Learn how vitamin D can help with autoimmunity.
There are few diseases more ironic than autoimmune diseases. Chronic, frustrating and difficult to understand: our defence system is solely responsible for making us ill. Those who should defend us are in fact those who attack us. It is the equivalent of a state in which the public security forces, troops and armies that should protect the country from threats devote themselves to attacking their own innocent populations, often gratuitously, at random, "just because".
Autoimmune diseases, as a group, are just that: a set of pathologies that arise when the immune system recognises as "aggressors" parts of our body that are not - cells, proteins, molecules - and develops attack reactions against them.
They all share the same basic dysfunction: a process of dysregulation of the immune function that wrongly identifies healthy elements of the body as targets to be eliminated. But, because an evil never comes alone, while it is focused on attacking us, it is no longer effective in defending us against what it really should be: infections, cancerous diseases,...
At a time when the world is realising that our ability to defend ourselves is our best defence, those suffering from one of these diseases are particularly vulnerable with this double risk. For them, it should not be discussed which is the best treatment or if this option is more certain than another but rather what can be done to improve immune function. Point.
Let me ask you: if you were in the middle of a war against an extremely powerful enemy who could easily destroy you, wouldn't you want to have all possible weapons, tools and strategies at your disposal so that your chances of victory would be greater? I would, for sure! And, fortunately, more and more people think like that.
The truth is that there are many different approaches to treat autoimmune diseases. All of them with proven "success", none of them with guaranteed efficacy, each one with specific risks and lifestyle adaptation needs. My aim with this article is not to compare therapeutic options (or to make an exhaustive review of the existing evidence about them), but just to share how vitamin D can help those who suffer from autoimmune diseases.
The staunchest defenders of "evidence-based medicine" will say that "there are no studies demonstrating the positive effect", that "there is no evidence to support its use" and that "vitamin D is not supported by scientific evidence". I have already written a few articles, like this one and this one on these points, which I advise you to read if you are curious what evidence there is on its use. They'll also say it "doesn't do anything" because "I took it and felt nothing", which is in fact true because it doesn't work on everyone (something I've already shared in this other article).
Those who come to us do so with one purpose: to try to win the war against their autoimmune disease. Many come already armed with weapons that were or are effective in one way or another. But either because they are no longer effective, or because they want more to increase their chances of success - or because they have seen the positive results in others, results they were told were impossible to achieve - they bring a question: how can vitamin D help them?
This is my answer.
A. Influence on the development of autoimmune responses.
Generalisations are risky because they are always open to error but, at that risk, it is possible to say that autoimmune diseases are "controlled" by a "section" of the immune system called Th17, so called because the Th(elper) cells that make it up produce a specific mediator called IL17.
Several publications over the last few years have demonstrated its role in different autoimmune diseases such as psoriasis, multiple sclerosis, rheumatoid arthritis, inflammatory bowel disease, lupus, ... Now, if this Th17 response is a fundamental part in the development of this type of pathologies, it is clearly a preferential target to combat them!
This is exactly where the role of vitamin D begins: it reduces the production and expression of IL17.
A study published in 2010 showed that when vitamin D undergoes the whole activation process and binds to its VDR receptor successfully, it can reduce the production of that interleukins 17 which, in turn, decreases the development of Th17 cells. In other words, the number of "agents coordinating the attack against the body" decreases!
It could be the only published study along those lines...but it wouldn't be the same, as the other one says. And, in fact, it isn't. Hundreds of studies have been published in recent years studying this effect and the impact vitamin D might have on the health of these populations.
More recently, a team of Dutch researchers showed something even more interesting - and with greater impact on health: not only did they find the same effects of reducing pro-inflammatory mediators such as IL17 or IFNg, but they also found that vitamin D treatment transforms attacking cells into defending cells!
It is almost as if there is a re-education of the troops and they finally realise again that their concern is to defend from the outside and not attack the inside! Fascinating!!!
Now, in practical terms, what do you think will happen to disease activity when this happens? Right.
B. Influence on disease activity
If increasing vitamin D reduces the mediators that underpin autoimmunity, you should not be surprised to learn that a lack of this vitamin is associated with the development of these conditions and the aggressiveness of the disease! In fact, numerous publications have demonstrated this association between reduced 25(OH)D3 levels and the incidence of autoimmune pathologies as well as greater aggressiveness of the disease.
In other words, the less vitamin D, the more likely you are to develop an auto immune disease, and if you do, the more active and aggressive it is.
Given this data, it makes sense that there should be as much vitamin D in circulation as is necessary to try to optimise the function of the immune system and attack autoimmune disease at its base, at the molecular point that is common to them.
It is essential to stress that it is not a question of using vitamin D instead of any other treatment. We are back to square one: who doesn't want to have at their disposal as many weapons as possible? Vitamin D appears to be one such weapon - and one that works very intelligently and with a very wide range.
How much vitamin D should you take? Excellent question! I'd love to have a clear and objective answer to give you but it's not possible, which brings me to my next point.
C. Effective use of vitamin D is highly personalised
I find it incredible when, in the year 2022, I still find myself having to argue the obvious: if we are all different, why the hell should we need the same treatment?
Two different cars need different maintenance, consume fuel at a different rate and have different capabilities. The same happens with two houses, two companies, two teams...and it's exactly the same with two people! We all have our own genetic code which, being very similar among all of us, allows us to be unique and different. This is not only "outwardly" verified by physical characteristics but also in the way our cells function.
Changes to the genetic code are known as mutations, which can exist at different levels and with very different consequences. Depending on the type of mutation and where they occur, they can have dramatic consequences that are incompatible with life, or they can be much more detailed.
It is possible that the mutation is in just one letter of the code which, while not enough to have a catastrophic impact, can alter the structure and influence the function of whatever is being coded. These variations are called single nucleotide polymorphisms (SNP) and have a direct influence on autoimmune disease.
In 2015, a team of researchers from ICBAS-UP published a study in autoimmune patients showing that the existence of SNPs in the vitamin D receptor was associated with greater aggressiveness of the disease, greater cumulative damage and greater difficulty in treatment, concluding that it constitutes a risk factor in these patients.
How can these variations have such a profound impact? It's simple: they reduce the effect of vitamin D.
These variations exist throughout vitamin D metabolism, from its transporters to its activating enzymes, the most studied site being the VDR gene which encodes the vitamin D receptor.A polymorphism in this gene will alter its structure and thereby influence its binding to activated vitamin D, creating a blockage in the process. Essentially, the existence of these SNPs creates a resistance to its function, just as a dam creates a resistance to the flow of water in a river, which can only continue towards the sea if it can cross it.
These genetic variations have been associated with many autoimmune diseases - multiple sclerosis, lupus, arthritis, psoriasis, ankylosing spondylitis, among others.
It is the existence of these polymorphisms that prevents there being a single effective dose, since, again, we are all different and therefore have different resistances and therefore need different concentrations of vitamin D to have the same beneficial effect. This is the principle of the use of high doses of vitamin D for the treatment of autoimmune diseases developed by Professor Cicero Coimbra.
On Protocol Coimbra higher doses of vitamin D than "normal" are used in order to "overcome" resistance and to maximise its biological effect, trying to reduce the production of mediators like IL17, decrease the number of Th17 cells and their reversion to effective immune cells, "turning off" a cause for autoimmune disease. The comprehensive impact that vitamin D has explains why its optimisation affects so many different autoimmune diseases, with potentially very positive results.
An autoimmune disease does not have to be a sentence. It is possible to fight it and succeed. It is possible to win the war. It is possible.
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