencies should be treated.  Blood levels should probably be increased to 30 ng/ml through supplementation. If testing isn’t practical, adult children or siblings of people with MS might simply supplement with approximately 2000 IU of vitamin D per day.  For most people, this dose of vitamin D will raise blood levels to above 30 ng/ml.”

This study suggests that children benefit from optimum levels of vitamin D as well. Dr. Teri Schreiner, Pediatric Neurologist at the Rocky Mountain MS Center at Anschutz Medical Campus, recommends that all of her MS patients have their children’s vitamin D levels tested every year or every other year. “If their children’s vitamin D levels are low, I recommend they supplement. Children who haven’t started puberty yet should be given a dose that corresponds to their level of vitamin deficiency. Children who have already started puberty can safely be given 1,000 IU of Vitamin D,” adds Schreiner.

Does Vitamin D Reduce Disease Activity?
eMS News, 8/16/2012

Vitamin D appears to have a vital role in the immune system–it is thought to trigger and arm the body’s T cells, which then seek out and destroy any invading bacteria and viruses.  There is growing evidence of a correlation between vitamin D deficiency and the development and exacerbation of MS.

Previous studies have shown that people living close to the equator are less likely to develop multiple sclerosis than those at higher latitudes, which could be explained by at the equator there is more sun exposure, resulting in higher vitamin D levels. In addition, patients with established MS diagnoses might have seasonal fluctuations of symptoms as demonstrated by a study done in Switzerland, where MS patients tend to have more relapses during the winter than during the summer. Other studies correlated MS severity directly with vitamin D levels and sun exposure (lower levels of vitamins D, along with lower levels of sun exposure correlated with higher levels of disability). In 2010, a study conducted at the University of Buffalo showed that low vitamin D levels may be associated with more advanced physical disability and cognitive impairment in people diagnosed with MS.

In 2012, the results of three additional independent studies have been published in the journal Neurology and suggest that higher levels of vitamin D may reduce disease activity in people with MS. It is also worth noting that two of these studies showed conflicting results on a possible interaction between vitamin D levels and treatment with interferon beta.

2012 Study Results

Tessel Runia, MD (Erasmus MC, Rotterdam, the Netherlands) and colleagues asked if vitamin D is beneficial for MS. They followed 73 people with relapsing-remitting MS by measuring vitamin D in blood samples every 8 weeks for an average of 1.7 years. The risk of disease worsening decreased when blood vitamin D levels were high. People whose vitamin D levels were considered “low” (less than 50 nmol/L) were twice as likely to experience a relapse as those whose vitamin D level was considered “high” (greater than 100 nmol/L), an association that persisted during all seasons. The effect of vitamin D on exacerbations was not affected by interferon beta use in this group of participants. (Neurology 2012 79:261-266)

Kristin Løken-Amsrud, MD (Innlander Hospital Trust, Lillehammer, Norway) and colleagues studied a group of 88 untreated people with relapsing-remitting MS by collecting 12 MRI scans and nine vitamin D measurements per person over 24 months. People with higher vitamin D levels had a reduced chance of developing new MRI-detected brain lesions. After beginning interferon beta treatment, there was no association between vitamin D levels and disease activity. (Neurology 2012;79:267-273)

Niall Stewart, PhD (University of Tasmania) and colleagues examined vitamin D levels in blood twice a year for at least two years in 178 people with MS. People with MS on interferon therapy had higher levels of vitamin D than people with MS who were not on interferon. People on interferon synthesized more vitamin D per unit of sun exposure time than those not on interferon. High vitamin D levels were associated with reduced relapse rates only in persons taking interferon. In people with low vitamin D levels, interferon appeared to increase the risk of relapse. (Neurology 2012;79:254-260) It was noted that the discrepancy between the latter two studies could be explained by differences in latitude (and thus differences in sun exposure) or differences in the timing of vitamin D administration. “In any case, these preliminary findings should be interpreted cautiously,” they write.

What Does This Mean for People Diagnosed with MS? Your doctor can test your vitamin D levels and see where you stand. Vitamin D supplementation coupled with safe amounts of sun exposure could help bring your vitamin D levels up to a healthier level. The current recommended dietary allowance (RDA) for vitamin D is 600 IU a day for adults and 700 IU for those over age 70. It is important to note that doses above 2,000 IU a day can increase the risk of hypocalcaemia and other complications and should always be discussed with your doctor. In addition to vitamin D supplements, the doctors at the Rocky Mountain MS Center recommend getting 15-20 minutes of sunshine on your arms and legs 2-3 times a week.

Vitamin D: The Sunshine Vitamin
By Dr. Augusto Miravalle
eMS News, 3/3/2012

Vitamin D is nicknamed the “sunshine vitamin” because the skin makes it from ultraviolet rays. Very few foods in nature contain vitamin D–although fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources. Vitamin D is an integral part of the immune system— it is thought to trigger and arm the body’s T cells, which then seek out and destroy any invading bacteria and viruses. Multiple sclerosis (MS) is an auto immune disease wherein your body’s immune system essentially attacks the central nervous system. There is growing evidence of a correlation between vitamin D deficiency and the development and exacerbation of MS.

The role of vitamin D in multiple sclerosis has been studied for some time now. Previous studies have shown that people living close to the equator are less likely to develop multiple sclerosis than those at higher latitudes. This difference could be explained by more sun exposure and higher vitamin D levels. In addition, patients with established MS diagnosis might have seasonal fluctuations of symptoms as demonstrated by a study done in Switzerland where MS patients tend to have more relapses during winter than during summer time. Other studies did correlate clinical measurements of MS severity directly with vitamin D status and sun exposure (lower levels of vitamins D, along with lower levels of sun exposure correlated with higher levels of disability).

A recent study out of Australia further supports this correlation. According to a report in “Neurology,” Robyn Lucas of The Australian National University and colleagues studied 216 adults who had started having the first symptoms of MS between 2003 and 2006. They also found a comparison group of nearly 400 people from the same regions of Australia, who matched the subjects in age and gender, but had no signs or symptoms of MS. Participants in both groups were asked how much time they had spent in the sun and where they had lived at different points in their lives. In addition they were tested for skin damage from the sun and the vitamin D levels in their blood were analyzed. On average, people with signs of MS were less likely to have high levels of skin damage caused by sun exposure, and their vitamin D levels were five to ten percent lower than those without MS.

In addition, a 2010 study conducted at the University of Buffalo showed that low vitamin D levels may be associated with more advanced physical disability and cognitive impairment in people diagnosed with MS. Clinical evaluation and magnetic resonance imaging (MRI) images showed that low blood levels of total vitamin D and certain active vitamin D byproducts are associated with increased disability, brain atrophy and brain lesion load in MS patients. A potential association exists between cognitive impairment in MS patients and low vitamin D levels.

In 2009 a University of Toronto study showed high doses of vitamin D dramatically cut the relapse rate in people with multiple sclerosis. In this study 25 people with MS were given an average of 14,000 international units (IU) of vitamin D a day for a year and only sixteen percent suffered relapses. In contrast, 40% of MS patients who took an average of 1,000 IU a day (the amount recommended by many MS specialists) developed relapses. No significant side effects were seen among patients. However, it is too early to draw any conclusions regarding the right dose of vitamin D supplementation. A current study (VITALITY) is evaluating the effects of dietary vitamin D consumption and MS. Results are expected in 2014.

So what does this mean for people diagnosed with MS? Your doctor can test your vitamin D levels and see where you stand. Vitamin D supplementation coupled with safe amounts of sun exposure could help bring your vitamin D levels up to a healthier level. The current recommended dietary allowance (RDA) for vitamin D is 600 IU a day for adults and 700 IU for those over age 70. It is important to note that doses above 2,000 IU a day can increase the risk of hypocalcaemia and other complications and should always be discussed with your doctor. In addition to vitamin D supplements, the doctors at the Rocky Mountain MS Center recommend getting 15-20 minutes of sunshine on your arms and legs 2-3 times a week.

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