Vitamin D and the Course of Disease in Multiple Sclerosis

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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

“When you talk about what causes MS, we don’t know exactly how to put the pieces of the puzzle together. Environmental factors appear to trump genetic factors and some of these environmental factors are potentially modifiable: vitamin D deficiency, Epstein-Barr virus exposure, diet, obesity, whether you smoke or not,” said Dr. Coyle.

“Clearly the host immune system is attacking its own body organ, the central nervous system, the brain and the spinal cord. But I don’t want to give short shrift to the neurodegenerative phase. This is the substrate of progressive MS which we have no disease modifying therapy for at the current time and we now know that neurodegeneration is ongoing from the very beginning of the disease,” she said.

Dr. Doghramji asked the panelists to discuss the risk associated with low levels of vitamin D, the target levels patients should maintain, and the appropriate age to begin testing vitamin D levels.

Dr. Dhib-Jalbut said clinicians should check for vitamin D in almost all patients now because about 40 percent of the MS population is deficient in vitamin D. He noted that “there is mounting evidence that vitamin D is important because it’s not just a vitamin, it’s an immunologically active molecule that has beneficial effects on the immune system.”

Dr. Lublin noted that although it appears that vitamin D does play a role in MS pathophysiology, “it has not yet gotten beyond the level of an association.”

“While it could be that vitamin D affects the course of MS it may be that MS causes low vitamin D, or that they’re separate and just have a shared metabolic pathway that’s altered. We need to refine the story better,” he said.”