I had written about the topic of vitamins some time ago, deliberately excluding vitamin D because it is a separate and now very intensively researched topic. It is known that MS is a disease that is predominantly found in the industrialized nations of the northern hemisphere – i.e. in regions with a temperate climate and relatively low sunlight, especially in the winter months. The closer one gets to the equator, i.e. countries with intense sunlight, the less common the disease becomes.
An explanation – the so-called missing link – could be a relative deficiency of Vitamin D. This is because Vitamin D is produced by sunlight on the skin, and the levels of this vitamin are indeed relatively low in most people in Northern Europe and North America, particularly in winter. Vitamin D is a substance that has various immunoregulatory properties, e.g., influencing the production of pro-inflammatory messengers, stimulating regulatory T-lymphocytes, or producing tissue-damaging substances through microglial cells. Therefore, there are various scientific indications that a relative deficiency of Vitamin D could be disadvantageous for patients with an autoimmune disease.
In this context, epidemiological studies and association studies that have established a connection between Vitamin D deficiency and MS risk are also interesting. A large study involving members of the US Army showed that there was a connection between low Vitamin D levels and MS risk. Moreover, several studies exist that were able to establish a connection between the level of Vitamin D and the severity of the disease – low relapse rates and a lower degree of disability were associated with higher Vitamin D levels.
However, such association studies are not capable of indicating the direction of an effect. Thus, it cannot be said whether the low Vitamin D level causes the disability, or whether the Vitamin D level is low due to the disability (because the person in question, for example, spends less time outdoors due to a disability). Nevertheless, these data are so interesting that studies are currently being carried out worldwide to precisely investigate the therapeutic benefit of Vitamin D supplementation in MS.
So one should actually wait for these results before forming a final opinion on the role of Vitamin D supplementation. On the other hand, the concept is interesting and easy to understand, and the supplementation of Vitamin D is simple, safe, and cost-effective. Therefore, I already recommend MS patients who are interested in the Vitamin D concept to supplement Vitamin D, especially in winter. A pragmatic approach is, for example, taking 2 – 4 D-Fluoretten (caries prophylaxis – equivalent to 1000 – 2000 IU of Vitamin D) per day or the once-weekly intake of Dekristol (equivalent to 20000 IU). However, one should not forget that it is good for the Vitamin D levels to spend a lot of time outdoors – 20 minutes in the sun with a bare face and bare forearms produces about 10000 IU of Vitamin D (which is why athletes also have higher Vitamin D levels than inactive people). One can also adjust the levels somewhat through diet – fish, for example, has a high content of Vitamin D, but often this alone is not sufficient to achieve the desired levels.
So, ultimately, it’s not a big deal, and it’s something I fully support and endorse from a medical perspective. What actually annoys me is that this whole concept now has an overlay that is anything but serious. Special Vitamin D formulations are being marketed on the Internet – at totally inflated prices. A lot of money is being spent on constant blood level determinations, even though it’s not even clear whether what we’re measuring is functionally relevant. And finally, some gurus on the Internet are advocating high-dose therapies that are not validated (and potentially harmful) and for which the data is still completely unclear. Ultimately, this leads to pressure being put on MS patients to do this or that, otherwise they would miss a chance. This approach is annoying and, at least before study data is available, I reject it.
But, as I said, there is absolutely nothing wrong with the pragmatic approach to Vitamin D in MS from a “conventional medical” perspective.
