Doctor Cicero Coimbry’s presentation for the members of the House of Chamber in Brasilia, the capital of Brazil, concerning the treatment of multiple sclerosis with high doses of vitamin D. August 2013. Cicero G. Coimbra, MD, PhD, Internal Medicine and Neurology Lab of Neuropathology & Neuroprotection, head Associate Professor of Neurology and Neuroscience Federal University of São Paulo – UNIFESP.
- Treating multiple sclerosis with high doses of vitamin D
- How much Vitamin D was used in clinical study?
- Effects of supplementing high doses of Vitamin D
- Doses of Vitamin D throughout the study
- Vitamin D for multiple sclerosis - summary
- Let’s move on to using vitamin D in patients with Parkinson.
- Leaving a bit behind the topic of the influence of vitamin D on MS and Parkinson…
- Read more
Treating multiple sclerosis with high doses of vitamin D
My experience mainly concerns high doses of vitamin D. Answering the questions about multiple sclerosis: around the year 2002 we started to prescribe 10.000 IU of vitamin D a day to the patients with MS, on the basis of the data available back then in the medical literature, showing that vitamin D is an immunoregulator, regulating the immune system and not inhibiting it, stimulating autoimmune system and effectively helping it fight infections, inhibiting improper autoimmune reactions, technically known as TH17.
Therefore, vitamin D is theoretically an ideal component or a pharmaceutical substance, as it offers the power of a hormone that fights contagious diseases, since we do not inhibit the defense system, quite the contrary, we increase the potential of normal defense reactions.
How much Vitamin D was used in clinical study?
We started the treatment with the doses of 10.000 IU of vitamin D a day and observed the improvement in our patients. With the dose of 10.000 IU the disease did not enter remission. The recurrences become rarer, but the diseases was still active. Each time, when our patients experienced emotional stress, the risk appeared that this emotional stress will entail a new attack.
Effects of supplementing high doses of Vitamin D
Years had been passing and we monitored the state of the patients under the influence of the high doses and observed that when we increased the doses, our patients experienced more positive effects. Around 2-3 years ago, we could determine an ideal dose, which could inhibit the pathological activity of the autoimmune system and it is around 1.000 IU per 1 kg of bodyweight. It is an average dose for the patients, as in reality, an individual dosage calculation is applied, which may be higher or lower, adequately to the state of each patient. We adjust these doses individually to the level of the parathyroid hormone (PTH). When the level of vitamin D increases the level of PTH is decreased. We are therefore trying to maintain PTH level at to bottom boundary of the normal scope.
We noticed that by maintaining the level of the parathyroid hormone (PTH) in the lower levels of the norm (without suppressing it), we could maintain the disease in remission. To achieve such low levels, we needed a dose, on average, of 1000 IU/kg of bodyweight.
To counteract the side-effects, which may appear with such high doses, unless a strict diet is applied, we excluded from a diet the products rich in calcium, primarily milk and its derivatives and also the products enriched in calcium, such as oat, rice and soya milk. When such precautions are taken, high doses may be considered quite safe.
In other words, we ask our patients for a minimal liquids intake of at least 2,5 l a day (water, juices, drinks, tea, soups…). All this together needs to provide 2,5 l a day as then diuresis of around 2 liters of liquids becomes possible, which maintains calcium in the dissolved state and eliminates it with urine. When calcium remains dissolved, avoiding its concentration, we may counteract evoking the biggest fear manifestation of vitamin D poisoning, which is nephrocalcinosis.
Doses of Vitamin D throughout the study
The doses of vitamin D (and its level in blood) have been gradually increased for years. In the past, we did not use any specific diet and observed that calcium levels were above the normal rage, we therefore maintained vitamin D level, but asked our patients to eliminate dairy products and other products rich in calcium. When this happed, we noticed the reduction of the level of calcium in the urine to the level even lower than before starting the therapy with vitamin D. Based on that, we could increase the doses of vitamin D to – as already mentioned – a daily dose on average of 1.000 IU per kilogram of bodyweight.
For obese patients, the dose may be even higher than the average one. Therefore, for example, it wouldn’t be an absurd for a person weighing 130 kg to take a dose of 200.000 IU a day. To compensate the subcutaneous fat absorption – as dr. Holick explained, subcutaneous fat eliminates vitamin D from the bloodstream – it is necessary to prescribe an additional amount to prevent vitamin D deprivation from the subcutaneous tissues, in connection to the vitamin D available in the body.
However, such doses need to be prescribed under strict clinical and laboratorial control and the patients should come to periodical control visits to make sure they follow the diet, as this is extremely important.
Higher doses of vitamin D than the ones we prescribe may bring the reverse effect. A person weighing 70 kg, who takes a daily dose higher than 150.000 IU of vitamin D, in any form, may lead to the reduction of calcium in bones, causing hypercalcemia. This may be stopped by the medicines known as bisphosphonates, such as alendronian, etydronian and others to effectively block this toxic effect.
However, we rarely reach for such doses, only in the case of patients, whose weight and body mass is far above the norm.
Vitamin D for multiple sclerosis - summary
I am not sure if I answered correctly my question about experience with vitamin D, but I only wanted to add that since 2002/2003, when we started, until today, we have been treating almost 1130 patients and 705 of them were treated with high doses of vitamin D. Since we started treating patients with the doses of 10.000 IU, we have had 1130 patients and the results are simply fantastic. There are certain patients here in the audience and we have a great satisfaction that we gave them their lives back. These patients do not have other attacks of the disease or changes in the magnetic resonance results. They are not afraid of becoming blind or paralyzed or that they will become disabled. They can look into the future and see normal life there.
The only thing that we do not know yet is for how long we should maintain high doses of vitamin D. This question is still unanswered.
The question from the audience:
Is it connected to some other drugs?
Which met the answer:
No, absolutely not. Only high doses of vitamin D.
As for the form of the dose, like I said, professor Michael Holick provided a great explanation that there are many forms of dosing, which are equally effective. When we apply high doses, such as the ones I mentioned, administering vitamin D under the tongue is an ineffective form. We will not achieve the same results in such a way and we have the feeling that the form based on lipids, mixed with oils gives a better effect than combining vitamin D with other forms, even if the oil is mixed with vitamin closed in dry capsules.
Let’s move on to using vitamin D in patients with Parkinson.
Vitamin D causes a trophic effect in the nervous system, therefore it is extremely important. It also demonstrates antioxidant effect by stimulating nerve cells to glutathione production and synthesis, which is a vital antioxidant. It also produces neurotrophic factors, which are the substances that maintain nervous cells alive.
These neurotrophic factors or neutrotrophins are produced from glial cells, such as astrocytes, under the influence of the stimulation by vitamin D. Vitamin D is picked up from the bloodstream and transformed in its active form, behind the blood-brain barrier, influencing all cells of the nervous system, affecting glial cells, stimulating the production of neurotrophic factors, which –as the name suggests – are responsible for the vitality of nerve cells, maintaining them alive.
Therefore, in every type of neurodegenerative diseases it is highly recommended to prescribe vitamin D to patients and I believe that there is no sense in prescribing the doses higher than 10.000 IU. Usually it depends on the patient’s weight, but we prescribe 10.000 IU to the patients with the bodyweight 50-55 kg. However, what we do for patients with Parkinson diseases is only normalizing the levels, reduction of PTH which is above the norm, leaving PTH it the lower levels of the normal range.
The dose may vary from 10.000 IU to 25.000 IU a day for the patients with Parkinson disease.
Leaving a bit behind the topic of the influence of vitamin D on MS and Parkinson…
I monitored more than 1200 patients with Parkinson’s diseases. The biggest problems of these patients consists in the fact, that the cause of their diseases seems to be the state of chronic suffering. The patients with Parkinson have always been restless, worrying individuals, who chronically suffered.
Before the diagnosis or before the beginning of the disease, these individuals experienced exceptional emotional stress. When these people faced a small problem, they reached the level of suffering incredibly above the norm. This cannot be noticed unless you carry out an interview with the patient and ask him or her about this concrete problem. It seems that this emotional stress causes forming in these people a neurotoxic substance called salsolinol or N-Methyl(R)-Salsolinol, which is a strong neurotoxin, which destroys neurons responsible for the production of dopamine, since it is formed inside these cells, which produce dopamine. This substance is found in high amounts in the cerebrospinal fluid of these people.
Vitamin D deficits in these patients may be rectified and in this way we may help these people, but their biggest challenge is to achieve lower level of suffering.
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