Sturgeon Bay, Wisconsin chiropractor, naturopath and health blogger Dr. J.G. Moellendorf, DC, ND, LCP notes that while its been known since 1922 that Vitamin D is vital for bone health, recent research reveals its importance in many other body functions, and suggests that the “sunshine” Vitamin is, for example, a relatively safe and inexpensive treatment for fibromyalgia without the high cost and side effects of typical prescription drug treatments.
Vitamin D And Multiple Sclerosis
The World Health Organization estimates that approximately 2.5 million people worldwide suffer from multiple sclerosis, a central nervous system disease causing difficulties with muscle control and strength, balance, feeling, vision, and thinking. Dr. Alberto Ascherio of Harvard School of Public Health in Boston, Massachusetts led an international research team to study the effects of vitamin D supplementation on the progression of multiple sclerosis.
The mission statement of Dr. Ascherio’s research group is to identify causes, risk factors (positive and negative), and biomarkers of susceptibility and early diagnosis of multiple sclerosis (MS), Parkinson’s disease (PD), and amyotrophic lateral sclerosis (ALS), noting that because of their progressive and disabling nature, these diseases have major adverse personal, social, and economic consequences. Prevention and early detection are critical, because there are no cures and the clinical diagnosis typically occurs after substantial and often irreversible neuronal loss, and at a time when neuroprotective interventions are probably too late to be fully effective.
Among the Ascherio lab’s research projects is the investigation of environmental determinants of MS, with focus on the possible etiological role of the Epstein-Barr virus and other infections and the protective effect of vitamin D. This is a collaborative effort with contributions from leading virologists, immunologists and geneticists in the U.S. and Europe.
Team researchers followed 465 early-stage multiple sclerosis patients from Canada, Israel, and 18 European countries to analyze whether blood levels of vitamin D would affect the long-term course of the disease. Patients with adequate levels of vitamin D had 57% less new brain lesions, 57% fewer relapses, and 25% lower increases in lesion volume annually compared to those with inadequate vitamin D levels.
The study was published in the March 2014 issue of JAMA Neurology titled Vitamin D as an Early Predictor of Multiple Sclerosis Activity and Progression (JAMA Neurol. 2014;71(3):306-314. doi:10.1001/jamaneurol.2013.5993), coauthored by Dr. Ascherio, Kassandra L. Munger, ScD, Kelly Claire Simon, ScD of the Harvard School of Public Health; Rick White, MSc of the University of British Columbia, Vancouver, Canada; Karl Kchert, PhD, and Rupert Sandbrink, MD, of Bayer HealthCare, Berlin, Germany; Chris H. Polman, MD, and Frederik Barkhof, MD, of the University Medical Center, Amsterdam, the Netherlands; Mark S. Freedman, MD, of the Ottawa Hospital Research Institute, Ottawa, Canada 5; Hans-Peter Hartung, MD, of Heinrich-Heine Universitt, Dusseldorf, Germany; David H. Miller, MD, of the University College London Institute of Neurology, London, England 7; Xavier Montalban, MD, of the Hospital Universitari Vall dHebron, Barcelona, Spain 8; Gilles Edan, MD, of the CHU-Hospital Pontchaillou, Rennes, France 9; 4; Dirk Pleimes, MD, of Bayer HealthCare Pharmaceuticals, Montville, New Jersey 10; Ernst-Wilhelm Rad, MD, and Ludwig Kappos, MD, of University Hospital Basel, Basel, Switzerland; and Christoph Pohl, MD, of the Department of Neurology, University Hospital of Bonn, Bonn, Germany.
The researchers note that it remains unclear whether the vitamin D insufficiency commonly found in individuals with multiple sclerosis (MS), has an adverse effect on MS outcomes, and that the study’s objective was to determine whether serum concentrations of 25-hydroxyvitamin D (25[OH]D), a marker of vitamin D status, predict disease activity and prognosis in patients with a first event suggestive of MS (clinically isolated syndrome).
The Betaferon/Betaseron in Newly Emerging multiple sclerosis For Initial Treatment study was a randomized trial originally designed to evaluate the impact of early vs delayed interferon beta-1b treatment in patients with clinically isolated syndrome. Serum 25(OH)D concentrations were measured at baseline and 6, 12, and 24 months. A total of 465 of the 468 patients randomized had at least 1 25(OH)D measurement, and 334 patients had them at both the 6- and 12-month (seasonally asynchronous) measurements. Patients were followed up for 5 years clinically and by magnetic resonance imaging.
The researchers monitored new active lesions, increased T2 lesion volume, and brain volume on magnetic resonance imaging, as well as MS relapses and disability (Expanded Disability Status Scale score), finding that higher 25(OH)D levels predicted reduced MS activity and a slower rate of progression. A 50-nmol/L (20-ng/mL) increment in average serum 25(OH)D levels within the first 12 months predicted a 57% lower rate of new active lesions (P<.001), 57% lower relapse rate (P=.03), 25% lower yearly increase in T2 lesion volume (P<.001), and 0.41% lower yearly loss in brain volume (P=.07) from months 12 to 60. Similar associations were found between 25(OH)D measured up to 12 months and MS activity or progression from months 24 to 60. In analyses using dichotomous 25(OH)D levels, values greater than or equal to 50 nmol/L (20 ng/mL) at up to 12 months predicted lower disability (Expanded Disability Status Scale score, 0.17; P=.004) during the subsequent 4 years.
The coauthors conclude that among patients with MS mainly treated with interferon beta-1b, low 25(OH)D levels early in the disease course are a strong risk factor for long-term MS activity and progression, reporting that the results indicate that vitamin D has a strong protective effect against the underlying disease process in multiple sclerosis. “The findings of our study indicate that identifying and correcting vitamin D insufficiency should become part of the standard of care for newly diagnosed MS patients,” Dr. Ascherio observes.
Vitamin D And Fibromyalgia Syndrome
Fibromyalgia (FM) has been defined as, a complex chronic pain disorder that according to the National Fibromyalgia Association affects an estimated 10 million Americans. Women are the demographic subset most frequently diagnosed with fibromyalgia, but it can affect men and children as well, and can range from being a subtle condition hardly interfering with life and all of its activities, to totals disability, precluding participation in work and the most desired aspects of daily living.
Dr. Moellendorf comments that FM typically has a slow, gradual onset that starts mild and gradually worsens, and that symptoms associated with FM include generalized pain all over the body (above and below the waist including neck, shoulders, chest, upper back, arms, hips, buttocks, legs, and feet). The pain can be symmetrical or more intense on the left or right side AND it can vary from day to day. To top it off, the pain is chronic and is usually present for three or more months, sometimes for years, before the FM patient might even mention it to their health care provider. The onset can be so gradual that other issues often become the center of focus until the intensity gets to the point where the patient finally complains.
In 1990, the American College of Rheumatology (ACR) introduced the diagnostic criteria for FM, which include a patient’s history of widespread pain for at least three months, AND pain in 11 or more of 18 specific tender points using 4 kg of pressure. Due to vigorous controversy about whether fibromyalgia is a “real” disease , it is stipulated that ONLY a physician knowledgable about FM should make the diagnosis. Moreover, ALL other conditions having similar presenting symptoms as FM, must be ruled out BEFORE making the diagnosis of FM (emphasis theirs).
Although the FM hallmark of is widespread, generalized pain (in all four body quadrants), a number of other symptoms are common amongst FM sufferers. Some of these include fatigue (moderate to severe), sleep disorders, brain fog, irritable bowel syndrome (IBS), headaches (including migraine), anxiety, depression, and environmental sensitivities. Studies suggest that there is a neuroendocrine (nerves and hormones) abnormality that may contribute to the FM symptoms.
Dr. Moellendorf observes that many fibromyalgia sufferers also experience other symptoms such as stiffness when awaking, sleep disorders, inability to concentrate, anxiety, and depression. This can have major effects on ones quality of life, social interaction, and ability to hold employment. Treatment for the various symptoms can be very expensive, and there is as yet nothing approaching a “total cure.”
He cites research findings that vitamin D reduces pain intensity in many chronic conditions. A research team led by Dr. Florian Wepner at Orthopaedic Hospital, Speising, Vienna, Austria, has found that many fibromyalgia sufferers had low vitamin D blood levels. The researchers theorized that if vitamin D levels could be increased, patients’ pain levels might decrease. A randomized controlled trial was done in which 30 women with fibromyalgia and low blood levels of vitamin D were randomly assigned to either a treatment or control group. The goal for the treatment group was to supplement with vitamin D to bring the blood level into the normal range for a period of at least 20 weeks. Blood levels were reevaluated at 5 and 13 weeks, with a readjustment of the dose as needed. Blood levels of vitamin D were assessed again at 25 weeks, at which time supplementation was stopped, with a final assessment 24 weeks after stopping the supplementation.
Dr. Moellendorf reports that between the 1st and 25th weeks of vitamin D supplementation, the treatment group showed substantial improvements in their physical functions, with no changes seen in the control group taking a placebo supplement. The treatment group also reported significantly less morning fatigue, but no significant changes in depression or anxiety. The treatment group also reported marked reduction in their pain level, even 24 weeks after stopping the vitamin D supplement. The study was published in the February 2014 issue of the journal Pain titled “Effects of Vitamin D on Patients with Fibromyalgia Syndrome: a Randomized Placebo-Controlled Trial” (Volume 155, Issue 2 , Pages 261-268, February 2014), coauthored by Florian Wepner, Raphael Scheuer, Birgit Schuetz-Wieser, Peter Machacek, Elisabeth Pieler-Bruha, Heide S. Cross, Julia Hahne, Martin Friedrich. Lead researcher Dr. Wepner reiterates that vitamin D is a relatively safe and inexpensive treatment for fibromyalgia without the high cost and side effects of drug treatment.
The coauthors report that they investigated the effects of adequately optimized serum calcifediol levels on their fibromyalgia syndrome patients’ perception of pain, health-related quality of life, and comorbidities, noting that the role of calcifediol in subjective perception of chronic pain is a “widely discussed” subject, but that low serum levels of calcifediol are especially common in patients with severe pain and fibromyalgia syndrome (FMS).
They observe that we lack evidence of vitamin D supplementation’s role in these patients’s symptomatic presentation, noting that to their knowledge, no randomized controlled trial had been published on the subject.
In their study reported in PAIN, thirty women with FMS according to the 1990 and 2010 American College of Rheumatology criteria, with serum calcifediol levels <32ng/mL (80nmol/L), were randomized to either a treatment group (TG) or a control group (CG). The goal was to achieve serum calcifediol levels between 32 and 48ng/mL for 20 weeks via oral supplementation with cholecalciferol.
The CG received placebo medication. Re-evaluation was performed in both groups after a further 24 weeks without cholecalciferol supplementation. The main hypothesis was that high levels of serum calcifediol should result in a reduction of pain (visual analog scale score). Additional variables were evaluated using the Short Form Health Survey 36, the Hospital Anxiety and Depression Scale, the Fibromyalgia Impact Questionnaire, and the Somatization subscale of Symptom Checklist-90-Revised.
The researcher report that a marked reduction in pain was noted over the treatment period in the TG. A 2 (groups)4 (time points) variance analysis showed a significant group effect in visual analog scale scores. This also was correlated with scores on the physical role functioning scale of the Short Form Health Survey 36. The scientists determined that optimization of calcifediol levels in FMS had a positive effect on the perception of pain, and that this economical therapy with a low side effect profile may well be considered in patients with FMS, although with the qualification that further studies with larger patient numbers are needed to prove the hypothesis.
Vitamin D And Parkinson’s Disease
Research has also determined that Vitamin D is important for nerve development and health, mitochondrial function, and anti-oxidation, all of which are important factors in Parkinsons Disease (PD). Dr. Amie L Peterson’s research team at the Veterans Administration Medical Center in Portland, Oregon examined 286 Parkinsons patients, of which 61 were determined to also have dementia. Those patients with higher blood levels of vitamin D performed better on numerous neuropsychiatric tests among those without dementia, especially for verbal fluency and verbal memory. Higher vitamin D levels were also associated with less depression.
The study, entitled Memory, Mood, and Vitamin D in Persons with Parkinson’s Disease (55. doi: 10.3233/JPD-130206) was published in the September 2013 issue of the Journal of Parkinsons Disease, coauthored by Peterson AL, Murchison C, Zabetian C, Leverenz JB, Watson GS, Montine T, Carney N, Bowman GL, Edwards K, Quinn JF of the Parkinson’s Disease Research, Education & Clinical Center (PADRECC), the Portland VA Medical Center, and the Health & Science University, Portland, Oregon, who note that health care practitioners are learning that vitamin D is vital in caring for not only fibromyalgia and multiple sclerosis, but also Parkinson’s, and probably many other neurological syndromes, and that research in recent years has suggested a role of vitamin D in the central nervous system.
They observe that final converting enzyme and vitamin D receptors are found throughout the human brain, and that from animal studies vitamin D appears important in neurodevelopment, up-regulation of neurotrophic factors, stabilization of mitochondrial function, and antioxidation. The objective of their add-on study to a longitudinal study following neuropsychiatric function in persons with PD was to examine the relationship between serum vitamin D and neuropsychiatric function in persons with PD.
Baseline neuropsychiatric performance and serum 25-hydroxyvitamin D were examined for 286 participants with PD. Measures of global cognitive function (MMSE, MOCA, Mattis Dementia Scale), verbal memory (Hopkins Verbal Learning Test), fluency (animals, vegetables, and FAS words), visuospatial function (Benton Line Orientation), executive function (Trails Making Test and Digit-Symbol Substitution), PD severity (Hoehn & Yahr and Unified Parkinson’s Disease Rating Scale) and depression (Geriatric Depression Scale (GDS)) were administered. Multivariate linear regression assessed the association between vitamin D concentration and neuropsychiatric function, in the entire cohort as well as the non-demented and demented subsets.
Using a multivariate model, higher vitamin D concentrations were associated with better performance on numerous neuropsychiatric tests in the non-demented subset of the cohort. Significant associations were specifically found between vitamin D concentration and verbal fluency and verbal memory (t = 4.31, p < 0.001 and t = 3.04, p = 0.0083). Vitamin D concentrations also correlated with depression scores (t = -3.08, p = 0.0083) in the non-demented subset.
The researchers conclude that higher plasma vitamin D is associated with better cognition and better mood in this sample of PD patients without dementia. Determination of causation will require a vitamin D intervention study.
Dr. Moellendorf can be contacted by phone (920) 493-2126, fax (920) 743-1145, email jgmoellendorf(at)itol(dot)com, his website at http://www.all-about-wellness.com, or send a carrier pigeon to 44.84722N and 87.36416W.
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The Journal of Parkinsons Disease
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