Dr. Cicero Galli Coimbra is a Brazilian Neurologist, Professor and Researcher who has become popular for treating Multiple Sclerosis and auto immune disease with high doses of vitamin D3 combined with a combination of other supplements and diet recommendations. Dr. Coimbra does not claim to cure MS [some of his patients will tell you differently] but he has proven that his treatment does stop it progression.
Please do not attempt to duplicate Dr. Coimbra's protocol without a full understanding of how he applies his treatment. The reason you won't find an exact written version of this protocol is that Dr. Coimbra does detailed testing of each one of his patients and alters the protocol for each one. He then monitors his patients continuously for their safety and to make adjustments to their daily dosing. We can only share some basic guidelines and principals he uses.
Dr. Coimbra has no problem stating publicly that he sees 10,000 IUs per day as the "physiological dose" of D3 that is safe for any adult to take. He also states the current US RDA of a maximum of 800 IUs for vitamin D is a "paltry" amount of D3. The commonly prescribed daily dose of vitamin D3 on Coimbra's protocol ranges from 40,000 to 200,000 IU's. He uses a formula of 1,000 IU's per kilogram [one kilogram is 2.2 pounds] to find the upper range doses.
Here is a list of the most common supplements used in Dr. Coimbra's protocol. Vitamin D3, vitamin B2, magnesium, boron, chromium picolinate, Omega 3 DHA, Zinc, Methylcobalamin form of B12, Choline and more. For years Dr. Coimbra has recommended magnesium glycinate but is now recommending magnesium chloride, 500 mg twice a day for most patients.
The Dietary Restrictions
All patients must discontinue eating or drinking dairy products or calcium enriched foods or beverages. Complete restriction is critical! This includes foods that are formed by milk, cheese, cheese spread, yogurt, curdled milk, cream of milk, caramel, milk pudding, condensed milk. Also includes products made of soy milk enriched with calcium (for reduction of the amount of calcium ingested due to the use of high doses of vitamin D in your treatment) . Think hard, this includes foods that use milk in their preparation. Mashed potato, breads, cakes, biscuits as well as butter and margarine need to be eliminated. While it's not mandatory Dr. Coimbra does advise the restriction of poultry, meat and pork meat for reduction of the quantity of heterocyclic amines in the diet. Information on these substances are easily found by doing a Google search for "heterocyclic amines". It is recommended egg vegetarian diet with fish, using soy protein, tofu, egg white and mercury free fish. Coimbra also encourages patients to avoid excessive or routine consumption of bananas. Of course this includes discontinuing any calcium supplement.
Hydration is Critical
Drink at least 2.5 liters [85 ounces] of fluids, preferably water, daily to avoid excessive concentration of calcium in the urine. From Dr. Coimbra "Ingest high amounts of liquids (at least 2 and a half litres of liquids daily, including water, juices,, soft drinks, teas, etc.). This higher quantity of liquids assures a urine volume around 2.000 ml which allows calcium dilution eliminated in the urine, and avoids excessive concentration of urinary calcium ( as when calcium is diluted it does not get deposited in the kidney, preserving renal function).
Must Discontinue the use of all Nephrotoxic Drugs
The use of nephrotoxic drugs must be avoided as they may limit the elimination of calcium through the kidneys. Thus allowing accumulation in the bloodstream, as "the door" between the intestine and the blood current is "open" by higher circulating levels of vitamin D. Avoid taking unnecessary medications all together. Be especially careful with anti-inflammatory drugs and antibiotics. Especially those administered by intravenous or intramuscular injection. If you are prescribed any medication as absolutely necessary, read the leaflet and request information from the doctor and pharmacist about its nephrotoxicity. If it is verified that the medication is in fact nephrotoxic, discuss alternatives with the physician who has prescribed the drug. If it is irreplaceable or absolutely necessary, hydration should be intensified to reduce drug concentration as much as possible in the urine that is formed in the kidneys. Special care must be taken with antibiotics such as the aminoglycosides that are taken intra-muscular or intra-venously for treatment of respiratory or urinary infections.
Required Test Used to Monitor Patients
Which includes B12, Urea/Creatine, Albumin, Ferritin, Chrome Serum, Serum Phosphate, Phosphaturia 24 hour and more.
These tests are critically important to get your doctor on board with if you plan on attempting the Coimbra Protocol on your own. Especially if you plan on increasing your daily dose of D3 above 40,000 IUs per day.
Make sure you down load or buy the only book to date by one of Dr. Coimbra's patients....Read "Multiple Sclerosis and (lots of) Vitamin D: My Eight Year Treatment with The Coimbra Protocol for Autoimmune Diseases" by Ana Claudia Domene.
Parathyroid (PTH) Levels
Dr. Coimbra seems to put the most emphasize on the parathyroid hormone (PTH) levels. This is due to the fact that PTH production is inhibited by vitamin D3 and the vitamin D immune benefit is at it's best when the circulating PTH has reached the lower limit of its normal range. PTH levels are also used as a way of monitoring for vitamin D intoxication. Which cannot occur if PTH is not pushed into the lower range.
In more detail Dr. Coimbra states...."Vitamin D inhibits the production of PTH. So if I measure PTH before the patient starts taking vitamin D and then measure it again after two months, I can use the variation of PTH as a parameter of the biological response to the effects of vitamin D. This is precisely the factor used to adjust the doses of vitamin D. Since vitamin D inhibits the production of PTH, I raise the vitamin D levels until PTH reaches its lowest normal level.
I therefore conclude that when vitamin D has reached the maximum inhibiting effect of PTH, it will also have reached its maximum immunoregulatory effect. I can not; however, suppress PTH to the point that it becomes undetectable, because if PTH is suppressed there's the risk that the dose of vitamin D will be too high, to the point that large amounts of calcium are withdrawn from the bones, and this can increase the calcium in the blood and cause kidney failure. So PTH for us is a security measure. If I do not suppress PTH, I'm sure I'm not giving toxic doses of vitamin D.
And so I adjust the dose of vitamin D according to the biological resistance to vitamin D that a person inherited genetically. In other words, an individual may require a dose of vitamin D, for example, of 30,000 IU so that their PTH reaches the lower normal limit. Another person may need 100,000 IU for their PTH to achieve the same lower limit. Therefore, measuring the level of PTH for us is a way to adjust the dose of vitamin D to the individual needs of the patient." Dr. Cicero Galli Coimbra
The urinary calcium test is very important, Dr. Coimbra says "The concentration of calcium in the urine is considered adequate if it is less than 250 mg per litre of urine as calculated through the 24 Hour calcium urine test. If the calcium concentration is higher than 250 mg per litre of urine, the patient should interrupt the daily doses of Cholecalciferol for 3 days, which is usually the necessary time to obtain the disappearance of excessive thirst. On the fourth day the patient should restart taking a lower daily dose of vitamin D, as per medical recommendation." Dr. Coimbra considers calcium to be low in the urine when it's under 100mg total. He considers the ideal level is around 100-150mg/L. He carefully monitors blood and urinary calcium, to avoid kidney stones.
Dr. Coimbra on the Interaction Between Calcium Levels and PTH
"PTH inhibition is an endpoint of one of the multiple effects of vitamin D. The magnitude of PTH decrease in response to a testing dose of vitamin D can indeedbe used to reliably assess the individual resistance to the biological effects of vitamin D provided that other variables that significantly influence the PTH level are kept under reasonable control. Ultimately calcium level (not vitamin D) is expected to be the most important determinant of PTH synthesis - simply because the primary PTH function is the control of calcium levels. Either hypercalcemia or hypocalcemia may cause death, so that serum calcium level has to be strictly kept within a narrow physiological range, and PTH is a major regulator of serum calcium. Therefore, changes of calcium levels can either override or increase the inhibitory effect of vitamin D on PTH synthesis, thereby preventing the use of PTH changes to adjust the dose of vitamin D as to compensate for the specific level of individual resistance (prevent tailoring of vitamin D daily dose).
That is another major reason why patients on high-dose vitamin D therapy have to comply with the recommended diet. If they exaggerate and put themselves into an excessively low calcium diet, serum calcium will get close to the lower limit of the normal range, in spite of the high level of vitamin D favoring . Consequently PTH will increase (despite the inhibitory effect of vitamin D) and will decrease the amount of urinary calcium to minimize calcium loss (calcium sparing). In addition, increased PTH will release calcium from bones (using bone calcium to prevent serum calcium from falling below the normal range (using bone tissue as a source of calcium). These PTH dependent mechanisms cooperate to prevent hypocalcemia under insufficient dietary calcium.
On the other hand, patients that do not comply with the recommended diet and keep taking foods containing excessive amounts of foods containing bioavailable calcium also affect the use of PTH for adjustment of vitamin D intake. As serum calcium gets closer to the upper limit of its normal range due to increased intestinal absorption PTH is inhibited, so that vitamin D is no longer the main inhibitor of PTH production. In such circumstance PTH level becomes low enough to falsely suggest adequate dose of vitamin D to suppress disease activity."
Why Include Vitamin B2?
Dr. Coimbra is now suggesting 50 - 100 mg four times per day. Dr. Coimbra tells us....."Vitamin B2 primarily or secondarily participates in a much wider range of critical metabolic pathways than currently recognized. An inherited disorder of the cellular uptake and trafficking of vitamin B2 metabolites may result in poor intestinal absorption, increased urinary loss, and disrupted homeostasis of vitamin B2 metabolites in the central nervous system or CNS. It may affect 10%–15% of the general population and be the most prevalent genetic risk factor for several human diseases.
The implications include altered metabolism of several biomolecules and enzyme systems of well-established pathophysiologic relevance such as vitamins B6, B9 (folate), B12, D3, NO, lipids, amino acids, proteins, DNA, cytochrome P-450 and other enzyme systems, HO, and homocysteine. Oxidative stress, and both apoptotic and necrotic phenomena may be enhanced. Due to the loss of the brain privilege for vitamin B2 supply, this inherited condition may be particularly relevant for CNS diseases such as migraine, brain ischemia, traumatic brain injury, neurodegenerative disorders (especially Parkinson and Alzheimer’s diseases), epilepsy, multiple sclerosis, and for Guillain-Barré syndrome, myasthenia, and mitochondrial myopathies.
Dr. Coimbra has claimed amazing results with his treatment and unfortunately very little is done in the US or the UK to prove or disprove any of his claims since our the medical industry has little interest in the subject. Researchers from the University of California, San Francisco have done some basic work on MS patients and have reported a reduction in brain lesions and disease activity in multiple sclerosis patients who had higher levels of vitamin D. This conclusion came after a 5 year study, involving 469 men and women with MS. All participants underwent yearly blood testing for vitamin D and brain magnetic resonance imaging (MRI) to evaluate disease progression. The researchers determined that with each 10 ng/ml increase in serum 25-hydroxyvitamin D, there was a corresponding 15% reduction in the risk of new brain lesions characteristic of MS. They also noted a 32% lower risk of areas of active disease as indicated by “white spots” or areas of inflammation visible on MRI images.
Calcium, Vitamin D and Auto Immune Disease
Dr. Coimbra believes that lack of vitamin D has led to an increase in occurrence of a growing number of diseases that affect all the organs and systems of the human body', where the most notorious ones are: infectious and autoimmune illnesses, cancer, cardiovascular illnesses, hypertension, diabetes, depression, autism, infertility, spontaneous miscarriages, and pre-eclampsia. Vitamin D deficiency leads to loss of control of 229 functions (genes) as well as in cells of the immune system, reducing the system’s potency to fight infections and allowing immune aggression against the organism. Individuals prone to developing autoimmune illnesses appear to be partially resistant to Vitamin D. Once they get ill, higher doses of vitamin D are needed in order to make the illness inactive. Not only to compensate this partial resistance, but also to "erase" the false information that part of the body sees as a micro-organism intruder by the immunological system memory.
Contrary to what occurs with high doses of steroids and with the use of immuno suppressive agents used as part of traditional treatment, the administration of vitamin D3 increases the power of immunological system in combating infections. When taking extremely high doses of D3 the absorption of excessive amounts of calcium present in food or supplementation can be a problem, at least that has been the common belief. But Dr. Coimbra has determined that these higher doses of vitamin D "completely open the door" to allow the passage of calcium from the interior of the bowel to the blood stream, obliging the organism to get rid of excess calcium through urine elimination. Calcium excess, concentrated during urine formation, could be deposited in the kidneys, and could cause loss of renal function and make the individual dependent on haemodialysis to survive. This is why the water intake he prescribes, as least 2.5 liters [85 ounces] of fluids preferably water, is so critical.
To avoid kidney lesions it is critical that the patient does not ingest calcium rich food such as dairy and including vegetable milks rich in calcium such as: soy, rice or oat as these foods cannot be present in the bowel when "the door" to the passage of calcium to blood is completely "open" by the vitamin D3 in higher doses. If there is not an excess of calcium in the other side of the door (i.e. intestine's interior), only the normal amount of calcium (present in other foods) will pass to the blood flow (when the door is open by higher doses of "vitamin" D); and the elimination of excess calcium through kidney is not necessary, which avoids risks to renal function and allows patients to safely continue the protocol and a normal life.
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