KORN KURATED RESEARCH

Vitamin D and Marine Omega-3 Fatty Acids Reduce the Risk of Autoimmune Disease

A new study with a large cohort analysis of over 20,000 participants supports the role of supplementary vitamin D and omega-three fatty acids as having a 22% reduced risk in autoimmune disease. An additional finding is that to be effective, supplementation must be ongoing as the effects wear off over time. Knowing this helps us answer our client’s questions when they ask: “How long do I have to do this for?”

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Autoimmune disease is highly associated with a history of traumatic stress and complex trauma. Lupus, Rheumatoid arthritis, and Hashimoto’s are among the complex diseases of the immune system resulting from being hypervigilant. The immune system then takes up the trauma response and, seeing danger everywhere, names itself the enemy and begins attacking itself. The resulting inflammatory response can also occur in response to food sensitivities, most often gluten and casein, which is why I also recommend an elimination trial of these foods.

Inflammation also influences the gut and neurotransmitter signaling in brain regions relevant to fear, anxiety, and emotion regulation. All of this suggests several integrative clinical pathways for us to travel toward the resolution of inflammation and autoimmune disease.

My clients often ask what the two most critical nutritional supports to add to their diet are, and I answer that omega-3 fatty acids and vitamin D.  Vitamin D is a neurohormone and not a vitamin, essential to the absorption of calcium and phosphate from the intestines, synthesis of cholesterol. Optimal vitamin D levels reduce pain, are antidepressant, and support immune function. 

It is rare to find anyone with adequate serum Vitamin D levels who is not supplementing, and everyone living above the 39th parallel should always supplement with Vitamin D.

A new study with a large cohort (over 20,000 participants) supports the role of supplementary vitamin D (2000 IU/day) and omega-three fatty acids (1000 mg/day) as having a 22% reduced risk in autoimmune disease. An additional finding is that to be effective, supplementation must be ongoing as the effects wear off over time. The measures tested were inflammatory markers confirming the anti-inflammatory effects of both D3 and Omegas 3s.

The preferred form of the vitamin is D3. Combine it with another fat-soluble vitamin, K2/3. Note that in this research, the dose levels were lower than what we use in clinical practice to optimize both vitamin D and omega-3 fatty acid levels. This suggests that a more optimal clinical dose might bring even better results.  

Vitamin D is fat soluble so take it with some fat. Following several months of supplementation, if Vitamin D levels do not rise enough, you might consider a genomic test for the Vitamin D receptor polymorphism (VDR), which can reduce cell receptivity to supplementation and thus require higher than normal doses.

Tags: Autoimmune, lupus, rheumatoid arthritis, Hashimoto’s, fish oil, vitamin D

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Referenced Research Publication

Arthritis & Rheumatology
2024, January 25
DOI: 10.1002/art.42811

Vitamin D and Marine n-3 Fatty Acids for Autoimmune Disease Prevention: Outcomes Two Years After Completion of a Double-Blind, Placebo-Controlled Trial

Abstract

Objective: In the 5.3 year randomized, 2 x 2 factorial, double-blind, placebo-controlled VITamin D and OmegA-3 TriaL (VITAL), vitamin D supplementation reduced autoimmune disease (AD) incidence (hazard ratio [HR] 0.78, 95% confidence interval 0.61-0.99). Omega-3(n-3) fatty acid supplementation showed a statistically non-significant reduction (HR 0.85, 0.67-1.08). We aimed to confirm further AD cases arising during and after randomization and assess sustained effects with 2 years of post-intervention observation.

Methods: Of the 12,786 men ≥ age 50 and 13,085 women ≥ age 55 initially randomized, we followed surviving and willing participants for 2 more years. We continued to confirm annual participant-reported new AD by medical record review. Cox models calculated HRs for all confirmed AD, and for secondary endpoints, confirmed and probable cases, and individual ADs, including the observational period and during randomized time.

Results: 21,592 participants (83.5%) were followed observationally for two more years. 514 participants had incident confirmed AD (236 since prior report). 255 had been randomized to vitamin D vs. 259 to vitamin D placebo: HR 0.98 (0.83-1.17) at 7 years. AD was confirmed in 234 participants initially randomized to n-3 fatty acids vs. 280 randomized to its placebo: HR 0.83 (0.70-0.99) at 7 years. Of newly confirmed cases, 65 had onset during randomization; their inclusion changed randomized results to: HR 0.85 (0.70-1.04) for vitamin D and HR 0.87 (0.71-1.06) for n-3 fatty acids.

Conclusions: Two years after trial termination, vitamin D 2000 IU/day's protective effects dissipated, but 1000 mg/day n-3 fatty acids had a sustained effect in reducing AD incidence.

Reference

Costenbader, K. H., Cook, N. R., Lee, I. M., Hahn, J., Walter, J., Bubes, V., Kotler, G., Yang, N., Friedman, S., Alexander, E. K., & Manson, J. E. (2024). Vitamin D and Marine n-3 Fatty Acids for Autoimmune Disease Prevention: Outcomes Two Years After Completion of a Double-Blind, Placebo-Controlled Trial. Arthritis & rheumatology (Hoboken, N.J.), 10.1002/art.42811.