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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

The vitamin D, lupus link: A review of the literature

As many blog readers know, there has been much research studying the relationship between vitamin D and systemic erythematosus lupus of late. Some research shows that vitamin D and lupus have a relationship. But what does all the research say?

A new systematic review published recently in PLOS ONE examined this very question.

Sakthiswary R, Raymond AA. The clinical significance of vitamin d in systemic lupus erythematosus: a systematic review. PLoS ONE. 2013;8(1):e55275.

Sytemic lupus erythematosus, or often just called lupus, is an autoimmune disease characterized by chronic inflammation. The immune system attacks skin, joints, blood cells, and internal organs. Many patients develop a distinctive rash on the face that resembles a butterfly.

Various cells of the immune system express the vitamin D receptor, and multiple studies have found that lupus patients are more vitamin D deficient than the general population. However, sun exposure is a known cause of lupus flare-ups, so it has been proposed that sun-avoidance by lupus patients might actually be the cause of their low vitamin D levels.

In this review, the authors searched databases for studies that were observational in nature. They found 22 observational studies that examined the relationship between lupus and vitamin D. Eight were case-control and 14 were cohort type studies. They found the following:

  • Out of the studies that looked at vitamin D levels and disease activity, 10 of the 15 studies found an inverse relationship between vitamin D levels and disease activity; the higher the vitamin D level, the lower the disease activity. Five of the fifteen studies did not find this relationship.
  • In studies that examined disease damage and vitamin D levels, only 1 out 6 studies found an inverse relationship, while the other five found no relationship.
  • In the four studies that investigated cardiovascular risk factors and vitamin D in lupus patients, the majority found that lower vitamin D levels were associated with more insulin resistance and unfavorable lipid profiles.

What does this mean for patients with lupus? The authors themselves say it best:

“…there is substantial evidence to convince us of the association between vitamin D levels and SLE disease activity.”

While acknowledging that some studies have not supported this relationship, they point out that the largest studies to date have confirmed the link between low vitamin D status and increased lupus disease activity.

However, the authors point out an interesting and unexpected finding of the research. The majority of studies found no relationship between vitamin D levels and organ damage from lupus disease activity. More disease activity usually translates to more damage to the organs. If higher vitamin D levels are associated with lower disease activity, why would there be no relationship between vitamin D levels and organ damage?

The cross-sectional nature of the majority of the studies reviewed makes it difficult to determine the long-term effects of vitamin D in lupus progression. Additionally, it may very well be that the true power of vitamin D lies in its power to prevent the conditions that allow an autoimmune disease to take hold. Once this process has started, vitamin D may not be as effective in treating the disease as it would have been in preventing it.

Also note that this systematic review only examined observational studies. The authors only wanted to examine the relationship between vitamin D and lupus, not if vitamin D had an effect as an intervention. The Vitamin D Council has previously blogged on a randomized controlled trial and an open label study, both designed to determine if vitamin D reduced flare-ups in people with lupus. Both studies found that supplementation with vitamin D did in fact reduce flare-ups:

The authors in this present review state that “more trials are needed,” and we know there are a few already underway. For now, the use of vitamin D in lupus looks promising.

  About: Rebecca Oshiro

Rebecca has a master of science degree in nutrition from Bastyr University where she conducted a university-funded study on vitamin D and athletic performance. She has a certificate in applied behavior analysis from the Florida Institute of Technology, and her passion is using behavioral technologies to assist others in making meaningful changes in their lives.

8 Responses to The vitamin D, lupus link: A review of the literature

  1. Ashtatara says:

    There are already a treatment of Lupus and other autoimmune diseases with high doses of Vitamin D3. It is available in Brail and Portugal. It is unethical not to treat patients with autoimmune diseases with high doses of Vitamin D3. I am very serious about this. I know this treatment will be acknowledged in the future. This Brazilian neurologist and brain researcher is lightyears ahead of all of you. It is a crime not to make this treatment avalable to everybody. We cannot wait for further research. http://www.youtube.com/watch?v=erAgu1XcY-U

  2. Rita and Misty says:

    I personally know a doctor now working at one of the Ivy Leagues. Much of his research is still focused in Brazil…This man isn’t a Vitamin D researcher; however, through collaborators in Brazil, he has been made aware of the health benefits of Vitamin D.

    He knows its potential. And, he agrees.

    But remember, it is difficult to swim against the tide. I’m certain many researchers and clinicians here in the USA realize the great healing potential of Vitamin D.

    The also have lives and careers and families. They are human. Few desire to be on the front line regarding this Public Health issue. It’s sometimes more politically correct to say: “Gee, that’s not my expertise.” And, I venture to say that is also human nature.

    I’m constantly being told that change occurs in small increments, and cannot be rushed.
    My response in return is “people will only grow if stretched.”

    Honestly, I do believe change is slow, but unless some of us keep extending the front boundaries, there is risk of complacency…of stagnation.

    I think it is possible to end this pandemic within the next 50 years.

    But, then at least a few may consider me to be a Pollyanna.

    To sunny days!
    Rita

  3. Rebecca Oshiro says:

    Rita, I think you said it best, I do not need to add to that. Thank you!

  4. Here are some of the titles of articles on Lupus and Vitamin D at VitaminDWiki
    Lupus and Vitamin D: good evidence, no conclusions – Review Jan 2013 (The study described at Vitamin D Council)
    Lupus flareups cut in half by just 2,000 IU of vitamin D – RCT Dec 2012
    When lupus affects the kidneys vitamin D levels drop even further – Nov 2012
    Hypothesis of Autoimmunity which includes Barr Virus and Vitamin D Deficiency – 2012
    Lupus flares totally eliminated by loading dose then 100000 IU of vitamin D each month – Oct 2012
    Vitamin D patent for treating immune system diseases
    Lupus 8X more likely to not even have 20 ng of vitamin D – May 2011
    Lupus in vicious circle with vitamin D – Nov 2010
    Vitamin D deficiency prevalent with Lupus R-Arthritis and Diabetes – Oct 2010
    Taking vitamin D reduced Lupus fatigue– Aug 2010
    Is it time to routinely supplement Lupus patients with vitamin D? – May 2010
    Lupus again found to be related to vitamin D deficiency – should supplementation start? – May 2010
    Link to all of those are at: http://www.vitamindwiki.com/Lupus

  5. Rita and Misty says:

    @Rebecca, I appreciate your kind words. :)

    BTW–If you (or others here) ever find yourself in a position of outreach…of trying to convince someone of the benefits of Vitamin D…I hope you’ll consider a lesson I learned from the field of labor relations:

    Always take the first negative response (actually, any negative response) you receive as an opportunity for you to solicit a positive future response…a “no” is always a “future yes” in my opinion.

    Simply circle around, and go back again (and again, and again).
    Change your approach, but keep trying.

    It isn’t for the faint of heart; and sometimes you’ll need to take a break–as this type of work can be extremely exhausting, but it does provide tremendous rewards, if diligent.

  6. Rebecca Oshiro says:

    @Rita, a dear colleague of mine’s motto was “No is the beginning of a negotiation.” 😀

  7. Rita and Misty says:

    :) At the risk of belaboring the point:

    “You learn by doing; and you heal by helping…”

    :) :) :)

  8. Rita and Misty says:

    From the below link (of course, I think the target 25(OH)D level is too low…but at least research is moving in the right direction:

    http://www.einstein.yu.edu/departments/medicine/medicine.aspx?id=16712

    “Vitamin D is well known for its essential role in maintaining bone density. A growing body of knowledge indicates that it may help prevent cancer, hypertension, and diabetes as well as improve muscle function in older individuals. Vitamin D may also have important immunological consequences for patients with autoimmune diseases such as lupus, according to Dr. John A. Hardin, Professor of Medicine (Rheumatology) and Microbiology and Immunology at Albert Einstein College of Medicine, Professor of Orthopedic Surgery at Montefiore Medical Center, and Chief Scientific Officer of the Arthritis Foundation.

    Systemic lupus erythematosus (SLE, or lupus) is a chronic, potentially fatal disease in which the body’s immune system attacks healthy cells, resulting in complications ranging from skin rashes and joint pain to seizures and kidney failure. Severe vitamin D deficiency is prevalent among patients with lupus, particularly African Americans, who are most commonly and severely affected by the disease. “Replacing patients’ vitamin D levels as part of treatment may improve the clinical outcome of SLE and significantly affect the health of people living in the Bronx,” said Hardin during a recent Medicine Grand Rounds on the topic.

    Target blood levels of vitamin D are currently thought to be 30–40 ng/ml. Daily doses of 1000–2000 IU achieve this level in most patients, and 2000 IU/day is considered safe.”