The correction of vitamin D deficiency in autoimmune disease is a therapeutic approach based on scientific evidence.
Studies have shown that vitamin D, in addition to the known role in calcium homeostasis, has numerous actions in the body, with major interventions in the immune system.
The amplitude of its action and the fact that all cells in the body have receptors for vitamin D, suggest that it is not a vitamin but the precursor of a hormone. Research demonstrates that vitamin D is in fact a steroid hormone that targets more than two thousand genes (1).
Vitamin D is hardly provided by food and it is obtained mainly by its synthesis by the skin. This synthesis depends on sun exposure of arms and legs for at least 15-20 minutes from 10am to 3pm to ensure the necessary daily amount of vitamin D (1).
In todays’s modern life, we spend most hours of the day under coverage of buildings and it appears that the vast majority of the world's population is vitamin D deficient, even in sunny latitudes.
Besides of the lack of sun exposure, it has been acknowledged that some individuals have genetic mutations that impair the production of vitamin D, dramatically reducing the conversion of vitamin D3 into its active form.
The majority of people with autoimmune diseases belong to this group and present serious deficiencies of the active form of vitamin D (the hormone). Among the autoimmune diseases, multiple sclerosis is the one in which the evidence is most striking. There are thousands of studies that show the relationship between multiple sclerosis and vitamin D3 deficiency.
In 2007, a study involving 12 patients showed that a gradual increase in vitamin D3 dosing over 7 months (from a daily dose of 4,000 IU to 40,000 IU) reduced the number of active lesions seen on patient’s imaging with no side effects noticed (2).
A clinical trial study published in 2012, compared Multiple Sclerosis patients treated with interferon for one year. One group received interferon plus placebo and the other group received interferon plus to vitamin D (weekly dose of 20,000 IU). The group treated with vitamin D showed reduction in the number of active lesions plus several other improvements and no side effects (3).
Vitamin D is an immune modulator and not an immunosuppressant. It decreases the autoimmune response by modulating the response of the Th17 lymphocytes (T helper 17 is the key cell involved in autoimmune diseases), while improving our immune defenses against infectious diseases, as seen for example, in the treatment of pulmonary tuberculosis (4).The Th17 lymphocytes are involved in all types of autoimmune responses. Not only patients with Multiple Sclerosis benefit from vitamin D modulating therapy but so do most of the common autoimmune diseases such as Rheumatoid Arthritis, Lupus, Hashimoto’s thyroiditis, Psoriasis and Inflammatory Bowel Disease (5).
According to the pioneering experience of Dr. Cicero Coimbra, MD, PhD, Associate Professor of Neurology and Neuroscience at the Federal University of São Paulo, Brazil, the correction of vitamin D levels may reverse in part or fully reverse the symptoms of Multiple Sclerosis and make the disease go into remission (6).
Individuals with Multiple Sclerosis are partially resistant to vitamin D due to genetic polymorphisms or mutations in the pathway to produce the active form of vitamin D (2). Therefore, they need larger doses of vitamin D to surpass the defective production of vitamin D until its final active hormonal form.
Because the therapy with high doses of vitamin D involves some risks, this treatment requires personalized monitoring with labs and radiological tests to ensure safety and appropriate adjustments of vitamin D.
(1) Holick MF. The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problems. Plume Ed, 2010.
(2) Kimball SM, Ursell MR, O'Connor P, Vieth R. Safety of vitamin D3 in adults with multiple sclerosis. American Journal of Clinical Nutrition. September 2007. vol. 86 no. 3 645-651.(2) Sundqvist E, Bäärnhielm M, Alfredsson L, Hillert J, Olsson T, Kockum I. Confirmation of association between multiple sclerosis and CYP27B1. European Journal of Human Genetics. 2010 December; 18(12): 1349–1352.
(3) Soilu-Hänninen M, Åivo J, Lindström BM, et al. A randomised, double blind, placebo controlled trial with vitamin D3 as an add on treatment to interferon ß-1b in patients with multiple sclerosis. Journal of Neurology Neurosurgery and Psychiatry. 2012; 83:565-571.
(4) Martineau AR, Timms PM, Bothamley GH, et al. High-dose vitamin D3 during intensive-phase antimicrobial treatment of pulmonary tuberculosis: a double-blind randomised controlled trial. The Lancet, Volume 377, Issue 9761, Pages 242 - 250, 15 January 2011.
(5) Maddur MS, Miossec P, Kaveri SV, Bayry J. Th17 Cells: Biology, Pathologenesis of Autoimmune and Inflammatory Diseases, and Therapeutic Strategies. The American Journal of Pathology. 2012 July; Volume 181(1):8-18.
(6) Vitamina D - Por uma outra terapia (Vitamin D - For an alternative therapy). Documentário online em: http://www.youtube.com/watch?v=erAgu1XcY-U
Vitamin D Protocol