The modern history of vitamin D began in the 1800s when doctors noticed city children had higher rates of rickets than country children. In 1824 cod liver oil was first prescribed for the treatment of rickets. By the 1920s knowledge about the production of vitamin D in the skin by ultra violet rays was well established and vitamin D was considered an essential nutrient for bone related disorders. Today there is promising research into vitamin D’s role in many other biochemical functions.
Vitamin D Modulates the Immune System
Vitamin D is considered a prohormone. It can be made inside the body by certain cells, and acts on cell membranes that induce cell signaling (give directions), which modifies our DNA. Alterations in the genes (DNA) involved in vitamin D hormone synthesis and hormone receptors have been implicated in Multiple Sclerosis risk. The human Leukocyte antigen (HLA)DRBI*1501 has consistently been associated with MS in nearly all populations tested.
This gene appears to be controlled by the vitamin D hormone
One plausible biological explanation for the vitamin D – MS association is the need for vitamin D to eliminate the autoimmune T lymphocytes that are capable of causing disease. Vitamin D sensitizes these T lymphocytes into programmed cell death within the central nervous system to prevent inflammation in this tissue. Furthermore Professor Anne R. Gocke, Ph.D., Dept. of Neurology Johns Hopkins University in their research found “myelin- reactive T helper cells are successfully generated in the presence of vitamin D3, that they secrete proinflammatory cytokines, and they do not differentiate into suppressor T cells”.
Vitamin D receptors are present in nearly all human cells, suggesting it plays multiple roles in the body. Receptors in mucus membranes have critical signaling pathways involved in the response to infection and inflammation. Critical functions of vitamin D include regulating the response to intestinal homeostasis (equilibrium), pathogen invasion, bacterial colonization, and mucosal defense. Studies have also indicated impairment of these vitamin D receptors may contribute to exaggerated inflammatory responses.
Recent animal research shows vitamin D affects the development of neurons (nerve cells), as well as their maintenance and survival. Research is being conducted on amyloid tissue called plaques (as seen in Alzheimer’s) and report vitamin D decreased this amyloid tissue and decreased inflammation in the brain.
MS Activity and Severity
At the 29th Congress of the European Committee for Treatment and Research in Multiple Sclerosis, 2013, a review of the BENEFIT trial presented by Dr. Ascherio of Harvard School of Public Health concluded the participants with vitamin D levels greater than 20ng/ml at the beginning of the study had less T2 lesions (T2 lesions are an indication of a person’s MS disease burden), reduced MS activity, and a slower rate of disease progression compared to participants with vitamin D levels less than 20ng/ml. During the following 4 years of the study, participants (with the higher vitamin D levels) had fewer active lesions on MRI, a lower increase in T2 lesion volume, a lower rate of brain loss, and lower disability, as measured by the Expanded Disability Status Scale score.
Vitamin D Levels
In 2010 the Institute of Medicine came out with new recommendations for vitamin D levels. The new recommendation is 600IUs/day for adults to age 70. This recommendation is only for minimum levels sufficient to prevent rickets and bone fractures. There was no consideration of levels for reducing inflammation, modulating immune response, or other physiological benefits. Research indicates a minimum level of 32 ng/mL was necessary for adequate calcium absorption.
The Institute of Medicine’s definition of deficiency is as follows: <12ng/ml risk/deficiency
Guidelines of 1,000IUs/day may have little bearing on your actual levels of vitamin D. Levels depend on numerous factors including the amount of sun exposure, skin pigmentation and very important factors like digestion and absorption.
Baseline testing is suggested to determine how aggressive treatment should begin. I frequently start patients on 5,000IUs, 2x/day. In severe deficiencies starting amounts may be upwards of 10,000IUs 2x/day, and then re-testing at a 2-3 month interval to determine results of supplementation. My desired targeted levels for the past 10 years have been for healthy individuals, 70-90 ng/ml and 100 ng/ml or higher for patients with all auto- immune diseases (not just MS). I even have a few patients with levels upwards of 140 ng/ml who are doing terrific.
The correct vitamin D test is 25(OH)D. This is a better marker for overall D status, and most strongly associated with overall health.
Vitamin D increases the uptake of calcium in the gut and tissues. The main consequence of vitamin D toxicity is the buildup of calcium in the blood, called hypercalcemia. Severe cases may eventually cause kidney failure and calcification of the arteries. Blood levels in reported toxicity cases ranged from 257-620 ng/ml. These levels are far greater than levels researchers are investigating to modulate disease processes.
J Burton, Doctor of Neurology of St. Michael’s Hospital at the University of Toronto in 2009 concluded, “We believe that vitamin D3 intake up to 40,000 IU/day for a brief period of time and 10,000 IU/day for a year appears to demonstrate biochemical safety, evidence of clinical benefit, and evidence of decreased T-cell proliferation”.
Certain medical conditions can increase the risk of hypercalcemia in response to vitamin D, including primary hyperparathyroidism, sarcoidosis, tuberculosis, and lymphoma. People with these conditions may develop hypercalcemia in response to any increase in vitamin D nutrition and should consult a qualified health care provider regarding any increase in vitamin D intake.
Vitamin D Drug Interactions
The following medications increase the metabolism of vitamin D and may decrease serum D levels: Phenytoin (Dilantin), fosphenytoin (Cerebyx), phenobarbital (Luminal), carbamazepine (Tegretol), and rifampin (Rimactane).
The following medications should not be taken at the same time as vitamin D because they can decrease the intestinal absorption of vitamin D: Cholestyramine (Questran), colestipol (Colestid), orlistat (Xenical), mineral oil, and the fat substitute Olestra. The oral anti-fungal medication, ketoconazole, inhibits the 25(OH)D3-1- hydroxylase enzyme and has been found to reduce serum levels of 1,25(OH)D in healthy men.
Vitamins A, D and K2: A Balance
Our modern diets have changed and exclude foods that were regularly consumed such as organ meats and fermented foods. These foods contain other fat soluble vitamins such as vitamin A and K. Foods such as grass-fed butter, pastured egg yolks, cod liver oil and fermented vegetables are excellent sources of these vitamins.
Vitamin A has several roles in eye health, immunity and the reproductive functions of both men and women. Another important function is vitamin A’s ability to spare vitamin K. Vitamin A can be obtained in adequate amounts through a mixed diet of liver, butter, eggs, some cheeses and the carotenoids in foods such as kale, squash, mangos, cantaloupes and sweet potatoes.
There are 2 recommended forms of vitamin K. K1 is found in green leafy vegetables and is involved in blood-clotting. Vitamin K2, has two forms Mk4 and Mk7, is different. If vitamin D increases calcium absorption, vitamin K2 regulates where it ends up. It shuttles calcium where it’s suppose to be and out of areas where it’s not suppose to be, like arterial plaque,
kidney stones, and bone spurs. More importantly it activates vitamin D’s signaling pathways involved in the response to infection and inflammation. It prevents free radical damage to neurons and in the brain vitamin K2 contributes to the production of myelin.
Vitamin A, retinol for its discovery in the retina, can usually be adequately obtained through quality animal fats, eggs and liver. To get adequate amounts of K2, except for natto- fermented soybeans, you would need to supplement. 90-180 micrograms is where I start patients, perhaps higher doses may be needed. There appears to be no toxicity reports for vitamin K2.
Vitamin D is currently the darling of the nutritional world. Good news is published about this nutrient ever day. These days everyone knows they need vitamin D. The current trend toward supplementing higher and higher doses of D will lead to an unhealthy balance without vitamins A & K2 to maintain the equilibrium.
Vitamin D supplements
Because vitamin D is a fat-soluble vitamin it needs to be taken with food. It also needs to be in liquid form. Yes, I know, many calcium supplements are hard, dry rocks and contain vitamin D. However, heating, drying and compressing a fat-soluble vitamin will destroy its integrity. I use liquid drops for my patients.
The correct form of vitamin D to supplement with is D3. When choosing a vitamin D supplement, it must contain vitamin E. Usually listed in other ingredients as D-Alpha Tocopherol, vitamin E acts as a preservative to keep the fat-soluble vitamin D from becoming rancid.
Talk to your health care provider about getting tested and adding vitamin D3 to your regimen.
Oils; The good, bad and ugly.
Dietary fats, oils and cholesterol are critical for Life. Understanding which fats and how to use them in a healthy nutritional program will be the discussion in the upcoming article.
About The Author, Tara Palmer
Tara Palmer, MS is a highly experienced Nutritional Biochemist with a unique set of skills and insights. Combining Biochemistry and Nutrition, for over 27 years she has successfully assisted individuals with complex, chronic medical conditions. Inflammation, malabsorption and immunity begin in the gut, and for her entire career she has focused on fixing a patient’s gut. Her motto is, “you are what you digest and absorb”. Tara has insisted on gluten free diets for all of her patients since the early 90’s, long before “gluten free” was fashionable or in the eye of the consumer. For more than 6 years she has recommended stricter “grain-free” diets to help her patients.
With a Master’s degree in Nutrition and a background in biochemistry, Tara can evaluate laboratory results, medications and symptom history to develop a successful approach to specifically address each patient’s needs.
Tara has been a contributing professional for MSWorld since 2007.