Saying “persons with MS” seems clumsy, but when MS patients are asked what they want to be called, they often choose phrases such as people with MS, persons with MS, or MSers.

Back to vitamin D. Many studies have shown that low vitamin D levels increase the risk of being diagnosed with MS and correlate with a higher number of new MRI lesions, relapses, and probably disability. Thus, raising vitamin D levels in the blood has been a target for years, but how much vitamin D to take?

In the United States, vitamin D levels are usually reported as nanograms per mL. Most laboratories establish a level of at least 30 to be acceptable. Many MS specialists believe that levels above 50 and perhaps above 75 are desirable. This, however, is not universally accepted, and there may be risks at higher levels.

There is a new study, analyzing blood that was stored from a large Betaseron study from 2003 to 2005 of over 1400 patients. It seems that increasing vitamin D levels from 20 to 40 reduced new MRI lesions by over 30%. Despite the effects on MRI, the higher levels did not seem to be correlated with brain atrophy or clinical outcomes.

It is possible that increasing the levels above the physiological limit of vitamin D, which is 60, is not beneficial and potentially harmful. A recent study utilized 14,000 units a day, and this showed no added benefit. For most patients, a dose of 2000 to 4000 units a day would probably achieve a level of at least 40. To me, levels between 40 and 60 seem optimal. Some patients may require 5000 units a day or higher. New studies may alter these recommendations.

For more information, see JAMA Neurology, December 2015, page 1458.

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