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David Perlmutter, M.D.

David Perlmutter, M.D.

Posted: February 10, 2011 08:08 AM

Current estimates report that about 300,000 Americans have been diagnosed with multiple sclerosis (MS) with an incredible 10,000 new cases being diagnosed each year. While there is a small hereditary component, by and large, most cases seem to just happen without an identifiable cause. Over the past few decades, the medical literature has focused on the possibility of some infectious agent playing a causal role and candidates have included the bacterium Chlamydia pneumoniae, as well as various viruses including Epstein-Barr and human herpes virus type six.

MS is considered an "autoimmune disorder," meaning a disease characterized by the immune system reacting against the body. In MS, this misdirected immune response is directed against myelin, the protective insulation coating around brain neurons. Ultimately, collections of damaged neurons form a hard or sclerotic plaque in the brain and appear in multiple areas -- hence the name multiple sclerosis.

The mainstay of treatment for MS these days is the use of so-called "immunomodulatory therapy," or treatments designed to modulate the overactive immune response. Common approaches using this approach involve the frequent injection of various forms of synthetic interferons. This approach has been shown to reduce the risk of new events or exacerbations of MS by as much as 28-30 percent. Unfortunately, this type of medical intervention is often associated with significant side effects and reports of patients feeling "flu-like symptoms" in as many as 78 percent of cases.

One interesting observation that has puzzled MS researchers over the past 30 years is the peculiar geographic distribution of the disease. It turns out that people who spend their early lives in northern latitudes have a significantly increased risk for developing the disease. More recently it has been demonstrated that the same is true in the southern hemisphere. So the farther away you live from the equator, either north or south, the more at risk you are for developing MS.

In trying to unravel this relationship, scientists concluded that perhaps living farther away from the equator might relate to MS risk because of a lack of sunshine. It is known that sunshine has a role to play in immune function, so scientists thought that perhaps a lack of sun exposure during winter made people more susceptible to the disease. But one other connection to sun exposure began to emerge. It is known that one of the key physiological events triggered by sun exposure is the body's production of vitamin D. Interestingly, research clearly demonstrated that MS patients have remarkably lower levels of vitamin D compared to non-afflicted individuals.

NOTE: Vitamin D can be toxic in large doses. People with MS should be aware of these findings, but should also discuss them with their neurologist.

These findings dovetailed nicely with the newly emerging reports expanding the understanding of the role of vitamin D in human physiology, not just for bone health, but as a key player in immune function as well. To put the idea of vitamin D's relationship to MS to the test, researchers in Toronto -- led by Jodie Burton, M.D. -- studied 49 MS patients for one year. Twenty-five of the patients received vitamin D in a dosage increasing up to 40,000 units daily, which was then reduced over the one-year period. The control group was given no vitamin D supplementation.

The results of their study, published in a recent issue of the journal Neurology, were astounding. The group receiving the vitamin D demonstrated a remarkable 41 percent reduction in new MS events, a figure that markedly exceeds what is claimed by the standard drug treatment discussed above. What's more, the treatment group actually demonstrated improvement in physical function, a finding not seen in the control group.There were no meaningful side effects in the group receiving the vitamin D treatment and researchers demonstrated that blood calcium levels remained perfectly normal throughout the test, even at the very highest dosages of vitamin D. This was an important part of the study since concern has been raised that high vitamin D levels might increase blood calcium levels. The authors reported:

We have demonstrated that vitamin D intake well above current recommendations and (vitamin D) levels well beyond the physiologic range, do not expose patients with MS to adverse biochemical or clinical events. Compared to a control group whose intake of vitamin D generally exceeded North American recommendations, only those on the treatment regimen had evidence of immunologic effects.

As a practicing neurologist actively treating patients with this sometimes-devastating disease, this new report has clearly offered a potentially new and powerful tool for my toolbox. Vitamin D is incredibly inexpensive, and, according to this report, safe and powerfully effective as well. Clearly we will need to see more research to confirm these findings, but what a breath of fresh air it is that such a wonderful gift might be available at the health food store, or even from the good old sun itself.

 
 
 

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Current estimates report that about 300,000 Americans have been diagnosed with multiple sclerosis (MS) with an incredible 10,000 new cases being diagnosed each year. While there is a small hereditary ...
Current estimates report that about 300,000 Americans have been diagnosed with multiple sclerosis (MS) with an incredible 10,000 new cases being diagnosed each year. While there is a small hereditary ...
 
 
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Sayer Ji
The World's Largest, Open Access, Natural Medicin
10:47 PM on 04/04/2011
We have collected 8 peer-reviewed from the National Library of Medicine on the connection between MS and Vitamin D. http://www.greenmedinfo.com/substance/vitamin-d You will in fact find research on the connection between 179 diseases and this essential vitamin/hormone.
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Kringle
Resurrection of the Gifting Spirit
12:04 PM on 02/14/2011
Isn't it true that Vitamin D is naturally sourced through exposure to the sun? Doesn't our skin produce oils that when reabsorbed by our skin provide us with Vitamin D?
01:01 PM on 02/11/2011
Vitamin D is just great in general. I used to get sick a lot, but it DRASTICALLY decreased since I started taking a Vitamin D supplement about a year ago. I'd recommend everyone to take 1000IU-2000IU daily.
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drvittoriarepetto
09:15 PM on 02/10/2011
Could the fact that we are not consuming enough fat to help absorb the fat soluble vitamins like Vitamin D (the fat soluble vitamins are Vitamin A, D, E and K) and Omega 3′s be playing a part in this besides not getting enough sun?
http://drvittoriarepetto.wordpress.com/2010/09/24/is-low-fat-really-healthy/
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David Perlmutter, M.D.
Vanguard Neurologist
09:22 PM on 02/10/2011
This is certainly a possibility. We have become a fat phobic society based on the misguided perception that low fat and no fat foods are healthful. In reality, humans thrive on fat in the diet. But the important distinction between "bad fats" (hydrogenated - saturated) and "good fats" (unprocessed - mono and polyunsaturated) still stands. Excellent point.
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Sister Bluebird
10:34 PM on 02/10/2011
How about the notion that some pesticides and other chemicals attach themselves to the fats in our bodies. Perhaps that is also contributing to issues with quality, lipid distribution and function.
09:20 AM on 02/11/2011
Except that recent work has found neither saturated fat nor red meat associated with heart disease.Omega 3 fatty acids have been associated with benefits. A recent study published in Br J Nutr. 2010 Dec;104(11):1586-600.
"n-6 fatty acid-specific and mixed polyunsaturate dietary interventions have different effects on CHD risk: a meta-analysis of randomised controlled trials."

Found that '.....RCT that substituted n-6 PUFA for TFA and SFA without simultaneously increasing n-3 PUFA produced an increase in risk of death that approached statistical significance (RR 1.16; 95 % CI 0.95, 1.42). Advice to specifically increase n-6 PUFA intake, based on mixed n-3/n-6 RCT data, is unlikely to provide the intended benefits, and may actually increase the risks of CHD and death.'....

So this review found that when you substituted N-6 polyunsatu­rated { the good fats ] for trans fats and saturated fats you are unlikely to receive any benefits and may in fact do harm {"Advice to specifically increase n-6 PUFA intake, based on mixed n-3/n-6 RCT data, is unlikely to provide the intended benefits, and may actually increase the risks of CHD and death.'...."
04:14 AM on 02/11/2011
No there is almost no vitamin d in food. It is lack of sun. So you either get some midday midsummer sun or you take supplements.
09:33 AM on 02/11/2011
And for MS a just published study found that both sun exposure and vitamin d levels may help " Sun Exposure, Vitamin D May Lower Risk of Multiple Sclerosis" http://www.aan.com/press/index.cfm?fuseaction=release.view&release=898 '.....“Added together, the differences in sun exposure, vitamin D levels and skin type accounted for a 32-percent increase in a diagnosed first event from the low to the high latitude regions of Australia,” Lucas said. Lucas noted that the effects of sun exposure and vitamin D acted independently of each other on the risk of first event. “Further research should evaluate both sun exposure and vitamin D for the prevention of MS,” Lucas said. ,,,"
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drvittoriarepetto
09:11 PM on 02/10/2011
from: http://www.aruplab.com/guides/ug/tests/0080379.jsp
18 years and older:
Deficiency: Less than 20 ng/mL
Insufficiency: 20-29 ng/mL
Optimum Level: 30-80 ng/mL
Possible Toxicity: Greater than 150 ng/mL
02:44 AM on 02/11/2011
Yet none of the people in the trial in the journal Neurology showed any signs of toxicity their blood calcium levels were stable and they were on what are considered very high doses.
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BETGR627
"No More Hurting People...Peace"
07:11 PM on 02/10/2011
For those of us in the northern states, we cannot get enough Vit. D from the sun. We need it from supplements. Make sure it is D3. http://www.vrp.com/bone-and-joint/vitamin-d3-higher-doses-reduce-risk-of-common-health-concerns.

I was prescribed Vit. D by my endocrinologist in large doses to begin with and now I'm down to a normal level and I do feel better after losing one of my parathyroid glands due to a tumor which caused too much calcium and was thus developing kidney stones. If this is your issue - do see an endocrinologist.
04:19 AM on 02/11/2011
The parathyroid along with 1,25(OH)D control the blood calcium levels. You had primary hyperparathyroidism. There is a disease called secondary hyperparathyroidism caused by very low 25(OH)D levels. You treat the second with vitamin d, the first by removing one of more parathyroid.

Remember the thyroid and the parathyroid are not the same.
03:33 PM on 02/10/2011
Concerning your NOTE: Vitamin D can be toxic in large doses.

If I am not mistaken, vitamin D supplements can be toxic( often people think if a little is good, more is better which is not the case for supplements) because of the calcium included in them which can build up in your blood causing calcium toxicity, also known as hypercalcemia, but Vitamin D3 acquired from sensible and moderate amounts of the sun or artificial sources of UVA and UVB like many sunbeds produce can never be toxic as your body self regulates this prohormone, therefore never getting to any type of toxic level.

According to one source i found recently,
http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/otherendo/vitamind.html
Vitamin D toxicity: "Excessive exposure to sunlight does not lead to overproduction of vitamin D. Vitamin D toxicity is inevitably the result of overdosing on vitamin D supplements. Certainly, vitamin D supplements are a valuable treatment for individuals with deficiencies. However, ingestion of excessive (milligram) quantities of vitamin D over periods of weeks of months can be severely toxic to humans and animals."

Also, My thought on the key west problem is health care workers tend to be sheltered from UV light by long shifts indoors and the others are probably die hard SPF users. Both of which trends are bad for their health IMO.
Get some sun, more and more medical research suggests more, or at least some unprotected UV exposure for good health.
04:13 AM on 02/11/2011
Toxicity with excessive vitamin d intake is caused by deregulation of the blood calcium control system, not because of the calcium in the supplements. The vitamin d in supplements is inert (has no effect), it is converted to 25(OH)D which is also inert (this is the storage version). Only when needed is it converted to 1,25(OH)D but in a controlled manner. With excessively high levels of vitamin d intake the supplement starts to deregulate the control system.

In your comment you quote milligram quantities. Well 1000IU is 25 micrograms so 1 milligram is 40,000IU and this intake must be maintained before there is any effect.
10:51 AM on 02/11/2011
More sunshine is simply not possible at -4 degrees in a northern climate (like where I live, in Minnesota).
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getsit
good morning, I'm here
02:48 PM on 02/10/2011
Not only do we not get enough vitamin D in food we cover up with sun block and clothing when we go outside. Those of us who live in northern climes with the angle of sun too low in winter make little vitamin D. We don't eat the foods that naturally have vitamin D in them like the eskimos used to. Many people don't drink milk or eat cereal with vit D added and even if they do it's still not enough.

My daughter has depression in the winter. I have her taking both fish oil and 2,000 IU vitamin D daily and she's much better this winter.

Many doctors are testing for vitamin D levels routinely during exams. Several of my friends are being told to take up to 2,000 IUs daily because they are so deficient.
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Sister Bluebird
10:36 PM on 02/10/2011
Consider a light box? Would that increase Vit D as well?
02:41 AM on 02/11/2011
No. You need hard UVB not light. You need a UVB lamp preferably narrow band (little UVA) as sold to treat some medical conditions.
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RMankovitz
Researcher, inventor, entrepreneur, author
02:44 PM on 02/10/2011
Good article. The new field of geomedicine explores the relationship between spatial data and health, and is beginning to uncover spatial correlations for a number of illnesses. As an example in the cancer arena, see this recent HuffPo article entitled “Geomedicine Shows Patterns in U.S. Breast and Prostate Cancer”:

http://www.huffingtonpost.com/bill-davenhall/post_1663_b_817254.html

Note that cancer incidence is higher at the more Northern latitudes, raising the possibility that sunlight and vitamin D levels may play a role in these cancers.

Roy Mankovitz, Director
http://www.MontecitoWellness.com
A research organization
02:41 PM on 02/10/2011
If you have a low level of Vitamin D in your blood, you can reduce the possibility of getting a wide variety of diseases by raising your Vitamin D level to a range of 40 ng/ml - 60 ng/ml. Watch the the following slide show:
http://www.grassrootshealth.net/media/download/vit_d_baggerly_tv.pdf
avg american
It's about jobs, jobs, jobs...
08:08 PM on 02/10/2011
Great Post!

f&f'ed for the slide show.
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Fred Butters
02:40 PM on 02/10/2011
It seems we're only now discovering all the functions of vitamin D. Why does the title talk about milk, but the article doesn't? You're not going to get enough vitamin D via diet anyway - sun or supplements are the only methods that work.

I've read that the body's attempt to fight off Wheat Germ Agglutinin - a lectin found in wheat, barley and millet - can lead to autoimmune disease like Celiac, MS and type 1 diabetes.
EvolveorPerish
R E anna what have you done?
11:53 PM on 02/10/2011
A lot of reading I've done implicates wheat and grains in a wide range of autoimmune diseases, the ones you mentioned plus allergies,asthma, add/adhd, arthritis, chron's, lupus etc.

Pair that with a vit D and omega 3 deficiency and you've got a recipe for a mess. Some people have added complications from the nightshade family(toms&potatoes) too adding more inflammation/arthritis.
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Camis
02:38 PM on 02/10/2011
Fanned, Faved, and whatever else I could check in the boxes. Thank you for this information. I have a life-long vestibular disorder that finally dropped me into the abyss of Disability, complicated by a life-long Depressive Disorder that doesn't help. Oh and Epstein Barr and allergies. And I was a happy camper for most of my life! My endocrinologist recently suggested i start taking Vitamin D. I have no idea if it will help with the depression or the vertigo but I know that it will help in some way, some boost to the system in general. More sunlight too, although I don't know if that means I should skip the darn sunblock after all. Anyway - Bless you doctors for your help, and for letting us know when there is a basic, natural, inexpensive way to improve the way we feel.
02:17 PM on 02/10/2011
To be fair, some of the current injectable treatments for MS can cause flu-like symptoms, but not all of them do. There is (at least) one that is easily tolerated by virtually all who take it.

To the article, count me among the MS-diagnosed who recently began a vitamin D regimen since, according to recent blood results, I had very, VERY low levels. Curious about how this will play out. Thanks!
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ldcbl
facts matter
04:01 PM on 02/10/2011
i was diagnosed almost 6 years ago and started on copaxone, the one CRAB drug that does not have flulike symptoms. My doctor put me on vitamin D immediately. I currewntly take 400 IUs per day and a 50000IU booster every other week. I have not had any further exacerbations since. Good luck
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HawaiiShira
He that knows & knows he knows is wise.
02:09 PM on 02/10/2011
When you consider that milk has been replaced in so many of our young peoples diets with high fructose carbonated drinks, and drink boxes, it is no wonder that there is an increase in MS and other autoimmune diseases. Further, so many of our foods have been so over-processed, that the good has been processed out, and we consume empty calories. But there is one other thing that was touched on here that people need to know -- immunomodulators. There are natural glyconutritionals that do provide this function, without side effects.....a product called Ambrotose. I have a son that suffers from sarcoidosis. He was told to avoid the sun. At the time he was living in FL. After initially allowing the medical profession to impose its regiment of massive doses of prednisone, and then the cancer treatment drug, methotrexate, he took measures in his own hands, moved back to Hawaii, chose to use a glyconutrient regimen, and has had great results. People have to find what works for them as naturally & toxin-free as possible.

One person wondered why there is an increase in MS among Key West residents. Perhaps sun blockers block the production of Vitamin D.
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onionboy
Blessed are the Cheese Makers
02:45 PM on 02/10/2011
Well, as someone below pointed out (I don't want to take credit), half of those Key West residents were health care workers. I don't see how that relates to sunblock.
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getsit
good morning, I'm here
02:55 PM on 02/10/2011
Our bodies make vitamin D when we are exposed to sunlight. Block the sunlight block the production of Vit D. Do it all one's life and be deficient. Health conscious people might not realize that blocking the sun to protect themselves from skin cancer and wrinkles also makes them nutritionally deficient in the vitamin. They need to add a supplement.

We are daylight creatures and sleep at night. Other animals make their own vitamin D without the need of sunlight. So we are meant to be in the sun.
01:53 PM on 02/10/2011
All this information is very similar to vitamin D association and Crohn's disease, which is also autoimmune disease: http://www.journey-with-crohns-disease.com/vitamin-d-deficiency-symptoms.html
04:42 AM on 02/12/2011
I find it interesting that in Crohn's disease the off licence use of immune suppressants (chemotherapy drugs, which are classified as possibly carcinogenic), is wide spread, but we are super cautious about raising our 25(OH)D levels, within the range that normally occurs.

It is probably better for those with Crohn's to get there vitamin d from sunlight or by applying it to the skin.