FAQs

Is it necessary to do the Protocol Coimbra with medical supervision?

Yes! This point cannot be overemphasized: although apparently simple, the Protocol Coimbra should always be performed under medical supervision. Unfortunately, we often receive in your consultation cases of people who courageously started the therapeutic process alone, or following online advice only, and end up not being successful or, worse, present changes that indicate toxicity. It is not worth taking the risk!

On the other hand, the long experience that the clinical team of Dr Cristina Sales - Functional Integrative Medicine has with the Protocol Coimbra, allowed us to reach a conclusion: one of the main factors influencing the success of the treatment, and that only a clinician trained in this therapy can offer, is the tranquility and security of feeling accompanied at every step of the protocol, having direct contact with those who know and can remove the doubts that naturally arise with this process. You do not need to take over all the decisions inherent to the Protocol Coimbra. Congratulations for knowing that there are other ways to combat the disease!

Can all autoimmune diseases be helped with the Coimbra Protocol?

In theory, all autoimmune diseases share the same basis of dysregulation of immune function, with active autoimmune processes being caused by suboptimal cellular function. Associated with this non-optimal function is resistance to the effects of vitamin D and the necessary intake of high doses of vitamin D to compensate. The most common diagnoses are multiple sclerosis, transverse myelitis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, systemic lupus erythematosus, Crohn's disease, ulcerative colitis, psoriasis, vitiligo, alopecia areata and Hashimoto's thyroiditis. Clinical improvement can be achieved in all of them.

Graves' disease presents particular characteristics that require redoubled care. When active and uncontrolled, this disease creates a state of clinical hyperthyroidism (high levels of thyroid hormone). This state is not compatible with the Protocol Coimbra as high levels of calcium are released into the blood circulation. This increase may induce toxicity situations. To avoid this, patients with Graves' disease should only start taking high doses of vitamin D after their thyroid function has been controlled with specific medication. They should see an endocrinologist to control and then control autoimmunity and the disease.

Is it necessary to suspend conventional medication and conventional clinical follow-up?

No! Not necessary: doing conventional pharmacotherapy is not associated with decreased therapeutic efficacy of the Protocol Coimbra, with the exception of the pharmacological group known as monoclonal antibodies. In this case, at an unpredictable rate, conventional therapy may considerably decrease the effect on vitamin D, compromising its success. This is not an increased risk of toxicity or any harmful reaction to the body, only a decrease in the therapeutic effect of vitamin D.

What is the evolution of the symptoms? When is it possible to feel improvement?

The clinical evolution is highly variable and depends on the specific case. In the most extreme cases, improvement can be felt after one or two weeks or after 2 years. Despite this variability, it is predictable that the improvement begins to be felt in the first 7 to 8 months of treatment. Only at the end of this period is it possible to have some 'certainty' (within what certainty means in Health) that vitamin D will be having its maximum effect. In other words, the immune responses will be switched off and the underlying disease process will be controlled.

As far as symptoms are concerned, the fastest improvements are usually felt at the level of fatigue and heat intolerance. This is because these symptoms are a consequence of the autoimmune activity and the inflammatory state of the individual. When the disease is turned off, there is a considerable improvement in these parameters.

So the Protocol Coimbra makes all the symptoms go away?

Unfortunately, it is not possible to say that it does. The symptom recovery depends on the duration of the symptoms. With the protocol Coimbra it is possible to recover symptoms that are caused by the autoimmune process and the inflammation of the target organ/tissue. However, if the duration of the autoimmune process has caused structural damage, "scars" (different depending on the disease and organ affected), then those symptoms will not be improvable.

In general, timings can be defined to assess the possibility of symptom recovery:

  • Symptoms lasting less than 1 year have a strong possibility of improving very substantially;

  • Symptoms lasting between 1 and 5 years have a very variable evolution : there are records of complete improvement in symptoms lasting about 5 years and, on the other hand, incomplete improvement with symptoms lasting 1.5 years

  • Symptoms lasting more than 5 years are unlikely to improve markedly. It does not mean that they cannot improve, but it is not likely that they will improve completely.

These do not include the symptoms of fatigue and heat intolerance, which are not caused by the involvement of any organ but by the existence of the autoimmune disease.

What is the evolution of nuclear magnetic resonance imaging (MRI) in multiple sclerosis?

Fortunately, it is possible to see the decrease in the lesional burden of multiple sclerosis with the action of Protocol Coimbra on MRIs. However, we cannot predict when this will happen. It varies from person to person, particularly with the duration of the lesion and/or symptom existence: the older the lesion, the less likely it is to disappear.

The interpretation of MRI images should be done with some care. One should bear in mind that, as a rule, Vitamin D only reaches its maximum therapeutic and biological effect 2 to 3 months after adjusting the vitamin D dose, which is done during the second visit (after 5 to 6 months of treatment), if necessary. This means that only when the Vitamin D reaches the desired effect will the pathological immune process be switched off, and therefore new lesions will not be created. On the other hand, during the first months of treatment, while the body is not fully protected, it is possible that new lesions will appear (remember, by this time the changes in the functioning of the immune system responsible for the autoimmune disease are active).

Thus, if an MRI performed at the end of the first year of the Protocol Coimbra is compared with an MRI prior to its initiation, it may reveal new lesions or be reported as "evidence of disease progression" or "of lesional burden". This does not mean that the Coimbra Protocol is not working or that the disease has actually progressed. Also check whether the lesions are active (i.e., uptake of galodynium contrast) or not. This contrast uptake is a characteristic of active lesions only. If they do not, they are not active.

If the MRI report brings less good news, the first question you should ask is: "Do I feel better? Is the disease progressing?". That is the main marker of success, that is what really matters: the improvement in quality of life and the decrease in the disease and its symptoms.

Is there an age limit to do the Protocol Coimbra?

No. The ages of the patients we follow range from 16 to 88. The big question is what guarantee does the person give that they will scrupulously comply with the dietary and hydration instructions? If this commitment exists, then there are conditions to start the Protocol.

Is it a toxic or dangerous treatment?

No. See an explanation at the end of the Protocol presentation . Coimbra Briefly, there are no toxic effects associated with Vitamin D other than through increased blood calcium levels. This means that it is essential to maintain strict control of calcium intake and the body's ability to eliminate it. To do this, simply follow these guidelines:

1. Diet - should maintain a diet free of

a. Dairy (or calcium-enriched vegetable drinks). 

b. Dried fruit and seeds

c. Green vegetable juices ("whole" vegetables can be ingested. The issue is the increased calcium concentration when you turn the vegetables into juice: imagine how much spinach you have to squeeze to get a glass of juice!)

2. Hydration - you should drink a minimum of 2.5 litres of fluids per day, including water, tea, coffee and juices (non-carbonated or sugary).

Is it mandatory to stick to the diet and hydration?

Absolutely! It is impossible to guarantee the safety of the Protocol Coimbra if there is no strict adherence to the recommendations. All the cases of toxicity in the world will happen because there has not been strict compliance with the diet and/or hydration. It is not possible to say it any other way: to integrate the Protocol Coimbra it is mandatory to comply with the recommendations.

Is it necessary to avoid calcium intake?

No. Only those existing in the foods mentioned. In fact, you need to maintain a minimum calcium intake for the whole systemic balance of vitamin D, parathormone, bone and muscle health to be maintained. No need for exhaustive scrutiny of the labels and nutritional constitutions of the foods you consume looking for calcium. Simply avoid the foods mentioned.

Are food products that mention the possibility of containing traces of nuts, seeds or dairy a problem?

No. These warnings are intended to alert people who suffer from allergies to these foods. There is no increase in the amount of calcium in these products, so they can be consumed.

What are the symptoms of possible toxicity?

The earliest symptom of a possible increase in blood calcium levels is thirst. But beware: being thirsty is different from having a dry mouth. The latter is what occurs, for example, after a long conversation, a speech in public or a period of increased stress. This is not the symptom that should cause concern. Thirst, in this context, refers to the continual need to drink large quantities of water to satisfy the craving you will be feeling. When this is the case, particularly when accompanied by nausea, it should be a cause for concern.

In this case, what you need to do is measure the amount of calcium that your body is releasing, using a test called 24-hour calciuria. This is the simplest and most sensitive method to find out if the cause of your thirst is due to the effects of excess calcium.

You can check for yourself whether you are safe or not. The upper limit for calcium concentration in 24-hour urine is 250 mg per liter (or 6.2 mmol per liter, depending on the units). So all you need to do is check your result against this value and see if it is too high or not.

One point to note: the way the analysis results are sent out can be misleading. Let me give you an example:

The results are usually presented with this figure:

Calcium - 400 mg/24h

Urine volume - 2000ml/24h

It appears that the calcium value is above the limit. However, what is really important to check is not the total amount of calcium produced in 24 hours but the concentration of calcium in the urine. You see, the limit value refers to 250 mg per litre of urine.

Thus, you should calculate what the concentration of the analysis. To do this, you must convert the urine volume to liters and divide the amount of calcium by the number of liters:

1. Calcium - 400 mg

    Urine volume - 2000ml = 2 litres

2. Calcium / Litre of urine - 400 mg / 2 litres = 200mg per litre

It can thus be seen that although the total amount of calcium is apparently high, the concentration is within the defined limit.

My 24-hour calciuria is above the limit. What should I do?

If you find that the limit has indeed been exceeded, you should:

1. Stop taking Vitamin D for 3 days, and after that period

2. Resume taking vitamin D at a dose that is 10,000 IUI to 20,000 IUI per day less than the dose you were taking before. For example, if you are taking 60,000 IUI per day, you should resume with 50,000 IUI per day. If you are taking 100,000 IUI per day, you should restart at 80,000 IUI per day.

You should then keep the new dose until you have a new follow-up protocol appointment Coimbra.

This process can be repeated as many times as necessary until you can adjust the dose to your specific sensitivity. The purpose of sharing this information is to give you all the tools you need to check that you are safe and within non-toxic levels at any time, and not rely on a medical contact to do so. 

I am sure I am following the dietary and hydration recommendations and yet my calciuria is above the limit. What could it be?

In our experience in monitoring situations like this, the main culprit is the calcium concentration in the water you are drinking. You should confirm this point. The calcium concentration in your water should be as low as possible, preferably less than 25mg per litre.

Is it necessary to follow a gluten-free diet? Are there any other dietary restrictions?

It is not necessary to adopt a gluten-restricted diet. The therapeutic effect of vitamin D, when it is optimised, should override the inflammatory effects described associated with cereal consumption. With the exception of those with celiac disease, who must remain on a gluten-free diet at all times, it is possible to ingest gluten without an increase in inflammatory parameters and patient status. As a rule, we have not consistently seen an improvement in the clinical outcome of those who combine a gluten-free diet with the Protocol Coimbra. On the other hand, there is no reason to eat foods that cause discomfort.

Is it a lifelong treatment?

Probably. At this moment it is not possible to know in which situations or which are the clinical criteria to guarantee that autoimmune processes are permanently off. The use of high doses of vitamin D in the Coimbra protocol is aimed at "correcting" a genetic particularity which is the basis of the pathology. It is a way to overcome the resistance caused by SNPs in vitamin D metabolism and to guarantee the best possible function of immune cells. For this reason, and given that it is not known to be possible to alter these genetic polymorphisms, vitamin D supplementation must be maintained until permanent inactivation of the immune responses associated with autoimmune diseases can be guaranteed.

When are clinical checks done?

The first phase of the protocol Coimbra lasts about 2 years, during which 4 medical consultations are recommended : the initial, the second after 5 to 6 months, the third after the first year of treatment and the fourth at the end of the second year of treatment. For these consultations it is always necessary to have a complete analytical study, so that it is possible to assess the therapeutic efficacy, the safety of the treatment and control the clinical evolution. Apart from the blood and urine tests, an osteodensitometry and, if possible, a nuclear magnetic resonance are necessary every year. After the first 2 years of treatment, the controls are done every 2 years and, later, every 5 years. In special and occasional situations, a higher frequency of consultations and/or analytical controls may be necessary, according to the clinical situation.

Is it only necessary to take vitamin D? Or are there other supplements that should be taken?

Yes, there is. Although vitamin D is primarily responsible for clinical improvement, there is a list of supplements that are highly advised. They will allow the existing systemic inflammatory component to be decreased more quickly, helping to recover as much as possible from the damage caused by autoimmunity - cellular recovery - and maximising the absorption and effectiveness of vitamin D.

The supplements and recommended doses may vary from case to case. However, these are the most commonly prescribed:

  • Omega 3, EPA/DHA, 500 to 1000mg 4 x day

  • Vitamin B2, 50 to 100mg 4 x day

  • Magnesium, 1000mg day, can be administered in different forms

Vitamin K2 is not included in this list of supplements. Although it was tested several years ago in the Protocol Coimbra, it was eliminated because, unlike when lower doses are taken (± 10,000 IU per day), its effect is not noticeable when high doses of vitamin D are taken. Another compound not included isLow-Dose Naltroxone ( LDN). In the case of this one, it has never been tested as part of the Protocol Coimbra and, despite some reports of benefit from taking it, we have not seen a sufficiently reproducible effect to recommend its use.

My previous Magnesium dose is quite a bit lower. Is there a mistake? Are there any side effects associated with such a high dose of Magnesium?

No mistake. The dose was increased in early 2017 by Professor Cicero Coimbra. It is aimed at maximizing intestinal absorption of vitamin D, improving bone health and muscle health (many of the spastic symptoms that are presented have been improved and even resolved with this adjustment in Magnesium dosage).

As for side effects, the negative changes associated with high doses of Magnesium are gastrointestinal. People who are more sensitive or less tolerant to Magnesium tend to suffer from changes in the consistency of their stools, becoming very soft or even diarrhea. In such cases, you should gradually decrease the dose of Magnesium you are taking, until you find the balance point between the maximum tolerated dose and intestinal health.