For a New Paradigm of Medical Treatment

The Autoimmunity Institute was created in the first half of 2011, an initiative of Dr Cicero Galli Coimbra and ex-patients who presented auto immunity manifestations, and have benefited from the treatment with Vitamin D. Currently these people have a normal level of quality of life, and remain free of any aggression to their immune system, to the point of considering these individuals as ex-patients of the disease. These ex-patients direct the Institute of Autoimmunity, in order to offer the same benefit for other patients, specially those in need.

Spontaneous reports from benefited patients created great repercussion in the internet, and generated the demand for activities that identify and correct metabolic disorders that cause autoimmune diseases, initially with special attention to the correction of the deficiency of vitamin D.

The vitamin D is now widely recognized by several members of the international scientific community as a paramount factor in the onset and exacerbation of autoimmunity diseases and other serious diseases, such as cancer.

The “vitamin D” (or “cholecalciferol”) is currently considered a pre-hormone in scientific means (because it is processed into various cells of the human body in hormone calcitriol – hormone that is potentially capable of modifying 229 biological functions in the human body – reference 1). The oral use of cholecalciferol treatment ( realistic doses – close to those obtained through exposure to abundant sunlight) has low cost and high effectiveness. Vitamin D is capable of maintaining patients without the physical, psychological and social impairments related to auto immune diseases, besides promoting a potentially complete regression of recent relapses and bringing well-being and self-confidence back to the patient.

Additionally, even the private and public health systems can save lavish amounts of money on hospital admissions and expensive medications. Vitamin D enables a large number of patients to have a life essentially normal and productive, as well as rid from their condition as chronic patients, incapacitated to work and dependent on the pension system. It is emphasized that this is not an alternative treatment, but in fact a treatment that reconstructs the mechanism which nature itself has developed with the objective of preventing auto immune aggression against people’s own bodies.

The existing conflict of interests related to the trade of pharmaceutical products (that with impressive marketing tools obstructs the absorption by medical community of these most recent findings). The Autoimmunity Institute is already working as the driving force to inspire activities that have the fundamental commitment to spread the bases of this treatment to other medical professionals, so they can also become broadcasters of this therapy, thus contributing to the benefit of a larger number of patients.

Current scientific knowledge shows that a deficiency of vitamin D (which affects 76.5 % of residents in São Paulo city (Brazil) during winter, which drops to just 37.3 % during summer (according to surveys published by University of Sao Paulo and UNIFESP (Federal University of Sao Paulo) in 2010 – reference 2) is associated with the occurrence (susceptibility) and sustaining (severity) of all autoimmune manifestations, including multiple sclerosis, optic neuritis, Devic’s Disease, Guillain-Barre (poliradiculo-neuritis), polyneuropathy, myasthenia gravis, rheumatoid arthritis, systemic lupus (discoid or systemic lupus erythematosus), Crohn’s disease, ulcerative colitis, celiac disease, primary biliary cirrhosis, hypothyroidism (Hashimoto’s thyroiditis), uveitis, episcleritis, psoriasis, vitiligo, abortions in the first trimester of pregnancy, periodontal disease, diabetes juvenile, allergies, etc. Other disorders or diseases that are not auto immune (or still not classified as auto immune by contemporary science), are also associated with the Vitamin D deficiency (facilitated, induced or favoured by it) such as cancer, hypertension, diabetes of maturity, cardiovascular, osteopenia and osteoporosis, depression, bipolar disorder, schizophrenia, infertility, birth defects, chronic pain (including fibromyalgia and migraine), neurodegenerative diseases (such as Parkinson’s and Alzheimer’s disease), excessive sleepiness, etc.

Recent epidemiological evidence indicates that autism is probably caused or at least greatly facilitated by serious deficiency of vitamin D occurred during the gestation of the affected child. Currently there are several scientific sources that highlight the ethical need of not allowing anyone (patients with or without these disorders) to be kept with vitamin D deficiency (which keeps happening due to an usual supplementation of only 200 IU per day in medical practices). With these ridiculous doses, a patient with multiple sclerosis has their level of vitamin D going from the average of 14 ng/ml to only 16 ng/ml after 2 months of treatment. The reference values for vitamin D (measured as 25 (OH)D3, and never as 1,25 (OH)2D3) are 30-100 ng/ml for the vast majority of clinical laboratories. It is emphasized that a 30 ng/ml level would be even lower than the appropriate vitamin D level, according to international scientists who are serious and ethical professionals. What is proposed as the ideal levels is at least 40-50 ng/ml of 25 (OH) D3 for a normal person. The most recent research, however, has demonstrated that patients with auto immune diseases, for genetic reasons (references 3 and 4), are partially resistant to the effects of cholecalciferol, and therefore, they need even higher levels in order to be free of aggression in their own immune system. In these cases, the appropriate level can only be established through clinical and laboratory follow-up to allow adjustments of their doses according to the individual need of each patient, without the risk of serious side effects, especially on the renal function.

Individuals with greater risk of vitamin D deficiency that can suffer serious complications resulting from this metabolic change are those people:

[ 1] with advanced age (the skin of a 70 year old individual produces only one-fourth of the amount of vitamin D produced by a young man of 20 years of age); [ 2] overweight (the accumulated fat under the skin highjacks the vitamin D from blood circulation; in general the need for vitamin D in these individuals is doubled in relation to a person with normal weight with the same height); [ 3] with dark skin (the melanin reduces the absorption of morning solar radiation which produces vitamin D); [ 4] that are working or studying exclusively in confined environments, isolated from sunlight in the morning, or in the end of the afternoon; [ 5] that, poorly oriented, use sunscreen indiscriminately, at times (such as in the initial period of the morning) in which the solar exposure is absolutely necessary for the abundant production of vitamin D in the uncovered skin and for health preservation (sun protection factor 8 reduces by 90% the production of vitamin D; the use of protective factor 15 reduces by 99% this production); [ 6] who live in places far from the Equator, where solar radiation is limited by long winter, shorter days, and people who use clothes that cover a greater extension of the skin for protection from the cold weather.

However it is important to emphasize, that even in locations near the Equator, the problem has already become very similar, due to [ 1] the expansion of underground road network with covered car parks, and occasionally with direct access to the interior of commercial centers, [ 2] the construction of a growing number of shopping centers (where entire families spend several hours of their weekend, instead of going to beaches, parks, zoos and botanical gardens); [ 3] the use of protective film on the windshield and windows of cars, [ 4] the construction of underground car parks under the commercial and domestic buildings, with direct access to elevators; [ 5] the growing amount of entertainment and competitions devices found in home environments, such as electronic games, paid TV, DVDs, “Blu Rays”, and by increasing interactivity offered by global network of computers. Parents feel comfortable seeing their children entertained with these domestic activities for leisure, and at the same time remaining distant from urban violence.

Meanwhile the percentage of children with diabetes type I is growing 6% a year in Europe; all of these characteristics of modern urban life allow individuals to move and carry out practically any activity in the urban environment with virtually zero exposure to the sun. Three evident factors, acting together, contribute to a disastrous effect on the public health and contribute to public and private expenses in this sector and in the pension sector: [ 1] the large percentage of affected individuals, specially urban population; [ 2] the large number of diseases and disorders caused or facilitated by the deficiency of a hormone that potentially participates in the regulation of 229 biological functions in the human body; [ 3] the lack of information of a great part of the medical class, that through many decades remains fearful of administering (preventive or in a therapeutically way to individuals that are adults) absolute physiological doses that are taken orally, such as 10,000 IU per day, which are the same amount of units produced by clear skinned people during mere 20 minutes of sun exposure in the morning, without sunscreen. To produce the same amount of vitamin D that is offered in 20 minutes under safe sun, an individual would have to ingest 100 glasses of milk, which is also 50 times higher than the daily dose of 200 IU (the most commonly prescribed, which are mistakenly disclosed as “recommended” ).

Therefore, a paradigm shift is absolutely vital and urgent in relation to the preventive and therapeutic potential offered by doses of cholecalciferol much higher than those commonly used, specially in patients who, for their own clinical condition, have limitations to expose themselves to the sun, such as lupus patients (by the possibility of worsening skin lesions induced by UV rays), vitiligo (due to the possibility of skin damaging) and multiple sclerosis (due to heat intolerance). Deficiency of vitamin d is aggravated in these patients, who are advised to avoid sun exposure, and as a result, have their auto immune diseases worsened.

It is deeply regrettable that thousands of young people, all over Brazil, suffering from multiple sclerosis, are becoming blind and paraplegic individuals, simply caused by the lack of a substance that could be administered in the form of drops, in a single daily dose, which gives them the right perspective of a normal life. There is no justification for not correcting any alteration or metabolic deficiency that can be corrected, even in the absence of clinical signs of possible harmful consequences to health. To do so is an obligation! And not doing anything can be seen as negligence or a result of misinformation. A doctor cannot leave their patient’s health under risk. Prevention is and will always be the best approach, be it in an individual way or as a government policy of public health.

What to say about a patient that is already suffering from an auto immune disease, such as multiple sclerosis, whose high frequency of outbreaks and high severity of neurological sequelae (paraplegia, blindness) correlates with the circulating levels of vitamin D (reference 5)? How to justify the habit of not even requesting a test to check the patient’s concentration levels of 25 (OH) D3, and of not even administering doses which are realistically able to correct a deficiency that, according to the specialized literature, is practically right? How to accept any passivity in face of a metabolic disorder of easy fix in relation to administering much higher doses (than those insignificantly called “recommended”) that reduce active lesions (reference 6) and were demonstrated to be perfectly safe (references 6 and 7)? How to accept such passivity, knowing that already in 1986 (26 years ago) it was shown that more modest doses (8 times lower than those shown as safe, but still 25 times higher than the “recommended” behaviour by conventional therapeutic) were shown to be able to reduce more than 50% the frequency of relapses in patients with MS (reference 8) ? Which is the justification for any physician, even in the face of such data, simply turn their back to this issue and let the patient (whose health is under their professional liability) with a metabolic disability whose correction is, per se (regardless of the presence of any disease), ethical and technically mandatory, and that could save your patient with multiple sclerosis from intense and permanent suffering caused by severe and irreversible sequelae, such as blindness and paraplegia?

How to propose “controlled” studies for the correction of any hypovitaminosis (not only the hypovitaminosis D), when such studies are ethically unviable, in the same way as you cannot administer placebos for diabetic children (deficient in insulin) to “ensure” that the efficiency of the administration of insulin is “scientifically” proven? The same occurs with the deficiency of vitamins such as folic acid in pregnant women. Would it be ethical to check in a “controlled way” that a larger number of children born with anencephaly or other congenital malformations in “placebo group”? Such studies were never and will never be made. So would it be correct, to not administer the folic acid for pregnant women with low levels of this nutrient, under the background of  “there are no controlled studies”? Evidently, unlike the study of the effectiveness of allopathic drugs, evaluation of the efficiency of the correction of any metabolic disorder may not be “controlled” using placebo. The absence of such studies may not justify not correcting any metabolic change, because it is a fallacious argument identified in studies of logic and statistics (reference 9).

All members of the executive board of the Autoimmunity Institute share the thought that feelings and perceptions that must guide the treatment of patients affected by these and other diseases are the common humanitarian sense, empathy capacity and genuine desire to help, serve, alleviate suffering and restore health. In this sense, it is imposed a radical change in the paradigm of research and treatment, which abandones the focus on the exclusive chronic use of drugs which, by its side effects, are deteriorating the quality of life of the patient, in addition to placing at risk their physical integrity and their life, without the prospect of a solution in any term. As a new paradigm to be sought, any pattern of behaviour, amendment or metabolic disorder that potentially contribute to the triggering, sustaining and/or worsening of the disease must be identified and corrected, whenever this correction is possible, with the aim of reaching symptoms disappearance, the solution to the problem and the release from the chronic use of medications.

Professor Cícero Galli Coimbra
Neurologist and Specialist on Internal Organs
Associate Professor, Federal University of São Paulo, UNIFESP
President, Autoimmunity Investigation and Research Institute

REFERÊNCES:

1 – Ramagopalan, S.V., Heger, A., Berlanga, A.J., Maugeri, N.J.,Lincoln, M.R., Burrell, A., Handunnetthi, L., Handel, A.E., Disanto,G., Orton, S.M., Watson, C.T., Morahan, J.M., Giovannoni, G., Ponting,C.P., Ebers, G.C., Knight, J.C. A ChIP-seq defined genome-wide map of vitamin D receptor binding: associations with disease and evolution. Genome research 2010; 20:1352-1360. – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945184/

2 – Unger, M.D., Cuppari, L., Titan, S.M., Magalhaes, M.C., Sassaki,A.L., dos Reis, L.M., Jorgetti, V., Moyses, R.M. Vitamin D status in a sunny country: where has the sun gone? Clinical nutrition 2010; 29,784-788 – http://www.sciencedirect.com/science/article/pii/S0261561410001111

3 – Pani, M.A., Regulla, K., Segni, M., Krause, M., Hofmann, S.,Hufner, M., Herwig, J., Pasquino, A.M., Usadel, K.H., Badenhoop, K.Vitamin D 1alpha-hydroxylase (CYP1alpha) polymorphism in Graves’disease, Hashimoto’s thyroiditis and type 1 diabetes mellitus.European Journal of Endocrinology 2002; 146:777-781.

http://eje-online.org/content/146/6/777.long

4 – Sundqvist, E., Baarnhielm, M., Alfredsson, L., Hillert, J., Olsson,T., Kockum, I. Confirmation of association between multiple sclerosis and CYP27B1. European journal of human genetics : European Journal of Human Genetics 2010; 18:1349-1352. – http://www.nature.com/ejhg/journal/v18/n12/full/ejhg2010113a.html

5 – Smolders, J., Menheere, P., Kessels, A., Damoiseaux, J., Hupperts, R. Association of vitamin D metabolite levels with relapse rate and disability in multiple sclerosis. Multiple Sclerosis 2008; http://msj.sagepub.com/content/14/9/1220

6 – Kimball, S.M., Ursell, M.R., O’Connor, P., Vieth, R. Safety of vitamin D3 in adults with multiple sclerosis. American Journal ofClinical Nutrition 2007; 86:645-651. – http://www.ajcn.org/content/86/3/645.long

7 – Garland, C.F., French, C.B., Baggerly, L.L., Heaney, R.P. Vitamin D supplement doses and serum 25-hydroxyvitamin D in the range associated with cancer prevention. Anticancer Research 2011; 31:607-11- http://www.ncbi.nlm.nih.gov/pubmed/21378345?dopt=Abstract

8 – Goldberg, P., Fleming, M.C., Picard, E.H. Multiple sclerosis: decreased relapse rate through dietary supplementation with calcium, magnesium and vitamin D. Medical hypotheses 1986; 21: 193-200. – http://www.sciencedirect.com/science/article/pii/0306987786900101

9 – Altman, D.G., Bland, J.M.. Absence of evidence is not evidence of absence. British Medical Journal 1995; 311:485. – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2550545/

Here is an article explaining why pharmaceutical companies are not much interested in promoting Vitamin D (unless they can turn it into a medicine that brings them higher margins)

http://www.naturalnews.com/032202_vitamin_D_deficiency_disease.html

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