Multiple Sclerosis and Vitamin D

English: This slide shows the global prevalenc...

English: This slide shows the global prevalence of multiple sclerosis. Based upon http://en.wikipedia.org/wiki/Image:MS_Risk.jpg (Photo credit: Wikipedia)

Multiple Sclerosis is a devastating disease. For some it can be nothing more than one attack of some strange neurologic symptoms that never recur. However, all to often MS is a slow steady decline into complete debility. And making it even more tragic is that it most often starts at a young age, most typically in a person’s twenties. And currently we have no idea what causes it and our treatments are very ineffective.

However, vitamin D has been well-studied in its relation to MS. Multiple studies have shown that vitamin D supplementation or normal levels are protective against MS decreasing the risk of having MS substantially. In fact studies done as far back as the 1990s showed that Vitamin D completely inhibited a mouse model for MS called experimental autoimmune encephalomyelitis. In fact Vitamin D as a protector against MS would explain the geographic distribution of MS that we see. It is almost nonexistent in equatorial areas and risk goes up with higher latitude. It also explains why in Scandinavian areas there is more MS inland than on the coastal areas where they eat more fish which is rich in Vitamin D.

These studies beg the question why Vitamin D is protective? We don’t know but it does stand to reason that it might be helping fight back an infection and there has been a lot of research looking into varicella and ebstein barr virus as possible causes or contributors to MS. Some studies have even looked at Acyclovir (an antiviral medication) as a possible treatment for MS. Two studies were done back in 1996 and again in 2005 and both were randomized controlled trials which showed benefit but did not reach significance due to small sample size (both were only about 60 patients).

First off a large randomized trial of Vitamin D for MS patients still has yet to be done and this has to be done NOW. There is no reason to wait. If we can demonstrate the benefit of Vitamin D in MS we can finally do what we should have been doing for the last 20 years for everyone, checking levels and supplementing as needed to make sure no MS patient is deficient.

Secondly, a large randomized trial of acyclovir needs to be done. So many MS treatments now are mostly geared toward suppressing the immune system. If it turns out it is related to a chronic viral infection then we are doing a huge disservice. However, given that it is a myelin related disease (the lining around the nerves) I feel it is more likely that we would find that a virus triggers an autoimmune reaction causing MS. If that is the case you will see some benefit from acyclovir but not much. But that would explain in part why Vitamin D helps and we need to see if any other vitamins or supplements can help modulate the immune system in that way. But that is for another post.

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