Monday , March 1 2021

Vitamin D as tablets in psoriasis or psoriatic arthritis

D vitamin

Many assume that they take little vitamin D. Deficiency is said to cause serious illnesses, including cancer. Effective advertising is advised to take additional vitamin D tablets; especially in winter. Even with skin diseases such as psoriasis or atopic dermatitis, it is repeatedly said that vitamin D can positively affect the disease. Is there something for this?

Have vitamin D deficiency tested

New studies show that vitamin D supplementation can not reduce disease risks. The only exception in the case of deficiency are bone diseases. Only those who have attested a genuine deficiency should resort to vitamin D tablets. That is, before buying the pills, a vitamin D test should be done.

This also applies to psoriasis: studies confirm that people with psoriasis usually have a vitamin D deficiency as healthy. But this does not apply to everyone! exist one A study in which patients with very high doses of vitamin D could improve their psoriasis. These things can only be done under strict medical supervision.

Scientifically, it is controversial whether healthy in winter with vitamin D are "needy". This is controversial because there is no clear value from which concentration in blood health may be at risk. A self-treatment with vitamin D supplements is actually harmless. But many are overdosed. In addition, some take other supplements that contain vitamin D (for example, multi-vitamins). This can quickly lead to overdose. But this increases the risk of falls and fractures or contraction of the kidneys. In combination with calcium, overdoses can even lead to heart disease.

Those who take vitamin D supplements and are in (any) treatment should always discuss this with their doctor.

Prevent vitamin D disease?

For years it has been stated in public that we have a vitamin D deficiency. We are asked to evaluate our individual status. Above all, we should definitely take vitamin D supplements to prevent health risks: bone diseases (osteoporosis, osteomalacia), tumors, asthma, multiple sclerosis, diabetes, rheumatoid arthritis, cancer, heart and circulatory diseases (high blood pressure), depression and various autoimmune diseases. Most physicians have always rejected statements like "vitamin D hype". Now it is finally clear that they were more certain.

"So far, there is only clear evidence that vitamin D[[[[causal]has an effect on bone health. "The reason for rickets is clearly vitamin D deficiency. In contrast, no other disease has been scientifically possible[1] be proven by a vitamin D deficiency causal cause is. Above all, proven for essential diseases that can be prevented by an additional dose of vitamin D, nor can they be treated effectively. Success stories that claimed otherwise were based on observational studies. The underlying data was scientifically very weak.

In March 2018, the test magazine spoke of "Degraded Vitamin D". All known studies would show "that vitamin D can not prevent cancer, diabetes, depression or cardiovascular disease."

In January 2019, ZEIT formulated that the "vitamin D myth" was (finally) shaken: a 5-year study with almost 26,000 participants showed that vitamin D supplements "neither the frequency of new cases of cancer nor of heart attacks or spills. " At the same time, the health risks of overdose have been long warned (including kidney failure, falls or kidney stones / calcification). In combination with calcium, overdoses can even lead to heart disease.

Consumer advocates regularly point out that vitamin D supplements sold over-the-counter are often overdosed. In the UK, many cases of "overdose" occurred; not in Germany so far.

Vitamin D deficiency as an indication of disease

Most experts assume that a very low vitamin D level not the cause, but the result a disease is. Inflammation, which is a typical concomitant of many diseases, reduces the level of 25-hydroxy-vitamin D (25-OH-D). So if a low OH-D value is measured, this is an indication that you are sick. The lack of vitamin D is not the reason for the disease. This would explain why with the additional intake of vitamin D, a disease can not be prevented in principle.

Vitamin D deficiency as a business

It is estimated that two million people take vitamin D supplements daily for fear of contracting because of a deficiency. In 2016, vitamin D supplements were sold in Germany for 179 million euros. That's gone. 2/3 Over the balcony counter. Although there were one million blood tests in 2010, it was 4.5 million six years later. Costs totaled more than 87 million euros in one year[2],

This caused a campaign[3]in the US, initiated by physician and biochemist Michael F. Holick. It has already been described as a dangerous deficiency when the level of vitamin D in a person falls below 30 mg / l. He claimed that this could lead to dangerous diseases in the long run. With this limit, 80% of the population would be missing in Western countries, such as the US or Germany. It triggered a heated discussion about the vitamin D thresholds[4], It is also complicated when asked more precisely: What measurement method was used to determine which vitamin D characteristic and which unit of measure and how often? "In Germany, regular interlaboratory testing across the country shows that method differences in vitamin D determination are significant." This leads to completely different values. It is dispensed by unreliable quick tests from the pharmacy. A single measurement does not produce a reliable result in these circumstances.

Insufficient supply of vitamin D Yes, no dangerous

It is indisputable that the population is not sufficiently supplied with vitamin D. More would be better for the health of the bones. However, experts do not consider this "undersupply" harmful to health. For most, it can be easily compensated for: "15 to 20 minutes of midday sun between April and October with arms folded to fill the vitamin reservoirs"[5]It is controversial whether healthy people should take vitamin D supplements during the dark season. Some experts believe that storage of vitamin D can deplete to a limit of risk. Others think it's an exaggeration. You can also take vitamin D through the diet, although in a limited amount of ten to 20 percent.

Who should take vitamin D tablets

There are at-risk groups that should actually take additional vitamin D supplements:

  • People who are very rarely outdoors, such as sick, disabled, nursing home or dermatologist. There are no mention of office workers, computer nerds and other couch potatoes.
  • People who have little sunlight on their skin, as if they are completely obscured.
  • People with dark skin who live in poor areas of the sun.
  • Children in the first 12 to 18 months of life until the second summer.
  • For the following diseases: anorexia, celiac disease, inflammatory bowel disease, short bowel syndrome, chronic liver and kidney disease.
  • Those taking medications, such as glucocorticoids (cortisone internally!), Anticonvulsants or cytostatics, should observe the vitamin D level.
  • Groups of people who are frequently affected by vitamin D deficiency should have their vitamin D status checked: elderly people over 65, vegetarians, vegetarians and, presumably, people with psoriasis.

Dosage and high dosage of vitamin D.

There are different recommendations on how much vitamin D should be taken daily: 400 I.E. (International Units). This corresponds to a daily amount of 10 micrograms. Since 2018, the Federal Institute for Risk Assessment recommends a maximum of 800 I.U., which is 20 micrograms (μg) per day[6], But Beware: Preparations should be checked for overdose[5], Anyone receiving medical treatment should inform the physician if additional vitamin D supplements are taken.

The Coimbra Protocol

There is much discussion today about a therapy in which multiple sclerosis patients are treated with very high dose vitamin D supplements. The concept ("Protocol of Coimbra") comes from the Brazilian physician Cicero Coimbra. He argues that in patients with autoimmune diseases, a genetic inheritance, partially resistant to the effects of vitamin D, is present (receptor disorder). Therefore, there is very little vitamin D in the body, which can affect the immune system. He claims to have treated thousands of patients with multiple sclerosis. In 95 percent of the symptoms of the disease were reduced, provided that they are high doses of vitamin D picked it up.

There are many questions, doubts and concerns about this approach. Especially in terms of long-term risks and side effects. Dr. Coimbra does not intend to conduct a study according to scientific standards "for ethical reasons". A scientific journal refused to publish its findings. The publisher's ethics committee had come out against it. "Because he does not work some data and publish himself, it's unknown." At first glance, there are parallels with Dr. med. Matthias Rath. He claimed to be able to fight and cure AIDS with high doses of vitamin preparations, cardiovascular disease, cancer and immunodeficiency – with fatal consequences, as we now know.

Vitamin D and psoriasis

There are several scientific publications on the relationship between vitamin D and psoriasis. Vitamin D is formed in the skin by UV light. For example, the effect of photo therapy can be explained. There regulates the development of skin cells, i. Division, growth, quality, but also death of keratinocytes. Vitamin D affects the barrier and the immune function of the skin. Some studies predict that it suppresses inflammatory cytokines.

A 2017 Italian study examined 141 patients with moderate and severe psoriasis and 62 healthy controls. Vitamin D levels in patients with cutaneous psoriasis were significantly lower than in healthy subjects. The more they were affected, the lower the values. However, this could not be proven for patients with joint involvement.

Another 2012 Italian study has 145 patients with chronic plaque psoriasis, 112 with rheumatoid arthritis (RA), and 141 healthy with vitamin D and calcium studied during one year. It has been found that vitamin D deficiency is very common in patients with chronic plaque psoriasis and in patients with APs. In winter, this affected 80% of patients, in the summer about 50%. The authors explicitly excluded that the study groups were exposed to different solar irradiances. Subsequently, patients received vitamin D preparations at commercial dosages ranging from 400 to 1000 IUs. This allowed vitamin D status to be corrected. That would be "no proof yet" that additional The administration of vitamin D reduces inflammation. In addition, the authors say, they can not conclude that vitamin D deficiency has caused or affected psoriasis.

In a 2018 paper, Qatar scientists have researched databases: most of the publications found suppose that vitamin D deficiency promotes psoriasis. Several clinical and observational studies have reported "beneficial effects of additional intake of vitamin D in the treatment of this skin disease." In one case, patients received 35,000 I.U. once a day for six months. D vitamin3As a result, their vitamin D status improved and psoriasis healed significantly. "It should be noted, however, that a high-dose vitamin D intake can occur only under medical supervision." Unfortunately, the publications found were of very different quality (statistics). The statements should therefore be carefully evaluated.

Vitamin is absorbed differently

It is interesting that the authors of QAR are cautious to compare studies of vitamin D from different countries. Because not every ethnic group has the same vitamin D receptors. So they were found in an Italian and Chinese population group, but not in the Croatian and Egyptian population. What a bad vitamin D instead receives psoriasis and does not respond as well to appropriate therapies (such as UV irradiation).


The publications suggest that vitamin D deficiency is more common in patients with psoriasis than in the healthy population; especially in winter. Therefore, all authors recommend that people with psoriasis be examined for vitamin D deficiency. In the case of a real deficiency detected, vitamin D supplements should be taken. A deficiency of vitamin D is said to be when the 25-OH-D label is below 30 nmol / l (12 ng / ml).

Other experts advise against "preventive" vitamin D measures. Point values ​​are not very significant, they say. There are different methods of measurement so that different laboratories can achieve different results. A blood test "at home" should be completely rejected[2]Instead, it should be measured only when typical symptoms of deficiency occur – but these are rare.

In the guide pages, a lot of typical everyday problems are listed as very spongy vitamin D deficiency symptoms. Doctors understand this as unexplained bone pain, unusual fractures, unexplained increase in alkaline phosphatase, or low levels of calcium or phosphate. In the ZEIT report of January 2019, the laboratory doctor, Matthias Orth, is the most radical: "There is really only a clear medical indication for the determination of vitamin D: a renal weakness. Patients with this disease have a variety of metabolic problems such as decalcified bones. "

The question of whether and how vitamin D intake improves psoriasis is unclear. Although there is the only study in which daily 35,000 I.E. Vitamin D has improved psoriasis. But high doses are risky and can, if necessary, be made only under medical supervision. Those who are supplied with commercial doses can, without hesitation, up to 800 I.E. Take each day. Who wants to spend the money only if the effect is really proven, should talk again with the dermatologist or the dermatologist.

[1]randomized, double-blind, evidence-based trials: random selection, accurate baseline data collection and parallel continuous therapy, placebo control group, no physician or patient knows who receives the drug, statistically significant number of participants.

[2]The hype about vitamin D – panacea or make money?, TV show of SWR Marktcheck, 17.10.2017

[3]In 2018, the New York Times managed to find funders behind this campaign: pharmaceutical companies, manufacturers of laboratory tests + lobbying of tanning salons. The Potato's Disadvantages of Vitamin D – On the Invention of a Health Problem, PHARMA-BRIEF 10/2018

[4]The fairy tale about lack, Birgit Schumacher, ÖKO-TEST Magazine 12/2018

[5]Vitamin D: sub or overestimated ?, Inga Richter, PSO aktuell 1/2017 and
Test of vitamin D preparations – best in the sun, ÖKO-TEST Magazine, 12/2018

[6] Test # 5/2018

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