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Recommended D Levels
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 Vitamin D is an important immune system regulator[1]. Its impact on Multiple Sclerosis, an autoimmune disease, has been well studied with the following generally accepted:

  • Low levels are associated with onset[2]
  • Injections of vitamin D hormone could protect against or arrest the animal forms of Multiple Sclerosis[3]
  • Risk of death is significantly reduced with increased Sunlight Exposure[4]

Vitamin D has been identified as a significant factor for incidence of several autoimmune illnesses such as multiple sclerosis, rheumatoid arthritis, insulin-dependent diabetes mellitus, and inflammatory bowel disease[5]. Significant improve from taking vitamin D has been reported for several autoimmune illnesses, for example rheumatoid arthritis[6] and lupus. Studies of fibromyalgia and persistent, nonspecific musculoskeletal pain have found that a low level of vitamin D is common[7]. The literature strongly suggests vitamin D supplementation.

A review of Co-Cure “MED” resources[8] found only a few resources suggesting Vitamin D has considerable merit for CFIDS/FM.

"Vitamin D deficiency is a major unrecognized epidemic in the adult population," Holick said. As many as 40% to 50% of adults older than 50 may be deficient in the vitamin, according to the researcher. He noted that some people who appear to have fibromyalgia, a syndrome marked by chronic muscle and joint pain, may in fact have vitamin D deficiency.”[9]

The remaining information from co-cure is summarized below.

·         Reduced Vitamin D levels are seen in both CFS and FM, correlating with increased musculoskeletal pain and lower bone density[10].

One of the few studies dealing with fatigue found 97.8% (493/504) patients had a vitamin D deficiency[11]. Patients with a small deficiency responded very well and the fatigue was greatly reduced or eliminated. Those with very low levels had a very variable outcome to vitamin D. This parallels the report for sarcoidosis patients where some could not tolerate any exogenous Vitamin D at all, and that those patients who were most sensitive to Vitamin D were less likely to achieve remission.[12]

With individuals with MCS, 24% were found to be vitamin D deficient[13].

Medline, Autoimmune illnesses and Vitamin D

The table below shows the results of National Library of Medicine[14] searches

Search

Records Found

"vitamin D" and "Myalgic Encephalomyelitis"

0

"vitamin D" and "Chronic Fatigue"

2

"vitamin D" and fibromyalgia

4

"vitamin D" and "multiple sclerosis"

78

"vitamin D" and lupus

106

“vitamin D” and “rheumatoid arthritis”

136

"vitamin D" and "psoriasis"

282

The above absence of research with CFIDS/FM has made patients with these conditions susceptible to novel protocols such at the one at http://marshallprotocol.com which is associated with a PhD in Electrical Engineering. For the other autoimmunity illnesses listed above, the refrain from the research appears to be “Low vitamin-D bad, vitamin-D supplements good”.

What is appropriate Vitamin D level and supplements?

The first question is simple, what should the Vitamin D level be? Reviewing recent literature suggests the following:

  • No less than 78 nmol/l (31 ng/ml)[15].
  • All numbers refer to Vitamin D3 (Vitamin D2 is estimated to be 20% as effective)

 It should be noted that 62.4 to 99.8 nmol/L (25 to 40 ng/mL) is cited by older reference books[16]. The older level was based on short term disease presentation, while the newer level was based on Serum iPTH[17].

 The author suggests that a level of 108 nmol/l (43 ng/ml) or more is desirable for CFIDS/FM patients and that lower levels may require supplementation. This is based on the observation that individual laboratories can differ by up to 38% on Vitamin D measurements[18], thus 78 x 1.38 insures that the minimal level is reached.

From Robert P Heaney, Functional indices of vitamin D status and ramifications of vitamin D
deficiency
Am J Clin Nutr 2004;80(suppl):1706S–9S.

 What is the supplemental dosage that may be appropriate? Reviewing recent literature suggests the following:

·         In healthy persons, it is recommended that supplements of at least 1000 IU vitamin D per day is required to maintain a healthy concentration of vitamin D in the blood[19].

·         For typical older individuals, supplemental oral intakes of approximately 1300 IU per day are required to reach the lower end of the optimal range[20]

The issue of toxicity always arise with Vitamin D, and apart from some rare specific illnesses, intermittent doses of more than 100000 IU are tolerated[21] and the lowest proven toxicity report is cited at continuous 40000 IU per day[22].

The typical need of a normal white female 30-59 is 1371 IU/day. A CFIDS white female 30-59 would have a lower initial level and require a higher dosage.

From Connie M Weaver and James C Fleet, Vitamin D requirements: current and future  Am J Clin Nutr 2004;80(suppl):1735S–9S

Summary

The following abstract is an effective summary of its potential impact on CFIDS/FM :

 “Beyond its effects on bone metabolism, calcium and phosphorus homeostasis, 1,25-dihydroxyvitamin D3 (1,25(OH)(2)D(3), calcitriol) exerts profound effects on the immune system. We here provide an overview over the metabolism, molecular and cellular action of 1,25(OH)(2)D(3) with particular regard to its immunomodulatory function. Effects of 1,25(OH)(2)D(3) on the immune system are manyfold and include suppression of T cell activation, shaping of cytokine secretion patterns, induction of regulatory T cells, modulation of proliferation, and interference with apoptosis. 1,25(OH)(2)D(3) further influences maturation, differentiation, and migration of antigen presenting cells. Altogether, its immunomodulatory potency is comparable to other established immunosuppressants without sharing their typical adverse effects. This profile makes 1,25(OH)(2)D(3) a potential drug for the treatment of immune-mediated diseases. Yet, the major obstacle for its clinical use, its potent calcemic activity, is not overcome to date. The identification or generation of novel vitamin D derivatives with dissociated calcemic and immunomodulatory properties is therefore a major task. Its success might eventually lead to promising drugs for future therapeutic exploitation of a wide array of immune diseases, such as psoriasis, multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, and others.”[23]

 The use of Vitamin D supplements appears to be well warranted with no documented risks in the suggested range of 1300-2000 IU/day for adult CFIDS/FM patients. MDs treating CFIDS/FM may wish to consider supplements of Vitamin D for their patients. Vitamin D may need to be introduced very slowly for many.

 Anecdotal reports found an interesting change of body temperature connected with Vitamin D. The temperature of an individual usually in the 97.4-97.8 is shown below, this low range is often seen with CFIDS.

Temperature

Time

97..8°F   36.6°C

Before 400IU of Vitamin D

98.6°F    37°C

2 hrs

99.3°F    37.4°C

5 hrs

98.6°F    37°C

7 hrs

On the prior day (after restricting vitamin D for some time), the temperature rose to 101.1°F after 400 IU of Vitamin D. The addition of Vitamin D appears to have caused the immune system to become active fighting infections that it had only mildly responded to prior. Additional anecdotal reports suggest Herxheimer reactions are being triggered with the addition of Vitamin D.

 Ken Lassesen, M.S.


[1] Zhu, Monica Froicu, and Anja Wittke Vitamin D status, 1,25-dihydroxyvitamin D3 and the Immune System, Margherita T Cantorna, Yan Am J Clin Nutr 2004;80(suppl):1717S–20S. http://www.ajcn.org/cgi/content/full/80/6/1717S

 

[2] Goldberg, P., Multiple Sclerosis: vitamin D and calcium as environmental determinants of prevalence. Part 1: Sunlight, dietary factors and epidemiology. Intern. J. Environmental Studies, v. 6, p. 19-27, 1974.  Goldberg, P., Multiple Sclerosis: vitamin D and calcium as environmental determinants of prevalence. Part 2: Biochemical and genetic factors. Intern. J. Environmental Studies, v. 6, p.121-129, 1974.

[3] Lemire, J. and Archer, D., 1991, 1,25-dehydroxyvitamin D3 prevents the in vivo induction of murine experimental autoimmune encephalomyelitis. J. Clin. Invest., v. 87, p. 1103-1107.

[4] D Michal Freedmana, Mustafa Dosemecib, Michael C R Alavanjab Mortality from multiple sclerosis and exposure to residential and occupational solar radiation: a case-control study based on death certificates. Occup Environ Med 2000;57:418-421 http://oem.bmjjournals.com/cgi/content/full/57/6/418

[5] Cantorna MT. Vitamin D and autoimmunity: is vitamin D status an environmental factor affecting autoimmune disease prevalence? Proc Soc Exp Biol Med. 2000 Mar;223(3):230-3. http://www.ebmonline.org/cgi/content/full/223/3/230

Cantorna MT, Mahon BD. Mounting evidence for vitamin D as an environmental factor affecting autoimmune disease prevalence. Exp Biol Med (Maywood). 2004 Dec;229(11):1136-42. http://www.ebmonline.org/cgi/content/full/229/11/1136

[6] Cantorna, M., Hayes, C. and DeLuca, H., 1,25-Dihydroxycholecalciferol inhibits the progression of arthritis in murine models of human arthritis. Journal of Nutrition, v. 128, p. 68-72. 1998 http://www.nutrition.org/cgi/content/full/128/1/68

[7] Al-Allaf AW, Mole PA, Paterson CR, Pullar T. Bone health in patients with fibromyalgia.

Rheumatology (Oxford). 2003 Oct;42(10):1202-6. Epub 2003 Jun 16. http://rheumatology.oupjournals.org/cgi/content/full/42/10/1202

Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain Mayo Clin Proc. 2003 Dec;78(12):1463-70.

[9] Anne Harding  A Little Bit of Sun May Be a Good Thing: Experts, February 15, 2002 http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0402D&L=co-cure&P=R8849

[10] Cited in “RESEARCH SESSION”,AACFS 2004 Meeting, by Charles W. Lapp, M.D. http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0411A&L=co-cure&P=R2304  Also reported by A.Komaroff (Boston). http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0411A&L=co-cure&P=R1351

[11] Hock, AD. Fatigue and 25-hydroxyvitamin D levels. Journal of Chronic Fatigue Syndrome, 1997, 3, 3, 117-127.

[12] Scadding JG: Sarcoidosis, with special reference to lung changes. BR Med J 1950, 1: 745-753

[15] Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9425501

[16] The Merck Manual of Diagnosis and Therapy: Vitamin D Deficiency and Dependency. 17th Edition, Section 1, Chapter 3 http://www.merck.com/mrkshared/mmanual/section1/chapter3/3d.jsp

[17] Chapuy MC, Preziosi P, Maamer M, Arnaud S, Galan P, Hercberg S, Meunier PJ. Prevalence of vitamin D insufficiency in an adult normal population. Osteoporos Int. 1997;7(5):439-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9425501

[18] Lips P, Chapuy MC, Dawson-Hughes B, Pols HA, Holick MF. An international comparison of serum 25-hydroxyvitamin D measurements.Osteoporos Int. 1999;9(5):394-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10550457

[19] Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004 Mar; 79(3):362-71.

[20] Heaney RP. Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr. 2004 Dec;80(6 Suppl):1706S-9S.

[23] May E, Asadullah K, Zugel U. Immunoregulation through 1,25-dihydroxyvitamin D3 and its analogs. Curr Drug Targets Inflamm Allergy. 2004 Dec;3(4):377-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15584887

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