Vitamin D & MS: An interview with Dr. Brenda Banwell

During last week’s webcast, Living Well with MS: Lifestyle, Diet and Complementary Therapies, we received a number of questions about vitamin D. We sat down with Dr. Brenda Banwell, MD, following the webcast to get answers to some of the most popular questions you submitted.

How much vitamin D should a person with MS be taking?

The graph below shows the current recommendations, for the general population, according to the Canadian Food Guide. If you are living with MS, I would recommend that you work with your healthcare provider to obtain your vitamin D blood levels (also called a 25-hydroxy vitamin D), which is a measurement of the circulating vitamin D in the body. vitamin D levels should be around 75 nanomals per liter (Canada) or between 40-80 nanograms per milliliter (United States). 

Many people with MS will require much higher doses than is recommended for the general population in order to bring their blood levels up, particularly in the winter. Under the care of a physician, it wouldn’t be unusual for a person with MS to take 3,000 to 5,000 IUs per day. But, if you are taking vitamin D in doses beyond what is recommended, you will want to make sure you are being monitored by a doctor, as vitamin D can potentially be toxic.

Age group Aim for an intake of international units (IU)/day
Infants 0-6 months old 400
Infants 7-12 months old 400
Children 1-3 years old 600
Children 4-8 years old 600
Children and Adults 9-70 years old 600
Adults over 71 years old 800
Pregnant and Breastfeeding Women 600
*This includes vitamin D from both food and supplements

Is it better to get Vitamin D through nutrition or sunlight?

The most effective way of obtaining vitamin D nutrition is through sunlight acting on the skin – particularly for people with lighter skin. People with darker skin absorb less vitamin D. If we weren’t worried about the negative effects of sunlight, then it would be a very good way (in the sunnier months) of obtaining vitamin D – but of course we have to balance the risks. We live in a world where there are harmful effects of ultraviolet (UV) radiation and skin cancer is a very real concern. Therefore, sunblock has become a major health initiative, and if you wear sunblock, you also block vitamin D production pretty dramatically. I advocate for the safer route of wearing sunscreen and taking oral supplements in order to obtain vitamin D.

Is it possible to get enough vitamin D from sunlight alone?

During certain times of the year, the amount of UV radiation from the sun is so low that no vitamin D is even made. One expert, Dr. Vieth, states that if you’re taller than your shadow, there’s not enough UV radiation to synthesize vitamin D through your skin. Typically in temperate climates, this would be from the end of September through the middle of April. So, during the winter months, we don’t make enough vitamin D on our own, and likely need supplements to keep normal blood levels.

Can vitamin D help prevent MS in family members of people with MS?

There haven’t been any primary prevention trials using vitamin D, so it would be very difficult to assume that vitamin D alone would be sufficient to prevent MS. However, the data at this point would suggest that there may be a connection between vitamin D levels and MS risk. One study looked at military recruits in the US who were sampled as part of routine blood screening when they entered the military. This study found a fairly strong relationship between levels of vitamin D and MS. Those who had higher levels of vitamin D at the time of the routine screening were much less likely to be diagnosed with MS in the 5 to 10 years following the screening than those with lower levels. What that suggests is that if you have robust vitamin D during childhood and teenage years, it could be one of the factors that reduces your MS risk.

Having healthy vitamin D levels and nutrition during childhood and teenage years is important not only for reduction in MS risk. It is important for bone health, and may also help reduce your risk for other autoimmune diseases. I would suggest anyone living in places where we get little sunlight during half of the year take steps to maintain their vitamin D nutrition. And, for family members who have an increased risk of MS, I think it would be a really wise investment to have your vitamin D levels tested and take vitamin D supplements if your levels are low.


Please tune in to the MS Connection blog tomorrow as Dr. Banwell discusses other supplements that are potentially helpful and harmful for people with MS  and throughout the coming week as we chat with Drs. Allen Bowling, Timothy Coetzee and Albert Lo about the roles of diet, exercise and other holistic approaches to living well with MS.

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Brenda

Brenda Banwell, MD

Division Chief, Neurology, Professor of Pediatrics (Neurology), Children's Hospital of Philadelphia, University of Pennsylvania

    33 Comments

  • Kay H   Jun 18, 2013 3:27 PM
    I was diagnosed with MS in 2004. I began taking Vitamin D3 in 2007. At first I took up to 20,000 IU's of D3, I reduced it to 10,000 IUs. I watched Canadian studies prior to taking D3. I have not had an exhaserbation, since 2004. I recently tested and was at 85%. This told me that I was probably very low before taking Vitamin D3. It's an inexpensive vitamin, and easy to find.
  • Kay H   Jun 18, 2013 3:27 PM
    I was diagnosed with MS in 2004. I began taking Vitamin D3 in 2007. At first I took up to 20,000 IU's of D3, I reduced it to 10,000 IUs. I watched Canadian studies prior to taking D3. I have not had an exhaserbation, since 2004. I recently tested and was at 85%. This told me that I was probably very low before taking Vitamin D3. It's an inexpensive vitamin, and easy to find.
  • Priscilla Michka   Jun 18, 2013 3:29 PM
    I appreciate your help with my MS. thank you
  • LANA FAULHABER   Jun 18, 2013 3:51 PM
    Why are there not studies on the elderly done with ms ? We would know what to look forward to.
  • Jennifer Creagh   Jun 18, 2013 4:41 PM
    I just want to say that if I get into sunlight it causes me to have a ms attack. I also don't like milk.
    Can you help me out with a good safe Diet?
    I really don't know how to deal with this.
  • Allora   Jun 18, 2013 4:46 PM
    If vitamin D levels correlate with RISK of ms, it is more possibly preventive not curative?
  • nicky   Jun 18, 2013 5:01 PM
    My comment is to James who is claiming to have a cure to diseases. First of all he is not even naming MS he keeps referring to diseases please do not fall for his $1,000 fee for his cure. He is non sense and shame on him for charging if he had a cure. James you are a scam artist shame on you.
  • jbrown04  Jun 18, 2013 5:59 PM
    WATCHING SOMEONE GO THROUGH CHALLENGES OF MS.
  • Sharon   Jun 18, 2013 7:31 PM
    I also believe there is a cure, however we do live in a world that's all about money!!!
    I have the possibility of MS. I was diagnosed with transverse myelitis 11 years ago. With a normal brain MRI until 5 months ago. I have no symptoms but my neurologist likes to check every year.
    11 years later I have 3 lesions on my brain. One of them is the one they are concerned with. I went to 3 opinions and they all said they are not sure but they think I might have very mild case of ms. They give me two options. Take medication to be
    on the safe side or do MRI every six months. I Decided to changed my life. Since I am a health coach and I studied so many Different approaches. I know exactly who I needed to see.
    I want to a dr who practices functional Medicine. Their theory is treating the Underlying cause rather then the Symptoms. They treat you as a whole and by doing this they can reverse any illness!
    So my journey started this march and the dr promised me if I do what he tells me to he can ELIMINATE THESE LESIONS OF MY BRAIN!!! I changed my diet and my lifestyle and I am very excited!! If anyone has a question please feel free to email me sharonklein21@gmail.com
    Good luck!!!
    Always remember what you eat is what you are!!!!!!
  • Heather   Jun 18, 2013 7:52 PM
    I was diagnosed with ms in 2010. I was taking avonex and recently just changed to techfidera. I find that staying in the sun for a bit actually makes me feel a little better but i do take supplements. I dont really eat to much dairy and i dont drink milk because my stomach is very sensitive.
  • DJ   Jun 19, 2013 2:13 AM
    Dear Dr. Banwell,
    Why should Canadians need less vitamin D3 than US citizens? The conversion factor for ng/mL 25-hydroxy vitamin D3 to nmol/L is 2.496. Thus, 75 nmol/L is only 30 ng/mL. A level this low is likely in the deficient range. 60 ng/mL is smack dab in the middle of 40-80 ng/mL range quoted for US citizens. This works out to 150 nmol/L. This is the ideal target value for 25-hydroxy vitamin D3. Moreover, Pierrot-Deseilligny et al. 2012 reported that every 10 nmol increase in 25-OH-D level, up to 110 nmol/L, was associated with a reduction in the relapse incidence rate of 13.7%. http://www.ncbi.nlm.nih.gov/pubmed/22783368 A mere 30 nmol/L increase in 25-hydroxy vitamin D3 puts it in the efficacy range of interferon beta1a with a 41% reduction in relapses.
  • Terri   Jun 19, 2013 9:55 AM
    I was diagnosed with MS in 2007, but had no symptoms at all. I had to have an MRI for a head injury when I was told about the lesions. I decided to start on Copaxone just the same to hopefully keep it at bay, and remained symptom free until 2012. Had a routine MRI in 2012, and two active lesions were discovered. The stress took a toll on my body and I had a serious "pity-party". But, with the help of an Holistic Dr. I decided to make some serious changes to the way I eat and live. I am now on the Paleo Diet. No dairy, gluten, soy or corn in my diet. It did take some time, but worth my health! I also practice Yoga 5 days a week and feel Yoga is the key to having the flexibility and movement needed with MS. I also work out regularly and take my vitamins ... especially D!! Keep a healthy attitude everyone and never give up!
  • Avid_Advocate   Jun 19, 2013 2:10 PM
    My doctor's advice is for me to stick with 4000 units vitamin D daily. That is my neurologist who specializes in MS. Why is your recommendation so much lower for adults? My doctor wants us to have a level of above 60. I was at 49 and I just tested at 75 but I am lowering my dosage to about 2000-3000 units. Still, that is a lot higher than your recommendation. Your thoughts?
  • Kate Olson   Jun 19, 2013 5:56 PM
    I'm interested in the information that was to be presented in June 19 blog, providing information on "other supplements that are potentially helpful and harmful for people with MS and the information throughout the coming week as we chat with Drs. Allen Bowling, Timothy Coetzee and Albert Lo about the roles of diet, exercise and other holistic approaches to living well with MS." (taken directly from the June 18 blog).
  • Susan   Jun 19, 2013 7:33 PM
    I have a friend whose neuroligist actually prescribed her 50,000 IU of Vitamin D per day! I am a little worried as when she first told me about this, I told her certainly it must be only 5,000 IU, but when I saw the label on her pill bottle, it does say, in fact, 50,000 IU! Since you state that you can have too much, I imagine I need to tell her to stop taking it. Why would he prescribe so much? She does notice a big difference since taking it though. What would some side effects be from taking too much?
  • Minnie   Jun 20, 2013 2:57 AM
    Trying to find specific diet for people with MS. I was told to stay away from red meat--that's it. That was 13 years ago. Thank you for the info on vitamin D but where may I find info on FOODS?
  • Miriam Mattos   Jun 20, 2013 6:23 AM
    Eu tenho MS ha 13 anos. Descobri isso por causa da Visao dupla. Tomei Avonex 4anos, Rebif 3anos, Tysabri 1ano e agora estou ha 4meses sem tomar nada, estou me sentindo super bem. Estou esperando por uma nova droga Tecfidera. Por que tenho que tomar esta droga se nada sinto? Sei que e uma droga muito forte. Please translation it and help me. God bless you.
  • mark naffziger   Jun 20, 2013 8:50 AM
    My sources of MS Dr.s is very limited. I end up reading this email stuff and looking up info on the internet. My vitamin D is at 6 pills a day, I read a MS Express Email that my doesage should be a minimum of 12 pills. My Dr. claims 6 is max for me after having my levels checked. Traveling to see Dr.s is not an option so I go with what I think is best and not nessasarly reliing on my Dr. 100 %. How can I know info given to me is accurate? I wonder if more D would improve my mobility ? I have a physical therapist I go to once a week and excersise is the best Medicine for me so far. I am curious what you think about this situation I have.
  • Cindy   Jun 20, 2013 1:42 PM
    I thought you could not take Vitamin D without taking Vitamin K.. I did not see any mention of that.
  • John Connor   Jun 21, 2013 2:52 PM
    Can't site the Article but read last year a leading medical exponent saying the levels where but d got anywhere near dangerous wax incredibly high - he took something like 50000 uda a day.
    Out at the mo - prob have it stashed on my computer.
  • Eddy   Jun 22, 2013 4:04 AM
    > Pierrot-Deseilligny et al. 2012 reported that every 10 nmol
    > increase in 25-OH-D level, up to 110 nmol/L, was
    > associated with a reduction in the relapse incidence
    > rate of 13.7%.
    >
    > http://www.ncbi.nlm.nih.gov/pubmed/22783368
    >
    > A mere 30 nmol/L increase in 25-hydroxy vitamin D3 puts
    > it in the efficacy range of interferon beta1a with a 41%
    > reduction in relapses.

    That's a great research paper. Thanks for sharing it!
  • maria1  Jun 22, 2013 1:48 PM
    Thank you Dr. Banwell. It is sweet having a Professor of Pediatrics to lecture. Makes me feel younger! Also having a daily recommended dosage of Vitamin D is good to know. Not being vague is a good thing and is appreciated.
  • Diane   Jun 23, 2013 8:48 AM
    Having MS I was taking 2,000 iu daily (doctor aware) and the bloodwork for my vitamin D levels came back low.
    Then going to a MS seminar in NY regarding vitamin D the recommendation was 8,000-10,000 IU of vitamin D3 daily for people living with MS.
  • rhonda matthews   Jun 23, 2013 10:11 AM
    I read an article yesterday about the FDA regulating supplements. I am so scared as I take 40'000 IUD of it a day. I have also been taking Alpha Lipopic acid along with Chorella which keeps me regular. The D is awesome as I so miss it and can tell when I am out. Will I need script for these if this passes? Or will I just not be able to get them at all? rhonda
  • Pamela Viers   Jul 1, 2013 11:50 AM
    When I read the negative comments left here I really don't want to participate in a ***** fest. I feel better about handling my issues on my own.
  • Debbie Ruffner   Jul 3, 2013 3:48 PM
    I have severe fatigue, I don't work anymore,when I get to hot or to tired I know I will pay for it with sleeping almost all the time for 3 to four days. I have not found anyone else that this happens to. Am I just going crazy?
  • Ann Marie   Jul 3, 2013 7:53 PM
    @Debbie Ruffner - no you aren't going crazy. There are days, especially in the Summer when the heat is oppresive, that I simply can't get out of bed. The fatigue is so debilitating. Dr has tried Provigil to no avail. I just to ride it out.
  • Kimberley a. Rolle   Jul 23, 2013 3:27 PM
    Dear Dr.
    Was told i have MS 2 years ago I'm on avonex injections weekly. but in researching I see in your country there is a lot of support, how can i get in ternational support
  • Avatar
    JOE_T  Jul 24, 2013 3:56 PM
    I'm 36 yr old and was diagnosed with MS a few months ago. The first thing my Dr recomended was start taking 1000 IU daily of vitamin D. This was after a blood test. I'll have another blood test in a few months to see if that 1000 IU is helping with my levels.
  • MANEL WIJESIRIWARDANA   Jul 30, 2013 7:31 AM
    My 48year daughter has been suffering from MS for the past 10 years. She is deaf and also blind on one eye. She has two sons 10 and 6 years old. Her husband divorced her after she got MS. The Court assigned me the guardianship for caring for all 3 of them. My daughter refuse her Copaxone daily injection. She also refuse to take her Vitamins or do any exercise. She barely eat any food. She needs psychological concelling and mental encouragement, I need her to get the necessary occupational therapy and physical therapy. It has been very difficult to get any help from Medicare. I'm her mother and I'm totally exhausted. Please Help!!!
  • mouni menas   Aug 7, 2013 3:19 PM
    mu sun ,16 years old , diagnosed with MS in mars 2013. we are from algeria , he takes "rebif 44". what's te the dose idéal of vit d3 dor him ? thanks.
  • Avatar
    sarahcheverie  Aug 9, 2013 12:37 PM
    When I moved to Alaska I began to take Vitamin D every day, I was diagnosed in 2013 and have been taking Vitamin D the whole time. In Alaska it is necessary to take it because, well, the sun is not always around. I find the VD theory kind of weird because of this, but I am still taking it, taking more.

    -Sarah C
  • FORAM GADA   Aug 10, 2013 7:55 AM
    HOPE FOR THE BEST AND FORGET THE REST.