The Autoimmune Disease Series Part 5: The Importance of Vitamin D in Autoimmunity
Current research shows a significant correlation between vitamin D levels and autoimmunity (1.) Vitamin D is a fat-soluble vitamin that people typically associate with strong bones, because of its importance in aiding calcium absorption and homeostasis. The active form of vitamin D in the body, calcitriol, is also crucial for normal cellular differentiation, proliferation, and growth. Especially important within the context of this article is the effect of vitamin D on the immune system. Calcitriol has an immunomodulatory effect on cells by decreasing the production of inflammatory cytokines (chemical messengers) like IL,-1, IL-6, IL-8, IL-12, and TNF-alpha, and increasing the production of anti-inflammatory cytokine IL-10 (2), (3), (4.)
If we refer to my previous article on autoimmunity and the cellular environment, we can elucidate that vitamin D plays a sizeable role in increasing the number of anti-inflammatory T-regulatory cells and decreasing the number of Th17 pro-inflammatory cells (5), (6), (7.) The take-home message is that proper vitamin D status is crucial for decreasing inflammation and taming autoimmunity. However, there is a twist!
Many autoimmune conditions, notably, Hashimoto’s and Grave’s disease (8), inflammatory bowel diseases (Crohn’s & Ulcerative Colitis) (9), SLE (10), Multiple Sclerosis (11), Type 1 Diabetes (12), Rheumatoid Arthritis (13), and more, exhibit a genetic defect in cellular vitamin D receptors. What does this mean? In order to exhibit its anti-inflammatory effects, calcitriol must get into cells and attach to a special receptor called a VDR, or “vitamin D receptor.” Think of your work office. In order to get in and do work, you must first unlock and pass through the door. In a normal situation, the key to the door works every time and you are able to get into your office without a problem. However, imagine if the door lock changed shape and your key no longer worked, or only worked part of the time. This is exactly what happens in the cells of people who have a VDR genetic defect, or “polymorphism.”
People with VDR polymorphisms often have chronically low levels of vitamin D, and decreased ability to get the vitamin D they do have into their cells, where it does its job. This is very unfortunate, considering that vitamin D has so many anti-inflammatory effects and can dampen autoimmunity. Proper supplementation with “physiological” doses of vitamin D is crucial to restoring proper levels in people with autoimmunity and the VDR polymorphism. Physiological doses refer to doses that are much higher than the traditionally accepted RDA (recommended daily allowance) of 400-600 IU daily. Physiological doses are often in the range of 2,000-20,000 IU daily, depending on the person’s levels and their doctor’s recommendations. 10,000 IU/day for 12 weeks in people with low vitamin D levels has been established to be effective and safe (14), however, you should ALWAYS consult with your doctor first!
Is there a test that can confirm whether or not you have the VDR polymorphism? Absolutely! Please see our blog posts on Naturopathic Genetic Analysis and check out the Genetic Evaluation page on our website: http://www.anwnaturopathic.com/genetic-evaluation. Using results from a 23 & Me genetic profile, we can determine if you have the VDR polymorphism plus a wide array of other polymorphisms associated with metabolism and detoxification.
Tips for optimizing vitamin D supplementation:
1. Since vitamin D is fat soluble, it is important to always take it with a fat source. Ideally, Naturopathic doctors recommend that clients take their vitamin D with their daily omega 3 fatty acid source in the morning with breakfast. This not only enhances absorption of vitamin D from the gut, but also delivers a “double whammy” of potent anti-inflammatory effects.
2. Take a practitioner-quality vitamin D supplement that has undergone rigorous quality control. Companies that produce supplements bought over-the-counter from convenience stores lack good quality control and frequently mislabel content of their supplements. A recent clinical trial has shown that emulsified drop form of vitamin D is the most effective delivery method (15) (Note that emulsified drops have the shortest shelf life!)
3. There are two forms of vitamin D available- D2 (ergocalciferol) and D3 (cholecalciferol.) A study published in the American Journal of Clinical Nutrition discusses why D3-cholecalciferol, is the better choice for optimizing vitamin D levels (16.)
Want to learn more about what Naturopathic medicine can offer for autoimmunity?
Check out our page on autoimmunity: http://www.anwnaturopathic.com/autoimmunity
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