Charles Pierrot-Deseilligny, MD
Service de Neurologie 1,
Hôpital de la Salpêtrière,
Assistance Publique- Hôpitaux de Paris,
Université Pierre et Marie Curie (Paris VI),
Paris, France
E cp.deseilligny@psl. aphp.fr
Biography
Publications
PubMed: C Pierrot-Deseilligny
Clinical trial
Pierrot-Deseilligny C, Rivaud-Péchoux S, Clerson P, de Paz R, Souberbielle JC.
Relationship between 25-OH-D serum level and relapse rate in multiple sclerosis patients before and after vitamin D supplementation.
Ther Adv Neurol Disord. 2012 Jul;5(4):187-98.
doi: 10.1177/1756285612447090.
This study meets 4 out of 5 requirements for a nutrient study to be informative.
Requirements for a nutrient study to be informative:
- basal nutrient status must be determined and used as an inclusion criterion
- the change in intake must be large enough to change nutrient status meaningfully
- the change in nutrient status, not the change in intake, must be the independent variable in the hypothesis
- change in status must be quantified
- co-nutrient status must be optimized
Vitamin D, Sunshine, Optimal Health: Putting it all Together
http://www.ucsd.tv/search-details.aspx?showID=29077
Design Components of Interventions/Studies of Vitamin D
http://www.ucsd.tv/search-details.aspx?showID=29081
Recommendations
Dr. Pierrot-Deseilligny has kindly answered my questions about the vitamin D level to strive for in MS and the daily amount of vitamin D3 and co-factors to take / co-nutrient status to achieve that level.
- The co-nutrient status must be optimized/has not been addressed in this study.
- Do you measure the serum 25-hydroxyvitamin D concentration of your patients with MS?
- If so, when do you measure their serum 25-hydroxyvitamin D concentration?
- What level do you strive for?
For us, on the basis of our results, 110 nmol/L (44 ng/ml) becomes the lower limit, and the 'optimal' target zone to try and maintain all year round should be comprised between 112,5 nmol/L (45 ng/ml) and 137,5 (55 ng/ml) (ideally 125 nmol/L (50ng/ml)), which is not so easy to reach and maintain since there are individual variations in compliance and vitamin D metabolism, requiring to adjust individually the daily dose somewhere between 1000 and 5000 IU/d (3000 IU/d on average) using monthly drinkable ampoules of 100 000 IU D3 (In France we do not have tablets of 1000 IU or so for a daily intake…!) that patients can take once a month (for most of them, i.e. corresponding to 3000 IU/d) or every 2 or 6 or 8 weeks, if necessary.
Vitamin D3
- Do you advise your patients with MS to take Vitamin D3?
- If so, how much Vitamin D3 do you advise them to take?
- and their children
In practice, for a better compliance, we feel it is preferable to maintain the same dose all year round. In fact, in the Paris region, seasonal variations of serum levels do not usually exceed 20% and therefore there is not actual risk of 'intoxication' in summer. For people taking really advantage of sunshine -- a minority here because of climate, the distance of sunny regions and Uthoff's phenomenon resulting frequently in natural avoidance of sun exposure -- I simply recommend to stop transitorily vitamine D supplementation in the July-August period.
Co-nutrient status
- Do you advise your patients with MS to take calcium?
- If so, how much calcium do you advise them to take?
What do you consider Vitamin D insufficient?
There is a summer-winter difference of ~ 50%
Do you consider < 44 ng/ml (110 nmol/L) vitamin D insufficient and > 44 ng/ml (110 nmol/L) all year round sufficient?