Vitamin D News--it boosts remyelination!

This just in today----

Vitamin D boosts remyelination
Researchers at the University of Cambridge set out to find what controls oligodendrocyte progenator cells (OPCs) ability to differentiate and create myelin--and discovered that it is Vitamin D which binds and activates vitamin D receptors and controls myelin sheath regeneration.  In fact, remyelination of axons is impaired when Vitamin D receptor (VDR) is blocked.  When Vitamin D was added to the brain's stem cells, production of OPCs increased 80%.
http://www.eurekalert.org/pub_releases/2015-12/rup-asf120115.php

In case we need even more proof that Vitamin D is an important part of MS recovery,   I'd like to round up the latest crop of papers, published in 2015,  linking higher Vitamin D levels with better health for people with MS.


Vitamin D prevents brain atrophy
Researchers at Yale University discovered that higher serum levels of Vitamin D is linked to higher levels of gray matter in the brain, and lower rates of tissue loss, or brain atrophy, in MS. They looked at 65 pwMS and measured brain volume on MRI.   The strongest correlation was between low Vitamin D levels and brain atrophy.
http://onlinelibrary.wiley.com/doi/10.1111/ene.12844/abstract

Vitamin D strengthens endothelial cells
A study from the University of Utah found that Vitamin D stabilizes the endothelium and strengthens the vasculature.  It acts directly on endothelial cells to inhibit vascular leak.  Since inflammation and "auto-immune" reactions are a function of plasmic particles leaking into tissue and setting off an immune reaction (in places like the gut or blood brain barrier)---finding ways to strengthen endothelial cells is vitally important.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607301/pdf/pone.0140370.pdf

Higher Vitamin D levels means more time from RRMS to SPMS conversion
Researchers in the Netherlands found that there was an association of low Vitamin D levels at the start of diagnosis of MS which was linked to an early conversion to SPMS.  Those with higher Vitamin D levels took longer to convert to SPMS.
http://www.ncbi.nlm.nih.gov/pubmed/26598277

Higher levels of sun exposure decreases MS risk
Australian researchers find the UV ray exposure is associated with lower MS progression rates and disease activity, through both Vitamin D and non-Vitamin D pathways.  UV rays modify and regulate immune cells.
http://www.futuremedicine.com/doi/full/10.2217/nmt.15.33


Pretty impressive research!  But are the benefits of Vitamin D for those with MS simply recent news?  Not really.  Dr. Ashton Embry's Direct-MS site is where Dr. Terry Wahls and many of us first heard about the connection between Vitamin D and improved MS outcomes almost a decade ago.  In fact, Direct-MS funded two trials on Vitamin D, and both had very positive results published in 2009 and 2010.  Thanks to the Embry Family for funding and pushing this research!
http://www.direct-ms.org/plannedresearch.html

I've been writing about the therapeutic powers of vitamin D on the vascular endothelium since 2008.  I also included sunshine and UV rays.
 http://ccsvi.org/index.php/helping-myself/endothelial-health

Here's a blog post from 2010, where I explain how Vitamin D provides "vasculoprotection" and prevents brain atrophy.
http://ccsviinms.blogspot.com/2010/07/vitamin-d-provides-vasculoprotection.html

Here's some completely anecdotal evidence from our home:
Jeff's Vitamin D level has stayed around 70ng/mL since he began supplementing and getting rays, and he continues to do well, with no MS progression or disabilities.  His Vitamin D level was at 15ng/mL when diagnosed for MS in 2007.  We had to pay for his first D3 test, since it wasn't covered by insurance. Our doctor asked why we wanted his D3 levels tested, and I shared the Direct-MS site with her.  Since then, our insurance company has seen the light (pun intended!) and covers yearly testing of D3 levels.  As for me, I hadn't been taking any D3 supplements, but that's recently changed. This past spring, my level was 17ng/mL and I was put on a high dose (50,000IU) weekly dosage for 2 months.  My levels are now good at 65g/mL and I maintain that with 4,000IU daily. I have much less arthritis pain and more energy.  There's a link to optimizing Vitamin D levels for healthy people, too.

Also know that there are many environmental factors which can contribute to a lower Vitamin D status- including obesity, older age, living in a more northern latitude with less UV exposure, smoking, skin color and pigmentation, micronutrient and mineral deficiencies (especially magnesium and zinc) and genetic mutations on the Vitamin D receptor (VDR) gene---and all of these factors may influence your serum Vitamin D levels.

So, while this info on Vitamin D is not new or ground-breaking for most following MS research, it is further building on the foundation.  Let this be a shout out to all people with MS.  Find out what your Vitamin D levels are, and make sure you optimize them!  This doesn't always mean simply taking a supplement.  It might involve more sun exposure or phototherapy, quitting smoking, losing weight and eating a whole food diet.  Work with your healthcare provider to establish the best program for you, and get those numbers up!  And don't forget, it's not about one pill or supplement, it's about living a new life.

Be well,
Joan

New research on UV rays and MS symptom reduction

Most of you know about my suggestion that people with MS seek UV ray therapy, by spending ten to fifteen minutes in sunshine daily, or using UVB phototherapy in less sunny locales.  Not just to maintain healthy Vitamin D levels, but to boost levels of Nitric Oxide (NO).

I first wrote about this in the Endothelial Health Program in 2008.  We make sure Jeff gets his daily rays (as well as daily exercise and phytonutrients.)  Here's the program again, for new readers.
http://ccsvi.org/index.php/helping-myself/endothelial-health

In the following note, I wrote about the ground-breaking, Noble prize winning research of Dr. Furchgott--he discovered the importance of Nitric Oxide and the process of "photorelaxation" or the vasodilation that occurs thanks to UVB rays.

Dr. Furchgott discovered the process of photorelaxation over 40 years ago.  What he noted in the lab was that exposure to UV rays changed the endothelium, encouraging nitric oxide production and vasodilation of arteries.  

http://ccsviinms.blogspot.com/2013/06/photorelaxation-uv-rays-and-ccsvi-june.html

It would be decades later Dr. Richard Weller discovered exactly how UVB rays released nitrates via our skin--and explained how this could explain the connection of latitude and heart disease.

Dr. Richard Weller of Edinburgh University reports on research finding that when skin is exposed to UV rays for 20 minutes, vasodilating nitric oxide is released.  This effect is independent of vitamin D levels--and may explain why even if D levels are raised by supplementation, the full benefit is not received.  

http://www.medicalnewstoday.com/articles/260247.php

So, I was understandably interested to see a group of neurologists looking at the effect of UVB rays on people with MS.  

http://www.ncbi.nlm.nih.gov/pubmed/24771567

The neurologists first look at the murine model of MS, called EAE.  But, as Dr. Weller explains in his wonderful TED talk---mouse models do not work when we're discussing UVB rays and their affect on humans....because mice do not process UV the same way we do.  They do not have the same skin.  After learning this, Dr. Weller did all of his research on his student lab assistants, and as he quips, "They are cheap, and no one pickets you saying, save the lab assistants!"

Here's Dr. Weller on his discovery of what UVB rays do in humans.  If you haven't watched this TED talk yet--please do!  You'll thank me later.  (For a scientist, he's really entertaining!) 

http://www.ted.com/talks/richard_weller_could_the_sun_be_good_for_your_heart

Alright, back to the new paper from the Department of Neurology in Munster, Germany, which is titled:
UVB light attenuates the systemic immune response in CNS autoimmunity.

http://www.ncbi.nlm.nih.gov/pubmed/24771567

Here's what they saw in humans....an anti-inflammatory response in MS due to UV ray exposure.

Additionally, patients with relapsing-remitting MS were treated with narrowband UVB phototherapy. Immunomodulatory effects were examined in skin biopsies, serum samples and in immune cells of the peripheral blood. 

Results: Regulatory T cells (Tregs), which are induced locally in the skin-draining lymph nodes in response to UVB exposure, connect the cutaneous immune response to CNS immunity by migration to the sites of inflammation (blood, spleen, CNS). Here, they attenuate the inflammatory response and ameliorate disease symptoms. Treg-inducing tolerogenic Dendritic Cells (DCs) were further necessary for induction of this systemic immune regulation by UVB radiation since ablation of Langerhans cells abolished the UVB-induced phenotype. MS patients treated with UVB phototherapy showed an increase in induced Tregs and tolerogenic DCs accompanied by the downregulation of the T-cell effector cytokine interleukin (IL) -21. The treatment further induced elevated serum levels of vitamin D. Interpretation: Local UVB radiation of the skin influences systemic immune reactions and attenuates systemic autoimmunity via the induction of skin-derived tolerogenic DCs and Tregs.

Now, in English :)  When people with MS were exposed to UVB rays, their lymph nodes responded by sending out regulatory t cells to areas of inflammation.  These Treg cells are"good guys."  They calm inflammation.  And Tregs are enhanced by UVB rays via skin cells.  People who got UVB rays had a reduction of MS symptoms.  No prescription necessary.

That's right---neurologists are telling us that UVB rays helped pwMS! 

In fact, we already know this happens.  It's why UV ray phototherapy is used for patients with psoriasis.  UV light increases Treg cells, which in turn reduce inflammatory cells.
http://www.medscape.com/viewarticle/814678_5

How, exactly, does this happen?  Although it's not mentioned here, other researchers have explained it ...Wait for it.....it's Nitric Oxide!

http://www.sciencedirect.com/science/article/pii/S1089860312000870

http://www.jimmunol.org/content/early/2013/05/28/jimmunol.1202580.abstract
http://www.ncbi.nlm.nih.gov/pubmed/23720815

Nitric Oxide (NO), the marker of endothelial health, is also responsible for helping those treg cells leave the lymph nodes and head to sites of inflammation, calming MS inflammation and symptoms.  The same Nitric Oxide that Dr. Weller has shown to be released from human skin cells by UVB rays.  It's all connected.

The endothelium is the interface between our vascular and immune systems.  The lining of our blood vessels connects every inch of our body.  Nitric Oxide is essential for our health.  And we can boost NO with nutrition, lifestyle, exercise, meditation, and sunshine.

http://www.ccsvi.org/index.php/helping-myself/endothelial-health

I continue to hope that neurologists will reach out across the aisle, and work with endothelial specialists, to understand the intricate interplay between our vascular and immune systems. To move beyond the credo of EAE and autoimmunity, which may exist in mice, but not in men.  To understand the connection of the heart and the brain, via the vasculature.  The ISNVD is looking at this connection, and they want neurologists to join them.

It's all there.

Sunny days ahead,

Joan

What has Changed?

In the five years since Dr. Zamboni's first publication on the connection of MS to extracranial hemodynamics, there have been many changes in mainstream MS treatment and new discoveries made by researchers around the world.

The relationship of the vascular system in MS is being explored, and dealt with in a sideways manner by neurologists.  I do not expect we will ever hear that CCSVI is valid science from neurologists--they will attempt to rename it, requantify slowed venous return and hypoperfusion, and make it their own.  They will call Dr. Zamboni's discovery of CCSVI junk science- while they are working on patenting drugs to address blood flow in pwMS.  This is because neurologists work with pharma and write prescriptions.  They do not deal with the mechanistics of the brain's circulation or with the venous malformations Dr. Zamboni has discovered.  They are not phlebologists or vascular surgeons. For MS specialists, this discovery of hemodynamic alterations goes beyond their practical expertise.

However, one neurologist recently published a paper on the vascular connection to MS, and said this:

"...vascular contributions in MS do appear to support the notion of the vasculature being an initiating target in MS etiology and not simply a bystander presentation of other disease processes. Perhaps the strongest support for this is the number of MS therapies that have been developed, which target leukocyte binding to activated endothelial cells, a central component of the blood-brain barrier (BBB)."
http://www.biomedcentral.com/1741-7015/11/219

Here are drugs being developed by neurologists to address blood flow:
http://ccsviinms.blogspot.com/2013/08/medications-for-ms-addressing-blood.html

What have we learned since Dr. Zamboni first began publishing his research on CCSVI?  

1. People with MS (pwMS) have slower cerebral hemodynamics than normal people.  Their blood flow exits the brain at a slower rate. There are hemodynamic differences between normal people and those with MS. Hypoperfusion is real, it opens the blood brain barrier and it damages the brain.  Whether it is a cause or effect of MS will be debated for decades, however vascular researchers have shown better perfusion and cerebral blood flow (CBF) and cerebral spinal fluid (CSF) flow after venoplasty for CCSVI.

http://www.hindawi.com/journals/msi/2013/598093

http://www.ncbi.nlm.nih.gov/pubmed/23523158

2. People with MS do better with exposure to UV rays, which may explain the long-established link of MS rates and northern latitudes. UV ray exposure relieves symptoms in many.  This may be due to increased vitamin D levels, but it might also be due to the way in which UV rays release nitric oxide, change the endothelium and increase blood flow. 

http://ccsviinms.blogspot.com/2013/06/photorelaxation-uv-rays-and-ccsvi-june.html

3. People with MS are being advised to consider their nutrition and to eat more fruits, vegetables and whole foods and less saturated fats and processed foods.   When Dr. Swank suggested this 60 years ago, it was called "junk science" and people with MS were told it wouldn't do them an ounce of good.  It is now given as helpful advice by the NMSS and the AAN.   

Same thing with exercise.  Only a few years ago, pwMS were advised not exert themselves, but to rest and conserve their energy.  Now we know that physical exercise and activity delays progression, and reverses gray matter atrophy.  Same thing with smoking cessation, stress reduction, and better sleep.  All of these cardiovascular lifestyle changes can make a difference.

http://www.nationalmssociety.org/living-with-multiple-sclerosis/healthy-living/index.aspx

4. Oxidative stress and inflammation are recognized as driving forces in MS progression.  This has lead to exploratons of new modalities of treatment, like the Nrf2 pathway. 

http://ccsviinms.blogspot.com/2012/09/oxidative-stress-multiple-sclerosis-and.html

5. Gray matter health has been recognized as a more accurate biomarker of MS progression than white matter lesions.  Gray matter atrophy will become the new target for MS therapies.

http://ccsviinms.blogspot.com/2012/01/iron-and-gray-matter-what-do-we-know.html

6. PwMS have much higher levels of the clotting proteins- fibrin and endothelin-1 in their serum than normals. These are markers of endothelial dysfunction.

http://ccsviinms.blogspot.com/2012/11/whats-blood-got-to-do-with-it-nov.html

7. Upright MRI has allowed us to see how cerebrospinal fluid and blood return to the heart is slowed and impeded in pwMS.

http://www.fonar.com/news/100511.htm

8.  The venous endothelium is being studied, and researchers are noting that there are changes happening to the lining of the veins in people with neurodegenerative disease.

http://www.biomedcentral.com/1741-7015/11/219

9.  CCSVI is being explored around the globe.  There are literally hundreds of papers published in vascular and neurological journals.  New papers come to press every day.  The connection of blood flow and diseases of neurodegeneration continues, as doctors admit that lifestyle interventions and prevention are staving off Alzheimer's and dementia, while none of the drugs have helped one bit.

http://www.ccsvi.org/index.php/component/search/index.php?option=com_search&task=search

10.  The ISNVD has been established.  There is now an international society of researchers working on understanding the venous connection to neurovascular disease.  Their fourth conference will be held in San Francisco in February, 2014.  The International Society for Neurovascular Disease is convening, publishing, and moving this research forward.
http://isnvdconference.org

All of these connections between MS and the cardiovascular system are new.  And this has happened in just the past five years.  

For those waiting for venoplasty to be accepted as an MS treatment, we have to step back and view the other changes that have happened in MS care.  

The American Academy of Neurologists has several papers featured on their page which connect slowed blood flow and neurodegenerative disease.  They have a patient outreach branch--The American Brain Foundation-- and they have a yearly Brain Fair to discuss diet and lifestyle changes people with neurodegenerative diseases, including MS, should consider.  So much for Dr. Swank's junk science.

Here's a wonderful video Christopher Alkenbrack found on Dr. Roy Swank's work.  It was made in 1989 as part of a Canadian news investigation into the success of Dr. Swank's diet in pwMS as compared to a vastly more expensive and failed chemotherapy trial.  If you haven't seen it, it's a must watch.  

Because today, 25 years later, the NMSS is making these very same dietary and lifestyle recommendations to pwMS.  Yet when asked about dietary changes for pwMS, the neurologist in this video from 1989 says there is "little to no benefit."

https://www.youtube.com/watch?feature=player_embedded&v=lEnn_AZT-SU 

When reporters, scientists, neurologists, MS specialists and others say, "Oh, the connection of CCSVI to MS, that's junk science."  We've investigated it, and there's nothing there"---remind them about Dr. Roy Swank.  Remind them how long it took his observations of "capillary fragility", slowed blood flow, increased fibrin and hypercoagulation to be accepted as part of MS.    

He was noting endothelial dysfunction decades before scientists knew about nitric oxide and how environmental factors contributed to blood flow.  And he has never once been credited by mainstream neurology.  You won't see his name or read his research in their journals.  But he was right.

Dr. Zamboni's discovery has revolutionized how we look at cerebral blood flow, by studying the under-researched extracranial venous system, and utilizing doppler ultrasound to understand venous malformations which alter cerebral hemodynamics.  Like Dr. Swank, Dr. T.J.Putnam and others, he is decades ahead of his time.  His discovery of CCSVI may very well be the rest of the equation in understanding the slowed venous return and endothelial dysfunction found in pwMS.   To say that it is junk science, and that there is no connection of venous return in MS, is to negate scientific fact.  

Joan

Photorelaxation, UV rays and CCSVI

June 20, 2013

Dr. Richard Weller of Edinburgh University reports on research finding that when skin is exposed to UV rays for 20 minutes, vasodilating nitric oxide is released.  This effect is independent of vitamin D levels--and may explain why even if D levels are raised by supplementation, the full benefit is not received.  

http://www.medicalnewstoday.com/articles/260247.php

Why does this matter to those with CCSVI and MS?

If MS is a disease of hypoperfusion (or slowed blood and CSF flow thru the brain)-- looking at all of the environmental issues which may compound this problem is essential.  An improvement in endothelial health and nitric oxide utilization can help in symptom relief.

http://www.ccsvi.org/index.php/helping-myself/endothelial-health

Here's more on how the research connects MS and UV rays--

MS and latitude--

There is a significant link between MS and the amount of sunshine we receive.  The connection of higher MS prevalence for those living in northern latitudes has been long-established---based on 30 years of research.   

http://www.medscape.com/viewarticle/750047

This explains why Canada, Ireland and Scotland have higher rates of MS than countries nearer the equator.

(NOTE-This does not mean living at a northern latitude causes MS.   It means there is an environmental link which has been scientifically noted regarding northern latitudes and the prevalence of MS diagnoses.)

There has been a recent surge in published research on the connection of Multiple Sclerosis and UV rays, in relation to vitamin D.  The connection is being further elucidated every day.   Dr. Embry's Direct-MS has the most complete library of full research papers available online.  Here is a link for those who wish to explore Vitamin D more thoroughly:

http://www.direct-ms.org/journalarticles.html

But UV rays may have an effect on MS, outside of the production of vitamin D.

+++++++++++++++++++++

Dr. Furchgott and the Discovery of Photorelaxation

In reading up on the effect of UV rays on the body, and I came back to the research of Nobel prize winning researcher, Dr. Robert F. Furchgott.  He passed away in 2009, and his university keeps his web page online.  Dr. Furchgott was a professor at SUNY Downstate in Brooklyn, NY---the same place where Dr. Sal Sclafani recently retired and where the first CCSVI conference was held in the US!   Here's Dr. Furchgott's page--

http://www.downstate.edu/pharmacology/faculty/furchgott.html

Dr. Furchgott discovered the process of photorelaxation over 40 years ago.  What he noted in the lab was that exposure to UV rays changed the endothelium, encouraging nitric oxide production and vasodilation of arteries.   In 2009, before he passed, he stated the current working hypothesis-- 

The present working hypothesis is that light photoactivates some material in the vascular smooth muscle, causing the release of some product which stimulates the guanylyl cyclase to produce cGMP. We are planning experiments to test this hypothesis. One possibility is that the vascular smooth muscle in vivo accumulates some "end pro" formed from the endothelium-derived nitric oxide, and that this product releases NO intracellularly when exposed to the proper wavelengths of light.

Seasonal Affective Disorder (SAD) and MS

It's that time of year again!  

The days are shorter.  Sunlight is hard to find.  We bundle up against the cold.  We also put on the extra winter pounds, sleep more and move less.  For those who live in the northern latitudes, the shorter days of winter are a reality.  And this can affect our mood and general health.  As we exercise less, our blood flow slows down. We feel more fatigued, more hopeless. The risk of cardiovascular disease increases.

There is a syndrome doctors know about---called "seasonal affective disorder"  or SAD.  It is very prevelant in northern latitudes.  Most of the association is with mood, or levels of depression.  But it is also linked to cardiovascular disease.

link

What connection does this have with MS?  

MS is a disease linked to northern latitudes, lack of vitamin D and lack of ultraviolet rays.  And we are learning more about the vascular risk.

For 68 years latitude has been identified as an important risk factor in the occurrence of multiple sclerosis (MS), but not satisfactory explanation has been offered for this relationship. Epidemiological studies of MS, however, have failed to take into account the degree of change in the amount of ambient light over the course of the year, a variable which is closely related to photoperiod and latitude. Seasonal affective disorder (SAD), another illness for which latitude is a risk factor, appears to be related to the decrease in ambient light during the winter months, and offers some relevant insights into the geographical distribution of risk for developing MS. 

link

 There is a very strong correlation between UV rays, photorelaxation and cardiovascular disease.

Here's a small sampling on this research.

Dr. Furchgott and the Discovery of Photorelaxation

I've been reading up on the effect of UV rays on the body, and I came back to  the research of Nobel prize winning researcher, Dr. Robert F. Furchgott.  He passed away in 2009, and his university keeps his web page online.  Dr. Furchgott was a professor at SUNY Downstate in Brooklyn, NY---the same place where Dr. Sal Sclafani recently retired and where the first CCSVI conference was held in the US!   Here's Dr. Furchgott's page--

http://www.downstate.edu/pharmacology/faculty/furchgott.html

Dr. Furchgott discovered the process of photorelaxation over 40 years ago.  What he noted in the lab was that exposure to UV rays changed the endothelium, encouraging nitric oxide production and vasodilation of arteries.   

In 2009, before he passed, he stated the current working hypothesis-- 

The present working hypothesis is that light photoactivates some material in the vascular smooth muscle, causing the release of some product which stimulates the guanylyl cyclase to produce cGMP. We are planning experiments to test this hypothesis. One possibility is that the vascular smooth muscle in vivo accumulates some "end pro" formed from the endothelium-derived nitric oxide, and that this product releases NO intracellularly when exposed to the proper wavelengths of light.

Photorelaxation and the Cardiovascular system 

Research into the connection of blood pressure and cardiovascular disease in northern latitudes continues....and the connection appears to be that of nitric oxide and UV rays.

http://circres.ahajournals.org/content/105/10/1031.full

Interestingly, mean systolic and diastolic pressures and the prevalence of hypertension vary throughout the world. Many data suggest a linear rise in blood pressure at increasing distances from the equator. Similarly, blood pressure is higher in winter than summer.3  

++++++++++++++++++++++++++++++++++++++

What can we do about this?  

How can we alleviate SAD, and maybe lessen MS symptoms during the winter months?

I'm going to suggest that for those in the northern latitudes, you might want to look into treatment for Seasonal Affective Disorder.

Talk to you doctor about this, especially before beginning a new exercise program or diet.

Do all you can to keep your vitamin D level optimized, but also look into UV treatment with an approved light box.

Move as much as you are able. Keep exercising, keep the body in motion.

Stick to your healthy diet.  Lots of fresh greens and fruits.  Yes, produce is harder to find.  Move to frozen veggies and fruits- if you're unable to find fresh produce.

If you're feeling depressed, please talk to family members, friends and your doctor.  The "winter blues" are not normal, and could be sign of other issues, like SAD.  There is no need for you to suffer in silence.  

MS is difficult enough.  If the winter months are bringing a worsening of your symptoms, and a change in your mood---please look for help. 

You are not alone.

be well,

Joan