Vitamin D | Arthritis Information

Dear Folks, There have been several mentions of genetic predispositions amongst northern peoples and I suggest that the lack of exposure to sunlight may be the root cause (This is not original with me). The short summers and long winters limit such exposure and thus reduce the bodies manufacture of Vitamin D. It appears that MS and shortage of Vitamin D are linked in some way, as is the linkage with other diseases. So if you don't take D supplements to compensate for lack of exposure to sunlight, you may become more susceptible to these diseases, and over generations, pass on that susceptibility. A contributing factor is the constant preaching to avoid exposure to the sun to reduce the incidence of skin cancer. As usual, the pendulum probably swung too far in that direction.

I ran across an article this morning by Dr. Mercola, who puts out a daily list of topics that range from serious to humorous. He lists the following diseases that Vitamin D influences: heart disease, cancer, diabetes and Inflammatory bowel disease, RA, MS, and osteoporosis. I would think that PMR would be on a more detailed list if RA is there.

Anyway, here's the link. Read it all the way because he discusses optimal levels, how to get them measured, etc. Hope this will be of value, particularly to you northerners (and for NZ, southerners).

http://articles.mercola.com/sites/articles/archive/2007/09/2 9/vitamin-d-the-secret-of-a-long-life.aspx

Bob, I think you are correct. My Rh said to be sure to get enough Vitamin D. The daily recommended dose has been increased in the last few years. I take Fosamax with D, Calcium with D, and multi vitamin with D. He approved this amount.

Since most of us stay out of sun, I don't think we get enough natural D. Thanks for the article.

Shirley
Bob,

You're very right. When I was referred to a teaching hospital here a few years ago and got to see a famous fibromyalgia researcher (he was head of the rheumatology department), he ordered all kinds of blood work, including one to measure Vit. D levels. They told me that there was research being done, and that Vit. D recommendations were presently on the low side. I was advised to take twice the recommended amount. My levels were on the low end of normal on the blood wrok. And yes, the pendulum has swung too far in the other direction in the mad rush to avoid the sun's harmful rays. Plus, living here in the Pacific Northwest, we don't get much sun in the wintertime. I once read that there is a higher incidence of MS in the Pacific Northwest than in the rest of the USA, and wondered if it was due to the lack of Vit. D. Interesting stuff to think about.

Reni

That is an interesting theory. I have always taken a vitamin supplement that contained Vitamin D. When I took calcium, I got the kind that didn't contain Vitamin D, because I had read that you can get too much Vitamin D in your system.

The rheumatologist took lots of blood when I first went to her. I don't know if she took a test for Vitamin D or not. I wish they would give on a copy of what was done. Maybe I should ask. I am completely in the dark about any tests that were taken.

Thank you for posting, Mary

Mary,

Yep, when I go to the dr. and have certain tests done that I think are important, or I want to compare them with later tests, I always ask for a copy. I have my own "medical file" at home (mostly the MRIs and x-rays, but some of the bloodwork, too). As far as the Vit. D, you need it with the calcium, as it helps the body to absorb the calcium. One of those combos that work together to give your body what it needs.

Reni
My rheumy tested me for vitD levels, but I get the impression it was more about making sure I would absorb the calcium supplements he put me on, rather than anything else. I actually had (have) a mild VitD deficiency, which I put down to not getting outside very much the last year, and a long winter during which I exposed no skin to the sun! However, in general, New Zealand is very sunny and people here are very keen on outdoor activities. I have heard that rickets are showing an appearance again and VitD deficiencies are not that rare, all because of the anti-sun message about malignant melanomas (of which New Zealand has one of the highest rates in the world). People coat their children and themselves in sunscreens and cover-up clothing out of fear of skin cancer, and end up short on VitD. I am making sure I'm getting 30 minutes of sunshine on my skin every day now. In light of the new research about calcium supplements, I am not taking any. I always suspected excess calcium stayed in the body and I don't want it in my arteries! Bob and all, I agree that vitD is imporant to the equation. One of the first
tests I was given atfter being referred to rheumatology was for vitD and I
was seriously defficient. I was put on an industrial strenth prescription for a
month which brought me back to normal. I was instructed to stay on double
the recommended amount and my level has continued to be normal. For
those who do take calcium vit is needed for absorption as you know; which
is an important concern for preventing bone loss and possibly osteoporosis,
another gift of our friend pred.

HI All:

We have had a beautiful day here in Southern Ontario. I went shopping with my granddaughter (she is 26 and just moved into a really cute apartmetn), but I tired after an hour. These are the time when PMR really gets me down!

Living here in Southern Ontario during the winter months, especially January we do not get a the sun. A few years ago, before PMR, after a bone density test, my dr made of point of calling me into the office to insure I was taking my Calcium and Vit D. Now, since having PMR and on Pred, he is doubly insistent, as recently as last week, that I am taking both. I daily take 1500mg Clacium and 1000mg Vit D. I want to counteract any of the side affects of Pred where possible.

Hope everyone has good days ahead!

Well here I am the odd woman out... My GYN immediately told me she
thought I was Vit D deficient after hearing i had PMR - PCP said she was
probably right & they both said everyone in Maine probably is (gray & dark
majority of year). They did blood levels and guess what? I was well within
normal limits... they told me NOT to take Vit D! We are all different
pgr

Thanks Bob.....I will call my rhumatologist this week and get the results of that last blood work. I will then have a bench mark of what is going on now.

I used to go to a doctor that gave me a lab report every year after my physical. The one I go to now sends some sort of form letter with the results written in the blanks. I have a file of all of them for the past 15 years.

Mary

Wow, an interesting topic! I've been trying to work out this for a while. I believe that although there is some VitD in egg yolk and fatty fish, it is very minimal and won't make up for lack of sunlight. Phyl, you ARE the odd lady out, haha

Thanks Bob,

I'm going in for some bloodwork in a couple of weeks. I'll ask the doc if I can also get tested for VitD.

BTW: I took your advice on splitting up the pred. I just took and extra 5 mg last night and I seemed to sleep better. So I just took 5 mg this morning and will another 5 mg at bedtime and see how it goes.

Take care, Kathy

Hi Bob.

Thanks for your input about vitamin D, I will find out about my level and see
if there is a lack. I also took your advice about splitting the Pred into 5 in
the morning and 5 at night. Seems to make a difference, so will keep doing
it. Your postings are very informative. Thanks again.

Take care, LibethI got conflicting advice at the beginning from my Dr and the pharmacist
about splitting the dose (by accident I had found it to be more effective)
The Dr said do it if it helps, but the pharmacisst said don't, as one dose
of it in a morning was more like how the body produced it, and hence
reduced side effects. Then I found this post on the 'Ask the Expert
section of the arthritis association of Canada website. The Q isn't from
someone with PMR, it'd about pred in general

Q I have been taking prednisone for 23 years. I'm on a low dose of 4mg/
daily. I have been doing 2mg in the a.m. and 2mg in p.m. Is this okay or
is it best to take it in one dose?

A In my experience, the more you divide up the same daily dose of
prednisone, the more effective it is but the more adverse effects it has.
For example, if 30 mg/day of prednisone were taken 10 mg three times
daily, it would be more effective than taking 30 mg once daily, but it
would have more adverse effects than 30 mg once daily. When the doses
of prednisone are as low as yours, 4mg/day, the adverse effects are so
minimal that taking 2mg twice daily versus 4mg once daily would make
little difference. However, the condition you are being treated for might
flare-up by changing to 4mg once daily. And after doing so well for so
long on such a low dose, it probably is not worth taking the chance.

If there were a need to reduce this dosage, I would do it very gradually. I
would reduce the evening dose to 1mg once weekly for 6 to 8 weeks,
keeping the dose at 2mg for the other 6 evenings of the week; then,
using the same timing, to 1mg on 2 alternate evenings per week and 2
mg on the other 5 evenings per week. If the process went well, then the
dosage could be reduced to 1mg every evening and 2 mg every morning.
It would take about one year to accomplish this! Although it is only a 1
mg/day dose reduction in absolute terms, it actually represents a 25%
reduction in the total daily amount of prednisone taken.

So I've tended to stick to not splitting it in the interests of minimising side
effects.

Margaret

Thank ou Margaret, that is very interestig. I split my dose on my dr's advice
because the major side effect I was having was sppeding and not sleeping. It
works and I knock on wood when I say so far no real side effects. I get so
scared every tme I say that out loud!!!

Have a good week all.
pgrI agree pgr. I have very few side effects, and feel incredibly lucky. The main
one I get is that I am impossible to live with when I'm dropping a dose.

MargaretThat is helpful tp know, Margaret as I get ready to drop next week. Will try
to be aware.
pgrI find it helps to warn people in advance - then if I snap they know I don't
really mean it, it's just the pred. (Or maybe I do mean it and the pred is
reducing my normal inhibitions about telling people what I really think????)

Good luck with your drop.

Margaret

I've tried both ways...all in the morning and a split dose. When I took all in the morning, my body seemed to run out of medication in about 18 or 20 hours, and I would get up almost as stiff and sore as without any pred at all. It would then take about 4 hours before I felt any relief.

So I take about 3/4 of the total dose for the morning and the rest before bed. Right now, for example, I am on 9 mg, which I split 7 and 2, which is about 78% and 22%. When I go to 8, hopefully in a couple of weeks, I'll try 6 and 2, which is exactly 75/25%. I think everyone will have somewhat different reactions. Maybe we metabolize at different rates, and we surely differ in body weight, so it may take some experimenting to get the most benefit from your dose. I think it may be better for sleeping that the evening dose be fairly small in comparison to the morning dose.

At these levels of pred, I think it's more important to maximize the relief from symptoms and worry less about side effects. I hope I'm right.