Multiple Sclerosis, Vitamin D, and the Microbiome

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The MD Magazine Peer Exchange "Modifying the Course of Multiple Sclerosis in New Ways: The Latest Advances in Treatment" features a distinguished panel of physician experts discussing key topics in multiple sclerosis (MS) research and management, including the latest insights into MS pathophysiology, new medication options and their application in clinical practice, and more.

This Peer Exchange is moderated by Paul Doghramji, MD, who is a family physician at Pottstown Memorial Medical Center in Pottstown, PA, and medical director of Health Services at Ursinus College, in Collegeville, PA.

The panelists are:

• Fred D. Lublin, MD, FAAN, FANA, the Saunders Family Professor of Neurology and director of The Corinne Goldsmith Dickinson Center for Multiple Sclerosis, and co-chief editor of Multiple Sclerosis and Related Disorders at the Icahn School of Medicine at Mount Sinai
• Patricia K. Coyle, MD, professor of neurology, vice chair of Clinical Affairs, and director of MS Comprehensive Care Center
• Suhayl Dhib-Jalbut, MD, professor and chief of the Department of Neurology at Rutgers, Robert Wood Johnson Medical School

There is some preliminary data that suggests vitamin D may be a treatment for multiple sclerosis disease activity. According to Dr. Coyle, there have been 2 studies that looked at the effect of vitamin D levels in interferon-treated patients with multiple sclerosis. The patients who had high normal levels of vitamin D experienced significantly less breakthrough activity compared to the patients who had low normal levels. “I think there’s sufficient data showing that vitamin D deficiency somehow greases the pathway to development of MS,” she said.

She regularly checks her patients’ vitamin D levels and recommends supplementation (5,000 mg per day, which does not require a prescription) if they are low. She advises her patients to aim for vitamin D levels that are on the high side of the normal range, provided they do not have a history of kidney stones.

Turning to the subject of the gut microbiome and the role it possibly plays in multiple sclerosis and other inflammatory diseases, Dr. Doghramji brought up the phenomenon of people from countries where the risk for multiple sclerosis is comparatively low whose risk increases when they come to the US. “Is that a microbiome situation that’s being altered which may be increasing their risk of MS?” he asked.

“There are multiple factors associated with risk associated with migration of people from one country to another. One of them might be genetic, the other could be related to the microbiome,” responded Dr. Dhib-Jalbut. Studies have shown that the composition of the gut microbiome varies from country to country and region to region. “There could be bacterial flora that are protective, others that might be harmful,” he said, and exposure to a new diet and environment may alter that composition and ultimately have an impact on disease risk.

However, Dr. Lublin pointed out that migration effects are age-dependent. “If you come here as an adult you keep the risk of the area you came from. If you come as a child it changes,” he said.