The benefits of a good diet have been a favorite topic of parents, and government campaigns since the dawn of time. We’ve clearly taken the advice to heart, with 50% of the US population taking vitamins and herbal supplements, at a cost of $21 billion. That’s nearly four times the annual budget of the United Nations – and an awful lot of little tablets.
No doubt, we take vitamins with the best of intentions, but what evidence is there that they have positive effects? Some see vitamin supplements as unnecessary for healthy people with diets to match, but what about people with ankylosing spondylitis (AS)? Should they be taking a tablet top-up? If you have AS, how vital are vitamins – and where’s the science to prove it? This AS Life puts its lab coat on and goes investigating…
An A+ for vitamin D
A quick search reveals that, when it comes to AS, vitamin D certainly gets a star prize for popularity. It dominates the field of vitamin research for AS. Perhaps that’s not surprising; vitamin D is key to keeping bones healthy (causing rickets in people who lack it)1 and its deficiency is a prime suspect in a range of autoimmune diseases.2
There are several studies showing significantly lower vitamin D levels in people with AS, compared with the general population.3 More severe cases of the disease have, in some cases at least, been shown to correspond with even lower levels of vitamin D.3
So would taking vitamin D supplements help with AS? The experts don’t know yet. Digging a little deeper reveals more answers to why, but more puzzles too. There seems to be a ‘chicken and egg’ relationship between AS and vitamin D, with researchers yet to work out whether lower vitamin D levels cause AS or the other way round.4,5 There’s been a call for trials to investigate whether giving people with AS vitamin D would help their disease,2 but none have been published yet. Hopefully, with more time – and lots more research – some more concrete answers will emerge.
In at least one study, by contrast, supplements have been shown to improve the symptoms of AS. Adding omega-3 supplements helped reduce disease activity in one Scandinavian study.6 Sadly it was a tiny study, only examining nine patients in each treatment group. Even the authors themselves stressed the need for a bigger, better study in the future.6
Currently, where AS and vitamins are concerned, vitamin D seems to have been occupying most of the researchers’ time. There are still a few small studies out there though, including one showing lower levels of vitamin A in people with AS.7 This finding is backed up in a second small study that showed lower levels in vitamins C and E too.8 In the main though, when it comes to solid science backing the use of vitamins in AS, evidence is thin on the ground.
Getting involved in your treatment
If the evidence seems slim, don’t be too disheartened – there could be a big difference between not being effective and just not being investigated. What is clear is the benefit patients get from taking an active role in how their AS is managed, whether by changing their diet, more active management of symptoms or taking more involvement in clinical decisions. This so-called ‘self management’ has been shown to have positive effects on quality of life and disease status for people with chronic diseases.9,10
It’s unclear if vitamin supplements fall into this category, but being self-motivated enough to get involved in your own treatment sounds like a positive place to start. Perhaps, after some research of your own (and with the advice of your doctor or another healthcare professional), you’ll find a way of actively managing your condition that works for you.
This article was written by one of the resident experts at ThisASLife.com. A social site, helping the whole AS community to: Learn. Share. Inspire. Discuss.
1. Galesnu C, Mocanu V. Red Med Chir Soc Med Nat Iasi 2015; 119:310–318.
2. Antico A et al. Autoimmun Rev 2012; 12:127–136.
3. Zhao S et al. Rheumatology (Oxford) 2014; 53:1595–1603.
4. Urrticoechea-Arana A et al. Arth Red Ther 2015; 17:211–220.
5. Pokhai GG et al. Rev Bras Reumatol 2014; 54:330–334.
6. Sundstrom B et al. Scand J Rheumatol 2006; 35:359–362.
7. O’Shea FD et al. J Rheumatol 2007; 34:2457–2459.
8. Naziroğu M et al. Clin Biochem 2011; 44:1412–1415.
9. Franek J. Ont Health Technol Assess Ser 2013; 13:1–60.
10. Iversen MD et al. Ann Rheum Dis 2010; 69:955–963.