Updated Review
Published: June 13, 2022
Since our review was published we found a new relevant meta-analysis (Front Neurol 2020;11:697). This study analyzed the pooled results of vitamin D levels from 4 publications and concluded that these levels are lower in people with ALS than healthy controls. This adds support to our conclusion that vitamin D levels should be checked in PALS. They analyzed the pooled results of 9 studies looking at correlations between vitamin D levels and ALS progression (ALSFRS-R or survival). Results were highly variable. Overall there was no clear relationship between vitamin D levels and progression, though 2 out of 3 studies did show that lower D levels correlated with shorter survival. Finally the paper analyzed the pooled results of 5 trials examining ALS progression in patients on vitamin D supplementation versus ALS patients who were not on supplementation. These studies collectively failed to show a benefit from vitamin D supplementation. However these trials may have suffered from a common design flaw: they compared patients who initially had low vitamin D and were supplemented to those who initially had normal vitamin D and were not supplemented. A better design would be a randomized placebo controlled trial in which all patients with ALS and low vitamin D levels were randomized to either vitamin D supplementation or placebo. We do not feel that this meta analysis changes our grades or our conclusions.
Key Information
Click on any letter grade below for more info:
Mechanism Grade: C
Preclinical Trials Grade: C
Cases Grade: F
Trials Grade: D
Risks Grade: B
Published: Apr 2014
At this time, there is evidence that PALS, like those with other chronic illnesses, are at increased risk for vitamin D deficiency. It is, therefore, reasonable to screen PALS for this. If vitamin D deficiency is found, it seems reasonable to supplement vitamin D according to established guidelines (31) in order to avoid medical complications of vitamin D deficiency. It is not yet clear, however, that vitamin D supplementation can slow disease progression, improve muscle strength, or reduce falls in PALS. We support further studies to answer these questions.