Monday, October 7, 2013

Vitamin D and Multiple Sclerosis: Low serum levels = MORE disease and MORE severity of disease

This recent abstract at a large Multiple Sclerosis meeting confirms what neurologists already know, but underlines it quite well: There is something going on between Vitamin D levels and both the diagnosis of Multiple Sclerosis and the progression of it. This study just helped support the concern that lower levels in the bloodstream, versus higher levels, meant more disability from the disease.

This study essentially compared normal levels of Vitamin D versus sub-par levels in the blood. All the normal level patients did better than those that ran low.

I have all my patients with MS take Vitamin D supplements of 4000 I.U. daily at a minimum and many at 10,000 I.U. daily. I would rather patients be on the higher end of the spectrum.

I starred my favorite line below, toward the end. 

I saw the original abstract which is quite tedious and boring-looking. Here's the more digestible story summary in greater detail below:

COPENHAGEN -- Higher levels of 25-hydroxyvitamin D correlate with less Multiple Sclerosis disease activity and progression, researchers reported .
Every 50 nmol/L increment in average serum 25-hydroxyvitamin D levels observed at baseline translated into a 57% lower rate of new active multiple sclerosis-defining lesions (P=0.0009), reported Alberto Ascherio, MD, MPH, professor of medicine at Brigham & Women's Hospital and Harvard Medical School.
In his oral platform presentation at the annual meeting of theEuropean Committee for Treatment and Research in Multiple Sclerosis, Ascherio also found that higher baseline differences in 25-hydroxyvitamin D levels were associated with:
  • A 57% lower relapse rate (P=0.03).
  • A 25% lower increase in T2 lesion volume (P=0.00004).
  • A 0.41% lower yearly loss in brain volume (P=0.07) from 12 to 60 months.
  • Fewer active lesions at MRI (Hazard ratio 0.73, P=0.002).
  • A lower increase in T2 lesion volume (difference = - 9% per year, P=0.008).
  • A lower rate of brain loss (0.32% versus 0.66% per year, P=0.005)
  • Lower disability demonstrated by a -.17-point reduction in the Expanded Disability Status Scale score (P=0.004) during the subsequent 4 years.
Ascherio said he was unable to determine from his dataset if the lower levels of 25-hydroxyvitamin D were due to the person's lifestyle or to the disease, which influences lifestyle choice.
However, the findings were compelling to session moderator Eva Havrdova, MD, professor of neurology at Charles University in Prague. She told MedPage Today, "The 'normal' level of Vitamin D he was talking about in his study is what is needed to prevent rickets. It is not a very high level of Vitamin D. I think supplements of Vitamin D to increase Vitamin D levels up to 100 nmol/L level would be worthwhile, and maybe you would see improvements in the health status of our patients."
For his study, Ascherio and colleagues scrutinized the patient records of those who participated in the BENEFIT study, which compared treating people with clinically isolated syndrome (CIS) either early in the course of the trial or later on. As part of the trial, researchers collected data of baseline 25-hydroxyvitamin D, a marker of vitamin D levels. Levels of 25-hydroxyvitamin D were tracked for a year. Ascherio and his research team then tracked how levels of vitamin D correlated with multiple sclerosis outcomes.
The comparisons in the study were made between those patients whose yearly average level of 25-hydroxyvitamin D was 50 nmol/L or greater and those with lower levels of 25-hydroxyvitamin D. The researchers also broke down the participants in quintiles to further elucidate how differences in 25-hydroxyvitamin D affected patient outcomes. The analyses were adjusted for sex, age, initial randomization group -- treatment with interferon beta-1b or placebo, baseline T2 lesion scores and type of CIS.
The study population included 251 patients with 25-hydroxyvitamin D levels below 50 nmol/L, and 213 patients with multiple sclerosis who had a higher level of 25-hydroxyvitamin D. The median level for the low 25-hydroxyvitamin D group was 39 nmol/L; the median for the higher 25-hydroxyvitamin D group was 60 nmol/L.
The subjects in the study were about 31 years of age; more than 70% were women. At baseline, the low 25-hydroxyvitamin D level patients had a median of 20 T2 lesions compared with 15 lesions in those with higher levels of 25-hydroxyvitamin D.
"Higher serum 25-hydroxyvitamin D levels early in the course of multiple sclerosis robustly predicted a lower degree of multiple sclerosis activity, MRI lesion load, brain atrophy, and clinical progression over 5 years," Ascherio said.
The study, however, leaves many unanswered questions, he said. "Further investigations are needed to determine whether results apply to patients of different races, those later in the disease course, those with progressive multiple sclerosis, or to the effects of 25-hydroxyvitamin D in combination with other drugs aside from interferon beta-1b," he added.