Protocol Coimbra

The development of the Protocol Coimbra began when Professor Cicero Coimbra verified the effects vitamin D supplementation had on a Parkinson's patient who also had patches of vitiligo.

After supplementing the patient with the physiological dose of 10,000 IUI per day for 3 months, with a view to normalising the blood values of this hormone, the spot had practically disappeared. The improvement had been absolutely remarkable! This observation was enough to start the process that today is known as the Coimbra protocol.

By then it was already possible to find several articles, published in prestigious scientific journals, indicating the important role of vitamin D in the physiopathological processes responsible for autoimmune diseases. Using this scientific evidence, a research process began on what role vitamin D could play in the treatment of autoimmune diseases. This hypothesis had (and still has) a major clinical impact: even today, the existing therapeutic solutions for autoimmune treatment are not satisfactory, either due to the existing levels of clinical control or the incredible side effects.

Interestingly, Vitamin D is not a true vitamin, as is vitamin A or C.

Do you remember cod liver oil, which you used to drink as a child every morning with that characteristic taste? Well, as recently as the 19th century, it was observed that children suffering from rickets (an epidemic disease in the 18th and 19th centuries characterized by poor bone formation, resulting in the well-known bowing of the legs) improved their clinical condition when they took this same cod liver oil. Based on these observations, it was written that the compound responsible for this crucial effect on health was the fourth vital element: Vitamin D.

Around the same time, a different course of research into this epidemic raging in the USA and the industrialised countries of Europe discovered another factor with a decisive effect on children's bone health: the sun. In fact, the more exposed to UVB radiation the environment in which a child lived, the fewer and less severe the cases of rickets. It was then discovered that solar radiation, when in contact with the skin, would produce the same compound, the same vital element: Vitamin D.

When they finally tried the two approaches simultaneously, on the same children, they found that their improvement was even greater, faster and longer lasting! It thus became the therapy of choice for treating bone malformations in children.

Only in the 20th century, when technological evolution allowed the development of laboratory methods capable of understanding the structure of existing compounds in circulation in the human body, it was possible to understand and draw the path of Vitamin D in our organism: it was realized that first a 25-hydroxyvitamin D was produced and that there was another, slightly different one, the 1,25-dihydroxyvitamin D, which would be produced by the kidney. Finally, only in the 80s of the last century, Dr. Michael Holick (author of The Vitamin D Solution) completed the initial part of the puzzle, describing the mechanism of Vitamin D production in the skin.

This is the big difference between Vitamin D and all the other vitamins, making it unique: while the others have to be obtained through food, Vitamin D can be produced by the human body. And that's just one of the differences!

Another is what our body does with it: it turns it into a pre-hormone, and activates it. Vitamin D's pathway in the body is (relatively) simple: when it hits the skin, UVB rays transform 7-dehydrocholesterol (a compound derived from cholesterol) into cholecalciferol, Vitamin D itself, the same compound we get from cod liver oil. From here, whether it came from the skin or from food, cholecalciferol is converted in the liver into the pre-hormone calcidiol (also known as 25-hydroxycholecalciferol or still 25(OH)D). This is ready to be activated in the kidney, becoming calcitriol (or 1,25- dihydroxycholecalciferol or 1,25(OH)2D), the active hormone, the active form of Vitamin D that will exert its effects in the body, after being released into the bloodstream and reaching the bones.

In short: skin / food - liver - kidney - bone. Sounds too simple? In fact, it is. 

In recent years, there has been mounting scientific evidence showing that the classic vitamin D mechanism, although correct, is highly limiting and does not reflect the myriad of pathways it follows. Yes, Vitamin D appears in our bodies, either as a result of UVB or from food, from there it is taken to the liver to be transformed. But 1-alpha-hydroxylase, the enzyme responsible for the final step in the activation process, which was thought to be located exclusively in the kidney, turns out to be more widely dispersed in the body. What's more, along with the thyroid hormone, they are the only compounds for which all cells have a receptor. In other words, all cells are affected by vitamin D, widening the horizons of its possible biological effects, which are no longer limited to bone alone.

1-alpha-hydroxylase is not the only piece of the vitamin D metabolism puzzle to be scattered throughout the body. Its receptor, the VDR, is also as widespread as the enzyme itself. But it is located in a particular and especially important area of the cell, its nucleus. And what useful "coincidences": it is only when calcitriol and this receptor come together that the Vitamin D pathway culminates and gives rise to its biological effect. Once formed, the calcitriol-VDR duo acts as a genetic transcription factor, influencing, modulating and optimising the reading of existing information in the human genome.

But the potential interference of Vitamin D is not small: it is estimated that the reading of between 5% and 20% of the entire human genome is influenced by the calcitriol-VDR pair. In other words, of the approximately 20,000 genes in the genome, the information contained in between 1000 and 5000 of them needs vitamin D in order to be read correctly and for the cell to operate optimally. This leads to the various organs being able to function optimally. For this reason, the beneficial effect of the fourth vital element for human health is not limited to bone!

The ultimate function of the immune system is to protect organisms from invading pathological agents and cancer cells. It is capable of generating an enormous variety of cells and molecules capable of recognizing and eliminating specifically and uniquely an unlimited spectrum of potential aggressor agents. The network formed by immune cells is highly complex, rivaling to the neurological system.

The immune responses that act in our defense can be divided into Th1 and Th2 responses. The first produces an environment that supports a nonspecific inflammatory state and activates certain T cells and macrophages. The second, on the other hand, activates mainly B cells and antibody-dependent immune responses. Both are necessary for effective immune action and optimal defense. Th1 and Th2 responses are thus considered our "good" responses.

However, with the continuous study of the immune system, it became evident that there were other kind of responses. It was possible to verify that one of the interleukins (an immune regulatory system component), the 17 (IL17), was produced by a specific cell lineage, quite different from the integrants of the responses known until then. For this reason, the response in which these cells are involved started to be defined as Th17 response. To this response are attributed functions of defending the organism against extracellular pathogens. Unfortunately, not all actions of this response are so beneficial for the organism: Altered Th17 response has been associated with several autoimmune diseases, among them multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, psoriasis, vitiligo, Crohn's disease and ulcerative colitis.

We are then before something that might seem impossible: the same substance can act both in the sense of decreasing the action of the immune system, decreasing autoimmunity, and in the opposite sense, increasing the body's defence capacity against invaders!

In the words of Professor Coimbra, "vitamin D is not an immunosuppressant but an immunomodulator, it always acts in favour of the organism". Through its effect on gene transcription, vitamin D acts by optimising cellular functions. Basically, the information that is inscribed in DNA is what is put into practice. And naturally, our immune cells do not have the information to attack us, the Th17 cells are not programmed for an aberrant function that leads to this type of pathology. Through the action of vitamin D it is possible to regulate our immune structure, increasing our defence capacity and reducing or even cancelling out the auto-attack. This is why it is possible to use this vitamin to have a positive effect on autoimmune diseases.

The most recent data for Portugal suggest that at least two thirds of the population (probably more) have low blood levels of vitamin D.

Given this finding, other questions arise: since the most recent data for Portugal indicate that at least two thirds of the population (probably more) have low blood levels of vitamin D, its circulating amount cannot be exclusively justified by the existence of an autoimmune disease. If this were true, the rate of this type of pathology would have to be incredibly higher...

And indeed it is. Carriers of these pathologies present other characteristics that lead to the development of an autoimmune disease: small genetic polymorphisms, called single nucleotide polymorphisms (SNP), which condition the biological effect of vitamin D on the cell. When, for example, the SNP occurs in the vitamin D receptor (VDR), gene transcription is compromised. And this has already been associated with several autoimmune pathologies. With altered transcription, the function of the cell changes and the autoimmune process can be triggered.

In order to overcome these physiological limitations of these people, the Protocol Coimbra uses high doses of vitamin D so that all resistance can be overcome, cellular gene transcription is optimized, cellular function is perfected, and thus the altered Th17 responses that cause autoimmune disease are switched off. In this way an immune regulation is achieved such that the reason for the disease to exist, its pathophysiological basis is controlled and switched off. In other words, the Protocol Coimbra allows to make the function of the immune cells so correct that they stop mistakenly attacking the organism (independent of the target tissue), increasing at the same time our global defense capacity. And this is what it has been possible to do with thousands of winners, who have thus successfully fought their disease!

The adoption of these amendments is mandatory and non-negotiable. It is the only strategy to ensure the safety of the protocol Coimbra and that the treatment runs without any problems or toxic effects of hypercalcemia. Let's look at it from another point of view: suffering or not suffering side effects of conventional treatments is a choice in which the patient has (to a large extent) no active part, being almost a question of luck or bad luck.

In the Protocol Coimbra, this decision is in the patient's hands: diet + hydration = safety.

If you suffer from an autoimmune disease, ask yourself this question: when you are more stressed, anxious or nervous, do your symptoms get worse? Is it after periods of more emotional instability that symptoms or flares occur more frequently?

It's not a suggestion: it's true.

Almost all of the people who seek the Protocol Coimbra report that emotional stress is, at the very least, a driver of the disease. Some - many - even attribute to this stress the reason for the existence of the disease. Naturally we cannot attribute the genesis of such complex pathologies to a single cause. However, there is scientific evidence to support this relationship.

Several thousand scientific papers have been published, shedding more and more light on the link between emotional state and autoimmune diseases. These data corroborate the work of Professor Coimbra who for years has advocated a central role for emotional imbalance and autoimmunity. In addition, it supports the assessment that thousands of sufferers of these conditions make about why their disease exists.

By this relationship, the existence and persistence of high levels of emotional stress is the main reason why the Protocol Coimbra may not exist the maximum therapeutic effect.

High doses of vitamin D are able to optimise cell function. However, they cannot overcome the damaging effect of stress. Imagine that autoimmunity is a fire that burns continuously. Vitamin D would correspond to the water used by firefighters to put out the fire. Using the high doses of vitamin D in the fight against the disease will be equivalent to the presence of the biggest and best equipped fire brigade. With greater or lesser difficulty, they will eventually put out the fire.

However, if despite all the effort of these combat actions, someone continues to start a fire or pour petrol on the existing fire, then these same efforts will not be enough to overcome and the fire will continue to burn. In this metaphor, emotional stress is the gasoline that is poured on the fire of autoimmunity: as long as the basic physiopathological process exists, the abnormal Th17 responses will be active, preventing a complete positive response.

All strategies to increase emotional balance are valid. From meditation and acupuncture to psychotherapy or psychopharmacology, they can all be used. No weapon should be avoided in this process. It is the main reason why the disease may remain active during the Protocol Coimbra. All strategies to increase emotional balance are valid. From meditation and acupuncture to psychotherapy or psychopharmacology, they can all be used.
No weapon should be avoided in this process.