Friday Feedback: Vitamin D -- the MS Magic Bullet?
Information provided by: Cherie C. Binns RN BS MSCN
Published: Jan 24, 2014
This week, Friday Feedback takes a second look at a reported correlation between vitamin D and slower disease progression in multiple sclerosis patients.
We reached out to a diverse group of physicians by email and asked them to respond to the following question:
On the strength of these observational data, how would you use these findings in the clinical management of your MS patients?
The participants this week:
Cherie C. Binns, RN, an independent multiple sclerosis-certified nurse based in Wakefield, R.I.
Marian L. Evatt, MD, MS, Department of Neurology, Emory University School of Medicine
Robert Fox, MD, an MS specialist in the Mellen Center for Multiple Sclerosis at the Cleveland Clinic
J. William Lindsey, MD, professor of neurology at the University of Texas Health Science Center at Houston (UTHealth) Medical School and a member of the Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center
Eva-Maria Maida, MD, professor and chair, department of neurology, Evangelical Hospital Vienna, Austria
Anthony T. Reder, MD, professor of neurology with a focus in multiple sclerosis, The Committees on Neurobiology and Immunology, University of Chicago Medicine
Study Adds to the Evidence
Marian L. Evatt, MD, MS: "This doesn't surprise me -- because of available data on MS and bone health, I've been trying to keep MS (and other neurology) patients >30 ng/mL for a while. So this study won't change what I do for MS patients. That said, I don't know how well these kinds of findings have gotten out to the general practice community, so this adds to the body of evidence to support general neurologists and primary care physicians paying attention to vitamin D levels in patients with newly diagnosed MS. Compared with many of my neurology colleagues, I am relatively aggressive about keeping 25OH vitamin D levels replete because there's plenty of evidence vitamin D interventions work for bone health and fall prevention (issues MS and other neurology patients commonly have)."
Eva-Maria Maida, MD: "I have been measuring the blood level of vitamin D in MS patients for several years. Nearly no one shows a normal level in Austria. I find this data very interesting. The methods of evaluating and looking for the correlation of vitamin D to MS progression, especially in the early stage of the disease, are convincing."
Robert Fox, MD: "There is a growing collection of data indicating that vitamin D deficiency is associated with poor outcomes in patients with MS. This study adds to that dataset and suggests that vitamin D supplementation may be beneficial in MS, even in patients already taking a standard MS therapy. Perhaps just as importantly, this study confirms previous observations that higher levels of vitamin D beyond normal levels do not confer further benefit. Vitamin D supplementation is not a "more is better" issue, but rather a "correct the deficiency" issue."
Cherie C. Binns, RN: "Many of the neurologists with whom I communicate are now trying to dose supplemental D3 to elevate serum levels to 80 or greater in their patients with MS. However, it's the People with Multiple Sclerosis (PWMS) who seem to be taking this far more seriously than their healthcare team and many admit to taking megadoses (100,000 IU or more weekly)."
J. William Lindsey, MD: "These observations agree with multiple previous studies reporting that low vitamin D levels are associated with more disease activity."
Anthony T. Reder, MD: "It is a correlation, but that is still important."
Reder: "An alternative explanation for these findings could be healthy people play outside and have higher vitamin D from more sunshine. My recommendation to patients is take 4000 U per day in the winter, or take a winter vacation in a sunny place."
Binns: "Unfortunately, the FDA continues to maintain its low Recommended Daily Allowances (RDA) for D and there do not seem to be clear guidelines as to maximum dose of benefit or dose, when exceeded, that may be problematic. There is far too little information available as to signs of D toxicity or overdose. Please address this topic this year."
Evatt: "Presence and or worsening of several neurologic diseases have recently been associated with low vitamin D levels; the trouble is we don't know if the disease causes the low D or low D contributes to the disease/disease worsening. Evidence is strong that optimal bone health levels should be above 30, but we can't say whether it's better to get vitamin D levels higher ... e.g., above 40 or 60 or 70."
Lindsey: "The outstanding remaining question is whether treatment to increase vitamin D levels will have a clinical benefit in MS. The results from a few small studies of vitamin D supplementation in MS are contradictory. At present, it is reasonable to measure vitamin D levels in MS patients, and give supplements to those with low vitamin D."
Fox: "Confirmation that vitamin D supplementation is indeed helpful in MS still awaits a formal clinical trial."
Friday Feedback is a feature that presents a sampling of opinions solicited by MedPage Today in response to a healthcare issue, clinical controversy, or new finding reported that week.