Vitamin D update
Subject: Vitamin D may provide protection
against developing Multiple Sclerosis, rheumatoid arthritis and other
diseases. This may explain the latitudinal variation in MS and increasing
incidence with age in RA.
A piece of medical trivia that has always bugged me is the distribution
of multiple sclerosis (MS). Historically MS has been a disease of
"Place." The further from the equator you lived, the more likely
you were to get it. There is also a genetic component to MS incidence;
certain populations that are more prone to developing the disease. This
pattern has decreased in recent years as different population groups have
migrated and as a result MS has become a disease of "race and place."
A recent paper from the Harvard School of Public Health suggests that
Vitamin D may protect against MS. If so, this offers a possible
explanation for the latitudinal variation sometimes seen in MS.
Researchers examined the data collected from the Nurses' Health Studies
in which over 187,000 women were followed. Women who received over 400
IU of vitamin D a day from diet and supplements had a 41% lower chance
of getting MS. The same group of researchers had previously looked
at antioxidant vitamins, (A, beta carotene, C, and E) and seen no protective
benefit against MS.
Vitamin D is manufactured in the skin when exposed to ultraviolet radiation
from sunlight. The closer to the equator one lives the more sun
exposure and the more vitamin D made. The further from the equator
the less vitamin D is made.
Another recent study noticed a protective effect against rheumatoid arthritis
(RA). Examining the health records of 30,000 women, researchers
noted that adequate levels of vitamin D decreased RA incidence by about
30%. Both conditions, MS and RA, are thought to occur when the body's
immune system turns against itself. Vitamin D may work by calming overactive
immune cells. There is some animal evidence to support this idea. Mice
with symptoms like those of multiple sclerosis or rheumatoid arthritis
improve with vitamin D treatment.
Vitamin D is a steroid hormone that helps the body absorb and retain calcium.
Too much can be toxic, while too little causes brittle bones. The vitamin
occurs naturally in some foods, such as liver and fatty fish, and is often
added to others. One cup of fortified milk contains about half of the
estimated adult daily need. But most of our vitamin D is home grown; the
body makes it in response to sunshine. The daily dose can be achieved
by soaking up bright sunshine on the face and hands for 15 minutes, three
times a week - weather permitting. Many people, particularly the
elderly, are vitamin D deficient. This may explain why rheumatoid
arthritis is more common in the elderly.
There is general agreement that a low vitamin D status is one of the causes
of osteoporosis. Low vitamin D can lead to a disturbed muscle function.
Besides rheumatoid arthritis and multiple sclerosis, data also show low
vitamin D levels play a role in tuberculosis, inflammatory bowel diseases,
hypertension, and specific types of cancer. Some intervention trials have
demonstrated that supplementation with vitamin D or its metabolites can:
(a) Reduce blood pressure in hypertensive patients;
(b) Improve blood glucose levels in diabetics;
(c) Improve symptoms of rheumatoid arthritis and multiple sclerosis
Information like these studies can leave us confused. The current
popular wisdom is that sun exposure is dangerous because it increases
risk of skin cancer. In avoiding sun exposure are we not opening
the door to other risks as yet unclear? When trying to sort through
this balance, of risk versus benefit there is a little detail we must
remember. For still unknown reasons, people feel better with regular
sun exposure. Although this isn't the bottom line, it should
count for something.
1 Neurology. 2004 Jan 13;62(1):60-5. Vitamin D intake and incidence of
multiple sclerosis. Munger KL, Zhang SM, O'Reilly E, Hernan MA, Olek MJ,
Willett WC, Ascherio A.
2 Neurology. 2001 Jul 10;57(1):75-80. Intakes of carotenoids, vitamin
C, and vitamin E and MS risk among two large cohorts of women. Zhang SM,
Hernan MA, Olek MJ, Spiegelman D, Willett WC, Ascherio A.
3 Merlino, L. A. et al. Vitamin D intake is inversely associated with
rheumatoid arthritis. Arthritis and Rheumatism, 50, 72 - 77, (2004).
4Br J Nutr. 2003 May;89(5):552-72. Vitamin D in preventive
medicine: are we ignoring the evidence?
5 BMC Dermatol. 2002 Apr 12;2(1):6. Impact of UVA exposure
on psychological parameters and circulating serotonin and melatonin. Gambichler
T, Bader A, Vojvodic M, Bechara FG, Sauermann K, Altmeyer P, Hoffmann
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