MS in Family Members
There are very substantial risks of developing MS in family members of people with MS (see the page on Genetics). Children of a parent with MS have about a 30-40 times higher risk than the rest of the population. This may be even higher if they smoke and are female. But there are now good data on reducing MS risk with adequate sun exposure and/or vitamin D supplements. I believe it is now a clear responsibility for doctors managing people with MS to advise them of this important avenue through which to potentially protect their children and other relatives from developing the disease.
The evidence for this risk reduction with sun exposure or vitamin D supplements or both is now clear. The 2003 Tasmanian study showed a major reduction in risk of MS for those who get adequate sun exposure, particularly in childhood in winter.1 For those who live in areas where getting adequate sunlight is a problem, or for those who wish to avoid the sun for other health reasons, the US Nurses Health Study has clearly shown that MS risk can be nearly halved by taking a small supplement of vitamin D (in that study anything over 400IU).2 From our knowledge of vitamin D effects on the body and immune system, it is likely that a higher dose would have even more significant protective effects. My recommendation for close relatives of people with MS would be a supplement of 5 000IU a day in winter and in summer on days when there is limited access to sun, reduced proportionately for children. The aim is to keep the level of vitamin D in blood at above 100nmol/L (40ng/mL in the USA). This is the level above which a number of studies have shown a protective effect against developing MS.
So to calculate the dose for children, using 50kg as the adult dose equivalent, a 25kg child would need half this dosage, and similarly a 10kg child one fifth of the dose. This can be omitted on days when there is adequate sun exposure. It has been suggested that on a population basis, in areas of high MS prevalence, supplementing with vitamin D during pregnancy and early childhood could prevent a great proportion of the MS in the world.3 The author suggests that, like folic acid, vitamin D supplementation should be routinely recommended in pregnancy. This is supported by a large epidemiological study showing that babies born at the end of winter were more likely to get MS later in life than those born at the end of summer.4 Children are never too young to begin vitamin D supplements; indeed they should ideally start while in the womb.
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So to calculate the dose for children, using 50kg as the adult dose equivalent, a 25kg child would need half this dosage, and similarly a 10kg child one fifth of the dose. This can be omitted on days when there is adequate sun exposure. It has been suggested that on a population basis, in areas of high MS prevalence, supplementing with vitamin D during pregnancy and early childhood could prevent a great proportion of the MS in the world.3 The author suggests that, like folic acid, vitamin D supplementation should be routinely recommended in pregnancy. This is supported by a large epidemiological study showing that babies born at the end of winter were more likely to get MS later in life than those born at the end of summer.4 Children are never too young to begin vitamin D supplements; indeed they should ideally start while in the womb.
Vitamin D3 capsules in a dose of 5,000IU per capsule can be obtained from www.vitamin-D-max.com, or in a dose of 2,500IU per capsule for children, and 5,000IU and 10 000IU capsules for adults, at www.iherb.com. The latter are gelatine capsules with olive oil, and so can be squeezed out onto food for smaller children. Another good product is vitamin D3 at 50,000IU per capsule, obtainable at http://www.prohealth.com//shop/product.cfm/product__code/PH301 for USD43 for 100 capsules. For teenagers or adults who don’t want to be taking something every day, taking one every fortnight or so is the equivalent of around 3,500IU a day, a pretty good preventive dose. It is also great for taking one-off megadoses for people just starting off.
The evidence in relation to dietary change is not so clear cut. While I am a strong advocate for people with MS following a plant-based wholefood diet that is very low in saturated fat, as detailed on this website, the question of whether to put family members on the same diet to reduce their risk has not been so clearly answered. Professor Swank points out in his book The Multiple Sclerosis Diet Book that he placed all family members on the same diet. Further in his experience of over 3,500 patients with MS, not one of their relatives on the diet developed the disease, to his knowledge. This is pretty extraordinary, given the statistics we have seen of the high risk in relatives. In Canada, around 1 in 500 people gets MS, and that risk is raised 30-40 fold in first degree relatives of people with MS. So in the 3,500 families Swank treated, we would have expected to see many hundreds of new cases of MS. To have not documented a single case is quite remarkable; given that Swank was the neurologist looking after these people, any such cases would almost certainly have come to his attention. So many people with MS will opt to use all avenues to protect their children and modify their diets as well as supplement with vitamin D.
Overall, the evidence is compelling. People with MS can, on the basis of the evidence presented here, reasonably expect to be able to reduce the risk of MS developing in our relatives. This will be very reassuring for those of us naturally very concerned about the health of our children and close relatives who are at greatly increased risk of developing this disease. It is good to finally see the MS societies starting to recommend vitamin D supplementation during pregnancy and for children where a parent has MS.
The evidence in relation to dietary change is not so clear cut. While I am a strong advocate for people with MS following a plant-based wholefood diet that is very low in saturated fat, as detailed on this website, the question of whether to put family members on the same diet to reduce their risk has not been so clearly answered. Professor Swank points out in his book The Multiple Sclerosis Diet Book that he placed all family members on the same diet. Further in his experience of over 3,500 patients with MS, not one of their relatives on the diet developed the disease, to his knowledge. This is pretty extraordinary, given the statistics we have seen of the high risk in relatives. In Canada, around 1 in 500 people gets MS, and that risk is raised 30-40 fold in first degree relatives of people with MS. So in the 3,500 families Swank treated, we would have expected to see many hundreds of new cases of MS. To have not documented a single case is quite remarkable; given that Swank was the neurologist looking after these people, any such cases would almost certainly have come to his attention. So many people with MS will opt to use all avenues to protect their children and modify their diets as well as supplement with vitamin D.
Overall, the evidence is compelling. People with MS can, on the basis of the evidence presented here, reasonably expect to be able to reduce the risk of MS developing in our relatives. This will be very reassuring for those of us naturally very concerned about the health of our children and close relatives who are at greatly increased risk of developing this disease. It is good to finally see the MS societies starting to recommend vitamin D supplementation during pregnancy and for children where a parent has MS.
- van der Mei IA, Ponsonby AL, Dwyer T, et al. Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ 2003; 327:316.
- Munger KL, Zhang SM, O’Reilly E, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology 2004; 62:60-65.
- Chaudhuri A. Why we should offer routine vitamin D supplementation in pregnancy and childhood to prevent multiple sclerosis. Med Hypotheses 2005; 64:608-618
- Willer CJ, Dyment DA, Sadovnick AD, et al. Timing of birth and risk of multiple sclerosis: population based study. BMJ 2005; 330:120
- van der Mei IA, Ponsonby AL, Dwyer T, et al. Past exposure to sun, skin phenotype, and risk of multiple sclerosis: case-control study. BMJ 2003; 327:316.
- Munger KL, Zhang SM, O’Reilly E, et al. Vitamin D intake and incidence of multiple sclerosis. Neurology 2004; 62:60-65.
- Chaudhuri A. Why we should offer routine vitamin D supplementation in pregnancy and childhood to prevent multiple sclerosis. Med Hypotheses 2005; 64:608-618
- Willer CJ, Dyment DA, Sadovnick AD, et al. Timing of birth and risk of multiple sclerosis: population based study. BMJ 2005; 330:120